Summertime — and the Livin’ Is Easy

Summertime — and the Livin’ Is Easy

With this past week’s high temperatures and high humidity, those of us who work and live in air conditioned buildings have had a lot to be thankful for.

Even a sojourn to the beach offers no relief from the heat, thanks to the prevailing southwest winds that blow hot air across the sand toward the ocean along our East-facing coastline of the Boston areaÊ

Still, as unbearable as this stretch has been for many people — and let’s not forget that hot weather kills more people than cold — does anyone doubt that in January, all of us will be pining for the heat of early August?

With just three weeks left until the Labor Day weekend, we do not have many more days of summer left. So let’s enjoy our Triple-H weather (hazy, hot, and humid) while we can. In the words of the early-’60s song by the great Nat King Cole:

Roll out those lazy, hazy, crazy days of summer

Those days of soda and pretzels and beer

Roll out those lazy, hazy, crazy days of summer

You’ll wish that summer could always be here  

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Church Needs to Take Swift Action on Sexual Abuse

Church Needs to Take Swift Action on Sexual Abuse

For the past several days, articles in the national media have reported accusations of Cardinal Theodore McCarrick’s sexual improprieties with several adults and his criminal violations of the sexual abuse of minors.  These alleged actions, when committed by any person, are morally unacceptable and incompatible with the role of a priest, bishop or cardinal.

I am deeply troubled by these reports that have traumatized many Catholics and members of the wider community. In one case involving a minor the Archdiocese of New York, after investigation, has found the accusation to be credible and substantiated. While another accusation concerning a minor is yet to be investigated, the reports are devastating for the victims, their families and for the Church itself. Each new report of clerical abuse at any level creates doubt in the minds of many that we are effectively addressing this catastrophe in the Church.

These cases and others require more than apologies. They raise up the fact that when charges are brought regarding a bishop or a cardinal, a major gap still exists in the Church’s policies on sexual conduct and sexual abuse. While the Church in the United States has adopted a zero tolerance policy regarding the sexual abuse of minors by priests we must have clearer procedures for cases involving bishops. Transparent and consistent protocols are needed to provide justice for the victims and to adequately respond to the legitimate indignation of the community. The Church needs a strong and comprehensive policy to address bishops’ violations of the vows of celibacy in cases of the criminal abuse of minors and in cases involving adults.

My experience in several dioceses and my work with the members of the Pontifical Commission for the Protection of Minors have brought me to this conclusion. The Church needs to swiftly and decisively take action regarding these matters of critical importance. In every instance of claims made by victims of sexual abuse, whether criminal violations or the abuse of power, the primary concern must be for the victim, their family and their loved ones. The victims are to be commended for bringing to light their tragic experience and must be treated with respect and dignity. Recent media reports also have referenced a letter sent to me from Rev. Boniface Ramsey, O.P. in June of 2015, which I did not personally receive. In keeping with the practice for matters concerning the Pontifical Commission for the Protection of Minors, at the staff level the letter was reviewed and determined that the matters presented did not fall under the purview of the Commission or the Archdiocese of Boston, which was shared with Fr. Ramsey in reply.

These accusations are understandably a source of great disappointment and anger for many. These cases, involving a cardinal, must be viewed in light of the last two decades of the Church’s experience with clerical sexual abuse. It is my conviction that three specific actions are required at this time. First, a fair and rapid adjudication of these accusations; second, an assessment of the adequacy of our standards and policies in the Church at every level, and especially in the case of bishops; and third, communicating more clearly to the Catholic faithful and to all victims the process for reporting allegations against bishops and cardinals. Failure to take these actions will threaten and endanger the already weakened moral authority of the Church and can destroy the trust required for the Church to minister to Catholics and have a meaningful role in the wider civil society. In this moment there is no greater imperative for the Church than to hold itself accountable to address these matters, which I will bring to my upcoming meetings with the Holy See with great urgency and concern.

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How to Address the Coming Shortfall of Primary Care Doctors

How to Address the Coming Shortfall of Primary Care Doctors

About 20,000 students recently graduated from U.S. medical schools. Now, they’re beginning the next chapter of their training, as residents.

Yet less than 7,000 will be pursuing careers in primary care. America will be short up to 43,100 primary care physicians by 2030, according to the Association of American Medical Colleges.

Medical schools have a responsibility to help fix this shortfall. They can do so by making primary care more alluring to students.

Primary care physicians are our healthcare system’s first line of defense. They diagnose illnesses, help manage chronic conditions, and refer patients to specialists. Without them, patients would get lost in today’s byzantine health system.

The shortage of primary care doctors is partially due to concerns over money and status. Specialists are better paid and often involved in prestigious new research.

Between April 2016 and March 2017, physician recruitment firm Merritt Hawkins conducted nearly 3,300 searches for its clients. The average offered to recruit an orthopedic surgeon was $579,000. The average to recruit a family practitioner was less than half that.

The shortage also occurs because U.S. medical school’s faculty are mainly specialists. Surgery departments in U.S. medical schools boast over 15,000 faculty members. Family practice departments have just 5,700 members.

Professors serve as role models to students, many of whom seek to follow in the footsteps of these mentors. Overwhelmingly, that means pursuing a career as a specialist.

Aspiring doctors also train in settings that push them toward specialties, not primary care. Medical students generally train in large teaching hospitals that serve patients who have been referred from primary and secondary care providers. Few students train in small clinics and local doctor’s offices.

But most health care — and almost all primary care — is delivered outside of the hospital. Americans make 923 million trips to physician offices every year — and only 130 million to emergency departments. More than half of office visits are to primary care physicians.

So medical students rarely gain enough experience in primary care settings to decide if it’s the right career path for them.

These barriers are significant but not insurmountable.

To start, schools could promote primary care as a career. In 2015, the medical school at the University of California, Riverside, partnered with the Desert Regional Medical Center and Desert Healthcare District to launch a new primary care residency program in Palm Springs. UC Riverside also partners with Loma Linda University to offer the Pediatric Primary Care Residency Training Program, which prepares residents for careers in pediatrics and family medicine.

Second, schools could ensure students gain hands-on primary care experience by encouraging them to serve at community clinics. At the University of California, Davis, School of Medicine, for example, nearly nine in 10 students volunteer in clinics in underserved communities. As a result, half of UC Davis students picked a primary care residency in 2015.

Third, schools could subsidize tuition for students who commit to primary care careers. At St. George’s University, on the Caribbean island of Grenada, our CityDoctors Scholarship program provides grants to students from New York City who agree to return to practice in the city’s public hospital system after they graduate. This year, eight students received CityDoctors scholarships worth a total of $1.1 million.

Medical schools must make careers in primary care exciting and affordable for a new generation of physicians.

  1. Richard Olds, M.D., is president of St. George’s University. He was founding dean of UC Riverside’s medical school.

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The News About the Environment is All Bad

The News About the Environment is All Bad

For anyone who is concerned about the environment (and that should be all of us), the news recently has been all bad.

Here’s a sampling: A heat wave in Japan sent 10,000 people to the hospital, 30 of whom died; Denver set a record-high temperature in June of 105; and temperatures in Siberia and northern Sweden — in the Arctic — reached 90 degrees, 40 degrees higher than normal.

Then there were the photos of the waves and waves of trash and garbage that are inundating the beaches of the Dominican Republic. Much of it is plastic, which is non-biodegradable. Plastics from our ubiquitous bottles of water and other sources will break down into microsize bits that eventually will be ingested by fish — so there is a good chance that if you are having fish for dinner this week, you are filling your body with plastic.

It should be clear that climate change and the destruction of our environment are occurring at a pace even faster than the scientists have been predicting. As we saw this winter with the unprecedented flooding in the Boston area, we are ill-prepared for the effects of climate change are occurring presently, let alone for the drastic consequences being predicted by the mid-century.

It is not only the future that is bleak — we are facing the disastrous consequences of climate change and environmental degradation today.

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Charlie Baker Represents All of Us

Charlie Baker Represents All of Us

A recent news article in The Boston Globe quoted a number of reportedly important RepubIican party members who asserted that they have been disappointed in the performance of Gov. Charlie Baker because he has been “too liberal.”

They are upset with his support both for social causes they deem “liberal” and for his assent to the recently-enacted, so-called “grand bargain” that will raise the minimum wage, among other items.

However, what they really seem to be upset about is that Charlie Baker rates as the most popular governor in the country among his own constituents. They would prefer a governor who is combative, negative, and insulting — in other words, they crave a Donald Trump at the governor’s desk, who is intent only on sowing seeds of hatred and discontent.

When you think about the disaster in Washington, as well as the bitterness that exists in many states among governors and their rivals, thank goodness we have Charlie Baker at the helm of our ship of state.

Massachusetts stands out among the the states in many measurable ways (such as our public schools’ performance), but chiefly we stand out because of the respect that our state’s leaders have for each other and the manner in which they work together.

They conduct our state’s business by the twin maxims that it is possible to disagree without being disagreeable and that politics is the art of compromise.

What these so-called Republicans are ignoring about Charlie Baker are four things:

First and foremost, he is as honest and straightforward as any governor who has served us;

Second, he campaigned in support of the issues he has signed into law. In short, he has kept his promises to the people who elected him — what a novel concept for a politician!;

Third, he is a Republican in Massachusetts — a True Blue state with veto-proof majorities in the Democratic-controlled legislature. Yet, Gov. Baker and the legislature  have achieved as much for the people of our state in the past four years as ever have been accomplished by previous administrations — including Democratic ones; and

Finally, Charlie Baker has appointed people in his administration who actually know what they are doing and who are dedicated to public service, such as Jay Ash, the secretary of housing and economic development.

The bottom line is that the vast majority of the people in Massachusetts believe that our state is headed in the right direction and they attribute that to our governor,  Charlie Baker.

Apparently, there are some who don’t agree and that certainly is their right to do so.

However, we are glad that Charlie Baker has failed to heed their calls for rancor and divisiveness. Massachusetts is moving forward — and the administration of Gov. Charlie Baker undeniably has played a large role in our success in the past four years.

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Massachusetts Falling Behind Rest of the Nation in Health Care Access, Efficiency

Massachusetts Falling Behind Rest of the Nation in Health Care Access, Efficiency

While Massachusetts has led the nation with health care reform, residents of the Commonwealth continue to lack basic access to primary and specialty care across the state. Poor patient access to care, an uncontrolled opioid epidemic and rising healthcare costs together present a perfect storm.  Many states however, have been proactive about removing practice barriers to increase access to NP driven care.

While other states have taken steps to position the NP workforce to meet rising needs, antiquated and unnecessarily restrictive laws and licensing requirements leave Massachusetts as one of only 13 states in the nation – and the only state in New England – that continues to maintain a such a restrictive nurse practice act. The unintended consequence of health reform is access to healthcare coverage without the same level of access to health care.  Without intervention for those patients seeking health care in Massachusetts, it is not likely to improve.

There are 9,500 qualified, educated Nurse Practitioners available to meet the healthcare challenges facing the Commonwealth. NPs are licensed, board certified and have achieved a master’s or doctoral degree.  With documented high quality outcomes, they are equipped to fill the gaps, enhance access to care, provide life-saving treatment for opioid use disorder and deliver a much-needed cost savings to the Commonwealth – and to patients. In failing to use NPs to the full extent of their education and training to optimize the state’s healthcare delivery system, Massachusetts is missing an opportunity to best serve patients.

For patients seeking access to basic healthcare services in Massachusetts, including both primary and specialty care, restricted NP practice contributes to longer wait times.  Research supports that for those patients seeking a new family medicine appointment, access delays in the Commonwealth are amongst the worst in the nation. Faced with longer wait times for appointments and contending with significant delays in care, patients may risk adverse health outcomes or rely on more costly care delivery settings, such as emergency rooms, for treatment.

Like the rest of the nation, the Commonwealth is experiencing an escalating number of opioid related deaths. According to the MA Department of Public Health, in 2016 there were 2,155 reported opioid related deaths in Massachusetts. Heartbreaking stories of neighbors, friends, coworkers, and family members dying from overdoses have become too familiar.  All available resources must be leveraged to combat this public health crisis, including access to Medication Assisted Treatment (MAT), which has proven to be lifesaving. Nationally, NPs have contributed significantly to treating this disease. However, in Massachusetts, antiquated and unnecessarily restrictive laws and regulations mandating physician supervision for NP prescriptive practice are limiting the ability of NPs to respond to the epidemic. For those patients with opioid use disorder, such delays in receiving care can be life-threatening.

In 2009, a study by the Rand Corporation evaluating access and cost of care estimated Massachusetts could save millions of dollars through increased utilization of NPs.  Despite these recommendations, the state has still not acted. Office visits with an NP are 20 – 35 percent lower in cost than physician driven visits, without compromise in quality outcomes.  Medicare, Medicaid and private insurers presently reimburse NPs at rates that are 75-85 percent of the physician rate. As Healthcare costs continue to increase, utilization of NPs in care is a viable and responsible way to help bring costs down.

Presently, there is legislation pending on Beacon Hill, which will remove barriers impeding Nurse Practitioners’ ability to practice to the full extent of their training and education. H.2451/S.1257, An Act to Contain Health Care Costs and Improve Access to Value Based Nurse Practitioner Care as Recommended by the IOM and FTC, will modernize Massachusetts licensure laws and grant Full Practice Authority to Nurse Practitioners in Massachusetts, thus removing the requirement for physician oversight for NP prescriptive practice. In doing so, NPs will be better positioned to respond to the evolving care delivery needs of the Commonwealth.  Increased access to basic healthcare, specialty services and opioid use disorder treatment all mean significant cost savings for the Commonwealth.

As registered nurses with advanced master’s or doctoral level education and national certification in advanced practice nursing specialties, Nurse Practitioners have the knowledge and experience needed to deliver high-quality, cost-effective healthcare to patients.

Stephanie Ahmed, DNP, FNP-BC

Chair of the Massachusetts Coalition of Nurse Practitioners’ Legislative Committee and Former MCNP President

Donna Hanson, MS ANP, BC, MGH Emergency Medicine

Resident, Wintrhop, MA

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Congratulations to the Class of 2018

Congratulations to the Class of 2018

For  Revere High School seniors graduation day is Thursday and  this day is one of the few occasions that brings a smile to the faces of everyone in a community, regardless of whether they know a graduate. It is an occasion when all of us share in the joy — and pride — that graduation day marks in the lives of our young people. For older folks, graduation day recalls a time when we too, were young and full of life.

However, graduation day marks a bittersweet moment for parents, friends, family, and teachers, as well the grads themselves. As befits every turning point in our lives, it is a time of mixed emotions of joy, sadness, and reflection. Although the graduates and those close to them are looking forward to the exciting future that lies before them, at the same time, they will be looking back on the passing of their carefree youth and of the friends and experiences that have shaped their lives to this point.

The young women and men who receive their diplomas no longer are considered “youths” in the eyes of the world. They are full-fledged adults who have been deemed ready to assume all of the rights — and responsibilities — that adulthood implies.

The graduates, most of whom have turned 18, can vote, run for public office, enter into contracts, be tried fully as adults in the criminal justice system, and fight and die for their country.

For the parents of the grads, watching their “little boy or girl” proceed to the podium to receive his or her diploma will be a poignant moment. No doubt every parent will be thinking of the sentiments expressed in the song “Sunrise, Sunset” from “Fiddler On The Roof:”

Is this the little girl I carried?

Is this the little boy at play?

I don’t remember growing older

When – did – they?

When did she get to be a beauty?

When did he grow to be so tall?

Wasn’t it yesterday when they – were – small?

Although economists these days tell us that the value of a high school diploma is not what it was a generation or more ago, the graduates should keep in mind, as they contemplate venturing out into an uncertain future, that their mere presence on the podium has proven that they have the ability and the determination to achieve whatever goals they may set for themselves.

We came across a news item from one of our sister publications, The Winthrop Sun-Transcript, from June 24, 1898. The article, which reprinted the Class Ode for the Winthrop High Class of 1898, is as timely today as it was 120 years ago, and sums up the feelings of all of us on graduation day.

The years pass by in swift array

We cannot check their onward flight;

The moments that were ours today,

Have passed forever from our sight.

 

Yet while the course of life moves by

We too, must never lag behind;

But work and strive as best we may

To aid and benefit all mankind.

 

This we must do, or soon too late

We think in sadness of our loss,

For “Each is Master of his Fate,”

Though some must bear a heavy cross.

 

And when the race of life is run,

This life that holds so much for each

Shall come the gentle words, “Well done!”

As we at last the goal have reached.

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To Cut Drug Prices, Start with the Facts

To Cut Drug Prices, Start with the Facts

Americans are paying too much for prescription medicines. State lawmakers are fed up with Washington’s apathy towards high pharmacy bills. So they’re taking matters into their own hands and pushing forward with several bills

Their proposals are well-intentioned — but they’re doomed to backfire and hurt patients. Why? The bills are based on false assumptions.

Many lawmakers believe that prescription drug prices are skyrocketing. They’re not. In fact, after accounting for all the rebates and discounts manufacturers offer, drug prices have barely budged in recent years. Drug spending grew just 1.3 percent in 2016, according to the latest federal data from the Centers for Medicare & Medicaid Services. Overall health spending increased by 4.3 percent.

In other words, drug spending is growing slower than hospital and nursing home expenditures. In fact, it’s growing even slower than the general inflation rate, which has averaged just under 2 percent.

Legislators also blame drug prices for rising costs in Medicaid, the entitlement program for low-income Americans that is managed and partly funded by the states. Once again, they’re mistaken.

Drug companies provide generous discounts and rebates back to Medicaid to curb its overall prescription drug spending. Medicaid’s statistics rarely reflect these discounts. In 2014, the program reported that its gross spending on drugs reached $21 billion. But after factoring in discounts, the program actually spent only $8 billion on medicines.

Federal law guarantees Medicaid the lowest drug prices on the market.

Nevertheless, state lawmakers insist that drug companies are charging too much. So they’re calling for a variety of price controls.

One measure floated in Utah would allow patients to import medicines from Canada. That’s a bad idea.

The policy wouldn’t lower healthcare costs. Ninety percent of all drugs sold in the United States are generic, and generics generally cost less in the United States than in Canada. a patient’s co-pay — what he actually pays at the pharmacy — is often lower than the price paid at a Canadian pharmacy, even if the list price of the medicine is higher in the United States.

Another proposal in Louisiana, would allow the state to infringe on manufacturers’ patents. State legislators want to give generic drug companies the right to make cheap knockoff copies of hepatitis C medicines, which are heavily utilized by the state’s Medicaid and prison populations.

This move simply isn’t necessary. In 2017, Medicaid spending on hepatitis C drugs fell by 28 percent — the biggest drop for any class of medicines.

If states start weakening patent protections, it will have a chilling effect on scientific research. Drug companies won’t plow billions in to developing new medicines if the government can break their patents on a whim. Patients would miss out on future treatments and cures as a result of this drop in research.

This isn’t to say that patients aren’t paying high prices for drugs. They are. But drug makers aren’t at fault.

Middlemen, like pharmacy benefit managers and insurers, are the ones raising prices on consumers.

PBMs negotiate drug prices on behalf of health plans. They secure big discounts and rebates from manufacturers. But PBMs and insurers routinely fail to pass these savings along to consumers. Instead, they hike consumers’ out-of-pocket expenses by forcing them to pay ever-higher co-pays and co-insurance.

If lawmakers want to reduce peoples’ pharmacy bills, they should demand more transparency from insurers and PBMs.

Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest.

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Congratulations, Pope John Hoop Team

Congratulations, Pope John Hoop Team

We join the local sports community and the Catholic Central League in congratulating Pope John XXIII High School of Everett on winning its first basketball state championship in its history.

Coach Leo Boucher and his team that included Chelsea standouts Luis Velasquez and Mehkhi Collins, brought much excitement to their fans this season and many students, alumni, and supporters traveled to Springfield Saturday to watch their Pope John Tigers defeat the defending state champion Maynard High Tigers for the Division 4 title.

It was a great day for the small school who rose up and defeated much larger schools and teams from powerful conferences in the MIAA Tournament. The team’s spectacular guard, Angel Price-Espada, submitted a performance for the ages with 49 points, including 10 three-pointers.

Mr. Boucher, a resident of Charlestown and a former basketball standout himself, previously showed his tremendous coaching skills at the St. Clement School, winning a state title there. When the school closed its doors, Pope John officials made a wise decision to bring him on board as its basketball coach.

It was also inspiring to see school administrators, Head of School Carl DiMaiti, Principal Thomas Mahoney, and Director of Athletics Ryan Murphy being a part of the fan delegation at the game and holding the championship so proudly following the Tigers’ 89-57 victory.

Mr. DiMaiti has presided over athletic successes before as the head of school at St. Mary’s High School in Lynn. A former track coach, Mr. DiMaiti understands the importance of interscholastic sports competition and how it can help build a positive foundation for student-athletes and pave the way to a college education. Mr. DiMaiti’s children, Drew and Carole, were both outstanding high school athletes, with Drew winning an individual state hurdles title before moving on to nearby Tufts University.

Mr. Mahoney is in the Chelsea High School Hall of Fame as the founder and head coach of the CHS soccer program that produced GBL titles and All-Scholastic players when he was leading the program. He is an alumnus of Pope John (and Boston College) as a member of the Everett school’s first graduating class, so this championship is doubly meaningful to him.

Mr. Murphy was an excellent choice to lead the school’s athletic program. He is always accessible to those who call upon him. He has helped student-athletes proceed through the college application process and been an exceptional representative for the school at AD meetings. A school’s athletic success begins at the top, and Mr. Murphy has the entire program heading in the right direction. And now he has a state championship team in his program.

To Coach Leo Boucher, associate head coach Larry Washington, freshman coach Paul Williams, and the Pope John basketball players – thanks for the memories and congratulations on an historic championship season.

We’ll see you all in the Pope John XXIII High School Hall of Fame one day.

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Let’s Not Even Think about Spring

Let’s Not Even Think about Spring

Spring has sprung,

The grass is riz.

I wonder where,

The flowers is? 

Springtime in eastern New England — now that’s an oxymoron if ever there was one.

This Tuesday, March 20, will mark the official start of the 2018 spring season. In view of the trio of nor’easters that have pummeled us in the past two weeks, thoughts of spring no doubt are dancing in all of our heads as we look to put the recent rough patch of late winter storms behind us.

But being the longtime (and long-suffering) New Englanders that we are, we know that spring is merely an illusion in our sliver of the world.

The weather can be sunny with temperatures in the 60s in the vicinity of Route 128, but for those of us closer to the ocean, we may as well be in another climatic zone altogether. Onshore breezes that blow off the ocean waters, where temperatures still are near-freezing, offset the warm air by at least 10 degrees and the wind itself makes us feel even chillier.

To be sure, there may be a day here or there when the ocean-effect will be of no consequence because the wind will be blowing offshore. On those glorious occasions, we will bask in the warmth of a sunny, 70-degree day. But days such as those, always too few and far between, will be only a tease.

The editor in one of our former sister publications, The Winthrop Visitor, put it succinctly when he wrote these words in 1888: “The season has arrived when Winter and Spring appear to strive for mastery. A day almost like June in its mildness is succeeded by weather that smacks of the Arctic regions, and poor human again assumes his furs and his warmest garments.”

Yes, we can hope for the arrival of an early spring season. But we know from experience that spring truly will not arrive for us for  weeks to come.

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