From the category archives:

Ethics and policy

heavy child running ShutterstockSchools have manned the front lines in the battle against childhood obesity. Through the Healthy, Hunger-Free Kids Act of 2010, First Lady Michelle Obama has promoted low-cal lunches, fresh produce and more. Now, she hopes to ban junk food and soda marketing in schools.

Are these efforts enough to turn the tide? Offering healthy foods and promoting physical activity at school may not be enough to negate the impact of other unhealthy influences in students’ homes and neighborhoods, according to Tracy Richmond, MD, MPH, of Boston Children’s Hospital’s Division of Adolescent Medicine.

Richmond recently published a study in PLOS One that looked at how a school’s physical activity or nutrition resources might influence fifth grade students’ body mass index (BMI).

The study focused on 4,387 students in Birmingham, Ala., Los Angeles and Houston. “We wanted to find out if certain schools look ‘heavier’ because of their composition—meaning that kids at higher risk of obesity, like African American girls or Hispanic boys, cluster within certain schools—or whether something structural in the school influences BMI, like the facilities or programs offered,” explains Richmond. Full story »

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chopping block CHIP

Some believe that ACA's insurance exchanges leave gaps in pediatric protection.

Funding for the federal Children’s Health Insurance Program (CHIP) will run out in 2015. Will this leave many kids without health insurance?

About 8 million children currently receive health insurance through CHIP, created in 1997 to bring coverage to children whose families earn too much to qualify for Medicaid but not enough to buy private insurance. States administer the program and receive federal matching funds to cover costs. In 2009, Congress reauthorized funding for CHIP through 2015.

What will happen to CHIP beyond 2015 is uncertain, not just because of the funding deadline but also because of changes brought on by the 2010 Affordable Care Act (ACA). Many believe that the ACA’s Medicaid enrollment incentives and expanded tax credits will add so many lower-income kids to the insurance rolls that CHIP will become unnecessary and simply go away. Others, however, say that the plans sold through the ACA’s insurance exchanges could produce gaps in coverage for children, making it crucial to keep CHIP funded. Full story »

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Smokestacks-toxins-brain-shutterstock_142235569Maitreyi Mazumdar, MD, MPH, practices pediatric neurology at Boston Children’s Hospital. She leads a research program in Bangladesh that studies the effects of the epidemic of arsenic poisoning on neurological outcomes in children.

Neurodevelopmental disorders, including autism and attention deficit/hyperactivity disorder (ADHD), affect many millions of children and appear to be increasing in frequency worldwide. Improved diagnosis and changes in diagnostic criteria explain a portion of the rise, but not all. In other words, the increase in neurodevelopmental disorders seems to be “real.”

To date, research has mainly invested in finding genetic causes, implicating biological pathways that affect, for example, the formation of synapses and the production of neurotransmitters. Such discoveries improve our understanding of the basic biology of neurodevelopmental disorders and may ultimately lead to new therapies. But genetic variants alone cannot explain the recent rise; if they did, population rates of neurodevelopmental disorders would be expected to stay the same, or even decrease over a 30- to 40-year period, due to affected people likely having fewer children. Instead, reported rates have steadily increased over the past several decades. Something else is going on. Full story »

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Checklist report card improving appendicitis care at pediatric hospitalsWith appendicitis readmissions rates at some hospitals as high as 30 percent for children with severe disease, a group of children’s hospitals has started handing out comparative performance report cards to grade the way they diagnose and treat the condition. The quarterly reports are tools for hospitals to examine their performance across the entire scope of appendicitis care, prioritize quality improvement efforts and establish best practices.

According to Shawn Rangel, MD, a surgeon at Boston Children’s Hospital, the report cards grew out an effort to “understand high rates of preventable readmissions for complicated appendicitis.” A few years ago, Rangel and his colleagues began comparing appendicitis readmission rates at hospitals in the Children’s Hospital Association. The researchers found that the rate of kids readmitted within 30 days ranged from a low of 5 percent to a high of 30 percent for children with severe (ruptured) appendicitis. Full story »

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Doctor handshake pediatric research partnershipOn the minds of everyone involved in the care of sick children is the pressing need for more pediatric research funding. Last November, Congress finally passed the National Pediatric Research Act. It authorizes the National Institutes of Health to support a nationwide network of up to 20 pediatric research consortia, but it falls short of actually increasing NIH spending. Indeed, the next step in implementing the Act is to secure a specific funding commitment from the NIH or Congress.

Currently, only about 5 percent of NIH’s budget goes to pediatric research. Rather than wait for the government, an editorial in Vector’s new sister publication, Innovation Insider, proposes that foundations and companies become active participants in the consortia.

The prospects for such alliances are good. Patient advocacy foundations are increasingly active in research, and academic-industry partnerships are on the rise. At Boston Children’s Hospital alone, sponsored research and collaborations with foundations and industry have tripled from nine in 2009 to 29 in 2013. Alan Crane, MBA, a partner at Polaris Partners and an advisor to Boston Children’s Technology and Innovation Development Office, points out that drug discovery is much harder and more complex today than it used to be—just as many products are coming off patent.

Read more on what makes these partnerships work.

If you’d like to receive Innovation Insider in your inbox, sign up here.

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Medicine on a keyboard - clinical trial data.Ed. note: This is the second in a two-part series on making clinical trial data more transparent. Click here for part 1.

To grossly oversimplify, there are two kinds of people in the world: those who want to see data from clinical trials made widely and freely available, and those who would rather have the data restricted for privacy or business reasons. And as we noted in our last post, there are valid arguments to be made on both sides.

But is there a way to balance the benefits of openness and the safety of confidentiality? Full story »

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clinical_trial_data_shutterstock_171501788Ed. note: This is the first in a two- part series on making clinical trial data more transparent. Click here for part 2.

2013 was the year when big data became, well, big. Everyone from investment companies to public utilities to security agencies—including medical researchers—are now clamoring for as much data on as many subjects and topics as they can get their digital hands on.

But while data in other fields are becoming ever more open, clinical trial data—especially from corporate-sponsored trials—are relatively hard for medical researchers to obtain. Full story »

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Predictions now that healthcare exchanges are launchedIt’s been a few months since the Affordable Care Act (ACA) health exchanges opened for business, and there’s still a lot of speculation on how the bill will affect children, hospitals and insurers.

One thing that’s clear is that ACA is having some success in bringing more people into the system. In his recent State of the Union address, President Obama reported that since the federal and state health insurance exchanges opened for business on Oct. 1, 2013, 3 million citizens have enrolled in private plans and 6.3 million have been deemed eligible for Medicaid. Moreover, some health care experts believe that the Obama Administration may meet its goal of adding 7 million Americans to private insurance rolls by the March 31 enrollment deadline.

Who’s signing up for insurance through the exchanges? According to an analysis by PricewaterhouseCoopers (PwC), individual exchange members have a median age of 33 and a median income of $21,716, or 186 percent of the Federal Poverty Level. Some 91 percent are expected to be in relatively good health. Full story »

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Doctor apologizing-shutterstock_47724541Apologizing for a mistake is always a good idea. With a sincere “I’m sorry,” you acknowledge that harm’s been done, take responsibility for your actions and start to move forward. But for medical professionals, apologizing—something avoided in the past—can have an added benefit: it can discourage malpractice lawsuits.

According to Konstantinos Papadakis, MD, a surgeon at Boston Children’s Hospital, there has been a large movement across the country to pass “apology laws,” which encourage clinicians to “apologize to patients and families if there’s been a medical mistake and to have a conversation in which they disclose the details.” Under these statutes, he says, medical professionals are granted legal protections when having these conversations. Full story »

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Roulette_wheel2013 saw an accelerated crumbling of borders and boundaries in health care, fueled by technological and scientific advances. Boundaries between high-tech Western medicine and global health practices have begun blurring in interesting ways, as are those between home and hospital, patient and doctor and even a patient’s own body and the treatment used for her disease.

Last year also saw a fierce political fight over the Affordable Care Act (ACA)—aka Obamacare—ending in some six million people crossing the boundary from uninsured to insured, according to HMS, if you count Medicaid and Children’s Health Insurance Program eligibles.

What does all this portend for 2014? This year, Vector asked leaders from all walks of life at Boston Children’s Hospital to weigh in with their predictions. Full story »

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