Next month, WBUR will launch an expanded CommonHealth site with a new staff and a sharpened focus on how health care reform in this state is actually playing out.

Joining forces with NPR, CommonHealth will offer around-the-clock reporting, fresh analysis and content provided by award-winning journalists. It will also broaden its reach to include multimedia stories on personal health and the struggle to contain medical costs while insuring quality.

In order to make this new site a success, CommonHealth will need your participation, expertise and insight. So please stay tuned for more news about this exciting project.

Two drug company executives were ordered by their employer, GlaxoSmithKline, to stop a little side business they had going, selling resveratrol — the wildly hyped, potential life-extending compound found in red wine — online, as a dietary supplement.

The story first broke on the business tech website, Xconomy.com, and TheStreet.com, and was then picked up in the New York Times prescriptions blog today.

One of the executives involved, Christoph Westphal, founded Cambridge-based Sirtris, which initially sought to commercialize resveratrol, and was purchased by GSK in 2008 for about $720 million. Westphal and a colleague, Michelle Dipp were selling a year’s supply of a less potent formulation of the compound through their nonprofit, Healthy Lifespan Institute, for $540, Xconomy.com reports:

Westphal and Dipp, who are both senior executives at Glaxo, informed the parent company about their decision to start the Healthy Lifespan Institute, according to TheStreet article, but “GSK [Glaxo] was not aware that the Healthy Lifespan Institute was selling a resveratrol formulation on the Internet,” Glaxo spokeswoman Sarah Alspach said in an e-mailed statement cited by TheStreet. “The company has instructed the GSK employees to cease their association with this activity and Michelle Dipp and Christoph Westphal will be resigning their positions on the board of Healthy Lifespan,” Alspach told TheStreet.

GlaxoSmithKline has a huge stake in the control of its resveratrol asset. The company paid about $720 million to acquire Sirtris two years ago, and has invested millions more since then in its potential as a pharmaceutical treatment for diseases that people get as they age, like diabetes. The company’s pharmaceutical grade version of resveratrol hasn’t made it through the clinical trial process required to win FDA approval and start selling a drug in the U.S. But as a dietary supplement in a lower-dose form, resveratrol doesn’t have to pass any of that sort of regulatory scrutiny before it can reach the consumer masses. Dipp told Xconomy in the original story that Healthy Lifespan Institute was selling the supplement for $540 for a one-year supply, just to cover the costs of functions like manufacturing and distribution, not to make a profit.

The Boston Herald reports that Michael Merlina, a 29-year-old glazier from North Reading who says he can’t afford health insurance, has sued the Massachusetts Health Insurance Connector Authority for slapping him with a $2,000 fine.

Merlina apparently doesn’t qualify for subsidized health care but earns too little to afford a plan for himself and his wife, which would cost about $800 a month, The Herald says.

Reporter Christine McConville writes:

Connector spokesman Dick Powers said Merlina is among the 2,500 people who appealed this year’s fine. About half of those appeals were upheld but mostly for people who had lost their homes to foreclosure, suffered through the death of a spouse or had been a domestic violence victim.

For a working guy like Merlina, it seems there’s no relief in sight.

A group of Catholics has appealed to the Pope to try to stop the acquisition of Caritas Christi Health Care by the New York equity firm, Cerberus Capital Management, the Boston Globe reports.

Even though both Caritas and Cerberus have said that the religious identity of the hospital chain will remain in tact, a “stewardship agreement they negotiated with the Archdiocese of Boston would allow the hospital chain’s new owners to terminate its religious affiliation, if it became materially burdensome, in exchange for a $25 million donation to a charity chosen by the archdiocese,” the Globe says. That provision, in particular, has angered the anti-merger group:

In their letter to the pope, the Coalition to Save Catholic Health Care likened the $25 million referenced in the stewardship agreement to the bribe that, according to the Gospel of John, Judas Iscariot took for betraying Jesus.

“Given the threats to human life . . . this is anathema,’’ the group wrote. “The $25 million can only be likened to 25 pieces of silver.’’

Generosity is good, right?

Sure. But given the skyrocketing cost of health care here, should the state of Massachusetts continue its far-reaching mandatory insurance coverage, for instance, requiring that fertility treatments and chiropractic services be covered by every health insurance policy?

In an opinion piece in today’s Boston Globe, Robert C. Pozen, a senior lecturer at the Harvard Business School says “No.”

He writes:

Massachusetts has one of the longest lists of mandatory insurance coverages of any state. There is no option for forgoing any mandatory coverage and paying a lower premium. The total incremental cost of mandatory benefits in Massachusetts was over $300 million during 2004-2005.

Pozen also suggests that a new system of co-payments — one that took into account the vast price differences for services delivered by different hospitals and providers — would also stabilize overall costs.

For example, the price charged by Massachusetts General Hospital for a normal delivery of a baby is at least $1,000 more than the price of a similar service at a high-quality suburban hospital. Similarly, the price of a magnetic resonance imaging test is $300 to $500 higher at Mass. General than at other Massachusetts facilities.

However, patients do not know about these large price differences and have no incentive to seek out a lower cost provider. By contrast, suppose patients were charged a $100 copayment for a normal baby delivery at Mass. General, and only a $30 copayment for a normal baby delivery at other high-quality hospitals. We would likely see a stampede to these other hospitals.

These are not isolated examples of cost differentials. According to a recent study by the attorney general, the difference in payments made to the lowest-paid versus highest-paid hospital in one major insurer’s local network exceeds 300 percent. Similarly, the price paid by another major insurer to the highest-paid group of doctors was 224 percent higher than the price it paid to the lowest-paid doctor groups.

Jon B. Hurst, president of the Retailers Association of Massachusetts, says a new law set to be signed tomorrow will provide help for individuals and small businesses, but that meaningful health care cost-cutting has only just begun:

As the 2010 formal session of the Legislature ended on July 31st, small businesses and their employees walked away with an important win – the ability to participate in cooperative small business health insurance purchasing. The Governor is expected to sign the bill tomorrow. The Retailers Association of Massachusetts joined forces with a coalition of 46 chambers of commerce and not-for-profit organizations, all determined to get small businesses and consumers finally to the table with big business, government, insurers, and providers! The Legislature and Administration are to be congratulated for passing this important market based reform. Yet the work is not done, and health care costs will again be a top agenda item next year.

Although the opposition was vocal, the Legislature truly delivered for Main Street employers and for consumers. Coupled with vital premium, medical loss ratio and mandate compliance transparency requirements, this legislation provides an important model not only for Massachusetts and other states, but also for the implementation of federal health care reform. A special thank you to our lead sponsors Sen. Steven Baddour (Methuen) and Rep. Steven Walsh (Lynn) for their tireless work!

Up to six cooperatives representing 85,000 lives will be formed under the legislation. The measure helps to push us toward the elimination of marketplace and regulatory discrimination brought about in the mid-90’s when groups of 50 or less were prohibited from group buying. This initiative will allow like-minded and motivated consumers to work together through innovative programs previously only used by big employers, including cost and quality data education and usage, wellness programs, and limited provider networks. The fruits of the labor of the groups will mean increased savings over time as more members of the cooperative become better educated and healthier consumers.

This comprehensive reform package also requires extensive insurer disclosure and transparency on premiums, administrative costs, and medical loss ratios by group size–important data to note differentials in the marketplace and to create pressure for comparable coverage for comparable premiums. It will also for the first time require disclosure by administrators of self-insured clients on the level of compliance with state mandated benefits, which under federal law many large employers can avoid. A change in the age rating factors will provide shock rate relief by requiring insurers to rate every year, as opposed to the current 5 year period. Other important provisions will allow for limited network products and an annual open enrollment period in the merged market, to prevent gaming of the system by individuals.

As we look forward to the next session of the Legislature beginning in January, we will be preparing to file legislation to further control healthcare costs at the provider level. One of the best ways to do that is to ensure that all consumers have clear premium transparency on where each and every dollar of their premium is going. Consumers need to know if they are using services which cost more than the premiums they are paying in. If armed with claims and cost data, employees and their employers can become better educated consumers, leading them to choose more cost-effective providers, and to participate in innovative cost avoidance and health enhancement initiatives such as wellness programs. They then become part of the solution, not part of the problem. Conversely, consumers have a right to know whether they are paying in far more than they are getting back in services. At a certain level, cross-subsidies become unfair, especially in an environment in which government says we must purchase health insurance.

Consumers also have a right to know what mandates they are paying for under state law, how much they cost, and how that compares to federal mandates which large, self-insured plans may follow. Are small businesses and their employees being treated fairly versus big businesses and their workers? If the evidence shows that those consumers covered by self-insured plans are not paying as much for their health insurance due to having to pay for less government mandates, action will be necessary on Beacon Hill to level the playing field for consumers insured by small business plans. Given the fact that over half the health insurance marketplace in Massachusetts is self-insured, one might conclude those plans have lower costs.

Consumers need to be given more say in what they buy, with less decision making done under the pressure of providers and recipients of certain services. Some of the mandates we cover today should be converted to a “mandate to offer,” with the consumer having the final say whether a particular service is something they want added at a disclosed price to the ever increasing total premium they are required to pay under state (and soon federal) law. We can all agree that there are services which apply to all of us, and they represent a starting point for government mandates. Yet, mandating everything–including mandates we will never use–leads to unwarranted medical inflation from the providers of those services which leads us away from affordable health insurance.

And finally as national reform begins to take shape, we need a discussion on how to move to the least costly option for local employers and consumers alike. Like the steps recently taken by Massachusetts on education, perhaps it is time to begin considering whether we should embrace the federal standard so consumers and employers from the Commonwealth will join our counterparts in 49 other states.

Earlier this week, Nicholas Wade of The New York Times reported on a fascinating new discovery about the role of certain sugars found in human breast milk that play an important role in protecting the infants gut from dangerous bacteria.

While breast milk has been shown to confer a range of benefits to the baby, from protection against certain diseases to improved cognitive performance, the notion of a protective coating for the gut is something new. Indeed, one of the scientists working to “deconstruct” milk as part of his research is quoted saying that in this phenomenon of evolution, “mothers are recruiting another life-force to baby-sit for her baby.”

Wade writes:

The details of this three-way relationship between mother, child and gut microbes are being worked out by three researchers at the University of California, Davis — Bruce German, Carlito Lebrilla and David Mills. They and colleagues have found that a particular strain of bacterium, a subspecies of Bifidobacterium longum, possesses a special suite of genes that enable it to thrive on the indigestible component of milk.

This subspecies is commonly found in the feces of breast-fed infants. It coats the lining of the infant’s intestine, protecting it from noxious bacteria.

Infants presumably acquire the special strain of bifido from their mothers, but strangely, it has not yet been detected in adults. “We’re all wondering where it hides out,” Dr. Mills said.

He continues:

The sugars are very similar to those found on the surface of human cells, and are constructed in the breast by the same enzymes. Many toxic bacteria and viruses bind to human cells by docking with the surface sugars. But they will bind to the complex sugars in milk instead. “We think mothers have evolved to let this stuff flush through the infant,” Dr. Mills said.

Dr. German sees milk as “an astonishing product of evolution,” one which has been vigorously shaped by natural selection because it is so critical to the survival of both mother and child. “Everything in milk costs the mother — she is literally dissolving her own tissues to make it,” he said. From the infant’s perspective, it is born into a world full of hostile microbes, with an untrained immune system and lacking the caustic stomach acid which in adults kills most bacteria. Any element in milk that protects the infant will be heavily favored by natural selection.

“We were astonished that milk had so much material that the infant couldn’t digest,” Dr. German said. “Finding that it selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy — mothers are recruiting another life-form to baby-sit their baby.”

Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, just agreed to ratchet back proposed rate increases to an average of about 8 percent, according to The Boston Globe, following the lead of three other insurers who reached similar deals with the state.

In announcing the deal, the Patrick administration said the “four agreements collectively cover about 90 percent of the small businesses and working families insured in the merged market in Massachusetts,” The Globe reports:

In a statement, Blue Cross Blue Shield president and chief executive Bill Van Faasen said the agreement will end months of uncertainty and provide for a more stable marketplace.

In April, the Massachusetts Division of Insurance disapproved proposed rate increases from Blue Cross Blue Shield ranging from 9.3 percent to 22.6 percent after finding them to be unreasonable or excessive in relation to the benefit provided, the administration noted.

“The settlement reduces those increases to a range of .4 percent to 12.9 percent, with an average blended base rate of about 8 percent,” the administration said in a press release, adding, “As with previous agreements, the settlement with Blue Cross Blue Shield does not include retroactive increases to April 1.”

Van Faasen said in his statement that Blue Cross Blue Shield agreed to accept “less than adequate premium rates” in order to “help move the community beyond the distraction of arbitrary caps on premiums and toward more meaningful and sustainable solutions that will bring real and lasting rate relief to employers and individuals.”

Insurers in this state are now required to cover a broad range of care and treatment for children with autism, The Association Press reports, making Massachusetts one of the most generous states in the nation for such coverage.

But business groups remain opposed to the law, saying the costs are simply too high. The AP reports:

The legislation, passed during the closing days of the Legislature’s formal session last week, mandates insurers cover the cost of diagnosis and treatment of autism spectrum disorder if it is deemed medically necessary by a doctor.

Those treatments include rehabilitative, psychiatric and therapeutic care, diagnostic tests, applied behavioral analysis as well as the cost of pharmaceuticals. Insurers would not be required to pay for in-school services.

The law also lets insurers opt out of providing coverage for three years if their costs rise by more than one percent a year.

Business groups say the costs of providing the extra coverage will fall largely on employers already struggling to cope with rising health premiums.

They said the law could increase the cost of health care coverage by as much as $340 million over the first five years, and that the average monthly increase in premiums could be as high as $2.45 per member.

Tufts Health Plan struck a deal with state regulators to limit increases in its insurance rates, according to a report in The Boston Globe.

So far, three big insurers — Tufts, Harvard Pilgrim and Neighborhood Health Plan — have agreed to similar rate-limiting agreements with the state. Reporter Todd Wallack writes:

Tufts agreed to raise rates in a range of 5.8 percent to 12.8 percent, starting next month — down from the 11.1 percent to 22.7 the company had proposed.

“This is great news,’’ said Barbara Anthony, the state’s undersecretary of the Office of Consumer Affairs and Business Regulation, which includes the Insurance Division. “I think everyone involved wants the same thing, which is lower health insurance premiums.’’

The pact comes four months after the Division of Insurance denied 235 out of 275 rate increase proposals from Tufts and five other insurance companies, arguing they were excessive or unreasonable. That set up a showdown between Massachusetts officials and insurers.

Still, Wallack reports, “three other health plans, including Blue Cross Blue Shield, the state’s largest insurer, Fallon Community Health Plan, and Health New England, are continuing to appeal the state’s denials of rate increases. A decision on the Blue Cross case is expected in the next few weeks.”

NPR’s Alix Spiegal examines a small change in the way mental health professionals now define “grief” after the loss of a loved one, and finds the shift has far-reaching implications.

With a new edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, coming out — the guide that lists mental disorders to enable medical diagnoses of illness — Spiegal reports that psychiatrists are looking at grief a little differently.

In the past, grief after a death — and the symptoms that go along with it — was considered normal, but now it appears that professionals consider grief with certain characteristics to be closer to a true mental disorder: depression.

Speigal explains:

Traditionally, the manual has warned doctors away from diagnosing major depression in people who have just lost a loved one in what’s called “bereavement exclusion.” The idea was that feelings of intense pain were normal, so they shouldn’t be labeled as a mental disorder.

But the new DSM changes this. Buried in the pages is a small but potentially potent alteration that has implications not only for people like Theresa, but ultimately for the way that we think about and understand the emotion of pain.

The DSM committee removed the bereavement exclusion — a small, almost footnote at the bottom of the section that describes the symptoms of major depression — from the manual.

But some experts worry that this shift may lead to overtreatment of people who merely need more time to process a profound loss.

…in the new manual, if symptoms like these [loss of appetite, lack of energy, crying, difficulty sleeping, etc.] persist for more than two weeks, the bereaved person will be considered to have a mental disorder: major depression. And treatment, either therapy or medication, is recommended.

Now according to [DSM committee member, Dr. Kenneth] Kendler, this change will affect a small number of people — less than 30 percent of the bereaved. But Holly Prigerson, a researcher at Harvard University who studies bereavement, says that while there’s no good research on what percentage of people will meet the criteria for depression after a loss, it’s clear that most experience depressive symptoms far beyond two weeks.

“What we found,” Prigerson says, “is that when you follow people — for example, between zero and six months post-loss — their depression symptom levels actually increase over time and peak at about six months post-loss.”

Because grief and depression look so much alike, Prigerson says, she worries that people who are suffering from normal grief will be told that they are sick when they are not, and encouraged to treat their symptoms when they don’t need to.

That is potentially a problem, Prigerson says, because we don’t know whether the pain of normal grief actually helps people to process their loss.

Valerie Bassett, executive director of the Massachusetts Public Health Association, writes about the passage of a new law that takes the fight against childhood obesity into the schools:

We generally think of Massachusetts as a healthy state, but when it comes to childhood obesity, there is much room for improvement.

According to the recent report, F as in Fat: How Obesity Threatens America’s Future, by the Trust for America’s Health and the Robert Wood Johnson Foundation, Massachusetts ranks 18th, below 17 other states with the lowest rates of childhood obesity. One out of four high school students in Massachusetts is now overweight or obese. For African-American and Latino children in the Commonwealth, the rates of obesity are much higher than for their white peers. This trend has resulted in a rise in preventable type II diabetes for children, leading many to project that this young generation may have a shorter lifespan than their parents.

Today, the Governor signs into law the School Nutrition Bill that takes an important step to establish standards for the foods sold outside of the regular meal at public schools.

Close to one million students are currently enrolled in Massachusetts Public Schools, and most communities have no standards for what is sold in school stores, vending machines, and a la carte in lunch lines. Instead of eating a salad or snack of fruit and cheese, students buy doughnuts, candy bars, soda, and potato chips. In schools, where we aim to set a good example and teach children habits for life, we offer the daily option of unhealthy foods that contribute to the problem of unhealthy weight.

Americans eat too much – at meals and between meals. Some public health advocates and nutritionists believe that schools shouldn’t sell anything other than the school meal. But as long as schools sell other food and beverages, they should nourish our children. And what’s nourishing is simple: whole, unsweetened, low-sodium foods and drinks.

Some will say this law restricts choice, but it will actually increase the selection of nourishing foods in public schools. It will require schools to make fresh drinking water available along with fruits and vegetables and other healthy foods anywhere food is sold. The Massachusetts Department of Public Health is also charged with developing nutritional standards for food or beverages sold in public schools. We will call for these standards to be the strongest in the nation, so Massachusetts can lead the way in obesity prevention.

This law also makes it easier for schools to purchase directly from Massachusetts farms, and encourages state institutions of higher education to do the same. Data show that kids eat more fruits and vegetables and try new options when they know the food is local.

There is much more work to be done to make all Massachusetts communities places where children and adults have a fair chance to eat healthy food and be physically active. The legislature is on the brink of enacting the Statewide Food Policy Council bill, which would help create a food system that benefits local agriculture and addresses inequities in access to healthy fresh food. The Massachusetts Public Health Association is partnering with other concerned organizations in a new coalition, Act FRESH, to continue to push the frontiers of policy for equity in healthy food access and safe public space for walking, wheeling, and moving.

But today, advocates are gathering at the State House to celebrate healthier schools. The School Nutrition Bill is the culmination of many years work by MPHA, scores of other organizations, thousands of concerned residents, and many state legislators, notably Chairman Koutoujian. We joined together to overcome opposition from the soda and food industry and pass this bill into law.

This law is about giving children the chance to live long, healthy lives.

With no added sugar, this moment is indeed sweet.

(MPHA, along with the American Health and Stroke Association, Children’s Hospital Boston, the Massachusetts Health Council and the School Nutrition Association are hosting a celebration at noon in the State House today to mark the bill’s passage into law.)

Once again the surgeon/writer Atul Gawande takes on a topic — in this case, the problematic approach to end-of-life care in the U.S. — and delivers a smarter, more nuanced and illuminating story than anyone else around.

In the current New Yorker, Gawande tells the agonizing story of a 34-year-old woman, Sara Monopoli, who, at 39 weeks pregnant, learns she has terminal lung cancer. Though she never smoked, and ate well, the cancer turns out to be aggressive — it has already metastasized, and is inoperable. Still, Monopoli, her family, and even her doctors push ahead, despite the negligible odds, for every possible treatment, each more experimental and physically punishing than the next, without considering the best way for her to actually die.

“This is the moment in Sara’s story that poses a fundamental question for everyone living in the era of modern medicine,” Gawande writes. “What do we want Sara and her doctors to do now? Or, to put it another way, if you were the one who had metastatic cancer—or, for that matter, a similarly advanced case of emphysema or congestive heart failure—what would you want your doctors to do?”

But beyond the compelling narrative, Gawande’s piece offers a portrait of hospice care as truly life enhancing, and according to some reseach, actually life-extending, as it provides patients with day-by-day and moment-to-moment comfort, both physical and psychological.

Gawande explains:

The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer. When Cox was transferred to hospice care, her doctors thought that she wouldn’t live much longer than a few weeks. With the supportive hospice therapy she received, she had already lived for a year.

Amid growing concerns about rising health care costs, state lawmakers approved a plan that would require insurers to cover a range of services to help children with autism, The Boston Globe reports.

The plan, passed by the House and now headed to the Senate, “contains mandated coverage for services known as ‘applied behavioral analysis,’ which include training children with autism and related disorders in social, verbal, and motor skills,” writes Kay Lazar.

But the proposal faces stiff opposition from businesses struggling to hold down costs, Lazar reports.

A broad coalition of business groups, insurers, and the Group Insurance Commission, which provides insurance to more than 300,000 state and municipal employees and their families, sent a letter to lawmakers yesterday opposing the bill.

It said there is “limited rigorous research’’ on the effectiveness of such autism services and said that the cost of the services, which are often provided at public schools through special education classes, would be shifted instead to the private market, falling heavily on small- and medium-size employers through their workers’ insurance premiums. Larger employers are not subject to state insurance mandates and would not be required to pay for these services.

In an essay about her role as “the family doctor,” Carolyn Roy-Bornstein, a pediatrician in Newburyport, worries about whether she made the right decision urging an elderly in-law into treatment for cancer:

Recently my mother-in-law Sylvia was diagnosed with ovarian cancer. She chose, for reasons of her own, to keep this news to herself for three months. By the time she let her children in on her little secret, she had also made another decision. She didn’t want any treatment.

I know 85 years is a long time on this earth and my mother-in-law was “feeling fine” (her reported reason for keeping mum). And if treatment was going to cause her to suffer and not buy her significantly more time, then I’d be all for this plan to just run the clock out on her life.

But she was operating in a vacuum; we all were. We needed information. That’s where I came in. I’m the doctor in the family. Being a pediatrician, ovarian cancer is not one of my specialties. But I do know how to search the scientific literature to answer certain questions: What is her prognosis? What is the recommended treatment? What are the side effects?

I came up with good news. With chemotherapy alone, her life expectancy may increase by as much as 36 months. And though her blood counts may decrease, putting her at risk for infection, other side effects she dreaded like nausea and hair loss were less likely. I called her, armed with this new information. She agreed to see the oncologist. I was elated.

But was I cherry-picking my data? I’m supposed to be objective. I’m a doctor; but I’m also a daughter-in-law who desperately wants her mother-in-law to live. Was I simply putting a rosy spin on grim statistics hoping to nudge her gently toward treatment just so I could have her for another few years? Was I being selfish?

I kept searching. An Australian study found that chemotherapy was well-tolerated by fit elderly patients. An Italian study concluded that older women with ovarian cancer were not being offered appropriate chemotherapy by physicians who falsely believed they wouldn’t tolerate the drugs’ side effects. These reports sounded promising.

My sister-in-law Marilyn and I took Sylvia to her appointment. The doctor summarized their previous interactions.

“Last time we met, Sylvia, you didn’t want any treatment. You were feeling pretty well and you didn’t want to lose your hair. What changed?”

Sylvia arched her eyebrows in my direction. I smiled sheepishly. He answered our questions. How much time did she have without treatment? (Maybe 6 months.) What about with it? (A year, maybe more.) What about side effects? (Low blood counts. Infection.) Nausea and hair loss? (Not so much.)

Sylvia took it all in, seemingly unconvinced. Silence filled the room. I told her about the Italian study with the elderly women not being offered treatment. We waited.

“Well?” her doctor asked. “It’s up to you, Sylvia.” “I’ll take it,” she announced. Marilyn and I looked at each other, stunned but delighted.

The doctor led us all down the hall and showed us the room where Sylvia would have her treatments. Full length glass windows looked out on a small tree-lined courtyard. Half a dozen fairly healthy-looking patients sat hooked up to their IVs. They watched TV or worked on laptops. The doctor boasted about the presence of wifi. We snickered among ourselves.

“I’ll bring a book,” Sylvia said.

We chose a date with the receptionist and penciled it into our calendars. Then we left. We walked out into the chilly autumn air. Clouds were gathering. It felt like snow.

In the car headed home, we shared our surprise and pleasure with our mom.

“What changed your mind?” I asked.

“It was that article you told me about: the one where the women were being denied treatment just because they were old.” My feminist mother-in-law would be damned if she was going to let someone write her off just because she was 85!

We dropped Sylvia off at the Jewish funeral home in town. Another one of Sylvia’s friends had died. She waved off our offers to go in with her.

“I’ll find a ride home,” she insisted, wrapping her scarf around her neck and heading inside.

Marilyn and I ate lunch at a Vietnamese restaurant downtown. We reveled in our mother’s acceptance of the chemo and marveled at her spunky reason for acquiescing. We clinked our thick white cups of green tea together in a toast to Sylvia.

“Thanks for coming, Cal,” Marilyn said. “She wouldn’t have agreed without you.”

But driving home alone, my doubts began to creep in. Had I only seen what I wanted to see in the studies I’d looked at? I knew that if Sylvia did well and had a few more good years with us–a few more vacations at the beach, another couple of Passover dinners–I might be credited with the bonus time. But if she suffered… if I was wrong… if her hair fell out… if she got an infection… if this didn’t buy her much time at all… I’d be held responsible for that too. By her. By my husband… Or maybe just by myself.

It’s been six months now and so far so good. No hair loss. No nausea. No infections. Her CA 125 levels are falling nicely. We know we have to lose Sylvia eventually. But we have her with us for now. I don’t take any particular credit for her longevity. I’m just glad to have her here, each day a gift.

In the first national assessment of its kind, researchers found that more than 70,000 children and teenagers are sent to the emergency room every year due to injuries and complications from medical devices, The Associated Press reports. Contact lenses are the top culprit, according to the new study, published in the medical journal Pediatrics.

Reporter Lindsey Tanner writes:

About one-fourth of the problems were things like infections and eye abrasions in contact lens wearers. These are sometimes preventable and can result from wearing contact lenses too long without cleaning them.

Other common problems found by researchers at the U.S. Food and Drug Administration include puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs; infections in young children with ear tubes; and skin tears from pelvic devices used during gynecological exams in teen girls.

Malfunction and misuse are among possible reasons; the researchers are working to determine how and why the injuries occurred and also are examining the prevalence in adults. Those efforts might result in FDA device warnings, depending on what they find, said study co-author Dr. Brock Hefflin.

The most serious problems involved implanted devices such as brain shunts for kids with hydrocephalus (water on the brain); chest catheters for cancer patients receiving chemotherapy at home; and insulin pumps for diabetics. Infections and overdoses are among problems associated with these devices. Only 6 percent of patients overall had to be hospitalized.

Dennis Rosen, a pulmonologist at Children’s Hospital Boston, writes in an editorial in the New York Times today about the dire shortage of sub-specialists to treat children.

While the shortage of primary care doctors and the overabundance of specialists who treat adults has been well documented, Dr. Rosen writes:

…pediatrics has the opposite problem: a growing shortage of pediatric subspecialists. There are plenty of general pediatricians in the United States — about 70 per 100,000 children. But according to the American Board of Pediatrics, there are only 751 practicing pediatric pulmonologists in the country: one for every 100,000 children. In four states — Alaska, Idaho, Montana and Wyoming, where more than 941,000 children live — there are none. Even in Massachusetts, the state with the highest ratio of pediatric pulmonologists to children in the country (2.6 for every 100,000 children), the wait for an appointment is often several months.

The numbers are similar for other pediatric subspecialties, leading to a shortage of doctors trained to treat problems many children face, like asthma, digestive issues and cancer. And not only are the current subspecialists aging (the average age of pediatric pulmonologists is 52.4), but few pediatric residents are choosing to undergo subspecialty training at the end of their residencies.

WBUR’s Sacha Pfeiffer reports on a new study that finds some nonprofit health insurers hoarding millions in extra cash while raising premiums significantly. Among the culprits are Blue Cross Blue Shield of Massachusetts.

She writes:

Insurers are required to keep surplus cash to cover unexpected losses. But the new report, which looks only at health plans run by Blue Cross Blue Shield, says seven of the 10 plans it analyzed have cash reserves more than triple the minimum amount needed to keep them financially sound.

Blue Cross Blue Shield of Massachusetts is among those seven.

Calling these reserves “enormous surpluses,” the report recommends that insurers spend that extra money on charitable work, refund it to consumers, or use it to set up “rate stabilization funds” that would lower fast-rising premiums.

“Really, when consumers are struggling to afford health care, should nonprofit plans be holding on to all of this money when they might be using it to reduce rate increases?” says Sondra Roberto, a staff attorney for Consumers Union, which did the report.

Harvard has tightened its conflict-of-interest restrictions on 11,000 faculty members, prohibiting them from speaking on behalf of pharmaceutical companies and medical device makers, and from accepting personal gifts, meals or travel, The Boston Globe reports.

Liz Kowalczyk writes that the new rules are intended to protect Harvard’s prestigious brand from being used to market drugs or other medical products.

The conflict-of-interest rules also place stricter limits on the income faculty can earn from companies for consulting, joining boards, and other work; require public reporting of payments of at least $5,000 on a medical school website; and promise more robust internal reporting and monitoring of these relationships.

Harvard, which provides continuing medical education for tens of thousands of doctors worldwide, also will erect a more solid firewall between itself and health care companies during these courses. The greatest impact will be on Pri-Med, an annual conference for primary care doctors at a Boston convention center, which features Harvard-taught courses. Pharmaceutical companies pay for separate breakfast, lunch, and dinner lectures by non-Harvard specialists and even market products in restrooms. The industry program will be moved to a more separate location, and marketing signs will no longer be allowed in bathrooms.

The new rules, which will be phased in after Jan. 1, are designed to keep doctors from becoming — or being perceived as — marketing agents for industry, said Dr. Robert Mayer, cochairman of the committee that wrote the new policy. “We’re anxious to be viewed publicly as doing what’s in the best interest of our patients,’’ he said. The school wants to “ensure credibility even more than we do today.’’

Alice Coombs, M.D., president of the Massachusetts Medical Society, says “tiering,” or “cost profiling, “ a system used to rate physicians’ performance, is deeply flawed:

Today, the American Medical Association, the MMS, and our colleagues in 46 other state medical societies delivered a letter to health insurance plans across the country, calling on them reevaluate the programs they’re using to profile physicians’ performance. We want the insurers to demonstrate that their programs are accurate, valid and reliable.

Some background: tiering is a practice that came into vogue some six years ago and purports to rate physicians on cost and quality using administrative data – claims information basically – submitted by participating health plans. It is part of the sweeping trend of transparency in health care, designed to reduce the ever-growing costs of care.

Yet physicians across the country have criticized the process, saying the programs have too many flaws, including the use of years-old claims data with little clinical relevance, the inability of physicians to validate data before it’s made public, the scarcity of the information available to the physicians, and in too many cases, erroneous information on physicians. As a result, physicians reputations could be harmed, access to care delayed, costs unfairly shifted to patients, and the doctor-patient relationship undermined.

Massachusetts physicians have balked at the programs since their inception in the Commonwealth.

The letter delivered today follows three separate studies by the RAND Corporation that prove, beyond a reasonable doubt, that these programs are flawed to their core.

As you know, we have been operating under one of the most aggressive physician tiering programs in the country, created and managed by the Massachusetts Group Insurance Commission, the agency that buys health insurance for all state employees and those in several municipalities.

The GIC developed the program in hopes of giving state employees an incentive to choose lower-cost and higher-quality physicians. If a doctor performs better than average, the patients are charged a lower co-pay for each office visit (usually $15). If the doctor performs worse than average, the patients are charged a higher co-pay for each visit (usually $45).

From the very beginning of the GIC’s program in 2006, we heard from physicians that the GIC program did not fairly or accurately represent the care they provide:

• Many physicians said they were assigned costs from patients they didn’t take care of, or for procedures and services they did not provide.
• Further, when physicians asked for detailed information on their care, the process was cumbersome and not transparent.
• While there is an appeals period, it is much too brief to give physicians a reasonable time to comb through the data, determine where the problems are, and ask for corrections.
RAND research proves that tiering does not accurately report the cost performance of an individual physician. For example, for internal medicine specialists, cost ratings are accurate only 50% of the time -you would be just as accurate with a coin flip!
This is particularly troubling for our primary care physicians, who already struggle terribly to keep their practices afloat. We worry that profiling programs like these would be the final blow for some practices.

We’re continuing to pursue our litigation against the GIC and two of its health plans. Five physicians have joined us as co-plaintiffs in the complaint. We want the court to order the GIC to do what the agency has refused to do willingly, which is to correct what’s wrong with the program.

We support, and welcome, holding physicians accountable for the cost and quality of their care. It’s the right thing. But as RAND demonstrates, this tiering program simply doesn’t get the job done.