vendredi 30 octobre 2015

US Breast Cancer Deaths Falling Steadily — But Black Women Increasingly At Risk

US Breast Cancer Deaths Falling Steadily — But Black Women Increasingly At Risk

The American Cancer Society has issued newly revised guidelines on mammography and breast cancer screening. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

The American Cancer Society has issued newly revised guidelines on mammography and breast cancer screening. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

By Richard Knox

With all the recent controversy over how often women should get mammograms, you might not realize that breast cancer is becoming an ever more-survivable disease.

But, alas, that’s not the case among black women in this country. Historically they’ve had the highest risk of dying if they get breast cancer among any ethnic group. And now, data from the American Cancer Society show that African-Americans have nearly caught up with whites over the past three years in their risk of getting breast cancer in the first place.

Given black women’s higher risk of dying from breast cancer, that’s particularly bad news.

Breast cancer accounts for one in every three malignancies among US women — it’s the most common type if you don’t count non-melanoma skin cancers, which are usually inconsequential. More than 230,000 American women will get a breast cancer diagnosis this year, and about 40,000 will die of the disease.

But over the past 26 years, the overall US breast cancer death rate has dropped by more than a third, according to recent research. That’s nearly a quarter-million living women who would have died from breast cancer at rates that prevailed among their mothers’ generation.

“Whether people realize it or not, breast cancer mortality rates have been dropping since about 1990,” says Carol DeSantis of the American Cancer Society, lead author of an update on the disease published Thursday in CA: A Cancer Journal for Clinicians.

Part of that success is due to widespread mammograms, which can find breast cancers at an early stage, although the contribution of regular mammogram screening is unclear.

“Screening has clearly contributed to lowering mortality, but we can’t say by how much,” DeSantis says.

Better treatments are clearly a big part of this success story — more effective chemotherapy, the estrogen-blocking drug tamoxifen, and drugs targeted at the protein HER2 and other growth promoters on the surface of some women’s breast cancer cells.

Put it together with our aging society — more women reaching the most breast cancer-prone years, and fewer women dying of the disease — and the result is record numbers of breast cancer survivors.

More than 3.1 million American women with a history of breast cancer are alive today, and the great majority of them are cancer-free, DeSantis says.

The number of survivors will reach four million within the coming decade.

But a closer look at the numbers shows that not all women are benefitting equally. Black women with breast cancer are 42 percent more likely to die of it than whites, the new report notes. In some US cities, the black-white disparity in breast cancer mortality is even wider, according to a study published last year and cited by the New York Times. In Memphis, for example, the mortality risk among black women is more than 200 percent higher than among whites; in Los Angeles, their risk is about 70 percent higher.

And while breast cancer mortality has been dropping among black women, “their rate is not dropping as much,” DeSantis says. “We think probably some of the advances in treatment are not getting to them.”

Black women report in national surveys that they get regular mammograms about as often as their white counterparts. Still, black women are more likely to have a later stage of cancer at diagnosis.

This may be a sign that when a black woman has a suspicious mammogram, she’s less likely to get prompt followup care.

In this context, the news that African-Americans are catching up to Caucasians in the incidence of breast cancer — their risk of getting breast cancer in the first place — is especially disturbing. “Historically, black women have had lower incidence rates than white women,” DeSantis says. “Now we see they have very similar incidence.”

The historical gap probably has something to do with blacks’ lower socioeconomic status. Among other things, that’s associated with earlier child-bearing and more pregnancies, both of which protect against breast cancer.

The growth of a black middle class may have something to do with increasing breast cancer incidence among African-American women. But DeSantis thinks another factor may be more potent: Strikingly higher obesity among black women.

“Fifty-eight percent of black women are clinically obese, compared to 33 percent of white women,” she says. “In seven states where breast cancer incidence is higher in black women than in whites, these are southern states which tend to have a larger proportion of women who are obese.”

DeSantis also notes that obesity in white women has leveled off in recent years — and so has their incidence of breast cancer, which has been stable since 2004. Breast cancer incidence is also stable among Hispanics and Native Americans.

But in black women, both obesity and breast cancer incidence have continued to increase in tandem.

Vomiting Up Brunch? Your Angry Tweet May Save Others From Food Poisoning

Vomiting Up Brunch? Your Angry Tweet May Save Others From Food Poisoning

When you're in this position, you likely don't want to call health officials and report food poisoning. (Irina Souiki/Flickr)

When you’re in this position, you likely don’t want to call health officials and report food poisoning. (Irina Souiki/Flickr)

By Chelsea Rice

One of the last warm Saturdays in September, my boyfriend and I planned to celebrate his birthday at a Cambridge restaurant that friends had praised as their favorite brunch spot. The food tasted great: We shared a plate of oysters to start, and he enjoyed eggs Benedict for his main course while I opted for a breakfast take on the classic BLT sandwich, mainly because it was served on a croissant, a buttery weakness of mine.

But upon arrival back home…our brunch backfired.

I ran out to pick up the birthday cake. When I returned, I found the birthday boy almost paralyzed by stomach pain, feverish and violently ill. While he spent the rest of his birthday in a migratory pattern between the bathroom and bedroom, I waited to see if I would get sick and searched online to learn how to report the food poisoning.

Turns out that here in the Boston environs, residents call a special number at the Boston Public Health Commission. It connects with a public health nurse who asks questions about symptoms, what you ate over the past few days, and where you ate it. On that memorable day, I shouted this option into the bathroom at my sick partner, but he was so nauseous he could barely talk to me. Reliving what he had eaten in the past 48 hours was the last thing he wanted to do.

As a health journalist, I know it’s important to report food poisoning — one in six Americans gets it every year. But as a consumer, filing a public health report can be an intimidating and impersonal process for a very personal — and vulnerable — experience.

We told all our friends and canceled the rest of the festivities, vowing never to return to the scene of the crime, but I still wondered: Were we selfish? Could we have helped others with our story? Have other diners had a similar experience at that restaurant?

According to the restaurant’s worst reviews on Yelp, the list is long. (I’m not naming it to give it the benefit of the doubt — maybe it was having an off day? — but the picture is grim. The worst reviews include bugs in the plates, under-cooked proteins and foreign objects that broke a tooth. There are even a few that reported diners getting sick after eating there. And those are just the brave few who posted. I was alarmed that this restaurant still had a line and a reservations list with complaints like that. There’s no way a health department could ignore claims like these, I thought, if they were written up in an official report.

Little did I know, there’s a new bridge between social media and public health that is finally crossing that divide.

In 2011, a research group out of Boston Children’s Hospital published a study using extracted, keyword-related Yelp reviews, showing that the ingredients people described in their reviews about food-borne illness matched up with relevant ingredients that the CDC reported were involved in food-borne outbreaks for that time.

An excerpt from HealthMap's tool to track tweets related to foodborne illness (Courtesy of HealthMap)

An excerpt from HealthMap’s tool to track tweets related to foodborne illness (Courtesy of HealthMap)

Now, that team is taking their work to help cities across the country address and more accurately monitor food-borne illness with HealthMap Foodborne Illness, part of a larger social media disease-tracking initiative based at Boston Children’s.

Dr. Elaine Nsoesie and Dr. John Brownstein, who co-founded the project, are working with New York City, Chicago, St. Louis and other major cities to customize their foodborne disease tracking tool for each city’s needs.

“It’s hard to make people come to you,” said Brownstein. “People aren’t engaged necessarily in public health.” But if you can tap in to their online voices, he said, “you can actually get a huge amount of information that would not come from another vehicle.”

In Chicago, the city’s public health department monitors Twitter in a social media tracking initiative that HealthMap customized for them called FoodborneChicago. The tool filters tweets that are geocoded to a specified area through a system that recognizes key words related to food poisoning. Think “sick,” “food,” “vomiting,” “diarrhea,” “poisoning” and various combinations like “restaurant made me sick” or “vomiting after that lunch.”

A public health official can monitor the filtered tweets live, and sort them into “relevant” (ambulance icon), “questionable” (question mark) and “irrelevant” (trash can), as in the image above. The system learns to better recognize food poisoning-related posts over time. The tool accurately classifies tweets 85 percent of the time, according to Jared Hawkins, part of the HealthMap development team and informatics junior faculty at Boston Children’s.

“It’s easy to complain on your social media and get sympathy, so if you complain on Yelp or Twitter you get a connection, but a report to a public health department goes into a black hole where there isn’t any sympathy or interaction,” said Brownstein. “When someone talks about diarrhea on Twitter they are really looking for people to care, and that’s really what it’s all about.”

The system takes advantage of that natural hunger for comfort to gather data. Once a tweet is validated as relevant, the tool takes the public health official to a separate screen where they can see the sick person’s publicly available profile information. At this point, HealthMap FoodBorne Illness prompts the health official to reply to the post with a dynamic range of responses from empathetic to authoritative to actionable.

If the official chooses “Actionable,” the system sends the sick person a link to a mobile-friendly online form to fill out the specific information about their experience, including when and where the foodborne illness occurred.

“When you have food poisoning, you don’t know who to call, if anyone,” said Hawkins, who also has a Ph.D. in immunology. “And while you can stumble onto the online form if your city has one, it’s usually many pages deep in the public health website,”

“People are sick or mad,” he added, “but they aren’t mad enough to fill out a 10-page PDF. But they will tweet about it. So it reaches a much wider audience. And if a tweet can be a real report, that is huge.”

So how might this work in Boston? According to HealthMap, 10 tweets a day on average are relevant to foodborne illness within a 25-mile radius of Boston. In October so far, there have been 57 tweets. The high was in April, with 119.

Currently, the Boston Public Health Commission and Boston Inspectional Services do not make social media a regular part of their monitoring process to identify and report foodborne illness, according to spokeswomen at both departments.

But according to Brownstein, there is definitely potential there. Here’s how our city compares with some other major cities across the country on the number of tweets related to foodborne illness:

(Source: HealthMap)

(Source: HealthMap)

So is it “TMI” to post to social media about food poisoning? Not when your city’s health department is watching. They might be the only ones who really care — and as social-media surveillance mounts, they may actually do something about it.

Chelsea Rice is a digital health journalist living in Boston. She’s previously written for Boston.com, The Boston Globe and HealthLeadersMedia.com. Follow her on Twitter @ChelseaRice.

Sample page from the HealthMap tool:

Sample page from the HealthMap tool

Parents: Kids Spurn Emotional Help For Fear ‘They Might Think I’m The Next Shooter’

Parents: Kids Spurn Emotional Help For Fear ‘They Might Think I’m The Next Shooter’

Candles spelling UCC -- for Umpqua Community College -- are displayed at a candlelight vigil for those killed during a fatal shooting at the school, Thursday in Roseburg, Oregon. (Rich Pedroncelli/AP)

Candles spelling UCC — for Umpqua Community College — are displayed at a candlelight vigil for those killed during a fatal shooting at the school in Roseburg, Oregon. (Rich Pedroncelli/AP)

By Lisa Lambert
Guest contributor

Lisa Lambert is the executive director of the Parent/Professional Advocacy League, which is subtitled “The Massachusetts Family Voice For Children’s Mental Health.”

“He doesn’t want to take the risk and have someone think he could be a shooter,” one mother said, “just because he has a mental health diagnosis.”

I was at a meeting with other parents whose children have mental health needs. This mother told us her son was reluctant to leave his high school classroom for an important evaluation, which included psychological testing.

Like much of America, we were talking about the recent and not-so-recent shootings on campuses and in communities across the country. For this mother, as with many parents whose children have mental health issues, the conversation is far more personal and troubling than for most.

Some parents said that in response to recent shooting incidents, their children are dropping out of services or refusing school supports so they won’t risk their peers or teachers finding out why they get treatment.

As a parent, this breaks my heart. Young adults shouldn’t have to choose between the safety found in avoiding treatment and the healing found in seeking it.

Lisa Lambert (courtesy)

Lisa Lambert (courtesy)

During our discussion, another mother reported that her son was in his first year of college and struggling to complete all his coursework. Freshman year is a stressful time for many students and even more so for students with depression. Because her son had had special education services in high school, he could access supports there to help him manage his academic and emotional stress.

She encouraged him to go to the college student services office to get help. He responded, “I’d rather drop the classes I am most behind in. If I go there, the professors and other students will know I have mental health problems. They might think I could be the next shooter.”

Often, as a news channel covers the latest shooting, the speculation immediately jumps to mental illness. While the station waits for details or settles in before the next briefing from local officials, the link between the troubled shooter and mental illness is made and strengthened, often with scant evidence.

Sometimes that link is real. In our hearts, many of us feel that a person’s mental health has to be compromised to take the lives of others. The search for signs of mental illness is on with an unspoken conviction that this must be the tipping factor which led to violence.

Young people with mental health issues watch the same news stations, read the same news-feeds online and see the same tweets as the rest of us. Their families (and I am one of those parents) do, too. In recent weeks, I’ve been hearing repeated reports that one effect of that news is to prompt some young adults to turn away from treatment and services because they are worried about being eyed with suspicion. They would rather take the chance that their depression, mood swings or even psychosis could worsen than risk the judgement that can result from other people hearing about a diagnosis.

According to a 2012 survey by the federal Substance Abuse and Mental Health Services Administration, nearly 20 percent of young adults ages 18-25 have a diagnosed mental illness. In that same age group, almost nine percent have experienced a major depressive episode, and over seven percent have had thoughts of suicide in the past year.

Yet more than half of those with a diagnosable illness are not receiving treatment. In addition, dropout rates from outpatient mental health services are high in young adults, and they are far more likely to drop out of treatment than mature adults.

Decisions about whether to seek treatment for mental health issues continue to be strongly impacted by stigma. This is especially true for teens and young adults who are discovering what their minds can do and how their moods affect them. They are often reluctant to accept treatment. Mental health care works best when the person needing help feels engaged and can give the treatment enough time to work.

Now we have additional stigma, which is affecting young adults more than any other group. Because they are young, they can often benefit greatly from treatment. Yet some see the very care that might help them as a neon arrow pointing at a “risky” student.

In our haste to talk about the incredibly small group of young adults, often young men, who have access to guns, who decide to use those guns and, yes, may have mental health problems, we must not forget the very large group of young people who also have mental health problems and will never make those choices.

They live in a time when the options for treatment are expanding and often can be tailored to their needs and their lives. They might find short-term services, medication, traditional therapy or nontraditional approaches suit them best. What we need to do for them is encourage them to find what works for them, not eye them with suspicion.

Congress is considering mental health reform. New approaches for treatment of first-episode psychosis (when patients, usually in their late teens or early 20s, have a first break with reality) have caught public interest. Talking about mental illness can lead to positive changes and shrink the gap between identifying a need and getting care.

It’s unlikely we will stop wondering what drives a young person to become a mass shooter. It’s unlikely we will stop thinking there must be something like a mental illness that made him decide this option was okay. It’s allowing that conversation to stop young people from seeking treatment that worries me.

Haunted House Science: You Don’t Need Gore To Terrify, If You Know The Brain

Haunted House Science: You Don’t Need Gore To Terrify, If You Know The Brain

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Shir Atzil, a former post-doc in the Interdisciplinary Affective Science Lab, uses her head to help scare haunted house visitors. (Courtesy NewtonHauntedHouse.org)

It’s a classic Halloween activity: the homemade haunted house, replete with cold spaghetti “worms” and bowls of peeled-grape “eyeballs.” Remember?

That old tradition gets a 21st-century scientific twist at an elaborate haunted house in Newton that opens for just one night a year — the night before Halloween — to raise money for charity. And it is elaborate not just in its multitudes of living ghouls, its gaggles of graves and squads of skeletons.

It is an exercise in scare tactics informed by brain science.

“You can be really artful about how you scare people without a lot of gore,” says Northeastern University professor Lisa Feldman Barrett. “And I thought, well, who better to do that than a lab that studies the science of emotion? We can use research to predict what the effects will be, to make it super-scary without a lot of blood and guts.”

Barrett leads the Interdisciplinary Affective Science Lab at Northeastern and Massachusetts General Hospital. For the last 10 Halloweens, she and her family have created a haunted basement in their Victorian home, helped by her lab colleagues — grad students, post-docs and other researchers who play monsters for the night.

Some of their scare techniques may not seem to differ much from those of amusement park haunted houses, but they’re devised by neuroscientists who live and breathe the brain.

“What your brain is doing is making predictions based on past experience,” Barrett says as she leads the way into the labyrinth in her basement. “So if we set up things to look really kitschy at the beginning, with a lot of props, your expectation is, ‘This is going to be pretty lame, this is not going to be very scary.’ And when you walk in, we will violate that expectation.”

Indeed they do. You walk into a dimly lit room and notice some skulls, some bats, and what seems to be a statue of a human-sized monster sitting on a table. You’re not sure, though, if it’s a statue or a live person, until it — or rather, he — opens his eyes very wide and stares into yours. Yikes.

Barrett says the effect carries a wallop in part because the brain is wired to pay huge attention to whether an object is alive or inanimate. (You can imagine why that would be important for survival.)

When visitors are unsure whether a figure is alive or a statue, they often “freeze in uncertainty,” she says, just like a rat in an experiment when it’s not sure whether it’s about to receive a small electric shock.

Also, certain special effects fire up specific parts of the brain, Barrett says, including the amygdala, an area important for detecting uncertainty or novelty. The neurons in the amygdala are very tuned to eyes, “to whether the eyes are open or shut or moving, and how much white. The more white there is, especially in a still face, the scarier people find it.”

Here’s another brain-science trick: It’s scarier when you first see something out of the corner of your eye, because your peripheral vision involves more uncertainty.

Many of the the haunted house effects are aimed at increasing uncertainty, Barrett says, “because uncertainty enhances arousal — I don’t mean sexual arousal, I mean feeling activated and worked up and jittery.”

The brain is constantly predicting what is going to happen next, she explains, so if you lead a person to expect gore and guts, their survival circuits kick into high gear. Her response:

“This, to me, is not a very artful way to create fear. A gentler, more interesting way — and frankly a more pleasant, fun way — is to curate uncertainty. Because we are not going for terror here, but for enjoyable, exuberant fear. In our own work, we show that fear feels different (and the brain patterns are different) for different types of fear — not all fear is unpleasant. So fear is not a single thing — it is a whole population of instances that vary from one another.”

You may never have thought of a Halloween haunted house as educational, but consider Barrett’s view:

“When there is a lot of uncertainty, and the brain has trouble predicting what is coming next, a person gets worked up — feeling tense — because really, the brain is preparing to learn so that it can take in the information it needs to predict better the next time around when in a similar situation. And the brain often interprets this tension as ‘fear’ when the context is right — like in a haunted house.”

Makes you see the whole experience a little differently, doesn’t it?

Barrett’s 16-year-old daughter, Sophia, came up with the idea for the haunted house when she was just five. And she has witnessed the power of some of its scare techniques — even on her neuroscientist mom.

“My mom always goes through a test run right before we open the haunted house,” she says, “and even though she knows exactly what’s coming, and she even directs her post-docs and grad students to do certain things, she gets legitimately scared and will scream. Even though she said, ‘OK, now you jump out like this’ — and then it’s, ‘Oh my God!'”

So that’s another lesson from the haunted house: Some responses to what you perceive are so powerful that even understanding your brain doesn’t mean you can control them.

“The effect of the sensations on your nervous system are not something you can control,” Barrett says, “and that’s really what we’re going after.

The haunted house donates all its proceeds — more than $12,000 over the past 10 years — to the Greater Boston Food Bank. It draws up to 500 people a night, the Barretts say.

And by the way, for kids — and adults — who aren’t into being terrified, when Sophia’s dad, computer scientist Dan Barrett, welcomes visitors in his role as the greeter ghoul, he offers three options: No scares, middle scary and super scary.

When a guest wants no scares, “I just shout ‘No scares, friendly monsters only!'” he says. That means the monsters will just kindly wave at the guest, and take off their masks if asked.

For “medium scares” — the monsters might jump out at you but not touch you, and might growl but won’t yell — he sounds a bell-like tone of warning. And for “super-scary,” he sounds a different tone and “Oftentimes, I will shout ‘Fresh meat!’ to the monsters.”

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(In the front row: Dan Barrett, Lisa Feldman Barrett and their daughter, Sophia; behind them, monsters from the Interdisciplinary Affective Science Lab. Photo courtesy NewtonHauntedHouse.org)

Related:

jeudi 29 octobre 2015

Father Who Suffered Unthinkable Loss Produces Documentary About Suicide

Father Who Suffered Unthinkable Loss Produces Documentary About Suicide

Steve Mongeau (left), the executive director of Samaritans, and Ken Lambert (right). (Robin Lubbock/WBUR)

Steve Mongeau (left), the executive director of Samaritans, and Ken Lambert (right). (Robin Lubbock/WBUR)

Nearly eight years ago, the news was filled with reports of a tragedy on Route 495 in Lowell. A woman carried two small children into the middle of the interstate. All three were killed.

The woman was 39-year-old Marci Thibault. The children were her niece and nephew. She was supposed to take them to her home in Bellingham for a sleepover. Investigators determined Thibault deliberately walked the children into the traffic.

“It was clearly a severe mental illness that made what happened happen, and it was not Marci in her own mind,” said Ken Lambert, the father of the two children.

Marci Thibault with her niece Kaleigh and nephew Shane. (Courtesy of the family)

Marci Thibault with her niece Kaleigh and nephew Shane. (Courtesy of the family)

Kaleigh was five and Shane was four when they died that night. Marci, who led them into the road, was their mother Danielle’s twin sister.

The tragedy left Ken and Danielle Lambert of Brentwood, New Hampshire, confronting the issues of mental illness and suicide. Even through his grief, Ken Lambert doesn’t villianize his sister-in-law for the death of his children. He says she was much more than her mental illness.

“People are quick to blame, but people forget she was a mother, she was a daughter, she was a sister, she was a friend,” he said. “You know, she had a family. She had a life. She ended up having, of course, a psychotic break. And we would have never thought that was even remotely possible.”

Lambert and his wife wanted to do something productive in memory of their loved ones. They started an organization called Keep Sound Minds. It’s goal is to raise awareness of mental illness and suicide.

And as part of the group’s work, Ken Lambert has produced a documentary film about an organization that many of us know from those signs near large bridges: Samaritans, Inc., the Boston-based group that has been around for 40 years. The documentary is called “Samaritans: You Are Not Alone.” At the heart of the organization is still a hotline you can call or now text (1-877-870-4673).

[Watch on YouTube]

Ken Lambert and Steve Mongeau, the executive director of Samaritans, Inc., joined WBUR’s All Things Considered.

Interview Highlights

On the Samaritans crisis hotline 

Mongeau: We take in over 100,000 calls and texts per year, from people who are feeling lonely or in despair. And we like to intercept them long before they consider a desperate act. And volunteers support that effort. It’s all about people helping people.

When I was taking calls, the thing that most surprised me was how incredibly rewarding it became, because you are concerned about what this person is going to do. But more often than not, you could just hear the tension drain in their voice during the conversation. You know, the number of times people just said, “God, thank you for being there. I needed this. Thank you for not judging me.”

On what Samiritans talks to callers about

Mongeau: We allow people to just share whatever it is they’re dealing with. We call it steering toward the pain. So we say, “Tell us what’s going on. Tell us more about it.” So we’re not giving them advice.

In the video there’s a sequence. One of the volunteers says if someone tells us they have a hard time getting out of bed in the morning, we say that’s OK. People can feel that way. It’s OK to feel that way.

On the role intervention could play in mental health illness 

Lambert: My sister-in-law did receive some treatment about four months prior to the tragedy. She did receive some treatment at McLean Hospital. After she left McLean, she was told, “Do this and do that,” and she did neither. Never went to counseling, stopped the medications within a few days, and we were aware of that, but she appeared to be getting better.

She was able to mask her symptoms because she did not want to go back to McLean, and she did not want to go to counseling. And she didn’t think she had an issue, and she didn’t want everyone to think she had an issue.

So she, when she was talking to you, she would almost, like, act like everything was fine. But if you asked, let’s say, five or six people in the family, at different times when Marci would be speaking to them one-on-one, something here would be a little off, something here would be a little off, something here. And each of those people think, “Eh, that’s not a big concern,” or whatever. But when you put it all together and you have a little knowledge in it, a little education, it is a concern.

People are optimistic, number one, that nothing is going to go wrong with their loved one, right? So that’s part of it, and then part of it is the head-in-the-sand mentality, which most people have that attitude in regard to mental illness.

On the conversation on mental illness changing

Lambert: Things are more out in the open, people are talking about it. Talking about “Well, I need help,” or talking about solutions. And, I could see it just because I’m in the middle of it. It’s progressing.

The Samaritans crisis hotline is 1-877-870-HOPE (or 1-877-870-4673).

The documentary, “Samaritans: You Are Not Alone” will be shown this Tuesday, Nov. 3, at Suffolk University.

Health Boost: Story-Sharing Kiosk For Patients Coping With Illness Set To Launch At MGH

Health Boost: Story-Sharing Kiosk For Patients Coping With Illness Set To Launch At MGH

If you were really sick, with cancer, let’s say, or a debilitating eating disorder or heart condition that put you in the hospital, would you want to hear from other patients like you? Would you feel better sharing your story?

That’s the idea behind the SharingClinic, a kiosk stocked with a collection of audio clips from patients facing a range of illnesses. It’s set to launch as an interactive exhibit at the Massachusetts General Hospital Paul S. Russell museum in January. The goal is to ultimately move the listening kiosk into the main hospital.

The project was born out of frustration with a medical system that no longer has the time to really listen to patients, says Dr. Annie Brewster, an MGH internist who’s been developing the listening kiosk for the past four years. Brewster (a frequent contributor to CommonHealth) is also the founder of Health Story Collaborative, a non-profit that helps patients and caregivers tell their own medical stories for therapeutic value.

Patients visiting the SharingClinic can can choose from a range of story types and perspectives. (Courtesy: Tara Keppler, graphic design)

Patients visiting the SharingClinic can can choose from a range of story types and perspectives. (Courtesy: Tara Keppler, graphic design)

Ultimately, the MGH kiosk will offer a range of storytelling from different perspectives: hospital patients, their families and friends, doctors, nurses, psychiatrists and others. A touch screen allows listeners to select stories by diagnosis, by theme or by perspective. Listeners will also be able to comment. Currently over 100 clips are already collected, and the process is ongoing. The software, designed in collaboration with computer programmer David Nunez, previously at the MIT Media Lab, allows for easy, regular addition of new content. A downloadable app is currently in development.

“SharingClinic will take on a life of its own, constantly growing and changing, shaped by story sharers and listeners,” Brewster said. Listen to few sample clips:

Why did she embark on all this? Brewster says: “Facing illness can be scary and isolating, and hospitals an be alienating. Our goals are to empower and connect individuals facing health challenges — to remind people that they are not alone — and to improve the culture of the hospital through storytelling.”

Brewster herself is involved in the audio collection and editing process, but has also recruited other providers to help; her goal is to transform the culture of the hospital through storytelling. So far, she has an MGH chaplain and two MGH social workers helping with story collection. Eventually, she envisions having an actual story-sharing “clinic” at MGH — a dedicated physical site, open at a regularly scheduled time, where patients and providers can come to share their stories. She hopes to staff this “clinic” with other healthcare providers across disciplines — doctors, nurses, mental health professionals and chaplains. Story clips will then be plugged into the kiosk, where they can be shared with any visitor to the MGH museum, part of the MGH campus.

“It would, of course, be ideal to have time for such story sharing within medical visits, but I don’t see this happening at any time soon given the structure of the health care system today,” says Brewster. “Because of this, we need to create other opportunities to share, feel listened to and feel like we are contributing to a collective conversation about illness and healing.”

There’s clear evidence that sharing stories in this way promotes health. But launching the project hasn’t been easy, Brewster said, mostly due to the many rules and regulations that exist within medical establishment, including patient privacy concerns and fear of litigation.  “…we sometimes let fear hinder progress,” she says. Story sharers will have to sign a waiver agreeing to the process, and only use first names or a pseudonym.

Dr. John Herman, associate chief in the Department of Psychiatry at MGH and an associate professor at Harvard Medical School said the listening kiosk is “a beautiful idea” that might help diminish stigma and worry about illness. He added: “I think we’ve all experienced this … humans seem to be motivated to tell stories, and in the process of making explicit, and articulating feelings which are implicit and unspoken, people are able to be aware of their own feelings. It’s a reflective opportunity. The psychobabble word is catharsis.” He equated the kiosk to a medical StoryCorps, “…moving, educational, therapeutic.”

The idea for SharingClinic was born out of Brewster’s personal and professional experiences with the healthcare system. She herself is a patient, living with multiple sclerosis since 2001, and her journey navigating medicine, both as a patient and a provider, have convinced her of the power of stories. This belief is the basis for her non-profit, Health Story Collaborative.

She says: “Stories are what make us human. Stories connect us. Stories allow us to make meaning in our lives. It seems obvious to me that when people are ill, the context of their lives — their stories — are essential to their healing. However, our current medical system, which is focused on maximizing efficiency and scientific mastery over relationships, often overlooks the stories of peoples’ lives. This is a tragedy. Medicine is in crisis, with hordes of dissatisfied doctors and unhappy patients. We need to take action to change the way things are.”

Brewster works with Jonathan Adler, Ph.D., a clinical psychologist and a professor at Olin College of Engineering in Needham whose research focuses on the health benefits of storytelling; Adler is the Chief Scientific Officer at Health Story Collaborative.

Brewster envisions her idea spreading broadly, to other hospitals and including other collaborators. That’s not always easy, she says. “Academic and medical institutions can breed isolation,” she says. “But we need to start thinking more collectively if we truly want to re-humanize medicine,” she says.

mercredi 28 octobre 2015

In NYC, More Severe Injuries After Painted Bike Lanes Installed, Study Finds

In NYC, More Severe Injuries After Painted Bike Lanes Installed, Study Finds

A study found that the severity of injuries among bicyclists hit by cars appeared to go up after New York City installed painted bike lanes. Here, the author of that report, Dr. Stephen Wall, finds a blocked NYC bike lane. (Courtesy of Stephen Wall)

A study found that the severity of injuries among bicyclists hit by cars appeared to go up after New York City installed painted bike lanes. Here, the author of that report, Dr. Stephen Wall, finds a blocked NYC bike lane. (Courtesy of Stephen Wall)

This may not surprise you if you’re a regular cyclist: Those painted bicycle lanes that are proliferating as the number of bike commuters rises? They don’t seem to make a dent in injuries and may even worsen their severity, according to a study presented in Boston this week at a national gathering of the American College of Emergency Physicians.

The study found that the severity of injuries among bicyclists hit by cars actually appeared to go up after New York City installed those painted bike lanes, at least among patients brought to Bellevue Hospital Centers’ emergency department.

Dr. Stephen Wall of New York University and Bellevue offers an immediate caveat, though: Bike lanes lead to increased volumes and may also lead to faster speeds.

“I don’t want people to look at this data and say, ‘Oh, bike lanes are bad,’ ” Wall said. “They’re not. They’re definitely beneficial.”

But, he said, design flaws in the bike lanes may increase risks, and behaviors by drivers, cyclists and pedestrians can still cause problems. The findings, Wall says, show how important it is to analyze the designs of bike lanes and make sure they do prevent injuries, especially as the numbers of bikers rise.

Ideally, Wall said, police, hospitals and emergency services would all share and integrate their data to create a map of where injuries occur. When cities make choices on how to protect cyclists, they must be analyzed as well, to be sure money is spent wisely.

In New York City, he said, it’s becoming ever more clear that there are major problems — “hot spots” — at the exits of bridges and tunnels, and more barriers may be needed there. Boston may have a similar issue, he said; he’d like to examine the city’s data.

I immediately thought of this story from last week: “Scientist Killed In Bike Crash, But Her Thyroid Stem Cell Work Lives On.” The Beacon Street ghost bike in memory of Dr. Anita Kurmann is right at the bottom of the Massachusetts Avenue bridge and it’s a known danger spot for bikers.

From the study’s abstract:

After screening for eligibility, 839 patients qualified for inclusion. In the period prior to installation of bike lanes and protected paths, 21 bicyclist versus motor vehicle incidents occurred on First and Second Avenues; all were mildly severe. In the period after installation, 45 incidents occurred including 6 moderately injured, 1 severely injured, and 1 critically injured. Multivariable ordinal logistic regression modeling revealed that, holding all other variables constant, bike lane availability was associated with nearly 70% increased log odds of a bicyclist having a more severe injury (i.e. moving up one level in ISS categories) compared to having no lane or path available (AOR 1.70 95% CI 1.08- 2.67).

An important note: The study found no significant worsening of injuries when the bike lane was protected from car traffic by concrete barriers.

There’s no simple, single solution to bicycle injuries, Dr. Wall said, but only good information can point the way forward.

“I’m not really sure what the right answer is,” he said, “but I wish I had better data.

Related:

Fecal Treatment Milestone: Stool Bank Starts Producing Long-Awaited ‘Poop Pill’

Fecal Treatment Milestone: Stool Bank Starts Producing Long-Awaited ‘Poop Pill’

Introducing: the poop pill (Courtesy of OpenBiome)

Introducing: the poop pill (Courtesy of OpenBiome)

By Gabrielle Emanuel

MEDFORD, Mass. — Fecal transplants may have just gotten a lot easier to swallow.

OpenBiome, the nation’s first stool bank, is beginning large-scale production of a poop pill. This week marks the first time such a pill will be commercially available to hospitals and clinics.

Early tests suggest the pill is highly effective and comparable to traditional, more invasive delivery methods — for instance via colonoscopy, enema or a plastic tube through the nose and into the stomach or intestines.

“Fecal transplants came from what used to be this dark art — where you needed a donor and a blender,” says Mark Smith, research director at OpenBiome and one of its founders. “And now you basically take something out of the freezer and can treat the patient immediately. I’m very, very excited about this.”

Try not to get grossed out because this is an upbeat story. It’s about a very effective medical treatment for a really nasty infection.

Earlier, we reported on fecal transplants and OpenBiome’s struggle to survive.

Founded by MIT students and based in Medford, OpenBiome is just like a blood bank but for poop.

It collects healthy poop and then gives it to doctors so they can perform fecal transplants. This procedure is used for patients with recurrent Clostridium difficile or C.diff infections. The bacterium is in the gut and can cause bad — sometimes debilitating — diarrhea.

C.diff sickens hundreds of thousands each year and kills more than 10,000 people annually in the U.S.

But fecal transplants have proven to be remarkably effective when it comes to C.diff. Technically called Fecal Microbiota Transplantation (FMT), the procedure has been shown to be nearly 90 percent effective in treating C.diff. That’s compared to standard antibiotics, which cure less than 40 percent of C.diff patients.

This procedure involves collecting stool from a healthy donor and infusing it in the gut of a sick individual. But the catch is that the delivery method is both unpleasant and invasive.

It’s often done through a colonoscopy or an enema. And sometimes it’s delivered through a tube that goes in the nose and all the way in to a person’s stomach or gut. These are involved, not-too-pleasant procedures that carry their own risks.

That’s why OpenBiome’s pill announcement is a big deal. It suggests there may be a much easier and far less invasive way to carry out fecal transplants: Just get a glass of water and swallow a pill.

“And [patients] usually will recover very quickly — within a couple days,” Smith says.

At this point, though, it does take more than just one pill. A dose is 30 large pills swallowed in a short period of time — usually within an hour and a half after removal from the freezer — and always in the presence of a doctor or nurse.

Inside the pills, called FMT Capsule G3s, are all the good bacteria in a concentrated form.

One dose of 30 pills costs $635. That’s compared to $385 for the colonoscopy and nose delivery method. OpenBiome says it sells everything at costs with no markups. So, they say, the cost difference reflects how much harder it is to make the pills.

“Right now, each one is made by hand,” Smith says. “We have an army of technicians that are making capsules every day.”

They’re hoping they’ll soon be able to automate the process and make it cheaper.

A pilot study suggests the pills are 70 percent effective with the first dose, according to OpenBiome. And if that doesn’t do the trick, the patient gets a second dose. After the second dose, the cure rate jumps to 94 percent. And they haven’t found any nasty side effects or problems yet.

A pill seems like a highly logical solution. But it didn’t exist until now because it’s actually a challenging thing to produce.

“Most of the capsules we have to deliver drugs are made to dissolve when they’re in poo,” Smith says.

Basically, inside the pill is good bacteria and it thinks its job is to break down food and really anything that comes its way — including the capsule walls. In addition, poop is fairly watery and capsules are designed to dissolve in water. Because of this, the pill would only last a few minutes before the poop dissolved the capsule walls.

Many scientists have been trying to figure out what to do about this. After about a year and a half of work and testing, researchers at OpenBiome came up with something they’re calling the Microbial Emulsion Matrix (MEM).

Basically they’re taking the poop and suspending it in oil. The oil prevents the water from dissolving the capsule. Then, they freeze the capsule. This doesn’t kill the bacteria but it does make them inactive, stopping them from breaking down the capsule. Only once the pill is inside the gut does it break down — this time from bacteria on the outside, instead of on the inside.

Smith says this is exciting, not just for C.diff patients. “This enables some studies to happen that couldn’t happen otherwise.”

He’s particularly interested in finding out whether fecal transplants could be used to treat chronic GI issues, including Inflammatory Bowel Disease and Irritable Bowel Syndrome. These chronic problems would require regular fecal transplants — maybe once a week or even every day.

“If you had to do a colonoscopy every day, you’d never enroll in a study,” says Smith. “But if you have to just take a capsule, it’s pretty reasonable.”

Smith warns this is all in a very early stage but still, he says, in the world of fecal treatment, it’s a big milestone.

Gabrielle Emanuel, a former WBUR Kroc Fellow, now works as an education reporter for NPR in Ann Arbor, Michigan.

mardi 27 octobre 2015

State Legislature Hears From Both Sides On Doctor-Assisted Suicide Debate

State Legislature Hears From Both Sides On Doctor-Assisted Suicide Debate

Compelling arguments on both sides of the doctor-assisted suicide debate were presented at a State House hearing Tuesday afternoon.

The Legislature’s Committee on Public Health is once again considering a bill that would allow doctors to prescribe lethal doses of medication to terminally ill patients.

The bill is similar to a ballot initiative that was narrowly defeated by voters three years ago. Patients with an incurable illness, judged by a doctor to be within six months of death would be able to request a lethal dose of medication that would end their lives. The request would need to be made before two witnesses, including one non-relative. The patient would also have to meet with a counselor to ensure they were not suffering from any psychological conditions that might be affecting their judgement. Marblehead State Rep. Lori Ehrlich said the bill gives terminally ill patients a choice.

“We are nothing, if not a compassionate state,” says Ehrlich. “And it doesn’t fit that we are telling residents of Massachusetts who are facing terminal illness, with accompanying pain and loss of dignity, that they must endure it all, or if they want more options, pick up and move to another state where the law is already in force.”

Oregon, Washington and Vermont currently permit doctor-assisted suicide for the terminally ill. California joins that list in January. Opponents of the measure say it may open the door to unintended consequences. Laura Lambert, a cancer surgeon and palliative care physician at the UMass Memorial Medical Center in Worcester calls the bill a personal death panel in a bottle.

“If passed, rather than encouraging our society to demand better palliative and hospice care, this bill runs the risk of creating a society expectation of a duty to die,” says Lambert.

Earlier this week, legislative leaders were non-committal to the future of the bill, with Gov. Charlie Baker saying he’s taking his lead from the voters who rejected the referendum in 2012.

Related:

Lawmakers To Hold Hearing On Physician-Assisted Suicide Bill

Lawmakers To Hold Hearing On Physician-Assisted Suicide Bill

State lawmakers on Beacon Hill will hear arguments Tuesday afternoon on a proposed measure to legalize physician-assisted suicide.

The bill would require a terminally ill patient — specifically, a person with an incurable illness or condition that can reasonably be expected to cause death within six months — be assessed by two doctors and a counselor before being prescribed life-ending medication.

The doctors would need to inform the patient about the diagnosis, prognosis, risks associated with taking the medication and other treatment.

The practice is currently legal in five states: California, Oregon, Washington, Montana and Vermont. Supporters have pushed for similar measures in dozens of other statehouses.

In 2012, Massachusetts voters narrowly rejected a ballot measure on doctor-assisted suicide. That measure called for two fewer doctor opinions than the new legislation being weighed.

Religious, medical and disability rights groups fought the 2012 measure, saying it was open to manipulation and relied on diagnoses that could be wrong. Cardinal Sean O’Malley, head of the Catholic Archdiocese of Boston, called the defeat the best outcome for the “common good.”

“We’re just looking for a compassionate way for them to face that inevitability,” state Rep. Louis Kafka, a sponsor of the new legislation, said of terminally ill patients seeking to end their lives.

The bill being discussed in Tuesday’s public hearing also requires that the patient’s request be drafted in writing and mandates that the patient self-administer the drugs.

People would be ineligible for the life-ending drugs if they’re minors, have guardians or are seeking them only because of age or disability.

Republican Gov. Charlie Baker pointed to the outcome of the 2012 ballot question.

“This is one where the details really matter, and I do take my lead a bit from the fact that the voters of the commonwealth had an opportunity to consider this and voted it down,” he said.

Democratic Senate President Stan Rosenberg said the Senate hasn’t discussed the issue, but he supports it.

“I think we can learn from what the other states that have implemented this have done,” Rosenberg said. “Personally I think we should take a hard look at it and find a … way to move forward with it.”

The Massachusetts Medical Society opposes the bill, saying the legislation will do more harm than good.

With reporting from the WBUR Newsroom and The Associated Press

Related:

Weighing In On The New Oprah-Weight Watchers Venture

Weighing In On The New Oprah-Weight Watchers Venture

Weight Watchers announced Oct. 19 that Oprah Winfrey is taking an approximately 10 percent stake in the weight management company for about $43.2 million and joining its board. Here, Winfrey is seen in an Oct. 14 file photo. (Greg Allen/Invision/AP)

Weight Watchers announced Oct. 19 that Oprah Winfrey is taking an approximately 10 percent stake in the weight management company for about $43.2 million and joining its board. Here, Winfrey is seen in an Oct. 14 file photo. (Greg Allen/Invision/AP)

By Jean Fain

When I learned that Oprah Winfrey would be the new face of Weight Watchers as well as a major investor in the international diet company, I panicked. Would this endorsement by a beloved celebrity lure even more desperate dieters into counting calories, weighing foods and getting sucked into the group’s particular brand of tough love?

Let me back up for a moment: If the partnership between the faltering diet company and former talk show host is news to you, Oprah recently invested $43.2 million in Weight Watchers International, Inc., to help dieters everywhere lose weight and gain health and happiness.

She initially bought 6.4 million shares, or 10 percent, of Weight Watchers, and has the option to buy another 3.5 million. Her investment immediately started paying off: The stock doubled on day one, earning the most recognizable black billionaire $70 million, at least on paper. What’s more, since Aug. 12, Oprah has lost 15 pounds.

So, is a Weight Watchers’ membership a wise investment? I’ve already written about what I feel are the organizations’ downsides in an earlier post. At best, Weight Watchers provides a short-term fix and conditional support for long-standing eating issues. At worst, the food plan can exacerbate the very problems members are hoping to resolve.

Unless you’ve been on a media diet, you already know that Oprah has a long history of gaining and losing weight. Over the last 25 years, the yo-yo dieter, who has written of her ongoing “food addiction,” has tried everything from liquid diets and rigorous exercise to a personal chef and a more spiritual path, but she’s yet to settle on any one successful, sustainable approach.

To help you make a wise investment, I solicited a half dozen expert opinions via email and asked what they think of Oprah’s slimming plan and her open invitation to “come join me” at Weight Watchers. More specifically, I posed two questions:

1) What’s your reaction to the announcement that Oprah is not only the new face of Weight Watchers, she’s a major investor in the diet company?

2) Oprah is asking everyone to join her in counting Weight Watchers’ points. Will you join her? Why or why not?

To be fair, I also asked Oprah and friends for their thoughts. Neither Gayle King, Oprah’s close pal, nor Oprah’s publicist got back to me. All I got from Stedman Graham, Oprah’s boyfriend, was an automated response. If there were a surprise, it’s how hard it was to find a single expert who’s excited about this fledgling partnership.

What follows are highlights from those recent email interviews:

– Marion Nestle, professor of nutrition, food studies and public health at New York University, author of “Soda Politics”:

“It’s a classic conflict of interest — she’s flacking a company in which she invests. The more she flacks, the more people join, and the more money she will make. There are worse things to flack. Weight Watchers is actually demonstrated to be a reasonable diet plan. It works for some people.

“I’m of the persuasion that weight can be managed by eating less. I’m trained in nutrition and don’t need to count points.”

 Traci Mann, diet researcher, author of “Secrets from the Eating Lab” and advocate of strategic eating:

“Oprah has made an outstanding investment. As long as people give diet companies the credit when they lose weight, but not the blame when they regain it, there will always be business for companies like Weight Watchers. As much as I love Oprah, I see no reason to join in with that near-futile mission. Weight Watchers leads to short-term weight loss, but in the long term, the majority of individuals regain what they lost.”

– Virgie Tovar, body image expert, fat activist and unrepentant foodie:

“I was disappointed [when I heard the news.] I see an investment in the diet industry as antithetical to the improvement of women’s lives. The diet industry (and surrounding industries) does not improve women’s lives. But women certainly disproportionately benefit the diet industry. Of the 108 million people on a diet in the U.S. 85% of the customers consuming weight-loss products and services are women. A 2015 study found that 80% of bariatric surgeries in the U.S. are performed on women. And over 90% of women report dissatisfaction with their bodies. [Will I be counting points?] Absolutely not! Asking people to count points is infantilizing and promotes self-surveillance.”

– Judith Matz, therapist, author of “Beyond A Shadow of a Diet” and “The Diet Survivor’s Handbook”:

“I commend Oprah on her efforts to empower women, and I empathize with the struggles she’s shared related to body image and emotional overeating. However, using her public influence to encourage women to diet is the most disempowering action that Oprah could take. I feel great concern that Oprah’s association with Weight Watchers will cause more women to pursue weight loss and remain engaged in the diet/binge cycle that can lead to shame, lower self-esteem, depression, poorer health outcomes, eating disorders, weight gain, and weight stigma. Anytime someone manipulates their eating for weight loss, it’s a diet, regardless of attempts to reframe it as being about health and happiness. The solution isn’t to keep trying the same thing over and over, but to get off the diet rollercoaster and learn how to reconnect with natural signals for hunger and fullness (known as attuned or intuitive eating), understand the many myths about health and weight, and accept that people naturally come in different shapes and sizes. [Will I be counting points?] Absolutely not!”

– Sarai Walker, author of “Dietland”:

“It’s too bad that someone with Oprah’s enormous influence continues to advocate for weight-based approaches to health. If she decided to promote a Health at Every Size model, she could cause a revolution. Instead, with this new deal, she has now become a stakeholder in the multi-billion dollar. So, no, I won’t be joining Oprah in her new business partnership.”

– Ronna Kabatznick, social psychologist, author of “The Zen of Eating” and advocate of mindful eating:

“It’s wonderful that Oprah is investing in Weight Watchers — both personally and financially. This will enable her to have an even wider influence worldwide on how to help people make positive physical, emotional and spiritual changes in life. I really appreciate that Oprah is so open and honest about her struggles with food. Not even Oprah can buy her way out of food compulsions. Hungers of the body and heart are eternal struggles. Every spiritual tradition addresses these longings — how we confuse the longing for wholeness with gluttony, lust, wealth, etc. But it never works. Oprah knows that, which is why she is a spiritual seeker. I hope she brings that spiritual element to Weight Watchers. Because without that focus, the hungry heart will wither while counting points. I won’t be counting points with Oprah or anyone. For me, in my sixties, it’s an hour of physical activity a day and eating in moderation what I love, which is mostly whole foods.”

Personally, while I don’t agree with all of the above opinions, the range of views has helped me broaden my perspective.

If you’re still craving perspective, consider asking yourself this: If a beloved friend asked you to join a diet organization with them, how would you respond? Would you respond any differently if that friend owned 10 percent of the organization? Keep breathing; the answer lies within.

Jean Fain is a Harvard Medical School-affiliated psychotherapist and the author of “The Self-Compassion Diet.”

lundi 26 octobre 2015

WHO Says Processed Meats Causes Cancer, So Should We Stop Eating It Altogether ?

WHO Says Processed Meats Causes Cancer, So Should We Stop Eating It Altogether ?

Didriks/Flickr

(Didriks/Flickr)

Is this the end of bacon, hot dogs and corned beef on rye?

How should consumers react to news from the World Health Organization that these and other processed meats can cause cancer, and that red meat, including beef, pork, veal and lamb are “probably carcinogenic to humans” too? Should we abstain completely now that the WHO’s International Agency for Research on Cancer (IARC) put processed meat in the same cancer-risk category as tobacco and asbestos?

Here’s the bottom line risk, from the IARC news release: “The experts concluded that each 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%.”

Processed meats have previously been inked to a range of illnesses, from heart disease to diabetes and cancer. But even with this big news from the WHO, many nutrition and public health experts said that reducing consumption of such meats is key, not eliminating them altogether.

Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, says there’s no need for everyone to suddenly become vegetarian or vegan. But, he said in an interview, he hopes the WHO announcement will spark real dietary change.

He made three points:

1. The WHO Announcement Is Big 

“I think the WHO announcement is very significant from a public health point of view because processed red meats have already been linked to type 2 diabetes, cardiovascular disease and other chronic disease, and this provides convincing evidence that consuming processed meats, like bacon, sausage, hot dogs, is linked to an increased risk of colorectal cancer in particular. Cutting back on red meat and processed meat reduces risk of diabetes and cardiovascular disease, but also reduces the risk of cancer. Improving your diet can actually be beneficial for reducing your cancer risk.”

2. You Don’t Need To Quit

“I’m not a vegetarian. This doesn’t mean everyone should become a vegetarian or vegan. Processed red meat should be consumed as little as possible — once or twice a week should not be a major problem. For unprocessed red meat, consumption should be moderate, but that’s hard to quantify; maybe every other day. We’re not talking about banning hot dogs, sausages or bacon, but we should change our dietary pattern from a meat-based diet to a more plant-based diet. That’s not really a new message. This message will hopefully raise more awareness. Hopefully it will motivate people to change their eating patterns.”

3. Change The Food Environment

“Certainly the risk accumulates as the amount increases, and if you can stay away from it completely that would be good. But occasional consumption of processed red meat isn’t going to create significant health problems … There are so many chemicals and ingredients in processed red meats — preservatives, nitrates, high sodium, saturated fats — it’s difficult to pinpoint exactly which chemicals cause cancer. From a public health point of view, it’s not necessary to know which chemicals are precisely responsible for the increased risk. Here the message is similar to tobacco, even though we may not know precisely which chemical cause the cancer, we can take actions to reduce the cancer risk by cutting back … It’s also important for the government to improve the food environment. There’s so much junk food in the food system.”

Others also backed a balanced approach to meat eating.

In its coverage of the WHO announcement, NPR quotes Susan Gapstur of the American Cancer Society, who in a written statement said that her organization recommends “consuming a healthy diet with an emphasis on plant foods and limiting consumption of processed meat and red meat.”

Cancer Research UK, a cancer research charity in the United Kingdom, responded to the WHO announcement with a statement from their epidemiologist at Oxford University, professor Tim Key: “We’ve known for some time about the probable link between red and processed meat and bowel cancer … Eating a bacon bap [sandwich] every once in a while isn’t going to do much harm — having a healthy diet is all about moderation.”

And here are some more level-headed thoughts from Center for Science and the Public Interest, which issued a statement from its nutrition director, Bonnie Liebman:

The International Agency for Research on Cancer has concluded that processed meats like bacon, sausage, and cold cuts are “carcinogenic to humans” and red meats like beef and pork are “probably carcinogenic to humans.” This solid and reasoned assessment, based on a comprehensive review of the scientific evidence, should guide the U.S. Departments of Agriculture and Health and Human Services as they finish writing the 2015 Dietary Guidelines for Americans.

Sadly, IARC’s report has already provoked new hysteria from the meat industry and is likely to stir up its allies in Congress. They will follow the playbook of all industries that feel they are under attack—asbestos, tobacco, and coal are three that come to mind—and shout from the rooftops that the science is in doubt.

It’s not.

If the meat industry and its political henchmen would listen for a moment, here’s what IARC said: “Eating meat has known health benefits. Many national health recommendations advise people to limit intake of processed meat and red meat, which are linked to increased risks of death from heart disease, diabetes, and other illnesses.”

Does that sound familiar? Here’s what the 2015 Dietary Guidelines Advisory Committee wrote in its report: “Thus, the U.S. population should be encouraged and guided to consume dietary patterns that are rich in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and beverages and refined grains.”

The American Cancer Society, American Institute for Cancer Research, and the World Cancer Research Fund have recommended eating less red and processed meats for years.

The meat industry, which is attacking the IARC, has less credibility than the Flat Earth Society. Here is what a veritable who’s who of scientists wrote in the National Institute for Environmental Health’s “Environmental Health Perspectives” earlier this year: “The IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public’s health.”

In short, IARC is the gold standard for rigor, comprehensiveness, and reasonableness—all qualities in short supply in the meat industry and its friends in Congress.

The North American Meat Industry also responded to the WHO report, saying in a statement that it “defies … common sense.”

‘Stick Around One More Day': Message Of Hope After Medford Man’s Suicide

‘Stick Around One More Day': Message Of Hope After Medford Man’s Suicide
[Watch on YouTube]

For Marlin Collingwood, Monday, May 5, 2014, started on a high note.

“It was a gorgeous day — a beautiful, perfect, New England May, early day in spring,” Collingwood recalls.

Collingwood’s husband, 45-year-old Gary Girton — who had been battling severe clinical depression for several years — had seemed happy the night before. The two had made dinner together and watched a movie.

But now, with Girton not answering the phone or responding to text messages, Collingwood drove home to Medford from his Boston office to check on his husband. And it became the day he had feared with the deepest of dread.

“As I was pulling down the street where we lived, I could see our front porch and there was note taped to the front door,” Collingwood says. “And it said, ‘Marlin, I’ve taken my own life. I don’t want you to find me. Call 911 and then call Molly. I love you, Gary.'”

Molly Baskette is Collingwood and Girton’s pastor. She’ll never forget the phone call she received from Collingwood that day.

“There was just Marlin screaming, crying on the other end of the line. He said, ‘[Gary’s] gone. He’s gone Molly, he’s gone, he’s gone.’ That’s all he could say. And I said, ‘I’m coming right over.’ And I just held him, and he wept and he raged.”

Marlin Collingwood, left, and Gary Girton kneel with one of their corgis. The Medford couple had married on a beach in Provincetown less than two years after same-sex marriage was legalized in Massachusetts. (Courtesy Marlin Collingwood)

Marlin Collingwood, left, and Gary Girton kneel with one of their corgis on their wedding day in 2005. (Courtesy Marlin Collingwood)

Baskette eventually went inside the house, where police had confirmed Girton was dead.

“Molly spent time with his body and anointed him, and prayed for him,” Collingwood recounts. “And I was adamant based on the way he had courageously fought this disease that we were not going to hide the fact that he had taken his own life.”

That started with Girton’s funeral at First Church Somerville.

“People need to know that we can have a conversation about this, that we have to,” Collingwood reflects. “People are dying every day. And the church and faith communities have to be able to reconcile that this is happening to people in their own communities.”

Talking Openly About Mental Illness And Suicide

Girton and Collingwood had gotten their whole church talking about mental illness. Girton wasn’t religious, but he was open-minded and enjoyed the congregational church community, his husband and pastor say. He spoke about his depression multiple times at Sunday services.

“He talked about how he saw God present in his very skilled psychotherapist or [in] the love, the healing love of this community,” Baskette says. “And a lot of people were helped by him having the courage to share that story.”

Collingwood says his husband would actually tell anyone who would listen — even strangers — about his mental illness and hospitalizations. He hoped to learn something new that might help him, and to shatter stigma.

“If somebody said to him, ‘How are you?’ He didn’t say, ‘I’m fine,’ like most of us did. He said, ‘You know what? I’m really struggling today, and here’s what’s going on. And I was in the hospital three weeks ago.’ He hated, hated when people would say to him, ‘You just need to pull yourself up by your boot straps. You just need to go take a walk,'” Collingwood explains.

The World Became Dark

Girton had suffered from depression since before he and Collingwood met in Pittsburgh in 1998. He kept it under control with medication for years, but he remained a “glass-half-empty” kind of guy, his husband says.

The two moved to the Boston area in 2003, just months before same-sex marriage was legalized. They married less than two years later, surrounded by family and friends on the beach in Provincetown. Educated as a teacher, Girton was working as an actor and mosaic artist.

“He loved kids. He loved to help kids learn to read,” Collingwood says. “And he was just the kind of person who would help you, who wanted to see a better place in the world for everyone, very committed to equality.”

And he loved the couple’s corgis, Harry and Torre. Collingwood points to a picture of Girton with the two dogs — a picture in which he is smiling — which was used at his memorial service. It’s Collingwood’s favorite.

Marlin Collingwood holds a frame containing his favorite photograph of his late husband, Gary Girton, who loved their corgis. (Robin Lubbock/WBUR)

Marlin Collingwood holds a frame containing his favorite photograph of his late husband, Gary Girton, who loved their corgis. (Robin Lubbock/WBUR)

The smile in the picture wasn’t a regular sight on Girton’s face. But he was leading a productive life — at least, that is, until 2011. Just after Girton recovered from a bad stomach virus, his depression became severe. Suddenly, as if a switch had been flipped, he told his husband the world had become dark. And it just got darker.

Girton was hospitalized at McLean Hospital multiple times, including once when Collingwood discovered some pills he had bought on the Internet to kill himself. He tried every therapy and medication psychologists and psychiatrists recommended, his husband says. He went out into the community to help others — tutoring homeless children in a shelter and feeding the homeless on Boston Common — as a form of therapy. Collingwood acted as Girton’s caregiver and advocate, making daily calls to doctors and going with him to his appointments.

“He did everything he was told. He was told exercise, and some mornings he would get up and he would get on the elliptical, and he would be crying because he did not want to do it,” Collingwood recalls. “He wanted to just go to bed. He would get up and he’d take a shower, and he’d get dressed and he would go to to work. And it was torture for him for a long time.”

Baskette recalls some of what she said to Girton when he discussed his suicidal thoughts with her: “We want you here. We want you here for your own sake, because I believe if you stay, you will come through this time. And you will be able to enjoy life again. And God has so much more in store for you here. And we want you here for our sake, because we love you, and because suicide leaves a terrible exit wound.”

Pastor Molly Baskette recalls talking to Gary Girton about his suicidal thoughts and trying to convince him that God had "so much more in store" for him. (Robin Lubbock/WBUR)

The Rev. Molly Baskette recalls talking to Gary Girton about his suicidal thoughts and trying to convince him that God had “so much more in store” for him. (Robin Lubbock/WBUR)

Electroconvulsive Therapy Brings Glimmer Of Hope — For A Time

With all other treatments failing, doctors at McLean recommended ECT — electroconvulsive therapy. Girton was hesitant because of frightening images he had seen from movies and knowing it would likely cause some memory loss.

But he started the shock therapy and would feel a bit better for a few days, then tell his husband he wasn’t getting better. Still, it was enough to give him a little hope, Collingwood says, and that’s all he wanted.

Then in November 2013, Girton experienced something that almost never happens with ECT. He went into cardiac arrest during the procedure. He was rushed to another hospital and revived, but wished he hadn’t been.

“His first reaction was, ‘You should have just let me die. This was my chance to be done, to be out of pain,'” Collingwood recalls.

Given what had happened, doctors said Girton could never do ECT again.

And that’s when the darkness really took over, according to Collingwood.

So every Sunday night, the couple had a ritual. Collingwood would ask his husband three questions that are recommended as part of suicide prevention and intervention.

“‘Do you have suicidal thoughts?’ And his answer was always, ‘Yes.’ He was very honest about that. ‘Do you have the means, and do you have a plan?’ And the answer to those two were always, ‘No.’ But it always was a kind of a ritual for us that we asked those questions.”

They went through that ritual, and Girton gave those answers, on Sunday, May 4, of last year.

But Collingwood now suspects Girton’s unusually upbeat demeanor that night came from feeling at peace about his decision. He did have means and a plan, and he carried it out the next day.

‘You’re Not A Burden’

While Girton was taking his own life at home, Collingwood was on the phone at work, trying to enroll his spouse in a study of a new treatment showing incredible promise for major depression that’s resisted other therapies.

Collingwood says his husband just missed out on that opportunity for hope. And that’s what drives this message that’s become his life’s mission.

“Stick around for one more day and then one more and then one more, because this doesn’t tend to be permanent. There tends to be things that do work. You are a not a burden. You are not making anyone’s life easier by dying. And if you’re hearing these words, this is your sign. Don’t take your own life today. Don’t do it.”

After his husband’s suicide, Collingwood left a public relations career and became executive director of the Waltham-based national Families for Depression Awareness organization. He teaches people how to be vocal, supportive caregivers for their depressed loved ones and how to talk openly about suicide — a lasting tribute to the man he calls the “great love” of his life.

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673)

‘Everything Is Grace': Looking To Faith For Answers To Suicide

‘Everything Is Grace': Looking To Faith For Answers To Suicide

In 34 years as pastor of Morning Star Baptist Church in Mattapan, Bishop John Borders has seen it all in terms of life struggles: church members or their loved ones lost to murder; people suffering from addiction, poverty, and cancer; grief and trauma from suicide.

“We need one another to survive in these challenging days. You cannot handle all the pressures of life alone,” Borders preached in a sermon earlier this year. “Any man or woman that’s suffering or going through hardship, you are not alone! Christ is suffering with you as you suffer with him!”

Bishop John Borders of Morning Star Baptist Church in Mattapan feels the faith movement has glossed over the pain of those with depression and suicidal feelings. (Robin Lubbock/WBUR)

Bishop John Borders of Morning Star Baptist Church in Mattapan feels the faith movement has glossed over the pain of those with depression and suicidal feelings. (Robin Lubbock/WBUR)

Borders views suicide in a way that would put him at odds with some other clergy.

“I do not see suicide as a sin. I do not think the scriptures teach that,” Borders says. “Who can really understand what’s going on in the mind and heart spiritually, emotionally, biochemically? None of us really knows.”

Borders thinks the faith movement in general has compounded the suffering of those with depression, by preaching that if someone had more faith in God, they wouldn’t be suffering or suicidal.

“We’re doing a disservice to people who are sitting in the congregation and thinking that their world is a mess and they’re in pain, and instead of embracing them and walking them through it, telling them to dismiss it by using their faith,” Borders reflects. “And that’s just not how it works.”

Solace Sought Through Faith During Suicidal Depression

Kathleen Laplante of Hudson became suicidal years after her father killed himself on her 21st birthday. She spiraled into severe depression.

Hudson resident Kathleen Laplante wrote a book about how her renewed Catholic faith helped her heal from her father's suicide and her own struggle with being suicidal. (Robin Lubbock/WBUR)

Hudson resident Kathleen Laplante wrote a book about how her renewed Catholic faith helped her heal from her father’s suicide and her own struggle with being suicidal. (Robin Lubbock/WBUR)

“Things became intense, and I started having suicidal thoughts,” Laplante recalls. “Not wanting to live, not caring about my kids, not able to care about my kids because I was in survival mode.”

Laplante had left the Catholic Church but during her depression took a retreat to a local monastery. She met a monk who became her spiritual advisor, then she converted back to Catholicism.

She wrote a book about her father’s suicide and her personal struggle. In it, she highlights how her renewed faith helped her survive.

“To me, everything is grace. Medicine is God’s grace. So to me the two are intertwined,” Laplante says.

And though she was originally mad at the thought of her father’s manner of death being considered a mortal sin, Laplante felt better after learning the Catholic Church gives more “leeway” on the issue now.

“With my father not being able to think clearly because of depression and alcoholism, that he may not be, you know, completely responsible for his suicide,” she explains.

Catholic Church Recognizes Suicide Stems From Mental Illness

Father James Bretzke, a moral theologian at Boston College, backs that up. And he’s particularly sensitive to the issue. He had to lead a funeral mass for his only sibling, a sister, who took her own life in 2006 after a battle with severe clinical depression. He thought a lot about her soul.

“I believe very, very strongly she fell into God’s loving embrace, because I’ve prayed very hard, ‘What happened to my sister?’ and that is the image I have, of her falling down into God’s arms,” Bretzke says.

Up until the 1950s, the Catholic Church considered suicide an absolute violation of the Fifth Commandment, ‘Thou shalt not kill,’ and people who killed themselves were denied Catholic funerals, according to Bretzke.

“We recognize now, and I think much more soundly so, that suicide is the result of a very, very serious psychological illness — that very few people, if anyone at all, really, freely takes his or her own life to try to rebel against God or something like that,” Bretzke explains.

Fr. James Bretzke, a moral theologian at Boston College whose sister took her own life, says the Catholic Church focuses on compassion and mercy when confronting the issue of suicide. (Robin Lubbock/WBUR)

Fr. James Bretzke, a moral theologian at Boston College whose sister took her own life, says the Catholic Church focuses on compassion and mercy when confronting the issue of suicide. (Robin Lubbock/WBUR)

He argues most, if not all, of the Biblical verses people cite as evidence that suicide is a mortal sin are not actually about suicide.

Though the intentional taking of one’s life is still considered to be against God’s plan, Bretzke says, the Catholic Church now focuses on compassion and mercy.

Father Bryan Hehir, the Secretary for Health and Social Services for the Archdiocese of Boston, says that approach comes in three stages: when someone who is thinking about killing himself or herself goes to a priest for help, during the funeral and burial of someone who has died by suicide, and in the months after a family has lost someone to suicide and those survivors need support.

“The main point is you are to be present to them in a moment of intense grief and confusion,” Hehir says. “And so you really want to make the life of the church in all its mercy, in all its sense of compassion and empathy, present to them. That means spending time with them.”

Don’t Castigate, Instead Embrace

The new imam at the Islamic Society of Boston Cultural Center, Shaykh Yasir Fahmy, says he preaches on issues of mental illness and suicide. And he prays with people who come to him with mental health issues.

“God, I seek refuge in you from worry and from sadness,” Fahmy translates after saying a prayer in Arabic. “And what the prophet teaches us [is] when you supplicate in this way, that God does free you from anxiety.”

Shaykh Yasir Fahmy, senior imam at the Islamic Society of Boston Cultural Center, says those who have suicidal impulses should not feel “evil or sinful.” (Robin Lubbock/WBUR)

A member of the mosque died by suicide just a few weeks ago. Muslims who kill themselves are given a traditional cleansing, prayer and burial.

The imam encourages congregants at New England’s largest mosque to embrace — not castigate — others who are depressed and suicidal.

“No one should feel that they are evil or sinful if they feel these impulses,” Fahmy says. “That doesn’t mean that God’s wrath is upon you.”

The mosque also has a free on-site counseling service. It was founded two years ago by Ben Herzig, a clinical psychologist who sees clients pro bono. He says the Muslim community has traditionally underutilized mental health services.

“There is an increasing willingness among the younger generation of American Muslims, particularly American-born Muslims, to reach out for services if they feel that the provider will be understanding of the role that religion plays in their life — whether the provider is Muslim or not,” Herzig explains.

Herzig says providers have a responsibility to develop that understanding, in order to validate the people they’re treating.

And he says though some Muslims openly talk about losses from suicide, others still feel it has brought shame and dishonor to their family, and they’ll never discuss it.

Crafting A Jewish Response To Suicide

Elana Premack Sandler, who is Jewish, says there was some secrecy in her family when her father killed himself when she was 8 years old.

“There were some confusing messages about, as children, what we were supposed to be doing — very sort of specific to Jewish life things, like whether we were supposed to say kaddish for our father, the memorial prayer for those who have died,” Premack Sandler says.

But, she says, her family got lots of support from their synagogue, where it was known her father took his own life.

She’s now a public health social worker and is on the board of Elijah’s Journey. The nonprofit organization is working to raise awareness about suicide in the Jewish community and to create resource guides on how to talk about it — for example, when sitting shiva after a suicide.

Rabbi David Lerner leads Temple Emunah in Lexington, a conservative egalitarian congregation. And he’s the president of the Massachusetts Board of Rabbis.

The prayers Lerner says with people who are suicidal focus on healing and renewal.

“Tears may linger in the evening, but joy comes in the morning,” Lerner translates from Hebrew from one of the Psalms. “The awareness that yes, there are times when we are going to cry, and the awareness of how painful that is, but to also be aware that there can be hope.”

Rabbi David Lerner of Temple Emunah in Lexington finds the question of what happens to the soul of someone who dies by suicide challenging. He hopes there is a realm in which the soul can be healed before moving on to the full afterlife. (Robin Lubbock/WBUR)

Rabbi David Lerner of Temple Emunah in Lexington finds the question of what happens to the soul of someone who dies by suicide challenging. He hopes there is a realm in which the soul can be healed before moving on to the full afterlife. (Robin Lubbock/WBUR)

Lerner says Jewish law teaches one cannot harm his or her body. In some stricter, Orthodox Jewish communities, fear of being ostracized or not finding a life partner might still keep people from openly discussing suicide.

In addition to referring people to mental health treatment, Lerner hopes the teachings of Judaism will help dissuade against the taking of one’s own life.

“If someone asked me, I would say, ‘yes, the tradition says your life is sacred and valuable. You are of ultimate worth. How could you contemplate even doing something to something so valuable and so treasured as yourself?'” Rabbi Lerner says. “That hopefully allows also the beauty of their own life to still be there, even in a time when they’re feeling so desperate and so lacking of hope.”

Concerns About The Afterlife Keep People Alive

Lerner still finds the question of what happens to someone following suicide challenging. He hopes the soul enters a dimension in which it can be healed and then moves on to the full afterlife.

Imam Yasir Fahmy at the Islamic Society of Boston Cultural Center says Muslims relegate a person’s destiny to Allah.

“God is the one we have confidence in. He is the most merciful,” says Fahmy. “We know that a person who commits suicide with the full intellectual capacity present, that that is a sinful act. How God will treat that reality, that is in God’s knowledge, not ours.”

About 140 studies have measured the impact of faith on attitudes toward suicide, and approximately 75 percent of them have found a significant connection, according to Dr. Harold Koenig. Koenig is a professor of psychiatry at Duke University Medical Center who researches religion and health.

“When I have a patient who has a strong religious faith, the likelihood of them committing suicide is just a lot less,” Koenig says.

It’s usually traditional religious doctrines that are a driving force in people not taking their own lives, he explains.

“I would have thought that, you know, because religion helps people to cope better, gives life more meaning and purpose, that that would be the reason why religious people don’t commit suicide,” Koenig says. “But actually, research is showing that that doesn’t have that much of an effect. It’s actually some of the, ‘I’m going to hell if I commit suicide.'”

Patients have told him they would have killed themselves if not for the fear of not joining their deceased spouse or parents in heaven.

Clergy Can Relate To Depression Among The Faithful

Morning Star Baptist Church also runs a free counseling service with church members who are therapists.

And Bishop John Borders can relate to those who are struggling.

“I’ve been depressed and burned out many times. So I know what depression is like,” Borders reflects. “There have been times in my life where I wanted to die, but I never felt like it was mine to take my own life. I felt alone. I felt no one understood what I was feeling or experiencing. And I felt that if I divulged what I was feeling, that it would be quickly dismissed.”

One day he thought he was going to have a nervous breakdown, until, he says, he saw the setting sun like a big orange in the sky.

“And I heard a small voice inside of me that said the sun still shines,” Borders says. “And if the sun still shines, there is a God. And if there’s a God, you are loved. And if you are loved, you can make it through this day.”

So even though he believes strongly that many people need more than faith — including counseling and medication — to get through mental illness, ultimately, he says, it was moments of enlightenment stemming from his faith that saved him.

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673)