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"Ellsworth Wareham, 97, in Loma Linda, Calif. Mr. Wareham was a heart surgeon who stopped working only two years ago. He is a vegan, but says choice is part of the "great American system."" Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A15) . . . last week, when the City Council approved Loma Linda's first McDonald's restaurant, many residents bemoaned the decision, worrying that the officials were jeopardizing the city's reputation as a paragon of healthy lifestyles.

. . .

. . . , Dr. Rigsby [said] . . . he would support having a citywide vote on whether fast-food outlets should be banned entirely from the city. "If this is something that people are really opposed to, that's how we should deal with it."

What would happen during such a vote is anyone's guess. Ellsworth Wareham, who stopped working as a heart surgeon only two years ago, at 95, is often used as an example of someone with more energy than someone half his age. Dr. Wareham attributes his health at least partly to the fact that he has been a vegan for the last 30 or 40 years (he does not remember precisely).

Eating at home, he said, is the best way to ensure that one is eating healthy food. He is certainly not about to let the impending arrival of McDonald's raise his blood pressure.

"I don't subscribe to the menu that these dear people put out, but let's face it, the average eating place serves food that is, let us say, a little bit of a higher quality, but the end result is the same -- it's unhealthy," he said.

"They can put it right next to the church as far as I am concerned," Dr. Wareham added. "If they choose to eat that way, I'm not going to stop them. That's the great American system."

For the full story, see:

JENNIFER MEDINA. "LOMA LINDA JOURNAL; Fast-Food Outlet Stirs Concerns in a Mecca of Healthy Living." The New York Times (Mon., December 19, 2011): A15.

(Note: ellipses added.)

(Note: the online version of the article is dated December 18, 2011.)

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(p. A18) Last week, Pinellas County, on Florida's west coast, voted to stop adding fluoride to its public water supply after starting the program seven years ago. The county joins about 200 jurisdictions from Georgia to Alaska that have chosen to end the practice in the last four years, motivated both by tight budgets and by skepticism about its benefits.

Eleven small cities or towns have opted out of fluoridating their water this year, including Fairbanks, Alaska, which acted after much deliberation and a comprehensive evaluation by a panel of scientists, doctors and dentists. The panel concluded that in Fairbanks, which has relatively high concentrations of naturally occurring fluoride, the extra dose no longer provided the help it once did and may, in fact, be harmful.

. . .

The movement to stop fluoridating water has gained traction, in large part, because the government has recently cautioned the public about excessive fluoride. A report released late last year by the Centers for Disease Control and Prevention linked fluoride to an increase among children in dental fluorosis, which causes white or yellow spots on teeth. About 40 percent of children ages 12 to 15 had dental fluorosis, mostly very mild or mild cases, from 1999 to 2004. That percentage was 22.6 in a 1986-87 study.

Fluorosis is mostly a cosmetic problem that can sometimes be bleached away. But critics argue that spotted teeth are a warning that other bones in the body may be absorbing too much fluoride. Excessive fluoride can lead to increases in bone fractures in adults as well as pain and tenderness.

"Teeth are the window to the bones," said Paul Connett, a retired professor of environmental chemistry and the director of the Fluoride Action Network, which advocates an end to fluoridated water.

Experts say that one possible factor in this increase may be that fluoridated water is consumed in vegetables and fruit, and juice and other beverages as well as tap water. And the consumption of beverages continues to increase.

. . .

The conclusion among these communities is that with fluoride now so widely available in toothpaste and mouthwash, there is less need to add it to water, which already has naturally occurring fluoride. Putting it in tap water, they say, is an imprecise way of distributing fluoride; how much fluoride a person gets depends on body weight and water consumed.

Doctors, scientists and dentists, including Dr. Bailey of the Public Health Service, mostly agree that fluoride works best when applied topically, directly to the teeth, as happens with brushing.

"The fact that no one really knows what dosage a given person receives from fluoridated water makes the subject of benefits and harms very difficult to quantify," said Rainer Newberry, a professor of geochemistry at University of Alaska, Fairbanks, who sat on the committee that studied the issue prior to the June vote in Fairbanks. "And this presumably explains the number of studies with diverging conclusions."

For the full story, see:

LIZETTE ALVAREZ. "Looking to Save Money, More Places Decide to Stop Fluoridating the Water." The New York Times (Fri., October 14, 2011): A18.

(Note: ellipses added.)

(Note: the online version of the article is dated October 13, 2011.)

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Source of book image: online version of the WSJ review quoted and cited below.

(p. A13) "We are at the cusp of a revolution in medicine and biotechnology," Ms. Arrison announces, "that will radically increase not just our life spans but also, and more importantly, our health spans."

. . .

She recounts advances in stem-cell research, pharmaceuticals and synthetic biology. And the tinkering with genes still goes on. We learn about Dr. Cynthia Kenyon at the University of California in San Francisco, who discovered that the life span of the tiny worm Caenorhabditis elegans could be doubled by partially disabling a single gene. Further improvements on the technique resulted in worms living six times longer than normal. "In human terms," Ms. Arrison says, "they be the equivalent of healthy, active five-hundred-year-olds." That may be a bit much to expect, but Ms. Arrison says she is confident that "human life expectancy will one day reach 150 years."

. . .

What is more, technology heavyweights are paying attention, including Bill Gates (if he were a teenager today, Mr. Gates once said, he'd be "hacking biology") and Jeff Bezos ("atom by atom we'll assemble small machines that will enter cell walls and make repairs"). Larry Ellison, of Oracle, started a foundation more than a decade ago to support anti-aging research; the institution donates about $42 million a year.

For the full review, see:

NICK SCHULZ. "BOOKSHELF; Bioengineering Methuselah; Human beings living to be 150? And you thought Social Security and Medicare were in trouble now." The Wall Street Journal (Weds., AUGUST 31, 2011): A13.

(Note: ellipses added.)

The book under review is:

Arrison, Sonia. 100 Plus: How the Coming Age of Longevity Will Change Everything, from Careers and Relationships to Family and Faith. New York: Basic Books, 2011.

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"Christopher Hitchens, after being released from the Texas hospital where he was treated for esophageal cancer." Source of caption and photo: online version of the NYT article quoted and cited below.

A few times I have had the pleasure of seeing Christopher Hitchens interviewed. His wit is always wonderful and he skewers much that deserves skewering. I admire his perseverance at being productive, even as he battles a difficult cancer. And I admire him for sticking to his reasoned principles, even when it might be easier to accept Pascal's Wager.

I have enjoyed the few reviews by Hitchens that I have read. I have purchased, but not yet read, two of his books---when I have read, I will write.

ADDENDUM: I wrote the above words back on November 10th, scheduled to run today. Yesterday I saw in the paper that Hitchens died on Thursday, December 15, 2011.

(p. C1) HOUSTON -- Christopher Hitchens, probably the country's most famous unbeliever, received the Freethinker of the Year Award at the annual convention of the Atheist Alliance of America here on Saturday. Mr. Hitchens was flattered by the honor, he said a few days beforehand, but also a little abashed. "I think being an atheist is something you are, not something you do," he explained, adding: "I'm not sure we need to be honored. We don't need positive reinforcement. On the other hand, we do need to stick up for ourselves, especially in a place like Texas, where they have laws, I think, that if you don't believe in Jesus Christ you can't run for sheriff."

Mr. Hitchens, a prolific essayist and the author of "God Is Not Great: How Religion Poisons Everything," discovered in June 2010 that he had Stage 4 esophageal cancer.

. . .

(p. C5) On balance, he reflected, the past year has been a pretty good one. He won a National Magazine Award, published "Arguably," debated Tony Blair in front of a huge audience and added two states to the list of those he has visited. "I lack only the Dakotas and Nebraska," he said, "though I may not get there unless someone comes up with some ethanol-based cancer treatment in Omaha."

For the full story, see:

CHARLES McGRATH. "A Voice, Still Vibrant, Reflects on Mortality." The New York Times (Mon., October 10, 2011): C1 & C5.

(Note: ellipsis added.)

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(p. D3) A new exploration of how evolution works at the genomic level may have a significant impact on drug development and other areas of medicine.

The report, published in Nature last week, offers new evidence in a longstanding debate about how organisms evolve. One well-known path to change is a heavily favorable mutation in a single gene. But it may be well known only because it is easy to study. Another path is exploitation of mildly favorable differences that already exist in many genes.

. . .

Three biologists at the University of California, Irvine, Molly K. Burke, Michael R. Rose and Anthony D. Long, followed populations of fruit flies through 600 generations and studied the whole genome of some 250 flies in order to see what kinds of genetic change they had undergone.

. . .

The conventional view is that evolutionary change is generally mediated by a favorable mutation in a gene that then washes through the whole population, a process called a hard sweep because all other versions of the gene are brushed away. The alternative, called a soft sweep, is that many genes influence a trait, in this case the rate of maturation, and that the growth-accelerating versions of each of these genes become just a little more common. Each fly has a greater chance of inheriting these growth-promoting versions and so will mature faster.

In sequencing their subjects' genomes, the researchers found that a soft sweep was indeed responsible for the earlier hatching. No single gene had swept through the population to effect the change; rather, the alternative versions of a large number of genes had become slightly more common.

. . .

Haldane favored the single mutation mechanism, but Fisher and Wright backed multiple gene change.

. . .

The demise of the Haldane view "is very bad news for the pharmaceutical industry in general," Dr. Rose said. If disease and other traits are controlled by many genes, it will be hard to find effective drugs; a single target would have been much simpler.

For the full story, see:

NICHOLAS WADE. "Natural Selection Cuts Broad Swath Through Fruit Fly Genome." The New York Times (Tues., September 21, 2010): D3.

(Note: ellipses added.)

(Note: the online version of the article is dated September 20, 2010.)

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(p. D6) Global warming may have one minor but previously unknown benefit, scientists said this month: it may be cutting down cases of bubonic plague in the United States.

. . .

A study in this month's issue of The American Journal of Tropical Medicine and Hygiene tracked climatic conditions in 195 counties in 13 Western states, from Washington to Texas, that reported even one plague case since 1950.

Cases have dropped over time, and the study concluded that rising nighttime temperatures since 1990 had helped. Warmer nights melt winter snowpacks earlier, leading to drier soil in rodent burrows. When the soil gets too dry, fleas die.

For the full story, see:

DONALD G. McNEIL Jr. "GLOBAL UPDATE; United States: Decrease in Bubonic Plague Cases May Be an Effect of Climate Change." The New York Times (Tues., September 21, 2010): D6.

(Note: ellipsis added.)

(Note: the online version of the article is dated September 20, 2010.)

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(p. D6) An analysis of studies including more than 100,000 subjects has found that high levels of chocolate consumption are associated with a significant reduction in the risk of certain cardiovascular disorders.

. . .

Over all, the report, published Monday in the British medical journal BMJ, showed that those in the group that consumed the most chocolate had decreases of 37 percent in the risk of any cardiovascular disorder and 29 percent in the risk for stroke.

For the full story, see:

NICHOLAS BAKALAR. "VITAL SIGNS; Prevention: Evidence of Heart Benefits From Chocolate." The New York Times (Tues., August 30, 2011): D6.

(Note: ellipsis added.)

(Note: the online version of the article is dated August 29, 2011.)

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"CHILDHOOD RELIC; Jungle gyms, like this one in Riverside Park in Manhattan, have disappeared from most American playgrounds in recent decades." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. D3) "There is no clear evidence that playground safety measures have lowered the average risk on playgrounds," said David Ball, a professor of risk management at Middlesex University in London. He noted that the risk of some injuries, like long fractures of the arm, actually increased after the introduction of softer surfaces on playgrounds in Britain and Australia.

"This sounds counterintuitive, but it shouldn't, because it is a common phenomenon," Dr. Ball said. "If children and parents believe they are in an environment which is safer than it actually is, they will take more risks. An argument against softer surfacing is that children think it is safe, but because they don't understand its properties, they overrate its performance."

Reducing the height of playground equipment may help toddlers, but it can produce unintended consequences among bigger children. "Older children are discouraged from taking healthy exercise on playgrounds because they have been designed with the safety of the very young in mind," Dr. Ball said. "Therefore, they may play in more dangerous places, or not at all."

Fear of litigation led New York City officials to remove seesaws, merry-go-rounds and the ropes that young Tarzans used to swing from one platform to another. Letting children swing on tires became taboo because of fears that the heavy swings could bang into a child.

"What happens in America is defined by tort lawyers, and unfortunately that limits some of the adventure playgrounds," said Adrian Benepe, the current parks commissioner.

For the full story, see:

JOHN TIERNEY. "FINDINGS; Grasping Risk in Life's Classroom." The New York Times (Tues., July 19, 2011): D1 & D3.

(Note: the online version of the article is dated July 18, 2011, and has the title "FINDINGS; Can a Playground Be Too Safe?.")

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(p. 404) No one expressed parental loss better (as no one expressed most things better) than William Shakespeare. These lines are from King John, written soon after his son Hamnet died at the age of eleven in 1596:

Grief fills the room up of my absent child
Lies in his bed, walks up and down with me,
Puts on his pretty looks, repeats his words,
Remembers me of all his gracious parts,
Stuffs out his vacant garments with his form.

(p. 405) These are not the words of someone for whom children are a product, and there is no reason to suppose - no evidence anywhere, including that of common sense - that parents were ever, at any point in the past, commonly indifferent to the happiness and well-being of their children. One clue lies in the name of the room in which we are now. 'Nursery' is first recorded in English in 1330 and has been in continuous use ever since. A room exclusively dedicated to the needs and comforts of children would hardly seem consistent with the belief that children were of no consequence within the household. No less significant is the word 'childhood' itself. It has existed in English for over a thousand years (the first recorded use is in the Lindisfarne Gospels circa AD 950), so whatever it may have meant emotionally to people, as a state of being, a condition of separate existence, it is indubitably ancient. To suggest that children were objects of indifference or barely existed as separate beings would appear to be a simplification at best.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

(Note: italics in original.)

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(p. D6) Cholera outbreaks seem to be on the increase, but a new study has found they cannot be explained by global warming.

A bigger factor may be the cycle of droughts and floods along big rivers, according to Tufts University scientists who published a study in The American Journal of Tropical Medicine and Hygiene this month.

For the full story, see:

DONALD G. McNEIL Jr. "GLOBAL UPDATE; Cholera: Climate Change Isn't a Culprit in Increasing Outbreaks, Study Finds." The New York Times (Tues., August 30, 2011): D6.

(Note: the online version of the article is dated August 29, 2011.)

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(p. 404) There is no doubt that children once died in great numbers and that parents had to adjust their expectations accordingly. The world before the modern era was overwhelmingly a place of tiny coffins. The figures usually cited are that one-third of children died in their first year of life and half failed to reach their fifth birthdays. Even in the best homes death was a regular visitor. Stephen Inwood notes that the future historian Edward Gibbon, growing up rich in healthy Putney, lost all six of his siblings in early childhood. But that isn't to say that parents were any less devastated by a loss than we would be today. The diarist John Evelyn and his wife had eight children and lost six of them in childhood, and were clearly heartbroken each time. 'Here ends the joy of my life,' Evelyn wrote simply after his oldest child died three days after his fifth birthday in 1658. The writer William Brownlow lost a child each year for four years, a chain of misfortune that 'hast broken me asunder and shaken me to pieces', he wrote, but in fact he and his wife had still more to endure: the tragic pattern of annual deaths continued for three years more until they had no children left to yield.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

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Source of map: online version of the NYT article quoted and cited below.

If the Black Death microbe is the same today as in the Middle Ages, maybe the difference in effects is partly due to our better nutrition, health, hygiene, and housing?

(p. D4) The agent of the Black Death is assumed to be Yersinia pestis, the microbe that causes bubonic plague today. But the epidemiology was strikingly different from that of modern outbreaks. Modern plague is carried by fleas and spreads no faster than the rats that carry them can travel. The Black Death seems to have spread directly from one person to another.

Victims sometimes emitted a deathly stench, which is not true of plague victims today. And the Black Death felled at least 30 percent of those it inflicted, whereas a modern plague in India that struck Bombay in 1904, before the advent of antibiotics, killed only 3 percent of its victims.

. . .

If Yersinia pestis was indeed the cause of the Black Death, why were the microbe's effects so different in medieval times? Its DNA sequence may hold the answer. Dr. Poinar's team has managed to reconstruct a part of the microbe's genetic endowment. Yersinia pestis has a single chromosome, containing the bulk of its genes, and three small circles of DNA known as plasmids.

The team has determined the full DNA sequence of the plasmid known as pPCP1 from the East Smithfield cemetery. But, disappointingly, it turns out to be identical to the modern-day plasmid, so it explains none of the differences in the microbe's effects.

For the full story, see:

NICHOLAS WADE. "Hunting for a Mass Killer in Medieval Graveyards." The New York Times (Tues., August 30, 2011): D4.

(Note: ellipsis added.)

(Note: the online version of the article is dated August 29, 2011.)

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"Two 9-month-old mice from the study. The one on the right received the drug to eliminate senescent cells." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A1) In a potentially fundamental advance, researchers have opened up a novel approach to combating the effects of aging with the discovery that a special category of cells, known as senescent cells, are bad actors that promote the aging of the tissues. Cleansing the body of the cells, they hope, could postpone many of the diseases of aging.

The findings raise the prospect that any therapy that rids the body of senescent cells would protect it from the ravages of aging. But many more tests will be needed before scientists know if drugs can be developed to help people live longer.

Senescent cells accumulate in aging tissues, like arthritic knees, cataracts and the plaque that may line elderly arteries. The cells secrete agents that stimulate the immune system and cause low-level inflammation. Until now, there has been no way to tell if the presence of the cells is good, bad or indifferent.

The answer turns out to be that (p. A4) the cells hasten aging in the tissues in which they accumulate. In a delicate feat of genetic engineering, a research team led by Darren J. Baker and Jan M. van Deursen at the Mayo Clinic in Rochester, Minn., has generated a strain of mouse in which all the senescent cells can be purged by giving the mice a drug that forces the cells to self-destruct.

Rid of the senescent cells, the Mayo Clinic researchers reported online Wednesday in the journal Nature, the mice's tissues showed a major improvement in the usual burden of age-related disorders. They did not develop cataracts, avoided the usual wasting of muscle with age, and could exercise much longer on a mouse treadmill. They retained the fat layers in the skin that usually thin out with age and, in people, cause wrinkling.

For the full story, see:

NICHOLAS WADE. "Prospect of Delaying Aging Ills Is Raised in Cell Study of Mice.To Challenges For Obama, Add Another." The New York Times (Thur., November 3, 2011): A1-A4.

(Note: the online version of the article is dated November 2, 2011 and has the title "Purging Cells in Mice Is Found to Combat Aging Ills.")

(Note: thanks to Luis Locay for sending me the link to this.)

Another worthwhile article summarizing the same research, is:

SHIRLEY S. WANG. "Cell Study Finds a Way to Slow Ravages of Age." The Wall Street Journal (Thur., November 3, 2011): A2.

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"A lab-made windpipe was implanted June 9 into a 36-year-old patient whose own windpipe was obstructed by a tumor." Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. A3) Doctors have replaced the cancer-stricken windpipe of a patient with an organ made in a lab, a landmark achievement for regenerative medicine. The patient no longer has cancer and is expected to have a normal life expectancy, doctors said.

"He was condemned to die," said Paolo Macchiarini, a professor of regenerative surgery who carried out the procedure at Sweden's Karolinska University Hospital. "We now plan to discharge him [Friday]."

The transplantation of an entirely synthetic and permanent windpipe had never been successfully done before the June 9 procedure. The researchers haven't yet published the details in a scientific journal.

For the full story, see:

GAUTAM NAIK. "Lab-Made Trachea Saves Man; Tumor-Blocked Windpipe Replaced Using Synthetic Materials, Patient's Own Cells." The Wall Street Journal (Fri., July 8, 2011): C8.

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Source of book image: http://0.tqn.com/d/archaeology/1/0/g/L/1/Statues-That-Walked-sm.jpg

The natives call Easter Island "Rapa Nui."

(p. C5) With the forest gone, Rapa Nui's soil degraded; unable to feed themselves, Mr. Diamond argued in his best-selling "Collapse" (2005), Easter Islanders faced "starvation, a population crash, and a descent into cannibalism." The fall was abrupt and overwhelming; scores of giant statues were abandoned, half-finished. Roggeveen had discovered a ruin--and a powerful eco-parable.

Books and articles by the hundred have pointed to Rapa Nui as the inevitable result of uncontrolled population growth, squandered resources and human fecklessness. "The person who felled the last tree could see it was the last tree," wrote Paul G. Bahn and John Flenley in "Easter Island, Earth Island" (1992). "But he (or she) still felled it." "The parallels between Easter Island and the whole modern world are chillingly obvious," Mr. Diamond proclaimed. "The clearest example of a society that destroyed itself by overexploiting its own resources," he said, Rapa Nui epitomizes "ecocide," presenting a stark image of "what may lie ahead of us in our own future."

No, it doesn't, write archaeologists Terry Hunt and Carl Lipo in "The Statues That Walked," a fascinating entry in the pop-science genre of Everything You Know Is Wrong. Messrs. Hunt and Lipo had no intention of challenging Mr. Diamond when they began research on Rapa Nui. But in their fourth year of field work, they obtained radiocarbon dates from Anakena Beach, thought to be the island's oldest settlement. The dates strongly indicated that the first settlers appeared around A.D. 1200--eight centuries later than Heyerdahl and other researchers had thought.

Wait a minute, the authors in effect said. Rapa Nui is so remote that researchers believe it must have been settled by a small group of adventurers--a few dozen people, brave or crazy, in boats. The new evidence suggested that their arrival had precipitated catastrophic deforestation "on the scale of decades, not centuries." The island then probably had only a few hundred inhabitants. Some ecologists estimate that the island originally had 16 million palm trees. How could so few people have cut down so much so fast?

. . .

The real culprit, according to "The Statues That Walked," was the Polynesian rat (Rattus exulans), which stowed away on the boats of the first Polynesian settlers. In laboratory settings, Polynesian rat populations can double in 47 days. Throw a breeding pair into an island with no predators and abundant food and arithmetic suggests the result: ratpocalypse. If the animals multiplied as they did in Hawaii, the authors calculate, Rapa Nui would quickly have housed between two and three million. Among the favorite food sources of R. exulans are tree seeds and tree sprouts. Humans surely cleared some of the forest, but the real damage would have come from the rats that prevented new growth.

"Rather than a case of abject failure," the authors argue, "Rapa Nui is an unlikely story of success." The islanders had migrated, perhaps accidentally, to a place with little water and "fundamentally unproductive" soil with "uniformly low" levels of phosphorus, an essential mineral for plant growth. To avoid the wind's dehydrating effects, the newcomers circled their gardens with stone walls known as manavai. Today, the researchers discovered, abandoned manavai occupy about 6.4 square miles, a tenth of the island's total surface.

More impressive still, about half of the island is covered by "lithic mulching," in which the islanders scattered broken stone over the fields. The uneven (p. C6) surface creates more turbulent airflow, reducing daytime surface temperatures and warming fields at night. And shattering the rocks exposes "fresh, unweathered surfaces, thus releasing mineral nutrients held within the rock." Only lithic mulching produced enough nutrients--just barely--to make Rapa Nui's terrible soil cultivable. Breaking and moving vast amounts of stone, the islanders had engineered an entirely new, more productive landscape.

Their success was short-lived. As Messrs. Hunt and Lipo point out, the 18th and 19th centuries were terrible times to reside in a small, almost defenseless Pacific nation. Rapa Nui was repeatedly ravaged by Peruvian slaving parties and nonnative diseases.

. . .

Easter Island's people did not destroy themselves, the authors say. They were destroyed.

. . .

Oral tradition said that the statues walked into their places. Oral tradition was correct, the authors say. By shaping the huge statues just right, the islanders were able to rock them from side to side, moving them forward in a style familiar to anyone who has had to move a refrigerator. Walking the statues, the authors show in experiments, needed only 15 or 20 people.

In a 2007 article in Science, Mr. Diamond estimated that hundreds of laborers were needed to move the statues, suggesting that the eastern settlements of the island alone had to have "a population of thousands"--which in turn was proof of the island's destructive overpopulation. By showing that the statues could have been moved by much fewer people, Messrs. Hunt and Lipo have removed one of the main supports of the ecocide theory and the parable about humankind it tells.

For the full review, see:

CHARLES C. MANN. "Don't Blame the Natives; It was a rat that caused the sudden collapse of Easter Island's civilization." The Wall Street Journal (Sat., JULY 30, 2011): C5-C6.

(Note: ellipses added; italics in original.)

Source of book under review:

Hunt, Terry, and Carl Lipo. The Statues That Walked: Unraveling the Mystery of Easter Island. New York: Free Press, 2011.

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"Protesters outside the Los Angeles Courthouse on Thursday denounced the police's moves against Rawesome, which offers raw milk products." Source of caption and photo: online version of the NYT article quoted and cited below.

LOS ANGELES -- Raw food enthusiasts fit right in here, in the earthy, health-conscious beach communities of Venice and Santa Monica, along with the farmers' markets, health food stores and vegan restaurants.

But this week, the police cleared the shelves of Rawesome, an establishment in Venice Beach, loading $70,000 of raw, organic produce and dairy products on the back of a flatbed truck.

And then, on Thursday, James Stewart, the proprietor, was arraigned on charges of illegally making, improperly labeling and illegally selling raw milk products, as well as other charges related to Rawesome's operations. Two farmers who work with Rawesome were also named in the district attorney's complaint.

. . .

The raid on Rawesome has riled people here who say that unpasteurized milk is safer and healthier. About 150 raw food advocates gathered at the Los Angeles County Courthouse on Thursday to oppose the crackdown.

"It's our right to choose what we want to put in our bodies," Ms. Buttery said. "When members filled out an application, they were saying they wanted natural bacteria in their systems. We don't want labeling. We don't want animals full of antibiotics."

For the full story, see:

IAN LOVETT. "Raw Food Co-op Is Raided in California." The New York Times (Fri., August 5, 2011): A11.

(Note: ellipsis added.)

(Note: the online version of the story is dated August 4, 2011.)

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(p. 365) It is hard now to appreciate just how radical and unwelcome Snow's views were. Many authorities actively detested him for them. The Lancet concluded that he was in the pocket of business interests which wished to continue to fill the air with 'pestilent vapours, miasms and loathsome abominations of every kind' and make themselves rich by poisoning their neighbours. 'After careful enquiry,' the parliamentary inquiry concluded, 'we see no reason to adopt this belief.'

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

(Note: italics in original.)

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(p. 362) The miasma theory had just one serious flaw: it was entirely without foundation. Unfortunately only one man saw this, and he couldn't get others to see it with him. His name was John Snow.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

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(p. 346) . . . in the Middle Ages the spread of plague made people consider more closely their attitude to hygiene and what they might do to modify their own susceptibility to outbreaks. Unfortunately, people everywhere came to exactly the wrong conclusion. All the best minds agreed that bathing opened the epidermal pores and encouraged deathly vapours to invade the body. The best policy was to plug the pores with dirt. For the next six hundred years most people didn't wash, or even get wet, if they could help it - and in consequence they paid an uncomfortable price. Infections became part of everyday life. Boils grew commonplace. Rashes and blotches were routine. Nearly everyone itched nearly all the time. Discomfort was constant, serious illness accepted with resignation.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

(Note: ellipsis added.)

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McKinsey is probably the best known business consulting and forecasting firm in the United States. Many well-known management gurus, and corporate executives, have spent time working for McKinsey (as did Chelsea Clinton). One of their senior partners (Foster) co-authored a useful book called Creative Destruction.

(p. A2) A report by McKinsey & Co. has found that 30% of employers are likely to stop offering workers health insurance after the bulk of the Obama administration's health overhaul takes effect in 2014.

. . .

Previous research has suggested the number of employers who opt to drop coverage altogether in 2014 would be minimal.

But the McKinsey study predicts a more dramatic shift from employer-sponsored health plans once the new marketplace takes effect. Starting in 2014, all but the smallest employers will be required to provide insurance or pay a fine, while most Americans will have to carry coverage or pay a different fine. Lower earners will get subsidies to help them pay for plans.

In surveying 1,300 employers earlier this year, McKinsey found that 30% said they would "definitely or probably" stop offering employer coverage in the years after 2014. That figure increased to more than 50% among employers with a high awareness of the overhaul law.

For the full story, see:

JANET ADAMY. "Study Sees Cuts to Health Plans." The Wall Street Journal (Weds., JUNE 8, 2011): A15.

(Note: ellipsis added.)

The Foster book is:

Foster, Richard N., and Sarah Kaplan. Creative Destruction: Why Companies That Are Built to Last Underperform the Market---and How to Successfully Transform Them. New York: Currency Books, 2001.

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(p. 2B) CORALVILLE -- Police closed down a lemonade stand in Coralville, telling its 4-year-old operator and her dad that she didn't have a permit.

. . .

Abigail's dad, Dustin Krutsinger, said the ordinance and its enforcers are going too far if they force a 4-year-old to abandon her lemonade stand.

For the full story, see:

AP. "Coralville shuts down girl's lemonade stand." Omaha World-Herald [Iowa Edition] (Weds., August 3, 2011): 2B.

(Note: ellipsis added.)

(Note: the online version of the article is dated August 2, 2011 and has the title "Girl's lemonade stand shut down.")

The next day, the Iowa Edition of the Omaha World-Herald ran an update:

(p. 2B) CORALVILLE -- Four-year-old Abigail Krutsinger wasn't the only lemonade stand operator who was closed down when RAGBRAI bicyclists poured into Coralville last week.

At least three stands run by children were closed down because they hadn't obtained permits and health inspections.

For the full story, see:

AP. "Coralville defends closing kids' stands." Omaha World-Herald [Iowa Edition] (Thurs., August 4, 2011): 2B.

(Note: the online version of the article is dated August 3, 2011, and has the title "More lemonade stands shuttered.")

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(p. 167) . . . , in 1939 a Harvard Medical School surgeon named John Crandon decided to settle matters once and for all by the age-old method of withholding Vitamin C from his diet for as long as it took to make himself really ill. It took a surprisingly long time. For the first eighteen weeks, his only symptom was extreme fatigue. (Remarkably, he continued to operate on patients throughout this period.) But in the nineteenth week he took an abrupt turn for the worse - so much so that he would almost certainly have died had he not been under close medical supervision. He was injected with 1,000 milligrams of Vitamin C and was restored to life (p. 168) almost at once. Interestingly, he had never acquired the one set of symptoms that everyone associates with scurvy: the falling out of teeth and bleeding of gums.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

(Note: ellipsis added.)

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(p. A3) A European study involving nearly 1,000 participants has found no link between cellular-phone use and brain tumors in children and adolescents, a group that may be particularly sensitive to phone emissions.

The study, published in the Journal of the National Cancer Institute, was prompted by concerns that the brains of younger users may be more vulnerable to adverse health effects--such as cancer--from cellphones.

For the full story, see:

GAUTAM NAIK. "Study Sees No Cellphone-Cancer Ties." The Wall Street Journal (Thurs., July 28, 2011): A3.

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(p. 165) What was needed was some kind of distilled essence - an antiscorbutic, as the medical men termed it - that would be effective against scurvy but portable too. In the 1760s, a Scottish doctor named William Stark, evidently encouraged by Benjamin Franklin, conducted a series of patently foolhardy experiments in which he tried (p. 166) to identify the active agent by, somewhat bizarrely, depriving himself of it. For weeks he lived on only the most basic of foods - bread and water chiefly - to see what would happen. What happened was that in just over six months he killed himself, from scurvy, without coming to any helpful conclusions at all.

In roughly the same period, James Lind, a naval surgeon, conducted a more scientifically rigorous (and personally less risky) experiment by finding twelve sailors who had scurvy already, dividing them into pairs, and giving each pair a different putative elixir - vinegar to one, garlic and mustard to another, oranges and lemons to a third, and so on. Five of the groups showed no improvement, but the pair given oranges and lemons made a swift and total recovery. Amazingly, Lind decided to ignore the significance of the result and doggedly stuck with his personal belief that scurvy was caused by incompletely digested food building up toxins within the body.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

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"Illegal rice wine for sale in Chinatown. The wine is popular among immigrants from Fujian Province." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A22) The restaurant looks like so many others in the roiling heart of Chinatown, in Lower Manhattan: a garish sign in Chinese and English, slapdash photos of featured dishes taped to the windows, and extended Chinese families crowding around tables, digging into communal plates of steamed fish, fried tofu and sautéed watercress.

But ask a waitress the right question and she will disappear into the back, returning with shot glasses and something not on the menu: a suspiciously unmarked plastic container containing a reddish liquid.

It is homemade rice wine -- "Chinatown's best," the restaurant owner asserts. It is also illegal.

In the city's Chinese enclaves, there is a booming black market for homemade rice wine, representing one of the more curious outbreaks of bootlegging in the city since Prohibition. The growth reflects a stark change in the longstanding pattern of immigration from China.

In recent years, as immigration from the coastal province of Fujian has surged, the Fujianese population has come to dominate the Chinatowns of Lower Manhattan and Sunset Park, Brooklyn, and has increased rapidly in other Chinese enclaves like the one in Flushing, Queens.

These newcomers have brought with them a robust tradition of making -- and hawking -- homemade rice wine. In these Fujianese neighborhoods, right under the noses of the authorities, restaurateurs brew rice wine in their kitchens and sell it proudly to customers. Vendors openly sell it on street corners, and quart-size containers of it are stacked in plain view in grocery store refrigerators, alongside other delicacies like jellyfish and duck eggs.

The sale of homemade rice wine -- which is typically between 10 and 18 percent alcohol, about the same as wine from grapes -- violates a host of local, state and federal laws that govern the commercial production and sale of alcohol, but the authorities have apparently not cracked down on it.

For the full story, see:

KIRK SEMPLE and JEFFREY E. SINGER. "Illegal Sale of Rice Wine Thrives in Chinese Enclaves." The New York Times (Weds., July 20, 2011): A22-A23.

(Note: the online version of the story is dated July 19, 2011.)

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"An obese mouse given the drug SRT-1720, center, and one not given the drug, right." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A1) Sustaining the flickering hope that human aging might somehow be decelerated, researchers have found they can substantially extend the average life span of obese mice with a specially designed drug.

The drug, SRT-1720, protects the mice from the usual diseases of obesity by reducing the amount of fat in the liver and increasing sensitivity to insulin. These and other positive health effects enable the obese mice to live 44 percent longer, on average, than obese mice that did not receive the drug, according to a team of researchers led by Rafael de Cabo, a gerontologist at the National Institute on Aging.

Drugs closely related to SRT-1720 are now undergoing clinical trials in humans.

The findings "demonstrate for the first time the feasibility of designing novel molecules that are safe and effective in promoting longevity and preventing multiple age-related diseases in mammals," Dr. de Cabo and colleagues write in Thursday's issue of the new journal Scientific Reports. Their conclusion supports claims that had been thrown in doubt by an earlier study that was critical of SRT-1720.

A drug that makes it cost-free to be obese may seem more a moral hazard than an incentive to good health. But the rationale behind the research is somewhat different: the researchers are trying to capture the benefits that allow mice on very low-calorie diets to live longer. It just so happens that such benefits are much easier to demonstrate in mice under physiological stress like obesity than in normal mice.

. . .

. . . , a small pharmaceutical concern in Cambridge, Mass., designed SRT-1720 and a set of similar drugs to mimic resveratrol -- the trace ingredient of red wine that is thought to activate protective proteins called sirtuins.

The sirtuins help bring about the 30 percent extension of life span enjoyed by mice and rats that are kept on very low-calorie diets.

For the full story, see:

NICHOLAS WADE. "Longer Lives for Obese Mice, With Hope for Humans of All Sizes." The New York Times (Fri., August 19, 2011): A1 & A3.

(Note: ellipses added.)

(Note: the online version of the story was dated August 18, 2011.)

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"A rule against selling food with added vitamins and minerals, like canned pudding, prompted the removal of several popular products from Abigail's, a shop in Copenhagen." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A6) COPENHAGEN -- For the last seven years, Marianne Orum has owned a narrow store in a charming street in the heart of this Danish capital.

A sign advertises "British and South African Food and Drink."

The shelves are lined with products familiar to most Americans, like Betty Crocker Pancake Mix, but also more exotic items, like Heinz's Taste of Home Delightful Spotted Dick Pudding in cans, and bottles of Harviestoun Old Engine Oil porter.

But in January Ms. Orum got a phone call from government food inspectors. Tipped off by a competitor, they told her she was selling products that were fortified with vitamins or minerals, and such products require government approval, which she did not have, so she would have to take them off the shelves.

The culprits were Ovaltine; a shredded wheat cereal called Shreddies; a malt drink called Horlicks; and Marmite, the curiously popular yeast byproduct that functions in England as a sandwich spread, snack or base for a soup (just add boiling water), and is sometimes known as tar-in-the-jar.

"That's four products in one go," said Ms. Orum, clearly angered. "That's a lot for a small company."

Application for approval, she said, costs almost $1,700 per product, and time for approval can run up to six months or more; the fee is not refunded if the product is rejected.

"It's a strange thing, this attitude in Denmark," she said, in a tone of exasperation. "The government wants to decide what we eat and not."

For the full story, see:

JOHN TAGLIABUE. "COPENHAGEN JOURNAL; Extra Vitamins? A Great Idea, Except in Denmark." The New York Times (Fri., June 17, 2011): A6.

(Note: the online version of the story was dated June 16, 2011.)

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Source of the "murder" quote is from:

J.D. Miles, reporter. "Elderly Woman Dies From Heat After A/C Stolen." Dallas, CBS 11 News, August 5, 2011.

(Note: this report is the source of the "murder" quote which was stated by Mrs. Grissom's neighbor Caroline Ware.)

(Note: Another version of the report with the "murder" quote has the title: "Texas Heat Wave." CBS 11 News, August 5, 2011.)

Another report on the incident is:

Source:

Ed Lavandera, reporter. "Woman Dies After Air Conditioner Stolen." CNN American Morning, August 5, 2011.

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(p. 67) . . . : The Nature of Bread, Honestly and Dishonestly Made, by Joseph Manning, M.D., . . . reported that it was common for bakers to add bean meal, chalk, white lead, slaked lime, and bone ash to every loaf they made.

These assertions are routinely reported as fact, even though it was demonstrated pretty conclusively over seventy years ago by Frederick A. Filby, in his classic work Food Adulteration (1934), that the claims could not possibly be true. Filby took the interesting and obvious step of baking loaves of bread using the accused adulterants in the manner and proportions described. In every case but one the bread was either as hard as (p. 68) concrete or failed to set at all, and nearly all the loaves smelled or tasted disgusting. Several needed more baking time than conventional loaves and so were actually more expensive to produce. Not one of the adulterated loaves was edible.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

(Note: ellipses added; italics in original.)

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(p. 5A) PORT-AU-PRINCE, Haiti (AP) -- Scientists have presented the strongest evidence yet that U.N. peacekeepers imported the chol­era strain that has killed more than 5,500 people in Haiti.

A report published in the July issue of the Emerging Infectious Diseases journal says research findings "strongly suggest" that the U.N. contingent from Nepal contaminated a Haitian river because of poor sanitation at a base. Author Renaud Piarroux had previously blamed peace­keepers. This study is more com­plete and its methodology was reviewed by other scientists.

Source:

AP. "U.N. may have brought cholera strain to Haiti." Omaha World-Herald (Thursday, June 30, 2011): 5A.

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(p. 59) . . . , not everyone was happy with the loss of open hearths. Many people missed the drifting smoke and were convinced they had been healthier when kept "well kippered in wood smoke," as one observer put it. As late as 1577, a William Harrison insisted that in the days of open fires our heads did never ake." Smoke in the roof space discouraged nesting birds and was believed to strengthen timbers. Above all, people complained that they weren't nearly as warm as before, which was true. Because fireplaces were so inefficient, they were constantly enlarged. Some became so enormous that they were built with benches in them, letting people sit inside the fireplace, almost the only place in the house where they could be really warm.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

(Note: ellipsis added.)

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If "necessity is the mother of invention," then why did it take so long for someone to invent the louvered slats mentioned at the end of this passage?

(p. 55) In even the best homes comfort was in short supply. It really is extraordinary how long it took people to achieve even the most elemental levels of comfort. There was one good reason for it: life was tough. Throughout the Middle Ages, a good deal of every life was devoted simply to surviving. Famine was common. The medieval world was a world without reserves; when harvests were poor, as they were about one year in four on average, hunger was immediate. When crops failed altogether, starvation inevitably followed. England suffered especially catastrophic harvests in 1272, 1277, 1283, 1292, and 1311, and then an unrelievedly murderous stretch from 1315 to 1319. And this was of course on top of plagues and other illnesses that swept away millions. People condemned to short lives and chronic hardship are perhaps unlikely to worry overmuch about decor. But even allowing for all that, there was just a great, strange slowness to strive for even modest levels of comfort. Roof holes, for instance, let smoke escape, but they also let in rain and drafts until somebody finally, belatedly invented a lantern structure with louvered slats that allowed smoke to escape but kept out rain, birds, and wind. It was a marvelous invention, but by the time it (p. 56) was thought of, in the fourteenth century, chimneys were already coming in and louvered caps were not needed.

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

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(p. 51) In even the best houses, floors were generally just bare earth strewn with rushes, harboring "spittle and vomit and urine of dogs and men, beer that hath been cast forth and remnants of fishes and other filth unmentionable," as the Dutch theologian and traveler Desiderius Erasmus rather crisply summarized in 1524. New layers of rushes were laid down twice a year normally, but the old accretions were seldom removed, so that, Erasmus added glumly, "the substratum may be unmolested for twenty years." The floors were in effect a very large nest, much appreciated by insects and furtive rodents, and a perfect incubator for plague. Yet a deep pile of flooring was generally a sign of prestige. It was common among the French to say of a rich man that he was "waist deep in straw."

Source:

Bryson, Bill. At Home: A Short History of Private Life. New York: Doubleday, 2010.

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""I had to train myself not to get too interested in their problems, and not to get sidetracked trying to be a semi-therapist." Dr. Donald Levin, a psychiatrist whose practice no longer includes talk therapy." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A1) DOYLESTOWN, Pa. -- Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: "Hold it. I'm not your therapist. I could adjust your medications, but I don't think that's appropriate."

Like many of the nation's 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

For the full story, see:

GARDINER HARRIS. "Talk Doesn't Pay, So Psychiatry Turns Instead to Drug Therapy." The New York Times, First Section (Sun., March 6, 2011): A1 & A21.

(Note: the online version of the story is dated March 5, 2011.)

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(p. D4) To the Editor:

The idea that ancient man had fewer tumors because he lived in a less polluted atmosphere ("Unearthing Prehistoric Tumors, and Debate," Dec. 28) can be held only by those who have limited experience living in a preindustrial way. Try cooking over an open fire burning half-rotten wood, or sitting in a cave warming yourself with a peat or dung fire, and you will know what pollution really is.

Carol Selinske

Rye Brook, N.Y.

Source of NYT letter to the Editor:

Carol Selinske. "LETTERS; Cancer, Then and Now." The New York Times (Tues., January 4, 2011): D4.

(Note: the online version of the letter is dated: January 3, 2011.)

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Source of graph: online version of the NYT article quoted and cited below.

(p. A6) People living in remote villages in Ecuador have a mutation that some biologists say may throw light on human longevity and ways to increase it.

The villagers are very small, generally less than three and a half feet tall, and have a rare condition known as Laron syndrome or Laron-type dwarfism. They are probably the descendants of conversos, Sephardic Jews from Spain and Portugal who were forced to convert to Christianity in the 1490s but were nonetheless persecuted in the Inquisition. They are also almost completely free of two age-related diseases, cancer and diabetes.

A group of 99 villagers with Laron syndrome has been studied for 24 years by Dr. Jaime Guevara-Aguirre, an Ecuadorean physician and diabetes specialist.

. . .

IGF-1 is part of an ancient signaling pathway that exists in the laboratory roundworm as well as in people. The gene that makes the receptor for IGF-1 in the roundworm is called DAF-2. And worms in which this gene is knocked out live twice as long as normal.

The Laron patients have the equivalent defect -- their cells make very little IGF-1, so very little IGF-1 signaling takes place, just as in the DAF-2-ablated worms. So the Laron patients might be expected to live much longer.

Because of their striking freedom from cancer and diabetes, they probably could live much longer if they did not have a much higher than usual death rate from causes unrelated to age, like alcoholism and accidents.

. . .

A strain of mice bred by John Kopchick of Ohio University has a defect in the growth hormone receptor gene, just as do the Laron patients, and lives 40 percent longer than usual.

. . .

The longest-lived mouse on record is one studied by Dr. Bartke. It had a defect in its growth hormone receptor gene, just as do the Laron patients. "It missed its fifth birthday by a week," he said. The mouse lived twice as long as usual and won Dr. Bartke a prize presented by the Methuselah Foundation (which rewards developments in life-extension therapies) in 2003.

For the full story, see:

NICHOLAS WADE. "Ecuadorean Villagers May Hold Secret to Longevity." The New York Times (Thurs., February 17, 2011): A6.

(Note: ellipses added.)

(Note: the online version of the story is dated February 16, 2011 and has the title "Ecuadorean Villagers May Hold Secret to Longevity.")

"A 67-year-old man who has Laron-type dwarfism with his daughter, 5, and sons, 7 and 10." Source of caption and photo: online version of the NYT article quoted and cited below.

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Source of book image: online version of the NYT review quoted and cited below.

(p. D3) Cheerfulness, optimism, extroversion and sociability may make life more enjoyable, but they won't necessarily extend it, Howard S. Friedman and Leslie R. Martin found in a study that covered eight decades. The key traits are prudence and persistence. "The findings clearly revealed that the best childhood personality predictor of longevity was conscientiousness," they write, "the qualities of a prudent, persistent, well-organized person, like a scientist-professor -- somewhat obsessive and not at all carefree."

. . .

There are three explanations for the dominant role of conscientiousness. The first and most obvious is that conscientious people are more likely to live healthy lifestyles, to not smoke or drink to excess, wear seat belts, follow doctors' orders and take medication as prescribed. Second, conscientious people tend to find themselves not only in healthier situations but also in healthier relationships: happier marriages, better friendships, healthier work situations.

The third explanation for the link between conscientiousness and longevity is the most intriguing. "We thought it must be something biological," Dr. Friedman said. "We ruled out every other factor." He and other researchers found that some people are biologically predisposed to be not only more conscientiousness but also healthier. "Not only do they tend to avoid violent deaths and illnesses linked to smoking and drinking," they write, "but conscientious individuals are less prone to a whole host of diseases, not just those caused by dangerous habits." The precise physiological explanation is unknown but seems to have to do with levels of chemicals like serotonin in the brain.

As for optimism, it has its downside. "If you're cheerful, very optimistic, especially in the face of illness and recovery, if you don't consider the possibility that you might have setbacks, then those setbacks are harder to deal with," Dr. Martin said. "If you're one of those people who think everything's fine -- 'no need to back up those computer files' -- the stress of failure, because you haven't been more careful, is harmful. You almost set yourself up for more problems."

For the full review, see:

KATHERINE BOUTO. "BOOKS ON SCIENCE; Eighty Years Along, a Longevity Study Still Has Ground to Cover." The New York Times (Tues., April 19, 2011): D3.

(Note: ellipsis added.)

(Note: the online version of the article is dated April 18, 2011.)

The book under review is:

Friedman, Howard S., and Leslie R. Martin. The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. New York: Hudson Street Press, 2011.

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Source of graphic: online version of the WSJ article quoted and cited below.

Back when I was a child, decades ago, my family opposed the fluoridation of public water supplies on the grounds that there might be health risks, and people could individually choose to apply fluoride to their teeth.

Well, now the government is suggesting that too much fluoride can harm children's teeth, and that the target level for fluoride in the water should be reduced.

(p. A3) The federal government lowered its recommended limit on the amount of fluoride in drinking water for the first time in nearly 50 years, saying that spots on some children's teeth show they are getting too much of the mineral.

Fluoride has been added to U.S. water supplies since 1945 to prevent tooth decay. Since 1962, the government has recommended adding a range of 0.7 milligrams to 1.2 milligrams per liter.

. . .

A study conducted between 1999 and 2004 by the federal Centers for Disease Control and Prevention found that 41% of children between the ages of 12 and 15 exhibited signs of dental fluorosis, a spotting or streaking on the teeth. That was up from nearly 23% found in a study from 1986 and 1987.

. . .

. . . for years, some groups have called for an end to fluoridation, arguing that it poses serious health dangers, including increased risk of bone fractures and of decreased thyroid function. Friday's announcement did little to appease such critics.

"The only rational course of action is to stop water fluoridation," said Paul Connett, executive director of the Fluoride Action Network, a nonprofit advocacy and fluoride-education group

For the full story, see:

TIMOTHY W. MARTIN. "Government Advises Less Fluoride in Water." The New York Times (Sat., JANUARY 8, 2011): A3.

(Note: ellipses added.)

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"Marti Conger, a business consultant in Benicia, Calif., went to England in October 2009 to get an implant of a new artificial disk for her spine developed by Spinal Kinetics of Sunnyvale, Calif., a short distance from her home." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. B1) Late last year, Biosensors International, a medical device company, shut down its operation in Southern California, which had once housed 90 people, including the company's top executives and researchers.

The reason, executives say, was that it would take too long to get its new cardiac stent approved by the Food and Drug Administration.

"It's available all over the world, including Mexico and Canada, but not in the United States," said the chief executive, Jeffrey B. Jump, an American who runs the company from Switzerland. "We decided, let's spend our money in China, Brazil, India, Europe."

. . .

(p. B7) "Ten years from now, we'll all get on planes and fly somewhere to get treated," said Jonathan MacQuitty, a Silicon Valley venture capitalist with Abingworth Management.

Marti Conger, a business consultant in Benicia, Calif., already has. She went to England in October 2009 to get an implant of a new artificial disk for her spine developed by Spinal Kinetics of Sunnyvale, Calif.

"Sunnyvale is 40 miles south of my house," said Ms. Conger, who has become an advocate for faster device approvals in the United States. "I had to go to England to get my surgery."

. . .

Device companies have been seeking early approval in Europe for years because it is easier. In Europe, a device must be shown to be safe, while in the United States it must also be shown to be effective in treating a disease or condition. And European approvals are handled by third parties, not a powerful central agency like the F.D.A.

But numerous device executives and venture capitalists said the F.D.A. has tightened regulatory oversight in the last couple of years. Not only does it take longer to get approval but it can take months or years to even begin a clinical trial necessary to gain approval.

Disc Dynamics made seven proposals over three years but could not get clearance from the F.D.A. to conduct a trial of its gel for spine repair, said David Stassen, managing partner of Split Rock Partners, a venture firm that backed the company. "It got to the point where the company just ran out of cash," Mr. Stassen said. Disc Dynamics was shut down last year after an investment of about $65 million.

For the full story, see:

ANDREW POLLACK. "Medical Treatment, Out of Reach." The New York Times (Thurs., February 10, 2011): B1 & B7.

(Note: ellipses added.)

(Note: the online version of the story is dated February 9, 2011.)

"An artificial disk like the one Marti Conger received."
Source of caption and photo: online version of the NYT article quoted and cited above.

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(p. 6) A decade ago, half of all Mexicans had no health insurance at all. Then the country's Congress passed a bill to ensure health care for every Mexican without access to it. The goal was explicit: universal coverage.

By September, the government expects to have enrolled about 51 million people in the insurance plan it created six years ago -- effectively reaching the target, at least on paper.

The big question, critics contend, is whether all those people actually get the health care the government has promised.

. . .

The money goes from the federal government to state governments, depending on how many people each state enrolls. From there, it is up to state governments to spend the money properly so that patients get the promised care.

That, critics say, is the plan's biggest weakness. State governments have every incentive to register large numbers, but they do not face any accountability for how they spend the money.

"You have people signed up on paper, but there are no doctors, no medicine, no hospital beds," said Miguel Pulido, the executive director of Fundar, a Mexican watchdog group that has studied the poor southern states of Guerrero and Chiapas.

Mr. Chertorivski acknowledges that getting some states to do their work properly is a problem. "You can't do a hostile takeover," he said.

The result is that how Mexicans are treated is very much a function of where they live. Lucila Rivera Díaz, 36, comes from one of the poorest regions in Guerrero. She said doctors there told her to take her mother, who they suspected had liver cancer, for tests in the neighboring state of Morelos.

For the full story, see:

ELISABETH MALKIN. "Mexico Struggles to Realize the Promise of Universal Health Care." The New York Times, First Section (Sun., January 30, 2011): 6.

(Note: the online version of the story is dated January 29, 2011 and has the title "Mexico's Universal Health Care Is Work in Progress.")

(Note: ellipsis added.)

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"A MRSA cell before treatment with nanoparticles." Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. A3) Researchers at International Business Machines Corp. said they developed a tiny drug, called a nanoparticle, that in test-tube experiments showed promise as a weapon against dangerous superbugs that have become resistant to antibiotics.

The company's researchers, in collaboration with scientists at the Institute of Bioengineering and Nanotechnology, Singapore, said their nanoparticle can target and destroy antibiotic-resistant bacteria--such as the potentially lethal Methicillin-resistant Staphylococcus aureus, or MRSA--without affecting healthy cells.

. . .

IBM, based in Armonk, N.Y., has been working for decades on nanotechnology, which involves engineering atomic-scale particles and electronics. Recently the company has applied those principles--used to create tiny, fast semiconductors--into new areas such as water purification and recyclable plastics. It's now applying those principles to medicine.

"It turns out that we've discovered a lot of ways to control materials at the molecular level as we went through building microelectronic devices," Dr. Hedrick said.

For the full story, see:

RON WINSLOW And SHARA TIBKEN. "Big Blue's Tiny Bug Zapper; IBM Researchers Develop Nanoparticle to Destroy Antibiotic-Resistent Bacteria." The Wall Street Journal (Mon., APRIL 4, 2011): A3.

(Note: ellipsis added.)

"What's left of the cell after getting zapped." Source of caption and photo: online version of the WSJ article quoted and cited above.

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"A mummy enters the CT scanner at St. Luke's Hospital in Kansas City, Mo. It was one of 52 mummies examined for signs of heart disease." Source of caption and photo: online version of the Omaha World-Herald article quoted and cited below.

(p. 6A) Atherosclerosis -- hardening of the arteries -- was surpris­ingly widespread during an­cient times, at least among the Egyptian mummies examined by an international team of sci­entists and heart specialists.

Their research, whose re­sults were presented April 3 in New Orleans at the annual meeting of the American Col­lege of Cardiology, found that 45 percent of the mummies they put through CT scans had signs of atherosclerosis.

That raises questions about whether hardening of the arter­ies is the modern disease that many think it is.

"We found it so easily and frequently that it appears to have been common in this soci­ety," said Randall Thompson, a cardiologist at St. Luke's Hospi­tal in Kansas City.

For the full story, see:

MC CLATCHY NEWSPAPERS. "Hardened Arteries Go Back Centuries." Omaha World-Herald (Mon., April 18, 2011): 6A.

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(p. 103) Claims of disastrous decline will he praised in the elite parts of society. Since many crave recognition or rewards from elites, people oblige by producing claims of disastrous decline. More generally, when things really are bad we naturally turn to eminent or powerful people for their advice and succor; when things are fine, the elite classes are of diminished importance to society. Important people like to feel important, and thus are biased toward viewing events in bleak terms. Consider that, during the 1990s, when nearly everything in the United States was trending positive, left-wing leaders as exemplified by the Manhattan chardonnay circuit, and right-wing leaders as exemplified by the Heritage Foundation circuit, slugged it out as though the world was ending: the left claiming religious fanatics were taking over the country, the right claiming the left was destroying the family and opposed to reading of the classics, to name a few totally cooked-up charges of that period. As Orlando Patterson, a Harvard University sociologist, noted in 1998, "It's astonish-(p. 104)ing how the Washington and New York elites, who benefit so much from the improvement of the United States, are so out of sync with it, endlessly talking about how things are getting worse when the country is clearly improving."

To those who benefit from bad news, either by fund-raising or increased self-importance, problems are not just problems but crises--the health care crisis, the farm-bill crisis, the tax crisis, the welfare crisis, the litigation crisis, the postage-rate crisis.

Source:

Easterbrook, Gregg. The Progress Paradox: How Life Gets Better While People Feel Worse. Paperback ed. New York: Random House, 2004.

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(p. B1) . . . Medicare's long-term funding gap -- . . . is by far the biggest source of looming federal deficits.

. . .

(p. B13) Some health economists believe that a combination of higher taxes and more Medicare cost controls can solve the problem. Mr. Ryan does not. And his skepticism is healthy.

To him, the only way to reduce Medicare's cost growth is to stop shielding people from the consequences of their decisions. If they want almost limitless medical treatments, they won't be able to foist the bill on taxpayers, as they do now. They will instead have to buy a generous insurance plan, partly with their own money. The resulting market forces, Mr. Ryan argues, will eventually bring down costs and leave most people better off.

For the full story, see:

DAVID LEONHARDT. "Economic Scene; A Lopsided Proposal for Medicare." The New York Times (Weds., April 6, 2011): B1 & B13.

(Note: ellipses added.)

(Note: the online version of the article is dated April 5, 2011 and has the title "Economic Scene; Generational Divide Colors Debate Over Medicare's Future.")

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(p. 6A) Sen. Ben Nelson can't shake the "Cornhusker Kickback."

This week, a government watchdog group named the Nebraska Democrat its "2010 Porker of the Year," based on an online poll.

Citizens Against Government Waste included Nelson in the poll, citing his role negotiating a pro­vision of the federal health care bill that would have exempted Nebraska from paying the added costs of the law's expanded Med­icaid coverage. That provi­sion was later dropped in fa­vor of relief for all states, which Nelson has said was his goal all along.

Nelson cast the decisive 60th vote for the bill in late 2009.

. . .

Mark Fahleson, chairman of the Nebraska Republican Party, said Nelson was trying to rewrite history. "The fact is he's the fa­ther of the Cornhusker Kick­back," he said.

For the full story, see:

MICHAEL O'CONNOR. "Nelson rejects group's 'Porker of Year' label." Omaha World-Herald (Fri., March 4, 2011): 6A.

(Note: ellipsis added.)

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Source of book image:
http://blogs.plos.org/takeasdirected/files/2011/02/Offit-Deadly-Choices1.jpg

Sometime during the weekend of Feb. 26-27, 2011, I saw several minutes of a C-Span book TV presentation by Paul Offit on his Deadly Choices book. He made a strong case that based on casual and unsound evidence, many parents are putting their children at risk by delaying or even foregoing having their children vaccinated.

As a result children are dying from diseases that they easily could have been protected against.

Book discussed:

Offit, Paul A. Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. New York: Basic Books, 2011.

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Source of book image: online version of the WSJ review quoted and cited below.

(p. A13) In "Hyping Health Risks," Geoffrey Kabat, an epidemiologist himself, shows how activists, regulators and scientists distort or magnify minuscule environmental risks. He duly notes the accomplishments of epidemiology, such as uncovering the risks of tobacco smoking and the dangers of exposure to vinyl chloride and asbestos. And he acknowledges that industry has attempted to manipulate science. But he is concerned about a less reported problem: "The highly charged climate surrounding environmental health risks can create powerful pressure for scientists to conform and to fall into line with a particular position."

Mr. Kabat looks at four claims -- those trying to link cancer to man-made chemicals, electromagnetic fields and radon and to link cancer and heart disease to passive smoking. In each, he finds more bias than biology -- until further research, years later, corrects exaggeration or error.

. . .

I know whereof Mr. Kabat speaks. In 1992, as the producer of a PBS program, I interviewed an epidemiologist who was on the EPA's passive-smoking scientific advisory board. He admitted to me that the EPA had put its thumb on the evidentiary scales to come to its conclusion. He had lent his name to this process because, he said, he wanted "to remain relevant to the policy process." Naturally, he didn't want to appear on TV contradicting the EPA.

For the full review, see:

RONALD BAILEY. "Bookshelf; Scared Senseless." The Wall Street Journal (Mon., AUGUST 11, 2008): A13.

(Note: ellipsis added.)

(Note: the first paragraph quoted above has slightly different wording in the online version than the print version; the second paragraph quoted is the same in both.)

The book under review is:

Kabat, Geoffrey C. Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology. New York: Columbia University Press, 2008.

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"Schools like Omaha's Masters Elementary, which held a recent holiday bake sale, count on the profits from selling cupcakes, caramel corn and other goodies to raise money for field trips and other activities." Source of caption and photo: online version of the Omaha World-Herald article quoted and cited below.

(p. 1A) A business club at Millard West High School peddles freshly baked cookies, raking in $15,000 annually to help send students to national conferences.

At Omaha's Masters Elementary, cupcakes, fudge and other bake-sale treats raise $500 for field trips, rain jackets for the safety patrol and playground equipment.

But the federal government could slam the brakes on those brownies and lower the boom on the lemon bars.

A child nutrition bill passed recently by Congress gives a fed­eral agency the power to limit the frequency of school bake sales and other school-sponsored fundraisers that sell unhealthy food.

To some, the bake sale provision makes about as much sense as leav­ing the marshmallows out of Rice Krispies treats.

It maybe makes sense for the fed­eral government to monitor the qual­ity of ground beef, eggs and milk sold in grocery stores. But caramel corn and snicker doodles whipped up by parents for school bake sales?

"Aren't there more important (p. 2A) things for them to be wor­ried about?" Sandy Hatcher, president of Masters' parent organization, said of the fed­eral government.

For the full story, see:

MICHAEL O'CONNOR. "Putting the brakes on bake sales; New federal rules on frequency during school day may affect fundraising." Omaha World-Herald (Sun., December 12, 2010): 1A-2A.

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"Dr. Felix Ramírez in Gambia in 2008." Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. A1) Felix Ramírez slipped into an Internet cafe in the West African nation of The Gambia, scoured the Web for contact information for U.S. diplomats, then phoned the U.S. embassy in Banjul, the capital.

He told the receptionist he was an American tourist who had lost his passport, and asked to speak to the visa section. As he waited to be connected, he practiced his script: "I am a Cuban doctor looking to go to America. When can we meet?"

Dr. Ramírez says he was told to go to a crowded Banjul supermarket and to look for a blond woman in a green dress--an American consular official. They circled one another a few times, then began to talk.

That furtive meeting in September 2008 began a journey for the 37-year-old surgeon that ended in May 2009 in Miami, where he became a legal refugee with a shot at citizenship.

Dr. Ramírez is part of a wave of Cubans who have defected to the U.S. since 2006 under the little-known Cuban Medical Professional Parole immigration program, which allows Cuban doctors and some other health workers who are serving their government overseas to enter the U.S. immediately as refugees. Data released to The Wall Street Journal under the Freedom of Information Act shows that, through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65 countries.

Cuba has been sending medical "brigades" to foreign countries since 1973, helping it to win friends abroad, to back "revolutionary" regimes in places like Ethiopia, Angola and Nicaragua, and perhaps most importantly, to earn hard currency. Communist Party newspaper Granma reported in June that Cuba had 37,041 doctors and other health workers in (p. A12) 77 countries. Estimates of what Cuba earns from its medical teams--revenue that Cuba's central bank counts as "exports of services"--vary widely, running to as much as $8 billion a year. Many Cubans complain that the brigades have undermined Cuba's ability to maintain a high standard of health care at home.

For the full story, see:

JOEL MILLMAN. "New Prize in Cold War: Cuban Doctors." The Wall Street Journal (Sat., JANUARY 15, 2011): A1 & A12.

Source of graph: online version of the WSJ article quoted and cited above.

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"DIAGNOSIS. Evidence of tumors in the skull of a male skeleton exhumed from an early medieval cemetery in Slovakia. Often thought of as a modern disease, cancer has always been with us." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. D1) When they excavated a Scythian burial mound in the Russian region of Tuva about 10 years ago, archaeologists literally struck gold. Crouched on the floor of a dark inner chamber were two skeletons, a man and a woman, surrounded by royal garb from 27 centuries ago: headdresses and capes adorned with gold horses, panthers and other sacred beasts.

But for paleopathologists -- scholars of ancient disease -- the richest treasure was the abundance of tumors that had riddled almost every bone of the man's body. The diagnosis: the oldest known case of metastasizing prostate cancer.

The prostate itself had disintegrated long ago. But malignant cells from the gland had migrated according to a familiar pattern and left identifiable scars. Proteins extracted from the bone tested positive for PSA, prostate specific antigen.

Often thought of as a modern disease, cancer has always been with us.

. . .

(p. D7) . . . , Tony Waldron, a paleopathologist at University College London, analyzed British mortality reports from 1901 to 1905 -- a period late enough to ensure reasonably good records and early enough to avoid skewing the data with, for example, the spike in lung cancer caused in later decades by the popularity of cigarettes.

Taking into account variations in life span and the likelihood that different malignancies will spread to bone, he estimated that in an "archaeological assemblage" one might expect cancer in less than 2 percent of male skeletons and 4 to 7 percent of female skeletons.

Andreas G. Nerlich and colleagues in Munich tried out the prediction on 905 skeletons from two ancient Egyptian necropolises. With the help of X-rays and CT scans they diagnosed five cancers -- right in line with Dr. Waldron's expectations. And as his statistics predicted, 13 cancers were found among 2,547 remains buried in an ossuary in southern Germany between A.D. 1400 and 1800.

For both groups, the authors wrote, malignant tumors "were not significantly fewer than expected" when compared with early-20th-century England. They concluded that "the current rise in tumor frequencies in present populations is much more related to the higher life expectancy than primary environmental or genetic factors."

. . .

"Cancer is an inevitability the moment you create complex multicellular organisms and give the individual cells the license to proliferate," said Dr. Weinberg of the Whitehead Institute. "It is simply a consequence of increasing entropy, increasing disorder."

He was not being fatalistic. Over the ages bodies have evolved formidable barriers to keep rebellious cells in line. Quitting smoking, losing weight, eating healthier diets and taking other preventive measures can stave off cancer for decades. Until we die of something else.

"If we lived long enough," Dr. Weinberg observed, "sooner or later we all would get cancer."

For the full story, see:

GEORGE JOHNSON. "Unearthing Prehistoric Tumors, and Debate." The New York Times (Tues., December 28, 2010): D1 & D7.

(Note: ellipses added.)

(Note: the online version of the article is dated December 27, 2010.)

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"MODERN MEETS ANCIENT. CT scans of some Egyptian mummies, like the one being done on this priest, reveal signs of atherosclerosis." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. D6) . . . a team of cardiologists used CT scanning on mummies in the Egyptian National Museum of Antiquities in Cairo to identify atherosclerosis -- a buildup of cholesterol, inflammation and scar tissue in the walls of the arteries, a problem that can lead to heart attack and stroke.

The cardiologists were able to identify the disease in some mummies because atherosclerotic tissue often develops calcification, which is visible as bright spots on a CT image. The finding that some mummies had hardened arteries raises questions about the common wisdom that factors in modern life, including stress, high-fat diets, smoking and sedentary routines, play an essential role in the development of cardiovascular disease, the researchers said.

"It tells us that we have to look beyond lifestyles and diet for the cause and progression of this disease," said Dr. Randall C. Thompson, a cardiologist at St. Luke's Mid America Heart Institute in Kansas City, Mo., and part of the team of cardiovascular imaging specialists who traveled to Cairo last year. "To a certain extent, getting the disease is part of the human condition."

For the full story, see:

NATASHA SINGER. "Artery Disease in Some Very Old Patients." The New York Times (Tues., November 24, 2009): D6.

(Note: ellipsis added.)

(Note: the online version of the review has the date November 23, 2009.)

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(p. A16) BOSTON -- On its face, it seemed reasonable enough: a bone marrow registry sending recruiters to malls, ballparks and other busy sites to enlist potential donors.

But the recruiters were actually flirtatious models in heels, short skirts and lab coats, law enforcement officials say, asking passers-by for DNA swabs without mentioning the price of the seemingly simple procedure. And the registry, Caitlin Raymond International, was paying up to $60,000 a week for the models while billing insurance companies up to $4,300 per test.

. . .

The registry is a nonprofit subsidiary of UMass Memorial Medical Center in Worcester, . . .

. . .

James T. Boffetti, the state's senior assistant attorney general, said the registry had hired models based on their photographs and had given them "explicit instructions" to wear heels and short skirts.

. . .

New Hampshire passed a law in 2006 requiring insurers to pay for tissue-typing tests for potential bone marrow donors.

For the full story, see:

ABBY GOODNOUGH. "Flirty Models Were Hired in Bid to Find Bone Marrow." The New York Times (Fri., December 17, 2010): A16.

(Note: ellipses added.)

(Note: the online version of the article is dated December 16, 2010.)

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"Jonathan Bush, nephew of one former president and cousin of another, built a small medical practice into a national enterprise with nearly 1,200 employees." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. B10) In the world of health care innovation, the founder and chief executive of Athenahealth has an outsize name. In part, that's because his name is Jonathan Bush, and he is the nephew of one former president and the cousin of another. But it's also because his company has mastered the intricacies of the doctor-insurer relationship and become a player in the emerging medical records industry.

Based in Watertown, Mass., Athenahealth offers a suite of administrative services for medical practices. It collects payments from insurers and patients, and it manages electronic health records and patient communication systems. All of this is done remotely through the Internet -- or "in the cloud," as Mr. Bush puts it. Doctors don't have to install or manage software or pay licensing fees; instead, Athenahealth keeps a percentage of the revenue.

. . .

Q. What's going on in the health care industry to deliver that kind of growth to you?

A. We are a disruptive technology. We are the only cloud-based service in an industry segment full of sclerotic, enormous, personality-free corporations that have been in business making 90 percent margins doing nothing for decades and decades.

Q. What keeps other companies from building cloud-based systems?

A. For software companies, the biggest barrier to entry is that they give up their business model. Those companies would get hammered on Wall Street if they started selling a service that they have to deliver at a loss for five years. In terms of new entrants, there are two things that we've done that would take a good decade to replicate. One, we've built out the health care Internet. We've been building connections into insurance companies and laboratories and hospital medical records for years and years and years.

And the other barrier to entry is that rules engine. Every time a doctor anywhere in the country gets a claim denied, we have analysts ask the Five Whys. When we get to root cause, we write a new rule into Athenanet and from that day on, no other doctor gets that particular denial from that particular insurance company ever again. We now know of 40 million ways that a doctor can have a claim denied in the United States. The average practice has to rework about 35 percent of their claims, and we only have to rework about 5 percent of ours.

Q. What's the prognosis for bill collecting under health care reform?

A. Well, there's going to be new connectors and a whole series of new insurance products that will be managed by the states' health insurance commissioners. And the law provides for every state to do all of these its own way, so they will have their own rules and regulations, and each state will do it differently. That sounds like springtime in Complexity Land.

Q. What do you think will happen to the total cost of health care under reform?

A. Oh, it's going to go through the roof! It's widely accepted that this is not a cost-reform bill -- it's an access bill. It's in fact a cost-expansion bill.

For the full story, see:

ROBB MANDELBAUM. "Views of Health Care Economics From a C.E.O. Named Bush." The New York Times (Thurs., September 9, 2010): B10.

(Note: ellipsis added.)

(Note: the online version of the article has the date September 8, 2010.)

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(p. D3) An operation commonly performed to remove brain tumors from the pituitary glands of humans is now available to dogs, thanks to a collaboration between a neurosurgeon and some veterinarians in Los Angeles. And that is turning out to be good for humans.

So far, nine dogs and one cat that otherwise would have died have been treated successfully.

. . .

What Dr. Mamelak has gained from teaching the procedure to veterinarians is access to tissue samples from the treated dogs. That's significant because Cushing's afflicts only one in a million humans, making it a difficult disease to study. By contrast, it afflicts about 100,000 dogs a year in the United States. The canine tissue samples are enabling him and his colleagues to develop drugs to one day treat Cushing's disease in both humans and dogs.

"We have a full loop," he said. "We're using a human procedure in animals, and using their tissue to study the disease."

For the full story, see:

SINDYA N. BHANOO. "Observatory; They Fetch, They Roll Over, They Aid Tumor Research." The New York Times, Science Times Section (Tues., October 26, 2010): D3.

(Note: ellipsIs added.)

(Note: the online version of the article is dated October 22 (sic), 2010.)

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"A government-created industry group worked with Domino's Pizza to bolster sales by increasing the cheese on pies." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. 1) Domino's Pizza was hurting early last year. Domestic sales had fallen, and a survey of big pizza chain customers left the company tied for the worst tasting pies.

Then help arrived from an organization called Dairy Management. It teamed up with Domino's to develop a new line of pizzas with 40 percent more cheese, and proceeded to devise and pay for a $12 million marketing campaign.

Consumers devoured the cheesier pizza, and sales soared by double digits. "This partnership is clearly working," Brandon Solano, the Domino's vice president for brand innovation, said in a statement to The New York Times.

But as healthy as this pizza has been for Domino's, one slice contains as much as two-thirds of a day's maximum recommended amount of saturated fat, which has been linked to heart disease and is high in calories.

And Dairy Management, which has made cheese its cause, is not a private business consultant. It is a marketing creation of the United States Department of Agriculture -- the same agency at the center of a federal anti-obesity drive that discourages over-consumption of some of the very foods Dairy Management is vigorously promoting.

. . .

When Michelle Obama implored restaurateurs in September to help fight obesity, she cited the proliferation of cheeseburgers and macaroni and cheese. "I (p. 23) want to challenge every restaurant to offer healthy menu options," she told the National Restaurant Association's annual meeting.

But in a series of confidential agreements approved by agriculture secretaries in both the Bush and Obama administrations, Dairy Management has worked with restaurants to expand their menus with cheese-laden products.

For the full story, see:

MICHAEL MOSS. "While Warning About Fat, U.S. Pushes Cheese Sales." The New York Times, First Section (Sun., November 7, 2010): 1 & 23.

(Note: the online version of the story is dated November 6, 2010.)

(Note: ellipsis added.)

Source of graphic: online version of the NYT article quoted and cited above.

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Source of graph: online version of the WSJ article quoted and cited below.

At first glance the graph and the text quoted below seem inconsistent on whether bilingualism delays the onset of dementia. The text says no, the graph says yes. On closer reading, the text is referring to the "physical signs of deterioration" while the graph is referring to "visible symptoms."

(p. D1) A lifetime of speaking two or more languages appears to pay off in old age, with recent research showing the symptoms of dementia can be delayed by an average of four years in bilingual people.

Multilingualism doesn't delay the onset of dementia--the brains of people who speak multiple languages still show physical signs of deterioration--but the process of speaking two or more languages appears to enable people to develop skills to better cope with the early symptoms of memory-robbing diseases, including Alzheimer's.

Scientists for years studied children and found that fluently speaking more than one language takes a lot of mental work. Compared with people who speak only one language, bilingual children and young adults have slightly smaller vocabularies and are slower performing certain verbal tasks, such as naming lists of animals or fruits.

But over time, regularly speaking more than one language appears to strengthen skills that boost the brain's so-called cognitive reserve, a capacity to work even when stressed or damaged. This build-up of cognitive reserve appears to help bilingual people as they age.

For the full story, see:

SHIRLEY S. WANG. "Building a More Resilient Brain." The Wall Street Journal (Tues., OCTOBER 12, 2010): D1 & D2.

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(p. D4) LONDON (Reuters) -- Starch grains found on 30,000-year-old grinding stones suggest that prehistoric humans may have dined on an early form of flatbread, contrary to their popular image as primarily meat eaters.

The findings, published in The Proceedings of the National Academy of Sciences journal on Monday, indicate that Paleolithic Europeans ground down plant roots similar to potatoes to make flour, which was later whisked into dough.

"It's like a flatbread, like a pancake with just water and flour," said Laura Longo, a researcher on the team, from the Italian Institute of Prehistory and Early History.

. . .

The findings may . . . upset fans of the so-called Paleolithic diet, which follows earlier research that assumes early humans ate a meat-centered diet.

For the full story, see:

REUTERS. "Paleolithic Humans Had Bread Along With Their Meat." The New York Times (Tues., October 19, 2010): D4.

(Note: ellipses added.)

(Note: the online version of the article is dated October 18, 2010.)

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(p. A19) ONE day in early 1970, a cross-country skier got lost along the 46-mile Kekekabic Trail, which winds through the Boundary Waters Canoe Area Wilderness in northern Minnesota. Unable to make his way out, he died of exposure.

In response, the Forest Service installed markers along the trail. But when, years later, it became time to replace them, the agency refused, claiming that the 1964 Wilderness Act banned signage in the nation's wilderness areas.

. . .

Over the decades an obvious contradiction has emerged between preservation and access. As the Forest Service, the National Park Service and the Bureau of Land Management -- each of which claims jurisdiction over different wilderness areas -- adopted stricter interpretations of the act, they forbade signs, baby strollers, certain climbing tools and carts that hunters use to carry game.

As a result, the agencies have made these supposedly open recreational areas inaccessible and even dangerous, putting themselves in opposition to healthy and environmentally sound human-powered activities, the very thing Congress intended the Wilderness Act to promote.

For the full commentary, see:

TED STROLL. "Aw, Wilderness!." The New York Times (Fri., August 27, 2010): A19.

(Note: ellipsis added.)

(Note: the online version of the article was dated August 26, 2010.)

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Source of graph: online version of the WSJ article quoted and cited below.

(p. A7) The health-care overhaul enacted last spring won't significantly change national health spending over the next decade compared with projections before the law was passed, according to government figures released Thursday.

The report by federal number-crunchers casts fresh doubt on Democrats' argument that the health-care law would curb the sharp increase in costs over the long term, the second setback this week for one of the party's biggest legislative achievements.

The Wall Street Journal reported Wednesday that insurance companies have proposed rate increases ranging from 1% to 9% nationwide that they attribute specifically to new health-law coverage mandates.

For the full story, see:

JANET ADAMY. "Health Outlays Still Seen Rising ." The Wall Street Journal (Thurs., SEPTEMBER 9, 2010): A7.

(Note: the online version of the graph has the date SEPTEMBER 8, 2010.)

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(p. A17) . . . it's a good time to check in on the state of the Cuban health-care system. That's just what Laurie Garrett, a senior fellow at the Council on Foreign Relations, does in the current issue of Foreign Affairs magazine.

. . .

Slightly more than half of all Cuban physicians work overseas; taxed by the Cuban state at a 66% rate, many of them wind up defecting. Doctors who remain in the country earn about $25 a month. As a result, Ms. Garrett writes, they often take "jobs as taxi drivers or in hotels," where they can make better money. As for the quality of the doctors, she notes that very few of those who manage to reach the U.S. can gain accreditation here, partly because of the language barrier, partly because of the "stark differences" in medical training. Typically, they wind up working as nurses.

As for the quality of medical treatment in Cuba, Ms. Garrett reports that hospital patients must arrive with their own syringes, towels and bed sheets. Women avoid gynecological exams "because they fear infection from unhygienic equipment and practices." Rates of cervical cancer have doubled in the past 25 years as the use of Pap tests has fallen by 30%.

And while Cuba's admirers love to advertise the country's low infant mortality rate (at least according to the Castro regime's dubious self-reporting) the flip-side has been a high rate of maternal mortality. "Most deaths," Ms. Garrett writes, "occur during delivery or within the next 48 hours and are caused by uterine hemorrhage or postpartum sepsis."

For the full commentary, see:

BRET STEPHENS. "Dr. Berwick and That Fabulous Cuban Health Care; The death march of progressive medicine." The Wall Street Journal (Sat., JULY 13, 2010): A17.

(Note: ellipses added.)

Reference to the Garrett article:

Garrett, Laurie A. "Castrocare in Crisis; Will Lifting the Embargo Make Things Worse?" Foreign Affairs 89, no. 4 (July/August 2010): 61-73.

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Source of graph: online version of the Omaha World-Herald article quoted and cited below.

The federal government puts quotas on the amount of sugar that can be imported from abroad, with the result that U.S. consumers pay higher prices for sugar. One result, as taught in economics micro principles courses, is that demand increases for sugar substitutes, such as corn syrup.

Evidence is accumulating (see below) that corn syrup is worse for our health than sugar.

Michelle Obama is leading a drive to reduce obesity. If she is serious, she can begin by asking her husband to ask his congress to remove import quotas on sugar.

(p. 2A) Well-publicized research also has suggested that high fructose corn syrup poses an even greater threat of obesity and other health problems than regular table sugar.

. . .

Researchers at Princeton University made headlines earlier this year when they released the results of a study that found rats drinking a high fructose corn syrup beverage for six months showed abnormal weight gain and other factors indicating obesity. The study concluded that overconsumption of the sweetener "could very well be a major factor in the 'obesity epidemic,' which correlates with the upsurge in the use of HFCS."

A related study found that rats drinking the high fructose corn syrup solution gained more weight than rats drinking a basic sucrose solution.

"The conclusion from that is that high fructose corn syrup and sucrose are not the same after all," said Bart Hoebel, the professor who worked on the study.

For the full story, see:

Ross Boettcher and Joseph Morton. "Is Corn Syrup Slump Healthy? ConAgra, Farmers Divided." Omaha World-Herald (Wednesday, July 26, 2010): 1A-2A.

(Note: ellipsis added.)

(Note: the online version of the article is dated July 26, 2010 and has the title "Consumers sour on sugars.)

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(p. 5A) WASHINGTON -- Senate Ma­jority Leader Harry Reid this week defended the now-defunct Nebraska Medicaid exemption that was tucked into the Senate health care bill as Reid sought the support of Sen. Ben Nelson, D-Neb.

Nelson has said that he never asked for the exemption and that his goal all along was to provide relief for all states.

Tagged with the derisive moni­ker "Cornhusker kickback," the arrangement quickly proved po­litically toxic.

. . .

Asked why he didn't offer the same deal to every state from the start, Reid said, "Because I didn't have it for everybody at that time. I thought I could get it as we moved along in the legisla­tion, and I did."

Van Susteren said: "You're telling me that when Ben Nelson got that, when the two of you sat down together, you said, 'Ben, we'll do it this way. ... Nebraska's got it now, but after we get this passed we're going to go for ev­erybody?' " "No, no, no. He got this for him­self. He wanted it," Reid said.

For the full story, see:

JOSEPH MORTON. "Reid thought Nelson should boast of 'kickback'; The Senate leader says it was a "terrific" Medicaid deal that all states now share." Omaha World-Herald (Weds., April 7, 2010): 5A.

(Note: first ellipsis added; second ellipsis in original.)

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(p. A10) As they constructed the requirement that Americans have health insurance, Democrats in Congress took pains to make their bill as constitutionally impregnable as possible.

But despite the health care law's elaborate scaffolding, attorneys general and governors from 20 states, all but one of them Republicans, have now joined as confident litigants in a bid to topple its central pillar. In the process, they hope to present the Supreme Court with a landmark opportunity to define the limits of federal authority, perhaps for generations.

In the seven weeks since the legislation passed, at least a dozen lawsuits have been filed in federal courts to challenge it, according to the Justice Department. But the case that could carry the most weight, and may be on the fastest track in the most advantageous venue, is the one filed in Pensacola, Fla., by state officials, just minutes after President Obama signed the bill.

Some legal scholars, including some who normally lean to the left, believe the states have identified the law's weak spot and devised a credible theory for eviscerating it.

The power of their argument lies in questioning whether Congress can regulate inactivity -- in this case by levying a tax penalty on those who do not obtain health insurance. If so, they ask, what would theoretically prevent the government from mandating all manner of acts in the national interest, say regular exercise or buying an American car?

. . .

Jonathan Turley, who teaches at George Washington University Law School, said that if forced to bet, he would predict that the courts would uphold the health care law. But Mr. Turley said that the federal government's case was far from open-and-shut, and that he found the arguments against the mandate compelling.

"There are few cases in the history of the court system that have a more significant assertion of authority by the government," said Mr. Turley, a civil libertarian who acknowledged being strange bedfellows with the conservative theorists behind the lawsuit. "This case, more than any other, may give the court sticker shock in terms of its impact on federalism."

For the full story, see:

KEVIN SACK. "Florida Suit Rated Best As Challenge to Care Law." The New York Times (Tues., May 11, 2010): A10 & A11.

(Note: the online version of the article is dated May 10, 2010 and has the slightly different title "Florida Suit Poses a Challenge to Health Care Law.")

(Note: ellipses added.)

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"Mice seem to reap cognitive benefits from cellphone electromagnetism." Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. D4) Alzheimer's and Cell Phones: Radiation associated with long-term cellphone use appears to protect against and reverse Alzheimer's-like symptoms in mice, according to a study in the Journal of Alzheimer's Disease. Mice genetically engineered to develop brain impairments similar to Alzheimer's in humans were divided into two groups. One group was exposed twice daily to hour-long electromagnetic fields akin to those created during cellphone use. Mice in the other group were not exposed to the radiation. After seven months, young mice in the first group fared significantly better on cognitive tests than their unexposed littermates. Older mice, which had already developed symptoms of Alzheimer's, exposed to the radiation for eight months in a subsequent experiment also performed better than older nonexposed mice. Mice, younger and older, not engineered to develop Alzheimer's also appeared to benefit from the radiation. Biopsies suggested such exposure might fight Alzheimer's by inhibiting the buildup of certain protein plaques in the brain, the researchers said.

For the full story, see:

JEREMY SINGER-VINE. "RESEARCH REPORT; NEW MEDICAL FINDINGS; Cellphone Radiation Aids Sick Mice." The Wall Street Journal (Tues., JANUARY 12, 2010): D4.

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(p. A21) The saddest fact of climate change--and the chief reason we should be concerned about finding a proper response--is that the countries it will hit hardest are already among the poorest and most long-suffering.

In the run-up to this month's global climate summit in Copenhagen, the Copenhagen Consensus Center dispatched researchers to the world's most likely global-warming hot spots. Their assignment: to ask locals to tell us their views about the problems they face. Over the past seven weeks, I recounted in these pages what they told us concerned them the most. In nearly every case, it wasn't global warming.

Everywhere we went we found people who spoke powerfully of the need to focus more attention on more immediate problems. In the Bauleni slum compound in Lusaka, Zambia, 27-year-old Samson Banda asked, "If I die from malaria tomorrow, why should I care about global warming?" In a camp for stateless Biharis in Bangladesh, 45-year-old Momota Begum said, "When my kids haven't got enough to eat, I don't think global warming will be an issue I will be thinking about." On the southeast slopes of Mt. Kilimanjaro in Tanzania, 45-year-old widow and HIV/AIDS sufferer Mary Thomas said she had noticed changes in the mountain's glaciers, but declared: "There is no need for ice on the mountain if there is no people around because of HIV/AIDS."

For the full commentary, see:

BJORN LOMBORG. "OPINION; Time for a Smarter Approach to Global Warming; Investing in energy R&D might work. Mandated emissions cuts won't.." The Wall Street Journal (Tues., DECEMBER 15, 2009): A21.

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"Scientists scanned 20 mummies, and examined scans of two more, for the study." Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. A5) ORLANDO, Fla. -- Researchers said they found evidence of hardening of the arteries in Egyptian mummies dating as far back as 3,500 years, challenging longstanding assumptions that cardiovascular disease is mainly a malady of modern societies.

A team of heart-imaging experts and Egyptologists examined 22 mummies from the Egyptian National Museum of Antiquities in Cairo in a CT scanning machine, looking for evidence of calcium buildup that could indicate vascular disease.

They were able to identify the hearts, arteries or both in 16 of the mummies, nine of whom had deposits of calcification. An analysis determined the deposits were either definite or probable evidence of atherosclerosis, the condition that leads to heart attacks and strokes.

"Not only do we have atherosclerosis now, it was prevalent as long as 3,500 years ago," said Gregory Thomas, a cardiologist and imaging specialist at University of California, Irvine, who was principal investigator of the study. "It is part of the human condition."

The research was presented Tuesday at the American Heart Association scientific meeting here. A report is also scheduled to appear in Wednesday's issue of the Journal of the American Medical Association.

For the full story, see:

RON WINSLOW. "Heart Disease Found in Egyptian Mummies." The Wall Street Journal (Weds., NOVEMBER 18, 2009): A5.

(Note: the online version of the article has a date of NOVEMBER 19, 2009 and is titled "Heart Disease Found in Egyptian Mummies.")

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(p. A17) In the West, campaigners for carbon regulations point out that global warming will increase the number of malaria victims. This is often used as an argument for drastic, immediate carbon cuts.

Warmer, wetter weather will improve conditions for the malaria parasite. Most estimates suggest that global warming will put 3% more of the Earth's population at risk of catching malaria by 2100. If we invest in the most efficient, global carbon cuts--designed to keep temperature rises under two degrees Celsius--we would spend a massive $40 trillion a year by 2100. In the best case scenario, we would reduce the at-risk population by only 3%.

In comparison, research commissioned by the Copenhagen Consensus Center shows that spending $3 billion annually on mosquito nets, environmentally safe indoor DDT sprays, and subsidies for effective new combination therapies could halve the number of those infected with malaria within one decade. For the money it takes to save one life with carbon cuts, smarter policies could save 78,000 lives. . . .

Malaria is only weakly related to temperature; it is strongly related to poverty. It has risen in sub-Saharan Africa over the past 20 years not because of global warming, but because of failing medical response.

For the full commentary, see:

BJORN LOMBORG. "Climate Change and Malaria in Africa; Limiting carbon emissions won't do much to stop disease in Zambia." The Wall Street Journal (Mon., NOVEMBER 2, 2009): A17.

(Note: ellipsis added.)

(Note: the online version of the article was dated Nov. 1st.)

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"The Reaper Curve: Ezekiel Emanuel used the above chart in a Lancet article to illustrate the ages on which health spending should be focused." Source of caption and graph: online version of the WSJ article quoted and cited below.

(p. A15) Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician's duty, insisting that it includes working for the greater good of society instead of focusing only on a patient's needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

. . .

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal--whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each--is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart nearby).

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

For the full commentary, see:

BETSY MCCAUGHEY. "Obama's Health Rationer-in-Chief; White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care." The Wall Street Journal (Thurs., August 27, 2009): A15.

(Note: first ellipsis added; second and third ellipses in original.)

The article that was the original source for the graph above, is:

Persad, Govind, Alan Wertheimer, and Ezekiel J. Emanuel. "Principles for Allocation of Scarce Medical Interventions." The Lancet 373, no. 9661 (Jan. 31, 2009): 423-31.

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Source of book image: http://bobsutton.typepad.com/.a/6a00d83451b75569e20120a5fa1e26970c-800wi.

(p. W8) Mr. Brown argues . . . emphatically for the close observation of users in their natural habitats. Traditional market-research tools--focus groups, surveys--rarely produce breakthrough findings, he claims. IDEO and others follow users around--making video recordings of them as they go about their routines, recording conversations with them--to build an understanding of what they really need. An IDEO employee in the health-care area, for instance, pretended to have a foot injury and checked himself into an emergency room with a hidden video camera to get a better view of the patient experience. This anthropological form of market research, Mr. Brown notes, has been adopted by companies such as Intel and Nokia.

For the full review, see:

DAVID A. PRICE. "The Shape of Things to Come; Design is more than aesthetics and ease of use. It's a way of doing business." The Wall Street Journal (Fri., OCTOBER 9, 2009): W8.

(Note: ellipsis added.)

Reference the book being reviewed:

Brown, Tim. Change by Design: How Design Thinking Transforms Organizations and Inspires Innovation. New York: HarperBusiness Publishers, 2009.

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(p. A21) Several years ago I grew concerned about my postmenopausal mother's risk of osteoporosis. I tried to convince her to initiate hormone replacement therapy. She didn't listen to me. Instead, she spoke with her gynecologist, who--contrary to best medical evidence at the time--recommended against such treatment. I would eventually be thankful my mother listened to the gynecologist who had known her for decades instead of me and the published medical reviews I was relying on. Some years later my mother was diagnosed with early breast cancer. Had she been on estrogen replacement, it is likely that her tumor would have progressed more rapidly. The gynecologist likely saved my mother's life.

Studies published in the medical literature are mostly produced by academics who face an imperative to publish or watch their careers perish. These academics aren't basing their careers on their clinical skills and experiences. Paradoxically, if we allow the academic literature to set guidelines for accepted practices, we are allowing those who are often academics first and clinicians second to determine what clinical care is appropriate.

Consciously or not, those who provide the peer review for medical journals are influenced by whether the work they are reviewing will impact their standing in the medical community. This is a dilemma. The experts who serve as reviewers compete with the work they are reviewing. Leaders in every community, therefore, exert disproportional influence on what gets published. We expect reviewers to be objective and free of conflicts, but in truth, only rarely is that the case.

Albert Einstein once noted that "a foolish faith in authority is the worst enemy of truth."

For the full commentary, see:

NORBERT GLEICHER. "'Expert Panels' Won't Improve Health Care; Government reliance on medical studies will make it harder to discard false prophecies and dogmas." The Wall Street Journal (Mon., October 19, 2009): A21.

(Note: the online version of the commentary is dated Sun., Oct. 18.)

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Whole Foods CEO John Mackey. Source of the caricature: online version of the WSJ interview quoted and cited below.

(p. A11) "I honestly don't know why the article became such a lightning rod," says John Mackey, CEO and founder of Whole Foods Market Inc., as he tries to explain the firestorm caused by his August op-ed on these pages opposing government-run health care.

. . .

. . . his now famous op-ed incited a boycott of Whole Foods by some of his left-wing customers. His piece advised that "the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us closer to a complete government takeover of our health-care system." Free-market groups retaliated with a "buy-cott," encouraging people to purchase more groceries at Whole Foods.

. . .

What Mr. Mackey is proposing is more or less what he has already implemented at his company--a plan that would allow more health savings accounts (HSAs), more low-premium, high-deductible plans, more incentives for wellness, and medical malpractice reform. None of these initiatives are in any of the Democratic bills winding their way through Congress. In fact, the Democrats want to kill HSAs and high-deductible plans and mandate coverage options that would inflate health insurance costs.

. . .

Mr. Mackey's latest crusade involves traveling to college campuses across the country, trying to persuade young people that business, profits and capitalism aren't forces of evil. He calls his concept "conscious capitalism."

What is that? "It means that business has the potential to have a deeper purpose. I mean, Whole Foods has a deeper purpose," he says, now sounding very much like a philosopher. "Most of the companies I most admire in the world I think have a deeper purpose." He continues, "I've met a lot of successful entrepreneurs. They all started their businesses not to maximize shareholder value or money but because they were pursuing a dream."

Mr. Mackey tells me he is trying to save capitalism: "I think that business has a noble purpose. It's not that there's anything wrong with making money. It's one of the important things that business contributes to society. But it's not the sole reason that businesses exist."

What does he mean by a "noble purpose"? "It means that just like every other profession, business serves society. They produce goods and services that make people's lives better. Doctors heal the sick. Teachers educate people. Architects design buildings. Lawyers promote justice. Whole Foods puts food on people's tables and we improve people's health."

Then he adds: "And we provide jobs. And we provide capital through profits that spur improvements in the world.

. . .

"I don't think anybody's too big to fail," he says. "If a business fails, what happens is, there are still assets, and those assets get reorganized. Either new management comes in or it's sold off to another business or it's bid on and the good assets are retained and the bad assets are eliminated. I believe in the dynamic creativity of capitalism, and it's self-correcting, if you just allow it to self-correct."

That's something Washington won't let happen these days, which helps explain why Mr. Mackey felt compelled to write that the Whole Foods health-insurance program is smarter and cheaper than the latest government proposals.

For the full interview, see:

STEPHEN MOORE. "The Conscience of a Capitalist; The Whole Foods founder talks about his Journal health-care op-ed that spawned a boycott, how he deals with unions, and why he thinks CEOs are overpaid." The Wall Street Journal (Sat., OCTOBER 3, 2009): A11.

(Note: ellipses added.)

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Source of photo: online version of the NYT article quoted and cited below.

(p. D1) It may be the ultimate free lunch -- how to reap all the advantages of a calorically restricted diet, including freedom from disease and an extended healthy life span, without eating one fewer calorie. Just take a drug that tricks the body into thinking it's on such a diet.

It sounds too good to be true, and maybe it is. Yet such drugs are now in clinical trials. Even if they should fail, as most candidate drugs do, their development represents a new optimism among research biologists that aging is not immutable, that the body has resources that can be mobilized into resisting disease and averting the adversities of old age.

This optimism, however, is not fully shared. Evolutionary biologists, the experts on the theory of aging, have strong reasons to suppose that human life span cannot be altered in any quick and easy way. But they have been confounded by experiments with small laboratory animals, like roundworms, fruit flies and mice. In all these species, the change of single genes has brought noticeable increases in life span.

With theorists' and their gloomy predictions cast in the shade, at least for the time being, experimental biologists are pushing confidently into the tangle of linkages that evolution has woven among food intake, fertility and life span. "My rule of thumb is to ignore the evolutionary biologists -- they're constantly telling you what you can't think," Gary Ruvkun of the Massachusetts General Hospital remarked this June after making an unusual discovery about longevity.

Excitement among researchers on aging has picked up in the last few years with the apparent convergence of two lines of inquiry: single gene changes and the diet known as caloric restriction.

. . .

In the view of evolutionary biologists, the life span of each species is adapted to the nature of its environment. Mice live at most a year in the wild because owls, cats and freezing to death are such frequent hazards. Mice with genes that allow longer life can rarely be favored by natural selection. Rather, the mice that leave the most progeny are those that devote resources to breeding at as early an age as possible.

According to this theory, if mice had wings and could escape their usual predators, natural selection ought to favor longer life. And indeed the maximum life span of bats is 3.5 times greater than flightless mammals of the same size, according to research by Gerald S. Wilkinson of the University of Maryland.

In this view, cells are so robust that they do not limit life span. Instead the problem, especially for longer-lived species, is to keep them under control lest they cause cancer. Cells have not blocked the evolution of extremely long life spans, like that of the bristlecone pine, which lives 5,000 years, or certain deep sea corals, whose age has been found to exceed 4,000 years.

Some species seem to be imperishable. A tiny freshwater animal known as a hydra can regenerate itself from almost any part of its body, apparently because it makes no distinction between its germ cells and its ordinary body cells. In people the germ cells, the egg and sperm, do not age; babies are born equally young, whatever the age of their parents. The genesis of aging was the division of labor in the first multicellular animals between the germ cells and the body cells.

That division put the role of maintaining the species on the germ cells and left the body cells free to become specialized, like neurons or skin cells. But in doing so the body cells made themselves disposable. The reason we die, in the view of Thomas Kirkwood, an expert on the theory of aging, is that constant effort is required to keep the body cells going. "This, in the long run, is unwarranted -- in terms of natural selection, there are more important things to do," he writes.

All that seems clear about life span is that it is not fixed. And if it is not fixed, there may indeed be ways to extend it.

For the full story, see:

NICHOLAS WADE. "Tests Begin on Drugs That May Slow Aging." The New York Times (Tues., August 18, 2009): D1 & D?.

(Note: ellipsis added.)

(Note: thanks to Luis Locay for calling my attention to the article quoted above.)

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"Michael Kellerman and daughter Jovi, 1, wait in line near 69th and Underwood for a flu shot Thursday morning." Source of caption and photo: online version of the Omaha World-Herald article quoted and cited below.

Thousands turned out this morning for Douglas County's first public clinic for H1N1 flu vaccinations.

The line ran out of the First United Methodist Church to the east, then down 69th Street before hooking west along Cass Street toward 72nd Street.

Police estimated that 4,000 people had gathered by 9:20 a.m.

Phil Rooney of the Douglas County Health Department said the turnout was no surprise.

"There hasn't been a clinic this size done in the county or in the surrounding counties recently, so we were prepared for a very large crowd, and that's what we've got," he said.

He said 252 people were vaccinated in the clinic's first hour. "The pace the first hour was slower than we wanted, so we're trying to pick that up," he added.

For the full story, see:

John Keenan and Rick Ruggles. "Long line for flu shots." Omaha World-Herald online edition (Thurs., Nov. 5, 2009).

(Note: as far as I can tell, having checked several online e-editions for Nov. 5 and Nov. 6, this version of the article was never published in any of the print editions of the paper.)

(Note: at some point the title of the online version of this article was changed to "Flu shot seekers turned away.")

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(p. 421) . . . , in 1928, Fred Griffith in Britain published a striking and puzzling finding. Earlier Griffith had discovered that all known types of pneumococci could exist with or without capsules. Virulent pneumococci had capsules; pneumococci without capsules could be easily destroyed by the immune system. Now he found something much stranger. He killed virulent pneumococci, ones surrounded by capsules, and injected them into mice. Since the bacteria were dead, all the mice survived. He also injected living pneumococci that had no capsules, that were not virulent. Again the mice lived. Their immune systems devoured the unencapsulated pneumococci. But then he injected dead pneumococci surrounded by capsules and living pneumococci without capsules.

The mice died. Somehow the living pneumococci had acquired cap-(p. 422)sules. Somehow they had changed. And, when isolated from the mice, they continued to grow with the capsule--as if they had inherited it.

Griffith's report seemed to make meaningless years of Avery's work-- and life. The immune system was based on specificity. Avery believed that the capsule was key to that specificity. But if the pneumococcus could change, that seemed to undermine everything Avery believed and thought he had proved. For months he dismissed Griffith's work as unsound. But Avery's despair seemed overwhelming. He left the laboratory for six months, suffering from Graves' disease, a disease likely related to stress. By the time he returned, Michael Dawson, a junior colleague he had asked to check Griffith's results, had confirmed them. Avery had to accept them.

His work now turned in a different direction. He had to understand how one kind of pneumococcus was transformed into another. He was now almost sixty years old. Thomas Huxley said, "A man of science past sixty does more harm than good." But now, more than ever, Avery focused on his task.

Source:

Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Revised ed. New York: Penguin Books, 2005.

(Note: ellipsis added.)

(Note: italics in original.)

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Nobel Prize winning economist Vernon Smith sees that the current health care system is an incentive and information "nightmare." The third parties, who pay, have neither the incentive nor the information to reward the providers who do a good job. And patients, who have the information, do not have the power or incentives to reward those who do a good job. And since providers are not being rewarded for doing a good job, they will only avoid becoming cynical bureaucrats as long as they are mission-driven saints.

A better system, that goes a long way toward Smith's "solution," has been suggested by Susan Feigenbaum, who suggests that third parties provide payments directly to patients, who then may choose what services to buy from which providers.

Here is the core of Smith's analysis:

(p. A11) The health-care provider, A, is in the position of recommending to the patient, B, what B should buy from A. A third party--the insurance company or the government--is paying A for it.

This structure defines an incentive nightmare.

. . .

I don't know whether this problem has a solution. If it does, I think it requires us to find mechanisms whereby third-party payment is made to the patient, B, who in turn pays A, supplemented with any co-payment from B for services. Hence, from the moment B seeks services from A both know who is going to be paying A for what is delivered. A and B each has need for what the other brings to the table, and this structure carries the potential for nurturing the relationship between A and B. B is empowered to become better informed about the services recommended by various A's that he might choose among, and the A's might find it particularly important to build good reputations with B's.

For the full commentary, see:

VERNON L. SMITH. "The ABC Dilemma of Health Reform; Third-party payment creates a big incentive problem." The Wall Street Journal (Sat., OCTOBER 16, 2009): A11.

(Note: ellipsis added.)

Feigenbaum's prescient suggestion for reform can be found in:

Feigenbaum, Susan. "Body Shop' Economics: What's Good for Our Cars May Be Good for Our Health." Regulation 15, no. 4 (Fall 1992): 26-27.

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"AGE WELL. David Sinclair, left, and Christoph Westphal, co-founders of Sitris Pharmaceuticals, in Dr. Sinclair's laboratory in Cambrdge, Mass. The company develops drugs that mimic resveratrol, a chemical found in some red wines." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. D4) BOSTON -- Who would have thought it? The quest for eternal life, or at least prolonged youthfulness, has now migrated from the outer fringes of alternative medicine to the halls of Harvard Medical School.

At a conference on aging held here last week, the medical school's dean, Jeffrey Flier, was to be seen greeting participants who ranged from members of the 120 club (they intend to live at least that long) to devotees of very low calorie diets.

. . .

Dr. Gallagher said that unpublished tests in mice showed that another chemical mimic, SRT-1720, increased both health and lifespan; after two years, twice as many mice taking the drug were alive compared with the undosed animals. Resveratrol itself has not been shown to increase lifespan in normal mice, although it does so in obese mice, laboratory roundworms and flies.

Sirtris has so far been doubly fortunate. No severe side effects have yet emerged from the clinical trials. The company has also been lucky in having apparently picked the right horse, or at least a good one, in a fast-developing field.

Besides the sirtuins, several other proteins are now known to influence longevity, energy use and the response to caloric restriction. These include the receptors for insulin and for another hormone called IGF-1, and a protein of increasing interest called TOR ("target of rapamycin"). Rapamycin is an antimicrobial that was recently found to extend lifespan significantly, even when given to mice at an advanced age. Since TOR is involved in the response to caloric restriction, rapamycin may extend life through this pathway.

. . .

"In five or six or seven years," said Christoph Westphal, Sirtris's other co-founder, "there will be drugs that prolong longevity."

But neither Dr. Sinclair nor Dr. Westphal was the most optimistic person at the conference. That status belonged to the English gerontologist Aubrey de Grey, who sports a beard so luxuriant that it is hard to see if he is wearing a tie. His goal is "negligible senescence."

. . .

Sirtris's quest for longevity drugs is founded on solid and promising research. But most drugs fail at some stage during trials. So there is no guarantee that any of Sirtris's candidate compounds will work in people. The first result from a Phase 2 clinical trial is not expected until the end of next year at the earliest.

Meanwhile, it is a pleasant and not wholly unfounded thought that, just possibly, a single drug might combat every degenerative disease of Western civilization.

For the full story, see:

NICHOLAS WADE. "Quest for a Long Life Gains Scientific Respect." The New York Times (Tues., September 28, 2009): D4.

(Note: ellipses added.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

I found the passage quoted below to be especially illuminating on how rapid mutation helps explain why the flu virus is so successful and dangerous. (An additional important factor is that the virus can survive in birds, without killing them.)

It occurs to me that something akin to rapid mutation (e.g., rapid experimentation) has also been advocated as a way to quickly advance science (Karl Popper), or enterprise (George Gilder).

(p. 105) Whenever an organism reproduces, its genes try to make exact copies of themselves. But sometimes mistakes--mutations--occur in this process.

This is true whether the genes belong to people, plants, or viruses. The more advanced the organism, however, the more mechanisms exist to prevent mutations. A person mutates at a much slower rate than bacteria, bacteria mutates at a much slower rate than a virus--and a DNA virus mutates at a much slower rate than an RNA virus.

DNA has a kind of built-in proofreading mechanism to cut down on copying mistakes. RNA has no proofreading mechanism whatsoever, no way to protect against mutation. So viruses that use RNA to carry their genetic information mutate much faster--from 10,000 to 1 million times faster--than any DNA virus.

Different RNA viruses mutate at different rates as well. A few mutate so rapidly that virologists consider them not so much a population of copies of the same virus as what they call a "quasi species" or a "mutant swarm."

These mutant swarms contain trillions and trillions of closely related but different viruses. Even the viruses produced from a single cell will include many different versions of themselves, and the swarm as a whole will routinely contain almost every possible permutation of its genetic code.

Most of these mutations interfere with the functioning of the virus and will either destroy the virus outright or destroy its ability to infect. But other mutations, sometimes in a single base, a single letter, in its genetic code will allow the virus to adapt rapidly to a new situation. It is this adaptability that explains why these quasi species, these mutant swarms, can move rapidly back and forth between different environments and also develop extraordinarily rapid drug resistance. As one investigator has observed, the rapid mutation "confers a certain randomness to the disease processes that accompany RNA [viral] infections."

Influenza is an RNA virus. So is HIV and the coronavirus. And of all RNA viruses, influenza and HIV are among those that mutate the fastest. The influenza virus mutates so fast that 99 percent of the 100,000 to 1 million new viruses that burst out of a cell in the reproduction process (p. 106) are too defective to infect another cell and reproduce again. But that still leaves between 1,000 and 10,000 viruses that can infect another cell.

Both influenza and HIV fit the concept of a quasi species, of a mutant swarm. In both, a drug-resistant mutation can emerge within days. And the influenza virus reproduces rapidly--far faster than HIV. Therefore it adapts rapidly as well, often too rapidly for the immune system to respond.

Source:

Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Revised ed. New York: Penguin Books, 2005.

(Note: italics in original.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

Here is the core of John Barry's account of how President Woodrow Wilson, and his administration, turned what might have been an ordinary flu, into what, by some measures, was the worst pandemic in human history:

(p. 396) . . . , whoever held power, whether a city government or some private gathering of the locals, they generally failed to keep the community together. They failed because they lost trust. They lost trust because they lied. (San Francisco was a rare exception; its leaders told the truth, and the city responded heroically.) And they lied for the war effort, for the propaganda machine that Wilson had created.

It is impossible to quantify how many deaths the lies caused. It is impossible to quantify how many young men died because the army refused to follow the advice of its own surgeon general. But while those in authority were reassuring people that this was influenza, only influenza, nothing different from ordinary "la grippe,' at least some people must have believed them, at least some people must have exposed themselves to the virus in ways they would not have otherwise, and at least some of these people must have died who would otherwise have lived. And fear really did kill people. It killed them because those who feared would not care for many of those who needed but could not find care, those who needed only hydration, food, and rest to survive.

Source:

Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Revised ed. New York: Penguin Books, 2005.

(Note: ellipsis added.)

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"Amir Jahan found her health insurance wouldn't pay for all of her $200 stomach surgery; she continues to work with an untreated tumor." Source of caption: print version of the WSJ article quoted and cited below. Source of photo: online version of the WSJ article quoted and cited below.

(p. A14) PANIPAT, India -- Amir Jahan can spin thick, white thread into magnificent cloth, but the 46-year-old weaver has been unable to unravel her health plan to pay for stomach surgery.

Under a health-insurance program introduced a few years ago, the Indian government has provided health-insurance coverage for the country's hand-loom weavers, a group of 6.5 million workers, 60% of them female, who are mostly illiterate and invariably poor. Yet holding an insurance card hasn't helped Ms. Jahan, who says the coverage only pays for minor ailments and not for major problems, such as the removal of a stomach tumor.

"The health care is all a sham," Ms. Jahan says angrily. "I was refused treatment on grounds of huge expense. I won't ever go to be humiliated again."

Ms. Jahan's health-care issues represent the problems that come with trying to provide insurance to India's poor. Access to quality care remains a distant dream for many in this country of 1.1 billion.

Last year, the Indian government launched the National Health Insurance Program on (sic) promised health coverage of $700 per person for families earning less than $100 a year.

Holders of health cards have to register in their home states to access benefits, thereby precluding a large population of migrant laborers. Those who can get past the complex state-identification and qualification process often can't cope with hospital bureaucracies.

For the full story, see:

VIBHUTI AGARWAL. "Indian Weavers Shun Health Plan." The Wall Street Journal (Sat., Sept., 2009): A14.

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

Source of book image: http://www.virology.ws/wp-content/uploads/2009/08/great-influenza.jpg

I like John Barry's The Great Influenza very much, although not entirely for the reasons that I had expected to like it. I wanted to learn more of the details of the worst flu pandemic in history, and the book delivers those details.

But I had not expected that there would be substantial discussion of the epistemology of science and medicine, and of the political and global context that preceded and affected the 1918 H1N1 influenza pandemic.

As an added bonus, the book gives substantial coverage to the life and work of one of my heroes, Oswald Avery. As a result of his research related to the pandemic, he discovered that DNA was the genetic material---a huge milestone in the history of medicine. But he never received the Nobel Prize because the Nobel Committee didn't want to be seen endorsing controversial work that had not stood the test of time.

On the other hand, the Nobel Committee had no such compunctions about giving the Nobel Peace Prize to President Woodrow Wilson. Barry's book indicts Wilson for having major responsibility for the severity of the pandemic. His administration drafted huge numbers of young men to fight in WWI, bringing them into close contact in shoddy, incomplete training camps. Some of these young men already had the flu, and they quickly spread it to many of their fellow soldiers. The Wilson administration continued to move these soldiers around the country and to Europe, vastly speeding the spread of the disease.

Barry also documents that the Wilson administration, in the name of patriotism and morale, punished those who told the truth about the severity of the pandemic. The results extended far beyond the trampling of civil liberties. For example, there was a huge parade in Philadelphia to sell war bonds, a parade that could easily have been canceled, but was not---igniting the rapid spread of the disease in that hard-hit city. If the newspapers had been allowed to print the truth about the pandemic, then there probably would have been sufficient outcry to cancel the parade; or at the very least, many better-informed citizens would have avoided the parade, and saved their lives, and the lives of their family members.

There is also a lot in book about the biology of the disease that is of interest, and about the suffering of those who experienced it.

But what I found eye-opening was the extent to which the severity of the disease was due to avoidable actions by Woodrow Wilson and his administration.

Source of book discussed above:

Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Revised ed: New York: Penguin Books, 2005.

For another eye-opening account about Woodrow Wilson and WWI, see:

Raico, Ralph. The Spanish-American War and World War I, Parts 1 & 2: Knowledge Products, 2006.

For a neat little paper on Oswald Avery, see:

Diamond, Arthur M., Jr. "Avery's 'Neurotic Reluctance'." Perspectives in Biology and Medicine 26, no. 1 (Autumn 1982): 132-36.

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"A nurse practitioner with a patient at a retail clinic in Wilmington, Del." Source of caption and photo: online version of the WSJ article quoted and cited below.

Clayton Christensen, in a chapter of Seeing What's Next, and at greater length in The Innovator's Prescription, has persuasively advocated the evolution of nurse practitioners and retail health clinics as disruptive innovations that have the potential to improve the quality and reduce the costs of health care.

An obstacle to the realization of Christensen's vision would be government regulation demanded by health care incumbents who would rather not have to compete with nurse practitioners and retail health clinics. See below for more:

(p. B1) Retail health clinics are adding treatments for chronic diseases such as asthma to their repertoire, hoping to find steadier revenue, but putting the clinics into greater competition with doctors' groups and hospitals.

Walgreen Co.'s Take Care retail clinic recently started a pilot program in Tampa and Orlando offering injected and infused drugs for asthma and osteoporosis to Medicare patients. At some MinuteClinics run by CVS Caremark Corp., nurse practitioners now counsel teenagers about acne, recommend over-the-counter products and sometimes prescribe antibiotics.

. . .

As part of their efforts to halt losses at the clinics, the chains are lobbying for more insurance coverage, and angling for a place in pending health-care reform legislation, while trying to temper calls for regulations.

. . .

(p. B2) But such moves are raising the ire of physicians' groups that see the in-store clinics as inappropriate venues for treating complex illnesses. In May, the Massachusetts Medical Society urged its members to press insurance companies on co-payments to eliminate any financial incentive to use retail clinics.

. . .

The clinics are helping alter the practice of medicine. Doctors are expanding office hours to evenings and weekends. Hospitals are opening more urgent-care centers to treat relatively minor health problems.

For the full story, see:

AMY MERRICK. "Retail Health Clinics Move to Treat Complex Illnesses, Rankling Doctors." The Wall Street Journal (Thurs., SEPTEMBER 10, 2009): B1-B2.

(Note: ellipses added.)

A brief commentary by Christensen (and Hwang) on these issues, can be found at:

CLAYTON CHRISTENSEN and JASON HWANG. "How CEOs Can Help Fix Health Care." The New York Times (Tues., July 28, 2009).

For the full account, see:

Christensen, Clayton M., Jerome H. Grossman, and Jason Hwang. The Innovator's Prescription: A Disruptive Solution for Health Care. New York: NY: McGraw-Hill, 2008.

Source of graph: online version of the WSJ article quoted and cited above.

Posted by Art Diamond at 1:01 AM | Permalink | Comments (1)

(p. A13) How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don't have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money.

More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state?

For the full commentary, see:

JOHN H. COCHRANE . "What to Do About Pre-existing Conditions; Most Americans worry about health coverage if they lose their job and get sick. There is a market solution." The Wall Street Journal (Fri., AUGUST 14, 2009): A13.

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

(p. A13) Consider someone rushed into an emergency room in severe cardiac distress. After starting acute life-support measures, doctors still apply the rule stated by Galen of Pergamum more than 1,800 years ago: primum non nocere, or "First, do no harm." Treatment interventions are selected carefully from a battery of technologies and potent drugs while recognizing that any one of them, or a combination, could hurt the patient if misapplied or given in the wrong dosage. Economic interventions require no less care.

. . .

Our economic doctors should permit America's uniquely effective immune system to take over as companies and financial institutions deleverage their balance sheets. With people and with capitalism, the tincture of time is often the best medicine.

For the full commentary, see:

MICHAEL MILKEN and JONATHAN SIMONS. "Illness as Economic Metaphor; The first rule, as always, is do no harm.." The Wall Street Journal (Sat., June 20, 2009): A13.

(Note: italics in original; ellipsis added.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

(p. 6) Founded in 1948 during the grim postwar era, the National Health Service is essential to Britain's identity. But Britons grouse about it, almost as a national sport. Among their complaints: it rations treatment; it forces people to wait for care; it favors the young over the old; its dental service is rudimentary at best; its hospitals are crawling with drug-resistant superbugs.

All these things are true, sometimes, up to a point.

. . .

Told my husband needed a sophisticated blood test from a particular doctor, I telephoned her office, only to be told there was a four-month wait.

"But I'm a private patient," I said.

"Then we can see you tomorrow," the secretary said.

And so it went. When it came time for my husband to undergo physical rehabilitation, I went to look at the facility offered by the N.H.S. The treatment was first rate, I was told, but the building was dismal: grim, dusty, hot, understaffed, housing 8 to 10 elderly men per ward. The food was inedible. The place reeked of desperation and despair.

Then I toured the other option, a private rehabilitation hospital with air-conditioned rooms, private bathrooms and cable televisions, a state-of-the-art gym, passably tasty food and cheery nurses who made a cup of cocoa for my husband every night before bed.

For the full commentary, see:

SARAH LYALL. "An Expat Goes for a Checkup." The New York Times, Week in Review Section (Sun., August 8, 2009): 1 & 6.

(Note: the online title is "Health Care in Britain: Expat Goes for a Checkup.")

(Note: ellipsis added.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

(p. A11) Native Americans have received federally funded health care for decades. A series of treaties, court cases and acts passed by Congress requires that the government provide low-cost and, in many cases, free care to American Indians. The Indian Health Service (IHS) is charged with delivering that care.

The IHS attempts to provide health care to American Indians and Alaska Natives in one of two ways. It runs 48 hospitals and 230 clinics for which it hires doctors, nurses, and staff and decides what services will be provided. Or it contracts with tribes under the Indian Self-Determination and Education Assistance Act passed in 1975. In this case, the IHS provides funding for the tribe, which delivers health care to tribal members and makes its own decisions about what services to provide.

. . .

Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole.

. . .

Personal stories from people within the system reveal the human side of these statistics. In 2005, Ta'Shon Rain Little Light, a 5-year-old member of the Crow tribe who loved to dress in traditional clothes, stopped eating and complained that her stomach hurt. When her mother took her to the IHS clinic in south central Montana, doctors dismissed her pain as depression. They didn't perform the tests that might have revealed the terminal cancer that was discovered several months later when Ta'Shon was flown to a children's hospital in Denver. "Maybe it would have been treatable" had the cancer been discovered sooner, her great-aunt Ada White told the Associated Press.

. . .

The Chippewa Cree Band runs its own hospital and has hired a registered dietician who has gotten the local grocery store to implement a shelf-labeling system to improve consumer nutritional information. They've also built a Wellness Center with a gym, track, basketball court, and pool. These are small steps that won't immediately eliminate heart disease or diabetes. But they move in the direction of local control and better health.

At a time when Americans are debating whether to give the government in Washington more control over their health care, some of the nation's first inhabitants are moving in the opposite direction.

For the full commentary, see:

TERRY ANDERSON. "OPINION: CROSS COUNTRY; Native Americans and the Public Option; After decades of government-run care, some Indians are finally saying enough." Wall Street Journal (Sat., August 29, 2009): A11.

(Note: ellipses added.)

(Note: the online version is dated Fri., Aug.28, 2009)

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"No, I mean it," said Ms. Brigugulio, "I expect you to keep your word on this." Source of the photo and caption: http://boss.blogs.nytimes.com/2009/07/30/mr-prez-meets-ms-biz-the-story-behind-the-photo/

(p. A11) Patty Briguglio thinks President Obama may have a public relations problem selling his health care plan to small-business owners.

And Ms. Briguglio, who was photographed exchanging a wagging finger with the president at his health care forum Wednesday in Raleigh, N.C., should know: she runs her own small business, MMI Associates, a public relations firm in Raleigh.

Ms. Briguglio pays much of the cost of health insurance for her firm's 19 employees, though she does not offer a group plan. Because the members of her staff are so young, it is cheaper simply to provide an allowance for them to buy individual policies.

When Mr. Obama called on Ms. Briguglio at Wednesday's forum, she asked, ''What current long-term social program created and run by the government should we look to as a model of success and one that we as taxpayers should be confident that a new government-run health care system would be better than the current system in place?''

The president suggested Veterans Affairs hospitals and Medicare, both of which, he said, ''have very high satisfaction rates.''

And, he added, ''Medicare costs have gone up more slowly than private-sector health care costs.''

Ms. Briguglio was not completely satisfied. ''I've never associated any government program with 'cost effective' or 'efficient,' '' she said in a telephone interview on Thursday. ''I don't believe that the government will be a better steward of the money that I set aside for health care for my employees than I will be.''

For the full story, see:

ROBB MANDELBAUM. "To Challenges For Obama, Add Another." The New York Times (Fri., July 31, 2009): A11.

(Note: the online version of the article does not have the photo of Briguglio wagging her finger, that was published in my print version of the paper. The photo above is from later in the exchange, and appeared on the NYT blog.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

Thomas Szaz has been defending liberty for many decades. It is good to see him still eloquently at it:

(p. A13) If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.

For the full commentary, see:

THOMAS SZASZ. "Universal Health Care Isn't Worth Our Freedom." Wall Street Journal (Weds., JULY 15, 2009): A13.

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"Rhesus monkeys, 27-year-old Canto, left, and Owen, 29, are among the oldest surviving subjects in a study of the links between diet and aging." Source of photo and caption: online version of the WSJ article quoted and cited below.

(p. A3) A study published Wednesday found that rapamycin, a drug used in organ transplants, increased the life span of mice by 9% to 14%, the first definitive case in which a chemical has been shown to extend the life span of normal mammals.

Anti-aging researchers also expect a second study, to be released this week, will show that sharply cutting the calorie intake of monkeys extends their lives substantially. The experiment is said to be the first technique shown to retard aging in primates.

The prospect of a reliable human longevity pill is still distant. A commentary released with the rapamycin study strongly cautioned against taking the drug to prolong life because of potentially deadly side effects. Rapamycin suppresses the immune system and carries strong warnings about the resulting risk of infections and death.

But the mouse and monkey findings appear to mark the most substantial scientific progress yet in the search for ways to extend human life spans -- once viewed as a fringe area of study.

"It's time to break out of our denial about aging," said Aubrey de Grey, a British gerontologist who has drawn controversy for his suggestions on how to forestall death. "Aging is, unequivocally, the major cause of death in the industrialized world and a perfectly legitimate target of medical intervention."

For the full story, see:

KEITH J. WINSTEIN. ""Two Mammals' Longevity Boosted; Transplant Drug Lengthens Lives of Mice, and Fewer Calories Benefit Monkeys." The Wall Street Journal (Thurs., JULY 10, 2009): A3.

Source of graphic: online version of the WSJ article quoted and cited above.

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

(p. A19) Is free-range pork better and safer to eat than conventional pork? Many consumers think so. The well-publicized horrors of intensive pig farming have fostered the widespread assumption that, as one purveyor of free-range meats put it, "the health benefits are indisputable." However, as yet another reminder that culinary wisdom is never conventional, scientists have found that free-range pork can be more likely than caged pork to carry dangerous bacteria and parasites. It's not only pistachios and 50-pound tubs of peanut paste that have been infected with salmonella but also 500-pound pigs allowed to root and to roam pastures happily before butting heads with a bolt gun.

The study published in the journal Foodborne Pathogens and Disease that brought these findings to light last year sampled more than 600 pigs in North Carolina, Ohio and Wisconsin. The study, financed by the National Pork Board, discovered not only higher rates of salmonella in free-range pigs (54 percent versus 39 percent) but also greater levels of the pathogen toxoplasma (6.8 percent versus 1.1 percent) and, most alarming, two free-range pigs that carried the parasite trichina (as opposed to zero for confined pigs). For many years, the pork industry has been assuring cooks that a little pink in the pork is fine. Trichinosis, which can be deadly, was assumed to be history.

. . .

Let's not forget that animal domestication has not been only about profit. It's also been about making meat more reliably available, safer to eat and consistently flavored. The critique of conventional animal farming that pervades food discussions today is right on the mark. But it should acknowledge that raising animals indoors, fighting their diseases with medicine and feeding them a carefully monitored diet have long been basic tenets of animal husbandry that allowed a lot more people to eat a lot more pork without getting sick.

For the full commentary, see:

JAMES E. McWILLIAMS. "Free-Range Trichinosis." The New York Times (Fri., April 10, 2009): A19.

(Note: ellipsis added.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

Source of graphic: online version of the WSJ article quoted and cited below.

(p. B1) Big pharmaceutical companies have spent billions of dollars to buy other drug giants lately, leaving behind small biotech companies that can no longer find investors.

The biotech industry had thrived as a new-drug incubator for big pharma companies, which poured money into acquisitions and partnerships to build up their biotech-drug product line. Some of that is still happening, but most sources of investment funding have dried up in recent months.

Since November, 10 biotechs have declared bankruptcy, says Ellen Dadisman, a spokeswoman for the Biotechnology Industry Organization. Meanwhile, 120 of the 360 publicly traded biotechs have less than six months of cash left, compared with just 12 companies in that position a year ago, according to Burrill & Co., a venture-capital concern in San Francisco that follows the industry.

For the full story, see:

KEITH J. WINSTEIN. "Cash Dries Up for Biotech Drug Firms." Wall Street Journal (Mon., MARCH 16, 2009): B1.

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Source of photo: http://images.quickblogcast.com/82086-71861/pedicurex_large.jpg

(p. A1) Until Mr. Ho brought his skin-eating fish here from China last year, no salon in the U.S. had been publicly known to employ a live animal in the exfoliation of feet. The novelty factor was such that Mr. Ho became a minor celebrity. On "Good Morning America" in July, Diane Sawyer placed her feet in a tank supplied by Mr. Ho and compared the fish nibbles to "tiny little delicate kisses."

Since then, cosmetology regulators have taken a less flattering view, insisting fish pedicures are unsanitary. At least 14 states, including Texas and Florida, have outlawed them. Virginia doesn't see a problem. Ohio permitted fish pedicures after a review, and other states haven't yet made up their minds. The world of foot care, meanwhile, has been plunged into a piscine uproar. Salon owners who (p. A12) bought fish and tanks before the bans were imposed in their states are fuming.

The issue: cosmetology regulations generally mandate that tools need to be discarded or sanitized after each use. But epidermis-eating fish are too expensive to throw away. "And there's no way to sanitize them unless you bake them for 20 minutes at 350 degrees," says Lynda Elliott, an official with the New Hampshire Board of Barbering, Cosmetology and Esthetics. The board outlawed fish pedicures in November.

In Ohio, ophthalmologist Marilyn Huheey, who sits on the Ohio State Board of Cosmetology, decided to try it out for herself in a Columbus salon last fall. After watching the fish lazily munch on her skin, she recommended approval to the board. "It seemed to me it was very sanitary, not sterile of course," Dr. Huheey says. "Sanitation is what we've got to live with in this world, not sterility."

. . .

State bans have disrupted Mr. Ho's plans to build a nationwide franchise network. Currently, he has four active franchises, in Virginia, Delaware, Maryland and Missouri. But others have terminated franchise agreements. In Calhoun, Ga., Tran Lam, owner of Sky Nails, says she paid Mr. Ho $17,500 in exchange for fish and custom-made pedicure tanks. A few weeks later, in October, the Georgia Board of Cosmetology deemed fish pedicures illegal. "I'm very mad," says Ms. Lam. "I lost a lot of money and the economy is so bad."

For the full story, see:

JOHN SCHWARTZ. "Ban on Feet-Nibbling Fish Leaves Nail Salons on the Hook; Mr. Ho's Import From China Caught On, But Some State Pedicure Inspectors Object." Wall Street Journal (Mon., MARCH 23, 2009): A1 & A12.

(Note: ellipsis added.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

(p. A15) The Founders might have used quill pens, but they would roll their eyes at how, in this supposedly technology-minded era, we're undermining their intention to encourage innovation. The U.S. is stumbling in the transition from their Industrial Age to our Information Age, despite the charge in the Constitution that Congress "promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries."

. . .

Both sides may be right. New empirical research by Boston University law professors James Bessen and Michael Meurer, reported in their book, "Patent Failure," found that the value of pharmaceutical patents outweighed the costs of pharmaceutical-patent litigation. But for all other industries combined, they estimate that since the mid-1990s, the cost of U.S. patent litigation to alleged infringers ($12 billion in legal and business costs in 1999) is greater than the global profits that companies earn from patents (less than $4 billion in 1999). Since the 1980s, patent litigation has tripled and the probability that a particular patent is litigated within four years has more than doubled. Small inventors feel the brunt of the uncertainty costs, since bigger companies only pay for rights they think the system will protect.

These are shocking findings, but they point to the solution. New drugs require great specificity to earn a patent, whereas patents are often granted to broad, thus vague, innovations in software, communications and other technologies. Ironically, the aggregate value of these technology patents is then wiped out through litigation costs.

Our patent system for most innovations has become patently absurd. It's a disincentive at a time when we expect software and other technology companies to be the growth engine of the economy. Imagine how much more productive our information-driven economy would be if the patent system lived up to the intention of the Founders, by encouraging progress instead of suppressing it.

For the full commentary, see:

L. GORDON CROVITZ. "OPINION: INFORMATION AGE; Patent Gridlock Suppresses Innovation." Wall Street Journal (Mon., JULY 14, 2008): A15.

(Note: ellipsis added.)

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"JOSHUA THOMPSON with his sons, Wyatt and Jordan, after his diagnosis, top, and before, with his wife, Joy, and Wyatt." Source of the photos and caption: online version of the NYT article quoted and cited below.

(p. 1) VIRGINIA BEACH -- As Lou Gehrig's disease sapped Joshua Thompson of his ability to move and speak last fall, he consistently summoned one question from within the prison of his own body. "Iplex," he asked, in a whisper that pierced his mother's heart. "When?"

Iplex had never been tested in people with amyotrophic lateral sclerosis, the formal name for the fatal disease that had struck Joshua, 34, in late 2006. Developed for a different condition and banished from the market by a patent dispute, it was not for sale to the public anywhere in the world.

But Kathy Thompson had vowed to get it for her son. On the Internet, she had found enthusiastic reviews from A.L.S. patients who had finagled a prescription for Iplex when it was available, along with speculation by leading researchers as to why it might slow the progressive paralysis that marks the disease. And for months, as she begged and bullied biotechnology companies, members of Congress, Italian doctors and federal drug regulators, she answered Joshua the same way:

"Soon," she said. "Soon."

At a time when terminally ill patients have more access to medical research than ever before, and perhaps a deeper conviction in its ability to cure them, many are campaigning for the chance to be treated with drugs whose safety and effectiveness is not yet known.

. . .

(p. 19) "Josh's sadness is unbearable," his mother wrote one night in her journal, nearly a year after her son's diagnosis.

Unexpected encouragement came in a Mother's Day note from her ex-husband. "You have given me some peace of mind that all potential options for Josh are being researched and acted upon," Bruce wrote. "Thank you."

Kathy's boyfriend accompanied her to Insmed's headquarters in Richmond, Va., offering to raise several million dollars to underwrite a compassionate use program for Iplex in the United States with A.L.S. patients. But the couple came away with a new understanding: F.D.A. regulations, they were told, prohibit any company from profiting on compassionate use. Even if Insmed could wriggle free of restrictions in the patent agreement, there was little financial incentive for it to invest in making the drug solely for compassionate use by A.L.S. patients.

. . .

On Jan. 16, when Dr. Werwath called to tell her the application had been rejected, she stood up in disbelief.

"How could that be?" she asked, dazed.

Kathy's friend Mrs. Reimers had received a call with the same news.

"He said they had safety concerns," Mrs. Reimers said. "This for a drug that was approved for children!"

"Safety," Kathy repeated. "And what, exactly, is safe about A.L.S.?"

Appealing an F.D.A. Denial

Before the F.D.A.'s decision, Kathy had spared little thought for any broader meaning of her quest for Joshua. But when she met with Richard A. Samp, a lawyer with the Washington Legal Foundation a week later, her outrage went beyond her son, and beyond Iplex.

"The F.D.A. is supposed to protect American citizens," Kathy fumed over an iced tea in Williamsburg, Va. "How does denying dying patients access to this drug serve the common good?"

Mr. Samp had handled a lawsuit by a patient advocacy group, the Abigail Alliance, that had sought to establish a constitutional right for terminally ill patients to use experimental drugs. In the case, which the group had lost on appeal in 2007, the F.D.A. claimed that it granted "nearly all" requests for compassionate use.

They would first make an administrative appeal, Mr. Samp told Kathy, asserting that the F.D.A. had violated its own guidelines. If that failed, they could pursue litigation that might allow them to raise the constitutional question again in a federal court in Virginia.

. . .

Kathy was pouring milk for her cereal on the morning of March 10 when Dr. Werwath's number flashed on her phone. The F.D.A. had just reversed itself, he said.

Before she could take a breath, Senator Mark Warner's office called. E-mail bleeped in as the news seeped out.

In the weeks after the appeal, Kathy learned, the F.D.A. had reached out to Insmed. The agency had persuaded the company to run a clinical trial for Iplex with several dozen A.L.S. patients, and permitted it to recoup the hefty costs directly from participants. In the trial, some of the participants would get a placebo. That way, the F.D.A. wrote on its Web site, the next wave of A.L.S. patients would learn whether the drug was in fact beneficial or harmful.

But for now, the agency had ruled, Joshua and 12 other patients would be given Iplex outside of the trial, on a compassionate use basis, if they agreed to read all the data about the risks.

For the full version of a very long story, see:

AMY HARMON. "Months to Live; Fighting for a Last Chance at Life; One Family's Tenacious Campaign for Access to an Unproven Drug." The New York Times, First Section (Sun., May 17, 2009): 1, 18-19.

(Note: ellipses added.)

"IN MARCH, Joshua Thompson received his first Iplex injection, from Dr. David L. Werwath. Thereafter Joshua's wife, Joy, left, and mother, Kathy, took over the daily duties." Source of the photo and caption: online version of the NYT article quoted and cited above.

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

(p. A11) I think there are two major but not fully formed or fully articulated fears among thinking Americans right now, and the deliberate obscurity of official language only intensifies those fears.

The first is that Mr. Obama's government, in all its flurry of activism, may kill the goose that laid the golden egg. This is as dreadful and obvious a cliché as they come, but too bad, it's what people fear. They see the spending plans and tax plans, the regulation and reform hunger, the energy proposals and health-care ambitions, and they--we--wonder if the men and women doing all this, working in their separate and discrete areas, are being overseen by anyone saying, "By the way, don't kill the goose."

The goose of course is the big, messy, spirited, inspiring, and sometimes in some respects damaging but on the whole brilliant and productive wealth-generator known as the free-market capitalist system. People do want things cleaned up and needed regulations instituted, and they don't mind at all if the very wealthy are more heavily taxed, but they greatly fear a goose killing. Economic freedom in all its chaos and disorder has kept us rich for 200 years, and allowed us as a nation to be generous and strong at home and in the world. But the goose can be killed--by carelessness, hostility, incrementalism, paralysis, and by no one saying, "Don't kill the goose."

For the full commentary, see:

PEGGY NOONAN. "What's Elevated, Health-Care Provider? Economy of language would be good for the economy." Wall Street Journal (Sat., MAY 15, 2009): A11.

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In the final sentences quoted below, note the under-appreciated role of air conditioning, and electric light, in advancing medical education.

(p. W6) "Gray's Anatomy" is one of the most famous medical books of all time, but if a picture is worth a thousand words, then the man most responsible for the success of the book was its long-forgotten illustrator, Henry Vandyke Carter. In "The Making of Mr. Gray's Anatomy," Ruth Richardson shows how Carter and Henry Gray came together to produce a classic that originally bore neither of their names -- it was published as "Anatomy Descriptive and Surgical" -- but she also affords us a remarkable glimpse of science in the 19th century.

. . .

Not much of a paper record exists regarding Henry Gray's life. Ms. Richardson speculates that his possessions were burned in the "Victorian terror" stirred by smallpox, the disease that would kill him at age 34. Henry Carter kept a diary, but its contents are not exactly a trove of detail about his life and times. . . .

. . .

Describing their methods, Ms. Richardson reminds us of what we now take for granted in medicine by relating what wasn't feasible back then. The "dissecting season" was the colder months, January-March, to make the most of the cadavers' preservation. And the work day had to begin soon after dawn because sunlight was so much better for close observation than any other light source.

For the full review, see:

MARK F. TEAFORD. "Dissecting an Unheralded Alliance; A classic medical text bears one man's name, but it was the product of a true collaboration." Wall Street Journal (Fri., MARCH 27, 2009): W6.

(Note: ellipses added.)

The reference to the reviewed book is:

Richardson, Ruth. The Making of Mr. Gray's Anatomy. Oxford, UK: Oxford University Press.

Source of book cover image: online version of the WSJ review quoted and cited above.

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"Dante Hesse, . . . , of Milk Thistle Farm, thinks Greenmarket rules are too hard on dairies." Source of caption and photo: online version of the NYT article quoted and cited below. (Note: ellipsis in caption added.)

(p. D4) The basic aim of the producer-only rules is to ensure that all foods sold at market originate entirely or mostly on family farms within a half day's drive from New York City. The 10-page document detailing these rules, however, is anything but clear.

"Cumbersome, confusing and contradictory," was the assessment of Michael Hurwitz, the director of Greenmarket, which operates 45 markets in the five boroughs.

Pickle makers can sell preserved foods such as peppers in vinegar, but not processed foods such as hot sauce. Farmers, on the other hand, can sell processed hot sauce if it is made with their peppers. Dairies may purchase a higher percentage of their milk for cheese if the cheese is made from one type of milk rather than two milks, such as cow and sheep. Cider makers can buy 40 percent of the apples they press from local farmers, whereas wheatgrass juice sellers must grow all their wheatgrass.

For the full story, see:

INDRANI SEN. "Greenmarket Sellers Debate Maze of Producer-Only Rules." The New York Times (Weds., August 6, 2008): D4.

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"Charles Wolf with laptop and Archie, in his house near Denver last spring." Source of the caption and the photo: online version of the WSJ article quoted and cited below.

(p. C5) He was irked when a cancer recurrence last year required him to resume morning radiation treatments, partly because that took him away from the market. "What kills me more than anything else is that I'm not there for the market open," he said.

For the full obituary, see:

E.S. BROWNING. "Wolf Loses Battle With Cancer; Disease Didn't Affect His Investing Success; Model Patient." The Wall Street Journal (Thurs., JANUARY 29, 2009): C5.

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"Jonas Salk, right, inoculates his son against polio as his wife, left, looks on." Source of caption and photo: online version of the WSJ quoted and cited below.

(p. W9C) "The Polio Crusade" will stir many memories with its account of successful efforts to eradicate the disease whose fear factor, we're told, was second only to that of the atom bomb. (Monday 9-10 p.m. ET on PBS's "American Experience" series, but check local listings.) The documentary also tells less-familiar, and sometimes disturbing, stories about the birth of modern fund-raising techniques, and old testing techniques.

. . .

Since the virus is spread most effectively by mouth, or through contact with byproducts of the intestinal tract, the improved hygiene of the 20th century should have led to a decrease in polio infections. The opposite happened. First in Europe and then in America, a disease which had barely registered on the medical radar began to strike more and more people, culminating in a U.S. record of nearly 58,000 cases in 1952.

The explanation for this seemingly counterintuitive symbiosis between cleanliness and disease is astonishing, yet simple. In a germier age, newborns were likely to be exposed to the polio virus very early in life, when they still had immunity conferred by their mother in the womb. When improved hygiene pushed back the time of exposure to a later age, or even to adulthood, many people were by then defenseless.

For the full review, see:

NANCY DEWOLF SMITH. "TELEVISION; In a Time of Plague." The Wall Street Journal (Tues., JANUARY 30, 2009): W9C.

(Note: ellipsis added.)

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"Charles Yogi, 89, a track & field athlete, is part of the Hawaii Lifespan Study." Source of caption and photo: online version of the WSJ story quoted and cited below.

(p. A18) Based on animal experiments, gerontologists believe that one key to a healthy, longer lifespan may be found in a few master genes that affect cellular responses to famine, drought and other survival stresses. The more active these genes are, the longer an organism seems to survive -- at least in the laboratory. Moreover, researchers are convinced that some genes may protect us against the risks of heart disease, diabetes, cancer and dementia.

. . .

Recent insights into the genetics of aging among simple organisms are stoking their enthusiasm. In January, for example, gerontologist Valter Longo at the University of Southern California reported that by altering two genes he made yeast that lived 10 times longer than normal. "We can really reprogram the lifespan of these organisms," he said. In March, scientists at the University of Washington identified 15 genes regulating lifespan in yeast and worms that resemble genes found in humans. At least three companies are working independently on potential therapies based on the discovery that life span in mammals may be regulated partly by genetically controlled enzymes called sirtuins.

For the full story, see:

ROBERT LEE HOTZ. "Secrets of the 'Wellderly'; Scientists Hope to Crack the Genetic Code of Those Who Live the Longest." The Wall Street Journal (Fri., SEPTEMBER 19, 2008): A18.

(Note: ellipsis added.)

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Source of image: online version of the WSJ article quoted and cited below.

(p. A17) In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.

Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.

Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

. . .

Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.

For the full commentary, see:

NADEEM ESMAIL. "'Too Old' for Hip Surgery." Wall Street Journal (Mon., February 9, 2009): A17.

(Note: ellipsis added.)

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Source of book image: http://images.barnesandnoble.com/images/34000000/34009038.jpg

Christensen's new book hit the shelves in December 2008. His ideas on health care are promising, if the special interests don't get in the way. (I have not yet read the new book, but have read earlier versions of his proposals on how disruptive innovations can improve health care.)

(p. R2) BUSINESS INSIGHT: Your coming book, "The Innovator's Prescription," takes a look at health care. How likely do you think it is we'll see substantial innovation in the structure of the U.S. health-care system?

DR. CHRISTENSEN: Well, one great benefit of the current economic crisis is that it will create pressure to find a real solution to the health-care problem. Right now, emergencies exist at companies like General Motors, which has got to drive the cost of its health care down. Every city and town in America would be bankrupt if they kept their books the way private-sector companies keep their books -- because of the obligation cities and towns have taken upon themselves to provide health care for their retirees.

And so we really are in an emergency where it's likely that employers and health-care providers are open to completely rethinking some of the basic assumptions that made innovation seem impossible. What we're hoping with this book is that we can just bring a way to frame the problem that can help people reach consensus around a course of action that otherwise, at another time, would have seemed quite counterintuitive.

For the full interview, see:

Martha E. Mangelsdorf, interviewer. "Executive Briefing; How Hard Times Can Drive Innovation." Wall Street Journal (Mon., DECEMBER 15, 2008): R2.

(Note: ellipses added.)

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In the passage quoted below, Hager discusses the reception that Leeuwenhoeck received to his first report of the "animalcules" seen under his microscope:

(p. 42) He hired a local artist to draw what he saw and sent his findings to the greatest scientific body of the day, the Royal Society of London.

(p. 43) Van Leeuwenhoek's raising of the curtain on a new world was greeted with what might kindly be called a degree of skepticism. Three centuries later a twentieth-century wit wrote a lampoon of what the Royal Society's secretary might well have responded:

Dear Mr. Anthony van Leeuwenhoek,

Your letter of October 10th has been received here with amusement. Your account of myriad "little animals" seen swimming in rainwater, with the aid of your so-called "microscope," caused the members of the society considerable merriment when read at our most recent meeting. Your novel descriptions of the sundry anatomies and occupations of these invisible creatures led one member to imagine that your "rainwater" might have contained an ample portion of distilled spirits---imbibed by the investigator. Another member raised a glass of clear water and exclaimed, "Behold, the Africk of Leeuwenhoek." For myself, I withhold judgement as to the sobriety of your observations and the veracity of your instrument. However, a vote having been taken among the members---accompanied, I regret to inform you, by considerable giggling---it has been decided not to publish your communication in the Proceedings of this esteemed society. However, all here wish your "little animals" health, prodigality and good husbandry by their ingenious "discoverer."

The satire was not far from the truth. Although very interested in the Dutchman's discoveries, so many English scientists were doubtful about his reports that van Leeuwenhoek had to enlist an English vicar and several jurists to attest to his findings. Then Hooke himself confirmed them. All doubt was dispelled.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

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One might expect that the Sudanese medicine men mentioned below, might have undermined the British physicians, as potential competition. So either there is more to the story than is sketched below, or else these Sudanese medicine men in 1939 placed the mission of saving lives, above their own narrow short-run self-interest. If it was the later, then they deserve our belated salute.

(p. 236) Meningitis was a vicious disease. The death rate had always been high, and nothing they did had much effect. The British physicians concentrated on nursing the sick and trying to limit the spread of the disease. The only thing different this year came in the form of three small sample bottles of sulfa that had been sent to their clinic for the treatment of strep diseases and pneumonia. Strep diseases were not the problem of the moment in Wau. This meningitis was caused not by strep but by the more common cause, a related germ called meningococcus. Still, they had the new medicine, they had nothing else, and they had nothing to lose. Someone decided to try it on a meningitis patient.

. . .

(p. 237) . . . There were twenty-one patients in the first group. The doctors hoped to save at least a few of them.

A few days later, all but one were still alive. The physicians immediately wired for more sulfa. Once it arrived, one of the British doctors stayed at the hospital while the other two went village to village, administering sulfa to every meningitis patient they could find. They asked the help of local "medicine men," as they called them, tribal healers whose dispensation was needed before the natives would accept treatment. The Sudanese healers knew how deadly the disease was. They told their people that the physicians had "magic in a bottle." They told them to take the shots. The physicians traveled day and night, injecting patients in grass huts, under trees, and along roadsides, The results, they wrote, were "spectacular." Within a few weeks, they treated more than four hundred patients. They saved more than 90 percent of them. They knocked out the epidemic before it could get started.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

(Note: ellipses added.)

Posted by Art Diamond at 1:01 AM | Permalink | Comments (0)

When new uses of old, unpatentable drugs are discovered, there seems to be inadequate incentive to publicize them, and bring them to market. (For example, I think I have seen research suggesting that aspirin and fish oil capsules, are as effective in fighting heart disease as some newer drugs, but are nonoptimally utilized because of perverse incentives.) Maybe a revision of the patent law should be considered that permits some patenting of new uses of old drugs and substances?

(p. 172) It was wonderful that this powerful, inexpensive medicine was now available, but for a year after the Pasteur Institute announcement, no one marketed it seriously in its pure form as a medicine. Because it was not patentable, it was difficult for major chemical or drug firms to see a way to make much of a profit from it. It was not until months after the Pasteur group's first publication on sulfa that the president of Rhône-Poulenc, an industrial supporter of Fourneau's laboratory, visited the Pasteur Institute to hear about it. After talking with the researchers he decided to launch Septazine, a variation on pure sulfa that he felt was different enough to allow patenting---and hence profits. Septazine reached the marketplace in May 1936.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

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The existence and details of patent laws can matter for creating incentives for invention and innovation. The patent laws in Germany and France in the 1930s reduced the incentives for inventing new drugs.

(p. 141) German chemical patents were often small masterpieces of mumbo jumbo. It was a market necessity. Patents in Germany were issued to protect processes used to make a new chemical, not, as in America, the new chemical itself; German law protected the means, not the end.   . . .

. . .

(p. 166) Fourneau decided that if the French were going to compete, the nation's scientists would either have to discover their own new drugs and get them into production before the Germans could or find ways to make French versions of German compounds before the Germans had earned back their research and production costs---in other words, get French versions of new German drugs into the market before the Germans could lower their prices. French patent laws, like those in Germany, did not protect the final product. "I was always against the French law and I thought it was shocking that one could not patent one's invention," Fourneau said, "but the law was what it was, and there was no reasons not to use it."

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

(Note: ellipses added.)

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Hager discusses the medical practices of Paris' Hôtel Dieu lying-in maternity hospital in the 17th century, that led to widespread, and often fatal, childbed fever:

(p. 114) Every day the senior doctors would arrive on their rounds followed closely by a gaggle of students. They would pull the women's covers down, pass hands over their abdomens, point, prod, and discuss. Although the physicians' wigs were carefully powdered, their hands were generally unwashed. Christian care, which emphasized purity of the soul over that of the body, had replaced Roman hygiene with frequent prayers and infrequent baths. In Paris the privies and slaughterhouses (as well as the hospital wards of the Hôtel Dieu) dumped their waste into the Seine, then drew drinking and washing water from the same source. Bedding was washed infrequently. Lice and fleas abounded.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

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(p. 65) . . . Domagk's future would be determined not only by his desire to stop disease but also by his own ambition, his family needs, and the plans of a small group of businessmen he had never met. He probably had heard of their leader, however, one of the preeminent figures in German business, a man the London Times would later eulogize as "the greatest industrialist the world has yet had." His name was Carl Duisberg.

Duisberg was a German version of Thomas Edison, Henry Ford, and John D. Rockefeller rolled into one. He had built an empire of science in Germany, leveraging the discoveries of dozens of chemists he employed into one of the most profitable businesses on earth. He knew how industrial science worked: He was himself a chemist. At least he had been long ago. Now, in the mid-1920s, in the twilight of his years, his fortunes made, his reputation assured, he often walked in his private park alone---still solidly built, with his shaved head and a bristling white mustache, still a commanding presence in his top hat and black overcoat---through acres of forest, fountains, classical statuary, around the pond in his full-scale Japanese garden by the lacquered teahouse, over his steams, and across his lawns.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

(Note: ellipsis added.)

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One of Domagk's predecessors, in goal and method, was Paul Ehrlich, who was a leader in the search for the Zuberkugeln (magic bullet) against disease causing organisms. He systematized the trial and error method, and pursued dyes as promising chemicals that might be modified to attach themselves to the intruders. But he never quite found a magic bullet:

(p. 82) Ehrlich announced to the world that he had found a cure for sleeping sickness. But he spoke too soon. Number 418, also, proved too toxic for general use. He and his chemists resumed the search.

Ehrlich said his method consisted basically of "examining and sweating"---and his coworkers joked that Ehrlich examined while they sweated. There was another motto attributed to Ehrlich's lab, the list of "Four Gs" needed for success: Geduld, Geschick, Glück, Geld---patience, skill, luck, and money.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

(Note: do not confuse the "Paul Ehrlich" discussed above, with the modern environmentalist "Paul Ehrlich" who is best known for losing his bet with Julian Simon.)

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Gerhard Damagk. Source of photo: http://www.nndb.com/people/744/000128360/

Gerhard Damagk spent most of his adult life in a focused, tireless effort to find the first cure for a bacterial infection. Finally, his laboratory discovered a sulfa drug they called "Prontosil," that seemed effective against strep and some other infections. Damagk published his first preliminary results on the drug in February 1935 (see Hager, p. 164). An increasing number of doctors began testing the drug on their desperate patients.

Life is not always unfair:

(p. 181) In early December 1935, just after the French published the discovery that pure sulfa was the active ingredient in Prontosil, Domagk's six-year-old daughter, Hildegarde, suffered a bad accident. She was making a Christmas decoration in their house when she decided that she needed help threading a needle. She was on her way downstairs to find her mother, carrying the needle and thread, when she fell. The needle was driven into her hand blunt end first, breaking off against a carpal bone. She was taken to the local clinic and the needle was surgically removed, but a few days later, her hand started swelling. After the stitches were removed, her temperature rose and kept rising. An abscess formed at the surgical site. She had a wound infection. The staff at the clinic tried opening and draining the abscess. When it became reinfected, they opened it again. Then again. The infection started moving up her arm. "Her general state and the abscess worsened to such a point that we became seriously concerned," Domagk wrote later. "More surgery was impossible." She was falling in and out of consciousness. The surgeons were talking about amputating her arm. Once the blood tests showed that the invading germ was strep, Domagk went to his laboratory and pocketed a supply of Prontosil tablets, returned to her hospital room, put the red tablets in her mouth himself, and made certain that she swallowed. Then he waited. A day later her temperature continued to rise. He gave her more tablets. No improvement. On day (p. 182) three he gave her more, a large dose, but there was still no improvement. Her situation was growing desperate, so he pulled out all the stops, on day four giving her more Prontosil tablets, then two large injections of Prontosil soluble. Finally her temperature started to drop. He gave her more tablets. After a week of treatment, her temperature finally returned to normal. The infection had been stopped. By Christmas she was able to celebrate the holidays with her family.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

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The sources of new ideas are diverse. Sometimes, as below, even a newspaper article can provide inspiration.

The passage below also provides another example of the project oriented entrepreneur, who is motivated by a mission to get the job done.

(p. 60) In Lister's early years, the mid-1800s, half of all amputation patients died from hospital fever; in some hospitals the rate was as high as 80 percent. Lister, like all surgeons, had little idea of how to improve the situation. Then he chanced on a newspaper article that caught his interest. It described how the residents of a local town, tired of the smell of their sewage, had begun treating it by pouring into their system something called German Creosote, a by-product of coal tar. Something in the creosote stopped the smell. Lister had heard about the work of Pasteur, and he made the same mental connection the French chemist had: The stink of sewage came from putrefaction, rotting organic matter; the stink of infected wounds also came from putrefaction; whatever stopped the putrefaction of sewage might also stop the putrefaction of infected wounds. So Lister decided to try coal-tar chemicals on his patients. And he found one that worked exceptionally well: carbolic acid, a solution of what today is called phenol.   . . .

. . .

(p. 61) Lister's insistence on stopping the transfer of bacteria in the operating room became absolute. Once when a visiting knighted physician from King's College idly poked a forefinger into a patient's incision during one of Lister's operations, Lister flung him bodily from the room.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

(Note: ellipses added.)

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Whether in science, or in entrepreneurship, at the initial stages of an important new idea, the majority of experts will reject the idea. So a key for the advance of science, or for innovation in the economy, is to allow scientists and entrepreneurs to accumulate sufficient resources so that they can make informed bets based on their conjectures, and on their tacit knowledge.

A few entries ago, Hager recounted how Leeuwenhoek faced initial skepticism from the experts. In the passage below, Hager recounts how Pasteur also faced initial skepticism from the experts:

(p. 44) If bacteria could rot meat, Pasteur reasoned, they could cause diseases, and he spent years proving the point. Two major problems hindered the acceptance of his work within the medical community: First, Pasteur, regardless of his ingenuity, was a brewing chemist, not a physician, so what could he possibly know about disease? And second, his work was both incomplete and imprecise. He had inferred that bacteria caused disease, but it was impossible for him to definitively prove the point. In order to prove that a type of bacterium could cause a specific disease, precisely and to the satisfaction of the scientific world, it would be necessary to isolate that one type of bacterium for study, to create a pure culture, and then test the disease-causing abilities of this pure culture.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

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I quoted a review of The Demon Under the Microscope in an entry from October 12, 2006. I finally managed to read the book, last month.

I don't always agree with Hager's interpretation of events, and his policy advice, but he writes well, and he has much to say of interest about how the first anti-bacterial antibiotic, sulfa, was developed.

In the coming weeks, I'll be highlighting a few key passages of special interest. In today's entry, below, Hager nicely summarizes the importance of the discovery of antibiotics for his (and my) baby boom generation.

(p. 3) I am part of that great demographic bulge, the World War II "Baby Boom" generation, which was the first in history to benefit from birth from the discovery of antibiotics. The impact of this discovery is difficult to overstate. If my parents came down with an ear infection as babies, they were treated with bed rest, painkillers, and sympathy. If I came down with an ear infection as a baby, I got antibiotics. If a cold turned into bronchitis, my parents got more bed rest and anxious vigilance; I got antibiotics. People in my parents' generation, as children, could and all too often did die from strep throats, infected cuts, scarlet fever, meningitis, pneumonia, or any number of infectious diseases. I and my classmates survived because of antibiotics. My parents as children, and their parents before them, lost friends and relatives, often at very early ages, to bacterial epidemics that swept through American cities every fall and winter, killing tens of thousands. The suddenness and inevitability of these epidemic deaths, facts of life before the 1930s, were for me historical curiosities, artifacts of another age. Antibiotics virtually eliminated them. In many cases, much-feared diseases of my grandparents' day---erysipelas, childbed fever, cellulitis---had become so rare they were nearly extinct. I never heard the names.

Source:

Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor's Heroic Search for the World's First Miracle Drug. New York: Three Rivers Press, 2007.

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Over the weekend of August 16-17, 2008, I caught a few minutes of an interview on one of the C-SPAN channels. Charles Murray was handing softball questions to an academic philosopher named Kronman. Kronman was pontificating that life could only be meaningful because there was death. He suggested that those pursuing longevity research were misguided.

I sat there appalled, pondering how many wonderful, amazing projects we could get done, if only we had more time.

Some wise philosopher once said that you can only have useful dialogue with someone if the two of you have some shared assumptions. I don't expect to be dialoguing with Anthony Kronman anytime soon. And that is just as well, since life is way too short to waste much time worrying about the Anthony Kronman's of the world.

(In case you think I'm making this up, I quote below, from Kronman.)

(p. 229) The spiritual emptiness of our civilization has its source in the technology whose achievements we celebrate and on whose powers we all now depend.

Technology relaxes or abolishes the existing limits on our powers. There is no limit to this process itself. Indeed, every step forward is merely a provocation to go further. This might be called the (p. 230) technological "imperative." . . .

. . .

(p. 230) If we lived forever, our powers, however great, would have no significance. How could it possibly matter whether we exercised them one way or another, sooner rather than later? This can matter to us only within the framework of a lifetime, that is, within the boundaries of a mortal existence. That we sometimes imagine (or think we imagine) that we want to have and use limitless powers in a limitless life is an illusion that always depends on our covertly smug-(p. 231)gling into our imagined picture of such an existence some essential feature of the human mortality we can never escape. In reality, the idea of immortality is for us quite unimaginable. It remains an empty abstraction.

PS: The following sentence appears on the copyright page of Kronman's book: "The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources."

So the longevity of books is pompously praised, while the longevity of humans is belittled?

Don't waste time on:

Kronman, Anthony T. Education's End: Why Our Colleges and Universities Have Given up on the Meaning of Life. New Haven, CT: Yale University Press, 2007.

(Note: ellipses added.)

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(p. D4) ATLANTA -- The average time that hospital emergency-room patients wait to see a doctor has grown to almost an hour from about 38 minutes over the past decade, according to new federal statistics released Wednesday.

The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the U.S. Centers for Disease Control and Prevention.

"There are more people arriving at the ERs. And there are fewer ERs," said Dr. Pitts, an associate professor of emergency medicine at Emory University.

The average time is based on a national survey of 362 hospital emergency departments.

Over all, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 -- a 32% increase.

Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.

. . .

The amount of time a patient waited before seeing a physician in an ER has been rising steadily, from 38 minutes in 1997, to 47 minutes in 2004, to 56 minutes in 2006.

Dr. Pitts added that 56 minutes may be the average, but it's not typical: The average was skewed to nearly an hour because of some very long waits.

. . .

"Millions more people each year are seeking emergency care, but emergency departments are continuing to close, often because so much care goes uncompensated," Dr. Linda Lawrence, president of the American College of Emergency Physicians, said in a statement.

"This report is very troubling, because it shows that care is being delayed for everyone, including people in pain and with heart attacks."

For the full story, see:

ASSOCIATED PRESS. Average ER Waiting Time Jumps to Nearly an Hour." The Wall Street Journal (Thurs., August 7, 2008): D4.

(Note: eillipses added.)

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"An urgent-care clinic in Atlantic Beach, Fla." "Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. D1) When a heavy metal door swung over her 14-year-old son's foot, ripping the nail almost completely off his big toe, Tina Mobley didn't want to take her chances in a crowded hospital emergency room or wait for an appointment at the pediatrician's office the next day. Instead, she drove to an urgent-care clinic inside a Wal-Mart in Yulee, Fla., near her rural home. Within minutes, the doctor on duty numbed the pain with an injection, removed the nail, and cleaned and bandaged the injury.

Patients who need immediate care for injuries and illness, be it a nail-gun puncture or a severe stomach bug, are increasingly turning to walk-in urgent-care clinics. These facilities aim to fill the gap between the growing shortage of primary-care doctors and a shrinking number of already-crowded hospital emergency departments, with no appointment necessary and extended evening and weekend hours. Urgent-care clinics are staffed by physicians, offer wait times as little as a few minutes and charge $60 to $200 depending on the procedure -- a fraction of the typical $1,000-plus emergency department visit. Some offer discounts and payment plans for the uninsured; for those with coverage, co-payments vary by insurance plan but may be less than half the amount of an ER visit, which can range from $50 to $200.

While the Yulee clinic that treated Ms. Mobley's son is one of three operated inside Wal-Mart stores by Jacksonville, Fla.-based Solantic, urgent-care centers aren't to be confused with the new crop of retail health clinics popping up in drugstores, which are run by nurse practitioners who prescribe medicine for minor illnesses and provide vaccinations. Urgent-care-center physicians and other medical staffers can put casts on broken bones, sew up lacerations, provide intravenous fluids for dehydrated patients, and deploy advanced life-support equipment for both adults and children. They often have equipment not available in physicians' offices, such as X-rays.

For the full story, see:

LAURA LANDRO. "THE INFORMED PATIENT; Options Expand For Avoiding Crowded ERs." The Wall Street Journal (Weds., August 6, 2008): D1-D2.

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"Dave Ratner, owner of four pet stores in Western Massachusetts, is worried about being able to pay into a state health benefits plan." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A16) AGAWAM, Mass. -- Dave Ratner, owner of Dave's Soda and Pet City, is pretty sure he is about to get "whacked" by the new state law that requires employers to contribute to health care benefits for their workers or pay a $295-per-employee penalty. In order to avoid thousands of dollars in fines, Mr. Ratner is considering not adding part-time workers at his four pet supply stores in Western Massachusetts.

But the penalty in Massachusetts is picayune compared with what some health experts believe Senator Barack Obama, the Democratic presidential nominee, might impose as part of his plan to provide affordable coverage for the uninsured. Though Mr. Obama has not released details, economists believe he might require large and medium companies to contribute as much as 6 percent of their payrolls.

That, Mr. Ratner said, would be catastrophic to a low-margin business like his, which has 90 employees, 29 of them full-time workers who are offered health benefits.

"To all of a sudden whack 6 to 7 percent of payroll costs, forget it," he said. "If they do that, prices go up and employment goes down because nobody can absorb that."

For the full story, see:

KEVIN SACK. "Businesses Wary of Details in Obama Health Plan." The New York Times (Mon., October 27, 2008): A16.

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Source of book image: http://www.simplenomics.com/wp-images/settingthetable-1.jpg

(p. R7) Most successful entrepreneurs like rattling on about how they did it.

The bookshelves have never been more crowded with such exploits from consultants, real-estate moguls and retailers. And publishers say there are more on the way. With layoffs and cutbacks dominating the headlines, demand for advice books based on true-life stories is peaking.

. . .

So what does it take to succeed?

"Pragmatic advice, [a book written by] somebody with a fairly high public profile, and a person who can hit the lecture circuit after the first rush of publicity and keep the book selling," says Grand Central's Mr. Wolff.

Those factors have contributed to the staying power of restaurateur Danny Meyer's book, "Setting the Table: The Transforming Power of Hospitality in Business."

News Corp.'s HarperCollins Publishers first published 30,000 copies in October 2006. (News Corp. also publishes The Wall Street Journal.) Mr. Meyer's work, chatty personal anecdotes wrapped around a core message that emphasizes hospitality as the key to creating satisfied customers, proved a hit.

. . .

"The most surprising thing was the interest from the hospital community," Mr. Meyer says. "That's an industry in turmoil based on the absence of hospitality. They over-focus on the metrics of stays and cure rates rather than how they make people feel."

For the full story, see:

JEFFREY A. TRACHTENBERG. "Running the Show; Me, Me, Me; So many entrepreneurs are writing books about how they made it. Their books, though, aren't nearly as successful." The Wall Street Journal (Mon., June 16, 2008): R7.

(Note: ellipses added.)

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Source of table: online version of the NYT article quoted and cited below.

(p. C1) On Wal-Mart's Web site, you can buy a walker for $59.92. It is called the Carex Explorer, and it's a typical walker: a few feet high, with four metal poles extending to the ground. The Explorer is one of the walkers covered by Medicare.

But Medicare and its beneficiaries aren't paying $59.92 for the Explorer or any similar walker. In fact, they're not paying anything close to it. They are paying about $110.

. . .

(p. C5) In the abstract, fixing the health care system sounds perfectly unobjectionable: it's about reducing costs (and then being able to cover the uninsured) by getting rid of inefficiency and waste. In reality, though, almost every bit of waste benefits someone.

Doctors who perform spinal fusion surgeries, despite decidedly mixed evidence that they're effective, are making a nice living. Hospitals that order $1,000 diagnostic tests, even when a cheaper one would work just as well, are helping their bottom line. Medical equipment makers selling walkers for $110, while Wal-Mart sells them for $60, are fattening their profits.

The current fight to protect those profits is a microcosm of what you can expect to see if a larger effort to rein in health costs ever gets going. The defenders of the status quo won't say that they are protecting themselves. Instead, they'll use the same arguments that the medical equipment makers are using -- that a change will destroy jobs, bankrupt small businesses and, above all, harm patients.

. . .

But this is a case in which the market can clearly do a better job than a government-mandated fee schedule. Just look at Wal-Mart's Web site or, for that matter, the bids that Medicare has already received.

By standing in the way of this competition, Congress is really standing up for higher health care costs.

For the full commentary, see:

DAVID LEONHARDT. "ECONOMIC SCENE; High Medicare Costs, Courtesy of Congress." The New York Times (Weds., June 25, 2008): C1 & C5.

(Note: ellipses added.)

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"Aurora Johnson, left, a dental therapist, filled cavities for Paul Towarak, 10, in the village of Unalakleet, Alaska. For more involved procedures, Ms. Johnson refers patients to a dentist." Source of caption and photo: online version of the NYT article quoted and cited below.

Clayton Christensen (and co-authors) have suggested that disruptive technologies could reduce the cost and improve the quality of health care. One pathway for this to occur is new technologies that permit effective treatment to be carried out by para-professionals with less education than MD's.

The article below illustrates Christensen's idea, and also highlights the main obstacle to its implementation: professional organizations asking the government to regulate and restrict competition from the lower-cost para-professionals.

(p. A1) UNALAKLEET, Alaska -- The dental clinic in this village on the edge of the Bering Sea looks like any other, with four chairs, a well-scrubbed floor and a waiting area filled with magazines.

But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.

Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. John-(p. A15)son's. And while such arrangements are common outside the United States, only one American dental school, in Anchorage, offers such a program.

. . .

(p. A15) In Alaska, the A.D.A. and the state's dental society had filed a lawsuit to block the program that trained people like Ms. Johnson, who are called dental therapists. The groups dropped the suit last summer after a state court judge issued a ruling critical of the dentists. But the A.D.A. continues to oppose allowing therapists to operate anywhere in the lower 49 states. Currently, therapists are allowed to practice only in Alaska, and only on Alaska Natives.

. . .

Therapists are a low-cost way to provide care to people who might not otherwise have access to it, according to Dr. Ron Nagel, a dentist and consultant for the Alaska Native Tribal Health Consortium, a nonprofit group financed mostly by federal money that provides medical and dental care to tribal communities. "There's a huge need for these basic services," Dr. Nagel said.

. . .

Since 1990, the number of private dentists has remained roughly flat, at 150,000, even as the United States population has increased 22 percent. As a result, dentists can easily fill their appointment books without seeing people who cannot meet their fees, and patients who have decayed teeth are suffering needlessly, said Tammy Guido, 50, who is one of seven students now training in Anchorage to become a therapist.

"We're meeting a need that is not being met," Ms. Guido said.

Alaskan tribal organizations sponsor Ms. Guido and the other students in Anchorage for the program. To be accepted, students must have a high school diploma or equivalency degree; for the newest class, 7 of 18 candidates were accepted.

In interviews, the students in this year's class all said they were enthusiastic about the chance to serve communities that have little access to care. All seven had quit full-time jobs and must now get by on a $750 monthly stipend during the two years of training.

"Anybody who's ever had a toothache can tell you it hurts," said Ben Steward, 24, the only man in this year's class. "But talk to someone who's had a toothache for a year."

For the full story, see:

ALEX BERENSON. "Dental Clinics, Meeting a Need With No Dentist." The New York Times (Mon., April 28, 2008): A1 & A15.

(Note: ellipses added.)

One source of Christensen's views on health care can be found in a chapter in:

Christensen, Clayton M., Scott D. Anthony, and Erik A. Roth. Seeing What's Next: Using Theories of Innovation to Predict Industry Change. Boston, MA: Harvard Business School Press, 2004.

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Source of graph: online version of the NYT article quoted and cited below.

The most interesting part of the article quoted below, was the above graph, that dramatically shows health care's large and growing share of disposable personal income.

(p. 28) Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

Health costs are "burying small business," said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by Ron Wyden, Democrat of Oregon.

Last year, Mr. Roach paid about $27,000 in health premiums for his eight employees. "It's a huge chunk of change," he said, noting that he was forced to raise his employees' yearly deductible by 50 percent, to $750.

For the full story, see:

REED ABELSON and MILT FREUDENHEIM. "Even the Insured Feel Strain of Health Costs." The New York Times, Section 1 (Sun., May 4, 2008): 1 & 28.

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"A grid in the monkey's brain carried signals from 100 neurons for the mechanical arm to grab and carry snacks to the mouth." Source of caption and photos: online version of the NYT article quoted and cited below.

(p. A1) Two monkeys with tiny sensors in their brains have learned to control a mechanical arm with just their thoughts, using it to reach for and grab food and even to adjust for the size and stickiness of morsels when necessary, scientists reported on Wednesday.

The report, released online by the journal Nature, is the most striking demonstration to date of brain-machine interface technology. Scientists expect that technology will eventually allow people with spinal cord injuries and other paralyzing conditions to gain more control over their lives.

The findings suggest that brain-controlled prosthetics, while not practical, are at least technically within reach.

In previous studies, researchers showed that humans who had been paralyzed for years could learn to control a cursor on a computer screen with their brain waves and that nonhuman primates could use their thoughts to move a mechanical arm, a robotic hand or a robot on a treadmill.

The new experiment goes a step further. In it, the monkeys' brains seem to have adopted the mechanical appendage as their own, refining its movement as it interacted with real objects in real time. The monkeys had their own arms gently restrained while they learned to use the added one.

For the full story, see:

BENEDICT CAREY. "Monkeys Think, Moving Artificial Arm as Own." The New York Times (Thurs., May 29, 2008): A1 & A18.

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"One of a handful of 2,000-year-old seeds (top) from the fortress of Masada in present-day Israel grew into a date palm plant (bottom) called Methuselah in 2005." Source of caption and photos: online article quoted and cited below.

The oldest-sprouted seed in the world is a 2,000-year-old plant from Jerusalem, a new study confirms.

"Methuselah," a 4-foot-tall (1.2-meter-tall) ancestor of the modern date palm, is being grown at a protected laboratory in the Israeli capital.

In 2005 the young plant was coaxed out of a seed recovered in 1963 from Masada, a fortress in present-day Israel where Jewish zealots killed themselves to avoid capture by the Romans in A.D. 70.

For the full story, see:

Anne Minard. ""Methuselah" Tree Grew From 2,000-Year-Old Seed." National Geographic News online (June 12, 2008), downloaded on 6/19/08 from: http://news.nationalgeographic.com/news/2008/06/080612-oldest-tree.html

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(p. C6) The American Medical Association is hulking mad at Marvel Studios.

Last week, the advocacy arm of the powerful physicians' group unleashed a tsk-tsk campaign against "The Incredible Hulk," a Marvel film that opened on Friday and is distributed by Universal Pictures. The complaint was of "gratuitous depictions of smoking."

In the movie, which drew a PG-13 rating from the Motion Picture Association of America, Gen. Thunderbolt Ross, a bad guy played by William Hurt, is rarely seen without a smoke-spewing cigar. (Presumably, the physicians' association worries that children who identify with the authoritarian general -- who wants to annihilate the Hulk, played by Edward Norton -- may be tempted to pick up the habit.)

For the full story, see:

BROOKS BARNES. "Physicians' Group Furious at Cigars in 'Hulk' Movie." The New York Times (Mon., June 16, 2008): C6.

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(p. A9) When Sam Houston was still hanging his hat in Tennessee in the 1830s, it wasn't uncommon for fellow Tennesseans who were packing up and moving south and west to hang a sign on their cabins that read "GTT" - Gone to Texas.

Today obstetricians, surgeons and other doctors might consider reviving the practice. Over the past three years, some 7,000 M.D.s have flooded into Texas, many from Tennessee.

Why? Two words: Tort reform.

In 2003 and in 2005, Texas enacted a series of reforms to the state's civil justice system. They are stunning in their success. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35%, saving doctors some $217 million over four years. There is also a competitive malpractice insurance industry in Texas, with over 30 companies competing for business. This is driving rates down.

The result is an influx of doctors so great that recently the State Board of Medical Examiners couldn't process all the new medical-license applications quickly enough. The board faced a backlog of 3,000 applications. To handle the extra workload, the legislature rushed through an emergency appropriation last year.

For the full commentary, see:

JOSEPH NIXON. "CROSS COUNTRY; Why Doctors Are Heading for Texas." The Wall Street Journal (Sat., May 17, 2008): A9.

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"Paul Metzger, holding the Handler, an anti-microbial device that helps users avoid touching surfaces that might carry germs." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. C5) With so many people worried about getting sick -- whether from the common cold and flu or exotic new strains of antibiotic-resistant bacteria -- Paul and Jeffrey Metzger had every reason to hope that the germ-fighting key fob they invented would be a runaway hit.

Their device, known as the Handler, began selling last year online and in stores like Duane Reade pharmacies for about $11. It features a pop-out hook so germophobes can avoid touching A.T.M. keypads, door handles and other public surfaces where undesirable microbes may lurk. As added protection, the Handler's rubber and plastic surfaces are impregnated with tiny particles of silver to kill germs that land on the device itself.

But those little silver particles have run Maker Enterprises, the Metzger brothers' partnership in Los Angeles, into a big regulatory thicket. The Metzgers belatedly realized that the Environmental Protection Agency might decide that a 1947-era law that regulates pesticides would apply to antimicrobial products like theirs.

The agency ruled last fall that the law covered Samsung's Silvercare washing machine. Samsung was told it would have to register the machine as a pesticide, a potentially costly and time-consuming process, because the company claims the silver ions generated by the washer kill bacteria in the laundry.

The Metzgers halted production of their key fob while they sought legal guidance on how to avoid a similar fate.

Their quandary highlights a challenge facing the growing number of entrepreneurs who have ventured into nanotechnology, a field that gets its name from its reliance on materials so small their dimensions are measured in nanometers, or billionths of a meter.

. . .

"They don't really know how they want to register these particles," said Tracy Heinzman, a lawyer in Washington who deals frequently with the E.P.A. "There's no clear path forward."

More broadly, the limbo into which the Handler has tumbled shows how the limited resources of agencies like the E.P.A. can combine with creaky regulations to act as a brake on innovation. "The marketplace is always ahead of the E.P.A.," Ms. Heinzman said.

For the full story, see:

BARNABY J. FEDER. "Small Business; Fighting Germs and Regulators; Pesticide Rules May Apply to Tiny Particles That Kill Microbes." The New York Times (Thurs., March 6, 2008): C5.

(Note: the title of the online version was "Small Business; New Device for Germophobes Runs Into Old Law.")

(Note: ellipsis added.)

"Production of the Handler has ceased for the time being." Source of caption and photo: online version of the NYT article quoted and cited above.

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(p. A1) Red wine may be much more potent than was thought in extending human lifespan, researchers say in a new report that is likely to give impetus to the rapidly growing search for longevity drugs.

The study is based on dosing mice with resveratrol, an ingredient of some red wines. Some scientists are already taking resveratrol in capsule form, but others believe it is far too early to take the drug, especially using wine as its source, until there is better data on its safety and effectiveness.

The report is part of a new wave of interest in drugs that may enhance longevity. On Monday, Sirtris, a startup founded in 2004 to develop drugs with the same effects as resveratrol, completed its sale to GlaxoSmithKline for $720 million.

. . .

(p. A16) Separately from Sirtris's investigations, a research team led by Tomas A. Prolla and Richard Weindruch, of the University of Wisconsin, reports in the journal PLoS One on Wednesday that resveratrol may be effective in mice and people in much lower doses than previously thought necessary. In earlier studies, like Dr. Auwerx's of mice on treadmills, the animals were fed such large amounts of resveratrol that to gain equivalent dosages people would have to drink more than 100 bottles of red wine a day.

The Wisconsin scientists used a dose on mice equivalent to just 35 bottles a day. But red wine contains many other resveratrol-like compounds that may also be beneficial. Taking these into account, as well as mice's higher metabolic rate, a mere four, five-ounce glasses of wine "starts getting close" to the amount of resveratrol they found effective, Dr. Weindruch said.

Resveratrol can also be obtained in the form of capsules marketed by several companies. Those made by one company, Longevinex, include extracts of red wine and of a Chinese plant called giant knotweed. The Wisconsin researchers conclude that resveratrol can mimic many of the effects of a caloric-restricted diet "at doses that can readily be achieved in humans."

For the full story, see:

NICHOLAS WADE. "New Hints Seen That Red Wine May Slow Aging." The New York Times (Weds., June 4, 2008): A1 & A16.

(Note: ellipsis added.)

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Source of the graphic: online version of the NYT article cited below.

The most interesting part of a recent David Leonhardt column, was not what he wrote, but the graphs that were included with the article, especially the one at the top of this entry. Notice that the price of education and medical care have increased much more dramatically than other categories of consumer spending. (And remember how heavily government is involved in those two sectors, both directly through government run institutions, and indirectly through regulations and subsidies.)

For the full commentary, see:

DAVID LEONHARDT. "ECONOMIC SCENE; Seeing Inflation Only in the Prices That Go Up." The New York Times (Weds., May 7, 2008): C1 and C11.

Source of the graphic: online version of the NYT article cited above.

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Medical entrepreneur Tom Harold.    Source of photo:   http://www.scyfix.org/management.php

(p. 1D) ScyFix, a Chanhassen, Minn., startup, has developed a device it claims treats diseases such as glaucoma and macular degeneration by shooting electric currents into the eye. The company, which is conducting clinical trials in India and the United States, hopes to sell the first device approved by the Food and Drug Administration designed to restore eyesight.

"To me, this is the pacemaker for the eye," said Dr. Darrell DeMello, ScyFix president and a former executive at Boston Scientific Corp.

ScyFix hopes to eventually raise $60 million to $70 million to finish its clinical trials.

. . .

(p. 2D) Thomas Harold first came up with the idea for ScyFix in 2002. An Internet entrepreneur and a former executive at General Mills, Harold became interested in studies that showed electricity could restore sight. Drugs, however, could only slow the effects of some diseases.

. . .

Specifically, the studies showed electricity could stimulate the production of neurotrophins, a family of proteins that can instruct optic nerve, retinal neurons and photoreceptor cells not to die. In addition, neuromodulation can also repair cell membranes, allowing cells to absorb nutrients, release wastes, improve blood flow to the eye and rewire faulty nerve connections.

Working with doctors and engineers, Harold, who has no medical background, developed a device that releases low-intensity electric currents into the eyelids through electrodes. A complex mathematical equation programmed into the device controls the amount and frequency of the electricity. Patients can administer the treatment at home twice a day for 20 minutes.

Harold says he is encouraged by the results so far: Since 2002, the device has halted progression of diseases in 95 percent of the 1,000 patients tested in 29 countries, according to ScyFix.

"Everything stopped getting worse," Harold said. "That was a win in itself."

In addition, 80 percent of the patients reported vision improvement. There were no side effects, the company said.

For the full story, see:

Lee, Thomas (The Star Tribune). "'Pacemaker' for eyes shows initial promise." Omaha World-Herald (Sunday, March 9, 2008): 1D & 2D.

(Note: ellipses added.)

Below I have pasted a couple of paragraphs from the ScyFIX web site. Note that Europeans are free to try the therapy, if they so desire. But citizens of the United States are not free to try the therapy, due to the regulations of the Food and Drug Admininstration (FDA) of the U.S. government.

Buy ScyFIX 600 and Accessories on-line!

Welcome to ScyFIX international web shop where you can order products, choose payment method, including a secure on-line credit card payment service (SSL), and check your delivery status on-line. Buying on-line is safe and easy and you will be guided all the way. All prices are in € (Euro). Place your order and your credit card company will convert the amount in € to your own currency. We accept Visa, Master Card, EuroCard and most bank cards connected to VISA or Master Card. Follow the instructions to take you through the pages, and then onto a secure site in which you will input your credit card and shipping details. When bank authorization has been attained, you will get a confirmation on-line, as well as a confirming e-mail. If at any stage you wish to change your order, just click the "Remove"-button.

Please note that ScyFIX can not ship devices to US addresses, until the ongoing FDA trials have resulted in an approval to market the product in the USA. US customers who mistakenly order and pay for a therapy kit over the web, will be contacted and refunded. However, ScyFIX will deduct 100€ (Euros) covering banking fees and handling costs. If you are a US resident and want to know more about our therapy, please send an inquiry by e-mail to our European office support@scyfix.org, or fill in your personal information in our Clinical Trial & Purchase Interest Form by clicking here www.scyfix.org/clinical_trial_form.htm.

The paragraphs were accessed on 3/9/08 from:

http://www.scyfix.org/shop/

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"Climbing stairs is a challenge for George Allen." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A1) WASHINGTON -- On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.

Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and he expects to lose his driver's license when it comes up for renewal. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.

So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide -- a dozen of them planned here in Washington and its suburbs -- their group is part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help and for baby boomers anticipating the future.

"We are totally dependent on ourselves," Mr. Allen said. "But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that's what we want."

Their group has registered as a nonprofit corporation, is setting membership dues, and is lining up providers of transportation, home repair, companionship, security and other services to meet their needs at home for as long as possible.

Urban planners and senior housing experts say this movement, organized by residents rather than government agencies or social service providers, could make "aging in place" safe and affordable for a majority of elderly people. Almost 9 in 10 Americans over the age of 60, according to AARP polls, share the Allens' wish to live out their lives in familiar surroundings.

. . .

(p. A18) The first village in the Washington area is expected to be on Capitol Hill. When it opens for business on Oct. 1, annual memberships will be $750 for a couple and $500 for an individual.

Among those eager to join are Marie Spiro, 74, and Georgine Reed, 78, who share a rambling house that they insist they will only leave "feet first." Between them, Ms. Spiro, an emeritus professor of art history and archaeology, and Ms. Reed, a retired designer of museum exhibits, have already endured three knee replacements and an array of other ailments.

Ms. Spiro describes huffing and puffing while grocery shopping; Ms. Reed is increasingly reluctant to visit friends across town. Both women, who are childless, would already welcome help with meals, transportation and paperwork. If they need home care, Capitol Hill Village will be able to organize that.

"I've never had to rely on other people, and I never wanted to," Ms. Spiro said. "But I'd rather pay a fee than have to ask favors."

For the full story, see:

JANE GROSS "A Grass-Roots Effort to Grow Old at Home The New York Times (Tues., August 14, 2007): A1 & A18.

(Note: ellipses added; caption for the George Allen photo is the online caption, not the different one in the print version of the article.)

"Georgine Reed, 78, right, and Marie Spiro, 74, share a Capitol Hill home and are joining a group that will help them stay there. "I'd rather pay a fee," Ms. Spiro said, "than have to ask favors."" Source of caption and photo: online version of the NYT article quoted and cited above.

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"Alicia Ledlie, senior director of health business development for Wal-Mart, said walk-in medical clinics would look like the mockup behind her, in a warehouse in Bentonville, Ark." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. C4) Moving to upgrade its walk-in medical clinic business, Wal-Mart is set to announce on Thursday plans for several hundred new clinics at its stores, using a standardized format and jointly branded with hospitals and medical groups.

. . .

Walk-in medical clinics are a growing industry, with numerous competitors that include big-box retailers, drugstores and even grocery chains around the country. Industry executives say 1,500 to 1,800 clinics will be open by the end of the year.

Propelled by the drugstore chains CVS and Walgreens, by far the biggest sponsors of the clinics to date, more than 700 clinics have opened in the last 15 months. But the business model is unproven so far.

Few, if any, clinics are profitable, according to industry analysts, and only a handful have broken even on daily operations. Most have been open a year or less, and executives say it takes up to three years for a clinic to become profitable enough to recover start-up costs.

Medical societies are inclined to be skeptical of the clinics. The American Academy of Pediatrics opposes them, saying they add to fragmentation in the health care system.

Dr. Edward Zissman, a pediatrician in central Florida, said he had qualms about hospitals that hook up with the clinics. "Putting their name on a product that I don't think has the highest quality," he said, "is going to cost them dearly with physicians."

The American Academy of Family Physicians and the American Medical Association have set forth principles for clinics to observe, including sending patients' medical record to their doctors and finding doctors for patients who do not already have them. Most states require varying degrees of physician supervision of the clinic nurses. Clinic operators say they are complying.

Many patients have said they like the convenience of the walk-in clinics' weekend and evening hours, the short waiting times to see a nurse practitioner, and the posted price lists for a limited menu of care like tests and prescriptions for sore throats and ear infections and seasonal flu shots.

. . .

"The clinics are the latest big example of how you could think about consumers and what their needs are, rather than a health care system exclusively designed around the needs of providers," said Margaret Laws, director of an innovations program at the California Health Care Foundation, an independent group that finances health policy research.

For the full story, see:

MILT FREUDENHEIM. "Wal-Mart Will Expand In-Store Medical Clinics." The New York Times (Thurs., February 7, 2008): C4.

(Note: ellipses added.)

"The design of the Wal-Mart medical clinic is intended to look like a doctor's office, complete with the usual medical hardware." Source of caption and photo: online version of the NYT article quoted and cited above.

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(p. 12) FROM the very beginning of the nation's modern social welfare system -- even before Michael Moore began to explore the issue -- there was a tension in it: What should the government be expected to provide? What should be left to the individual? How much government is too much?

The questions were asked even in 1935, not exactly a time to instill confidence in the resilient power of private markets. Senator Thomas Pryor Gore, Democrat of Oklahoma, put it bluntly when Frances Perkins, the secretary of labor, testified on Capitol Hill that year about President Franklin D. Roosevelt's plan for a new program called Social Security.

''Isn't this socialism?'' Senator Gore demanded. When Ms. Perkins denied it, he asked again: ''Isn't this a teeny-weeny bit of socialism?'' In recent days, on Capitol Hill and on the campaign trail, a new version of that debate has been flaring, this time around an issue that the New Dealers decided (perhaps wisely) to put off for a later date: health care.

For the full commentary, see:

Robin Toner. "IDEAS & TRENDS; Less, Less, Less! More, More, Moore!" The New York Times, Week in Review section (Sun., August 5, 2007): 12.

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(p. A16) Environmental leaders must join the 21st century, acknowledge the mistakes Carson made, and balance the hypothetical risks of DDT with the real and devastating consequences of malaria. Uganda has demonstrated that, with the proper support, we can conduct model indoor spraying programs and ensure that money is spent wisely, chemicals are handled properly, our program responds promptly to changing conditions, and malaria is brought under control.

Africa is determined to rise above the contemporary colonialism that keeps us impoverished. We expect strong leadership in G-8 countries to stop paying lip service to African self-determination and start supporting solutions that are already working.

For the full commentary, see:

Sam Zaramba. "Give Us DDT." Wall Street Journal (Tues., Jun 12, 2007): A16.

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Shannon Brownlee is the author of "Overtreated" which "diagnoses the big flaw in medical spending." Source of caption and photo: online version of the NYT commentary quoted and cited below.

(p. C5) Fortunately -- if that's the right word -- there is an obvious candidate for cost-cutting: all that care that brings no health benefit. It's not hard to find examples. Scientific studies have shown that many treatments, including spinal fusion, routine episiotomies and neonatal intensive care, are overdone. These procedures often help specific subsets of patients. But for a lot of people, and "Overtreated" is full of stories, the treatments are a modern-day version of bloodletting.

"We spend between one fifth and one third of our health care dollars," writes Ms. Brownlee, a senior fellow at the New America Foundation and former writer for U.S. News & World Report, "on care that does nothing to improve our health."

Worst of all, overtreatment often causes harm, because even the safest procedures bring some risk. One study found that a group of Medicare patients admitted to high-spending hospitals were 2 to 6 percent more likely to die than a group admitted to more conservative hospitals.

For the rest of the commentary, see:

DAVID LEONHARDT. "ECONOMIC SCENE; No. 1 Book, And It Offers Solutions." The New York Times (Weds., December 19, 2007): C1 & C5.

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(p. A22) When my Labrador retriever became acutely lame, we were able to locate a veterinary orthopedic expert in Atlanta within 48 hours who was able to repair a ruptured tendon within one week. But my prospects of identifying an endocrinologist who can care for my daughter's diabetes when she turns 18 are much less promising.

The limited number of endocrine specialists is a not a consequence of limited demand -- everyone is aware of the epidemic of diabetes we are facing. There are also shortages of generalists and other specialists, and the reason is the absence of market signals -- i.e., market-based prices -- for influencing the supply of physicians in various specialties.

The roots of this problem lay in the use of administrative pricing structures in medicine. The way prices are set in health care already distorts the appropriate allocation of efforts and resources in health care today. Unfortunately, many of the suggested reforms of our health care system -- including the various plans for universal care, or universal insurance, or a single-payer system, that various policy makers and Democratic presidential candidates espouse -- rest on the same unsound foundations, and will produce more of the same.

. . .

One important lesson of the 20th century is that, while markets are far from perfect, more choices are available when people are able to use free markets to interact with each other. Markets may not get the prices exactly correct all the time, but they are capable of self- correction, a capacity that has yet to be demonstrated by administrative pricing.

It tells you something when the supply of and demand for specialist veterinary care is so easily matched when the prices of these services are established on the market -- while shortages and oversupplies are common for human medical care when the prices of these services are set by administrators in the public sector. Will health-care reformers -- and American citizens -- get the message?

For the full commentary, see:

Robert A. Swerlick. "Our Soviet Health System." Wall Street Journal (Tues., Jun 5, 2007): A22.

(Note: ellipsis added.)

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Source of photo: screen capture from slide show on online version of the NYT article quoted and cited below.

(p. C1) Part David Attenborough, part Indiana Jones, Mr. Kilham, an ethnobotanist from Massachusetts who calls himself the Medicine Hunter, has scoured remote jungles and highlands for three decades for plants, oils and extracts that can heal. He has eaten bees and scorpions in China, fired blow guns with Amazonian natives, and learned traditional war dances from Pacific Islanders.

But behind the colorful tales lies the prospect of money, lots of money -- for Western pharmaceutical companies, impoverished indigenous tribes and Mr. Kilham.

. . .

(p. C5) In Peru, Mr. Kilham is betting on maca, a small root vegetable that grows here in the central highlands -- "a turnip that packs a punch," he says, adding "it imparts energy, sex drive and stamina like nothing else."

That view is supported by studies carried out at the International Potato Center, a Lima-based research center that is internationally financed and staffed. Studies there show maca improves stamina, reduces the risk of prostate cancer and increases the motility, volume and quality of sperm.

Some peer reviewed studies published in the journal Reproductive Biology and Endocrinology backed up those findings.

. . .

One product, Maca Stimulant, is sold in Wal-Mart under Mr. Kilham's Medicine Hunter brand. Mr. Kilham earns a retainer from both Naturex and Enzymatic Therapy, in addition to royalties from another Medicine Hunter-branded product at Wal-Mart.

Mr. Kilham says he earns around $200,000 each year in retainers, and sales are so buoyant he expects to make "in the mid-six figures" in royalties next year.

Mr. Kilham insists he is not in the business simply for financial gain. His motivation comes from promoting herbal medicines and helping traditional communities, he said.

"I have financial security and don't need to make money from this," he said. "I believe trade is the best way to get good medicines to the public, to help the environment and to help indigenous people."

He and Mr. Cam pay growers here in Ninacaca a premium of 6 soles (about $2) for a kilo of maca, almost twice the going rate of 3 to 3.40 soles a kilo. They have set up a computer room at the Chakarunas warehouse and a free dental clinic, the town's first.

Mr. Kilham is clearly adored by the locals in these desolate, wind-swept villages. On a recent visit here, shamans, maca growers and their families flocked to him. Since only maca and potatoes grow at this altitude, they are thankful Mr. Kilham is helping them sell their produce.

For the full story, see:

ANDREW DOWNIE. "On a Remote Path to Cures." The New York Times (Tues., January 1, 2008): C1 & C5.

(Note: ellipses added.)

Source of photo: screen capture from slide show on online version of the NYT article quoted and cited above.

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In the full version of the commentary quoted below, the authors mention four lines of research that they believe hold promise for the future: vaccines, epigenetics, targeted therapies, and cancer "stem cells."

(p. A17) This week, the National Cancer Institute, in conjunction with other organizations that track cancers, reported that the death rate from cancer declined from 2002-2004 by an average of 2.1% per year. This is an improvement over the 1.1% annual declines from 1993-2002 and is very good news indeed. Each 1% decline represents 5,000 people living rather than dying, and, of course, this figure is compounded each year.

While some part of the declining death rate from cancer is the consequence of screening, much is the result of greatly improved treatments. And we believe that the successes achieved to date are only the modest beginning of a revolution in the research into and treatment of cancer.

During the last half of the 20th century, almost all treatments of cancers involved forms of chemotherapy in which cancerous and normal tissues were bombarded with nonselective cytoxic drugs. These drugs killed all cells, healthy as well as malignant. Worse, they did not kill all cancer cells, so the cancer progressed -- leading to the pessimism dominant in people's minds today, a reflection of years of articles and opinion pieces in the popular press expressing the view that "the war on cancer" has been waged incorrectly, if not lost.

Now, however, new therapeutic modes are in play, based on better understandings of cancers and great advances in technologies.

. . .

The danger is that misconceived pessimism might result in a loss of popular moral support for the revolutionary new approaches to cancer research and treatment.

For the full commentary, see:

Samuel Waxman and Richard Gambino. "The New Ways We Fight Cancer." Wall Street Journal (Oct 18, 2007): A17.

(Note: ellipsis added.)

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The passage below is from a WSJ summary of an article that appeared in the December 2007 issue of Discover:

(p. B12) Scientists are increasingly hopeful that controlling inflammation will allow them to turn back the clock on aging, writes Kathleen McGowan in Discover magazine.

Inflammation is already a well-established predictor of many chronic illnesses, such as diabetes, atherosclerosis and Alzheimer's disease.  . . .

. . .

Many prominent gerontologists reason that if these chronic diseases are the product of an overactive immune system, then they can be countered with the right anti-inflammatory drug.    . . .

"The research is really to prevent the chronic debilitating diseases of aging," says Nir Barzilai, a molecular geneticist and director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. "But if I develop a drug, it will have a side effect, which is that you will live longer."

For the full summary, see:

"The Informed Reader; Health; How Scientists Hope to Shrink Aging Effects." Wall Street Journal (Weds., Nov. 14, 2007): B12.

(Note: ellipses added.)

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"Braided hair is intact on a Peruvian mummy like those used in a study. Scientists say lice in the Americas predated Columbus." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A10) When two pre-Columbian individuals died 1,000 years ago, arid conditions in the region of what is now Peru naturally mummified their bodies, as well as the lice in their long, braided hair.

That was all scientists needed, they reported Wednesday, to extract well-preserved louse DNA and establish that lice had accompanied their human hosts in the original peopling of the Americas, probably as early as 15,000 years ago. The DNA matched that of the most common type of louse known to exist worldwide now and also before Europeans colonized the New World.

The findings absolve Columbus of responsibility for at least one wrong unintentionally wrought on the people he found in the Americas and called Indians. The Europeans who followed Columbus to America may have introduced diseases, namely smallpox and measles, but not the most common of lice, as had been suspected.

For the full story, see:

JOHN NOBLE WILFORD. "Scientists Say Mummies' Lice Show Pre-Columbian Origins." The New York Times (Thurs., February 7, 2008): A10.

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  Moving water is easier with the 20-gallon rolling drum.  Source of photo:  online version of the NYT article quoted and cited below.

(p. D3)  . . . , the Cooper-Hewitt National Design Museum, . . . , is honoring inventors dedicated to “the other 90 percent,” particularly the billions of people living on less than $2 a day.

Their creations, on display in the museum garden until Sept. 23, have a sort of forehead-thumping “Why didn’t someone think of that before?” quality.

. . .

Interestingly, most of the designers who spoke at the opening of the exhibition spurned the idea of charity.

“The No. 1 need that poor people have is a way to make more cash,” said Martin Fisher, an engineer who founded KickStart, an organization that says it has helped 230,000 people escape poverty.  It sells human-powered pumps costing $35 to $95.

Pumping water can help a farmer grow grain in the dry season, when it fetches triple the normal price.  Dr. Fisher described customers who had skipped meals for weeks to buy a pump and then earned $1,000 the next year selling vegetables.

For the full story, see: 

DONALD G. McNEIL Jr.  "Design That Solves Problems for the World's Poor."  The New York Times  (Tues., May 29, 2007):  D3.

(Note:  ellipses added.)

   The photo on the left shows a woman safely drinking bacteria-laden water through a filter.  The photo on the right shows a "pot-in-pot cooler" that evaporates water from wet sand between the pots, in order to cool what is in the inner pot.  Source of photos:  online version of the NYT article quoted and cited above.

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  Moving water is easier with the 20-gallon rolling drum.  Source of photo:  online version of the NYT article quoted and cited below.

(p. D3)  . . . , the Cooper-Hewitt National Design Museum, . . . , is honoring inventors dedicated to “the other 90 percent,” particularly the billions of people living on less than $2 a day.

Their creations, on display in the museum garden until Sept. 23, have a sort of forehead-thumping “Why didn’t someone think of that before?” quality.

. . .

Interestingly, most of the designers who spoke at the opening of the exhibition spurned the idea of charity.

“The No. 1 need that poor people have is a way to make more cash,” said Martin Fisher, an engineer who founded KickStart, an organization that says it has helped 230,000 people escape poverty.  It sells human-powered pumps costing $35 to $95.

Pumping water can help a farmer grow grain in the dry season, when it fetches triple the normal price.  Dr. Fisher described customers who had skipped meals for weeks to buy a pump and then earned $1,000 the next year selling vegetables.

For the full story, see: 

DONALD G. McNEIL Jr.  "Design That Solves Problems for the World's Poor."  The New York Times  (Tues., May 29, 2007):  D3.

(Note:  ellipses added.)

   The photo on the left shows a woman safely drinking bacteria-laden water through a filter.  The photo on the right shows a "pot-in-pot cooler" that evaporates water from wet sand between the pots, in order to cool what is in the inner pot.  Source of photos:  online version of the NYT article quoted and cited above.

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(p. A1) Researchers in New York believe they have solved one of the great mysteries of the flu: Why does the infection spread primarily in the winter months?

The answer, they say, has to do with the virus itself. It is more stable and stays in the air longer when air is cold and dry, the exact conditions for much of the flu season.

. . .

(p. A22) To his surprise, Dr. Palese stumbled upon a solution that appeared to be a good second best.

Reading a paper published in 1919 in the Journal of the American Medical Association on the flu epidemic at Camp Cody in New Mexico, he came upon a key passage: "It is interesting to note that very soon after the epidemic of influenza reached this camp, our laboratory guinea pigs began to die." At first, the study's authors wrote, they thought the animals had died from food poisoning. But, they continued, "a necropsy on a dead pig revealed unmistakable signs of pneumonia."

Dr. Palese bought some guinea pigs and exposed them to the flu virus. Just as the paper suggested, they got the flu and spread it among themselves. So Dr. Palese and his colleagues began their experiments.

. . .

As for Dr. Palese, he was glad he spotted the journal article that mentioned guinea pigs.

"Sometimes it pays to read the old literature," he said.

 

For the full story, see:

GINA KOLATA. "Study Shows Why the Flu Likes Winter." The New York Times (Weds., December 5, 2007): A1 & A22.

(Note:  ellipses added.)

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    Source of image:  online version of the WSJ article quoted and cited below.

(p. D1)  As part of the government's focus on energy and the environment, Americans are urged to buy compact fluorescent light bulbs, which use only about 25% of the energy and last up to 10 times as long as traditional incandescent bulbs. Nearly 300 million such bulbs were sold in U.S. in 2007, compared with 100 million two years earlier, according to the Department of Energy.

. . .

Yet unlike traditional incandescent bulbs, these bulbs contain mercury, a metal hazardous to human health and the environment. Consumers are urged not to toss them in the trash. In some states, such as California, it's illegal to throw them away; they must be recycled. Still, many cities and towns don't have recycling programs for the bulbs, and consumers aren't sure what to do with them.

For the full story, see: 

SARA SCHAEFER MUÑOZ.  "The Dark Side Of 'Green' Bulbs Disposing of Fluorescents, Electronics Releases Toxins; Companies Tout Recycling." The Wall Street Journal  (Thurs., January 24, 2008):  D1.  

(Note:  ellipsis added.)

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    Source of graph:  online version of the NYT article cited below. 

(p. C1)  In politics, every serious candidate for the White House has a health care plan. So too in business, where the two leading candidates for Web supremacy, Google and Microsoft, are working up their plans to improve the nation’s health care.

. . .

(p. C8)  If the efforts of the two big co