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September 18, 2016

Lack of Control at Job Causes Stress, Leading to Cardiovascular Disease



(p. 6) Allostasis is not about preserving constancy; it is about calibrating the body's functions in response to external as well as internal conditions. The body doesn't so much defend a particular set point as allow it to fluctuate in response to changing demands, including those of one's social circumstances. Allostasis is, in that sense, a politically sophisticated theory of human physiology. Indeed, because of its sensitivity to social circumstances, allostasis is in many ways better than homeostasis for explaining modern chronic diseases.

Consider hypertension. Seventy million adults in the United States have it. For more than 90 percent of them, we don't know the cause. However, we do have some clues. Hypertension disproportionately affects blacks, especially in poor communities.


. . .


Peter Sterling, a neurobiologist and a proponent of allostasis, has written that hypertension in these communities is a normal response to "chronic arousal" (or stress).


. . .


Allostasis is attractive because it puts psychosocial factors front and center in how we think about health problems. In one of his papers, Dr. Sterling talks about how, while canvassing in poor neighborhoods in Cleveland in the 1960s, he would frequently come across black men with limps and drooping faces, results of stroke. He was shocked, but today it is well established that poverty and racism are associated with stroke and poor cardiovascular health.

These associations also hold true in white communities. One example comes from the Whitehall study of almost 30,000 Civil Service workers in Britain over the past several decades. Mortality and poor health were found to increase stepwise from the highest to the lowest levels in the occupational hierarchy: Messengers and porters, for example, had nearly twice the death rate of administrators, even after accounting for differences in smoking and alcohol consumption. Researchers concluded that stress -- from financial instability, time pressures or a general lack of job control -- was driving much of the difference in survival.



For the full commentary, see:

SANDEEP JAUHAR. "When Blood Pressure Is Political." The New York Times, SundayReview Section (Sun., AUG. 7, 2016): 6.

(Note: ellipses added.)

(Note: the online version of the review has the date AUG. 6, 2016.)


The commentary quoted above is distantly related to Jauhar's book:

Jauhar, Sandeep. Doctored: The Disillusionment of an American Physician. New York: Farrar, Straus and Giroux, 2014.






September 16, 2016

Greenland Shark Likely to Have Lived to at Least 272 Years Old



(p. A11) The mysterious Greenland shark lives at extreme depths in dark, icy waters, which have long protected it from scientists' prying eyes.

But now, an international group of researchers has estimated the dark brown cartilaginous fish may live as long as 500 years--which would make it the longest-living vertebrate on the planet.

The work, published Thursday [Aug. 11, 2016] in the journal Science, "offers the first hard evidence of how long-lived this poorly understood shark species can be," said Steve Campana, a shark expert at the University of Iceland in Reykjavik, who wasn't involved in the study.


. . .


. . . the 11-person team of researchers turned to math models and radiocarbon dating, a technique typically used to date fossils. They focused their work on the eye lens nucleus of each shark, a structure that stops developing at birth and therefore serves as a rough proxy of birth date. They measured the levels of carbon-14 in the tissue, which animals stop accumulating when they die.

The oldest shark in the study, which measured more than 16 feet, lived an estimated 392 years, according to the scientists. Because the study had a margin of error of 120 years for that fish, the researchers concluded the sharks could live up to about 500 years.



For the full story, see:

DANIELA HERNANDEZ. "Enigmatic Shark Can Live for Centuries, Study Says." The Wall Street Journal (Fri., Aug. 12, 2016): A12.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date Aug. 11, 2016, and has the title "Mysterious Greenland Shark May Live Hundreds of Years, Scientists Say." The online version included several additional sentences, interspersed through the article, that were not included in the print version. The sentences quoted above, appeared in both versions, but the formatting of the quotes above, most closely follow the print version.)


The research article reporting findings discussed above, is:

Nielsen, Julius, Rasmus B. Hedeholm, Jan Heinemeier, Peter G. Bushnell, Jørgen S. Christiansen, Jesper Olsen, Christopher Bronk Ramsey, Richard W. Brill, Malene Simon, Kirstine F. Steffensen, and John F. Steffensen. "Eye Lens Radiocarbon Reveals Centuries of Longevity in the Greenland Shark (Somniosus microcephalus)." Science 353, no. 6300 (Aug. 12, 2016): 702-04.






September 14, 2016

Traveling Health Volunteers Often Do Harm



(p. D3) Tens of thousands of religious and secular institutions now send hundreds of thousands of health volunteers from the United States out into the world, generating close to an estimated $1 billion worth of unpaid labor. Volunteers include experienced medical professionals and individuals who can provide only elbow grease; between these extremes of competence are the hordes of students in the health professions, among whom global volunteering has become immensely popular.


. . .


Students may take advantage of the circumstances to attempt tasks well beyond their expertise. Seasoned professionals may cling to standards of practice that are irrelevant or impossible to sustain in poor countries. Unskilled volunteers who do not speak the language may monopolize local personnel with their interpreting needs without providing much of value in return.

Problems may lie with the structure of a program rather than the personnel. Volunteer projects may be choppy and discontinuous, one set of volunteers not knowing what the previous group was up to, and not able to leave suggestions for the next group. Medications may run out. Surgery may be performed with insufficient provisions for postoperative care.

Even well-organized programs may undermine hosting communities in unanticipated ways: For instance, a good volunteer-based clinic may sap confidence in local medical care and, providing free services, threaten to put local physicians out of business.


. . .


A few studies on the long-term effects of short-term good works are ongoing. In the meantime, "there is little evidence that short-term volunteer trips produce the kinds of transformational changes that are often promised," Dr. Lasker finds.



For the full review, see:

ABIGAIL ZUGER, M.D. "The Folly of the Well-Meaning Traveling Volunteer." The New York Times (Tues., APRIL 26, 2016): D3.

(Note: ellipses added.)

(Note: the online version of the review has the date APRIL 25, 2016, and has the title "Books; Book Review: 'Hoping to Help' Questions Value of Volunteers.")


The book under review, is:

Lasker, Judith N. Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, The Culture and Politics of Health Care Work. Ithaca, NY: Cornell University Press, 2016.






September 11, 2016

FDA Blocking Stem-Cell Therapies from Those With No Other Hope



(p. D2) Research is exploding into ways stem cells might be harnessed to cure diseases, mend damaged tissue, even grow replacement organs.


. . .


Jeffrey Weiss, a retinal surgeon in Margate, Fla., has treated about 570 patients with retinal and optic nerve diseases with stem cells taken from patients' bone marrow as part of a study, and says that about 60% have had meaningful improvement. Patients pay $19,000 to $21,000 to receive the injections.

Shawn Rockafellow, a 31-year old truck dispatcher in Chandler, Ariz., started rapidly losing his vision in 2014 to a genetic disease and says he was told to accept that he was going blind. His mother read about Dr. Weiss's work. Mr. Rockafellow raised the $20,000 fee on GoFundMe, a personal charity website, and had the treatment in both eyes in January.

After three months, the vision in his right eye went from roughly 20/1,000 to 20/400. After six months, it was 20/300. His left eye hasn't improved as much, so he wants to try the treatment again. His regular ophthalmologist, Scott Markham, says "the fact that he's not worsening is fantastic."


. . .


Mark Berman, a Beverly Hills, Calif., cosmetic surgeon who co-founded a network of stem-cell clinics, says "fundamentally, all we are doing is a simple, surgical procedure. This is not witch-doctor stuff. We are repairing cell damage with people's own stem cells." He says the member clinics in 25 states have treated about 5,000 patients to date, with no significant adverse events.

SammyJo Wilkinson, a former dot-com executive, developed multiple sclerosis in 1995 and was confined to a wheelchair by 2011. She says her symptoms started to improve almost immediately after receiving a high-dose stem cell treatment at a Houston clinic in 2012. When the FDA blocked access to that form of therapy, Ms. Wilkinson went to Cancún, Mexico, for follow-ups. After a total of five treatments for $90,000, she says she has far less pain, can exercise and walk short distances with the help of a walker.

At the FDA hearing, Ms. Wilkinson, who founded a patient group called Patients for Stem Cells, plans to appeal for a faster approval process for stem-cell therapies and a registry to monitor patient outcomes. "Patients will never get these treatments if they have to go the traditional double-blind placebo-controlled trial route. That takes 10 years and $1 billion," she says. "There's got to be a middle ground, where you don't shut off treatment, you just keep track of it."



For the full story, see:

Beck, Melinda. "Stem-Cell Treatments Become More Available, and Face More Scrutiny." The Wall Street Journal (Tues., Aug. 30, 2016): D2.

(Note: ellipses added.)

(Note: the online version of the story has the date Aug. 29, 2016, and has the title "Stem-Cell Treatments Become More Available, and Face More Scrutiny." There are minor differences in wording between the online and print versions. The sentences quoted above, follow the online version.)






September 8, 2016

Precautionary Principle Slows Cloning Innovation



(p. A8) Dolly the Sheep started her life in a test tube in 1996 and died just six years later. When she was only a year old, there was evidence that she might have been physically older. At five, she was diagnosed with osteoarthritis. And at six, a CT scan revealed tumors growing in her lungs, likely the result of an incurable infectious disease. Rather than let Dolly suffer, the vets put her to rest.

Poor Dolly never stood a chance. Or did she?

Meet Daisy, Diana, Debbie and Denise. "They're old ladies. They're very healthy for their age," said Kevin Sinclair, a developmental biologist who, with his colleagues at the University of Nottingham in Britain, has answered a longstanding question about whether cloned animals like Dolly age prematurely.

In a study published Tuesday in Nature Communications, the scientists tested these four sheep, created from the same cell line as Dolly, and nine other cloned sheep, finding that, contrary to popular belief, cloned animals appear to age normally.


. . .


Not only did many countries, including Canada and Australia, ban reproductive cloning in animals, but the United Nations banned all kinds of cloning in humans in 2005. Last year the European Union made importing food from cloned animals or their offspring illegal.


. . .


Now, based on results of this new study, researchers have confirmed what most scientists believed years ago: Cloning does not lead to premature aging.


. . .


Many scientists hope that changes in perception will lead to advances in reproductive technology that will enable us to provide food for a growing global population, save endangered species and develop advanced therapies.



For the full story, see:

JOANNA KLEIN. "Dolly's Fellow Clones, Enjoying the Golden Years." The New York Times (Weds., JULY 27, 2016): A8.

(Note: ellipses added.)

(Note: the online version of the commentary has the date JULY 26, 2016, and has the title "Dolly the Sheep's Fellow Clones, Enjoying Their Golden Years.")






September 2, 2016

Mather and Boylston Risked Much to Fight Smallpox




I enjoyed reading the book reviewed below. From the title, and from reviews, I had the impression that it would mostly be about the smallpox epidemic and the innoculation conflict. I was surprised that of equal, or greater, importance in the book is the role of James Franklin's newspaper in laying the intellectual groundwork for the American Revolution. I learned from that part of the book too, but some might feel misled from the title about what the book was mainly about. (I think "fever" in the title is intended as a double entendre, referring both to a fever from smallpox, and a fever from the ideas of liberty.)



(p. A11) Inoculation was proposed by Cotton Mather, a figure much diminished in the 30 years since Salem. He had suffered a terrible sequence of tragedies, losing his wife and 10 of his children to accidents and epidemic disease. He had also been marginalized within the religious community by quarrels and scandals. But he had become an assiduous student of science, corresponding with the Royal Society in London and learning from its "Transactions" that inoculation against smallpox had long been practiced in Constantinople. Mr. Coss shows how Mather's investigations led him to consult a source closer to home. His slave Onesimus, when asked whether he had ever had smallpox, replied "both Yes, and No": He had been inoculated as a child in Africa, receiving a mild infection and subsequent immunity.

Inoculation was commonplace across swaths of Africa, the Middle East and Asia, Mr. Coss explains, but this inclined the doctors of Enlightenment-era Europe to regard it as a primitive superstition. Such was the view of William Douglass, the only man in Boston with the letters "M.D." after his name, who was convinced that "infusing such malignant filth" in a healthy subject was lethal folly. The only person Mather could persuade to perform the operation was a surgeon, Zabdiel Boylston, whose frontier upbringing made him sympathetic to native medicine and who was already pockmarked from a near-fatal case of the disease.

"Given that attempting inoculation constituted an almost complete leap of faith for Boylston," Mr. Coss writes, "he spent surprisingly little time agonizing over it." He knew personally just how savage the toll could be. On June 26, 1721, just as the epidemic began to rage in earnest, Boyston filled a quill with the fluid from an infected blister and scratched it into the skin of two family slaves and his own young son.

News of the experiment was greeted with public fury and terror that it would spread the contagion. A town-hall meeting was convened, at Dr. Douglass's instigation, at which inoculation was condemned and banned. Mather's house was firebombed with an incendiary device to which a note was attached: "I will inoculate you with this."



For the full review, see:

MIKE JAY. "'BOOKSHELF; An Ounce of Prevention; When Cotton Mather advocated inoculation during a smallpox outbreak, young Benjamin Franklin helped foment outrage against him." The Wall Street Journal (Thurs., March 3, 2016): A11.

(Note: the online version of the review has the date March 2, 2016, and has the title "'BOOKSHELF; When Ben Franklin Was Against Vaccines; When Cotton Mather advocated inoculation during a smallpox outbreak, young Benjamin Franklin helped foment outrage against him.")


The book under review, is:

Coss, Stephen. The Fever of 1721: The Epidemic That Revolutionized Medicine and American Politics. New York: Simon & Schuster, 2016.






August 30, 2016

Fragmented Health Care Causes Polypharmacy Harms



(p. D5) Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.

"A cardiologist puts someone on good, evidence-based medications for his heart," said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. "An endocrinologist does the same for his bones."


. . .


"Pretty soon, you have an 82-year-old man who's on 14 medications," Dr. Alexander said, barely exaggerating.

Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.


. . .


Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to health care. "The system is not geared to look at a person as a whole, to see how the patterns fit together," Dr. Steinman said.



For the full commentary, see:

Span, Paula. "THE NEW OLD AGE; An Ever-Mounting Pile of Pills." The New York Times (Tues., APRIL 26, 2016): D5.

(Note: ellipses added.)

(Note: the online version of the commentary has the date APRIL 22, 2016, and has the title "THE NEW OLD AGE; The Dangers of 'Polypharmacy,' the Ever-Mounting Pile of Pills.")






August 28, 2016

Cancer Is Not Due to Modernity



(p. 1A) Scientists' conventional opinion about cancer was that it's a relatively recent phenomenon caused by the stresses of modern life.

Dietary changes, behavioral changes and man-made changes to our environment have subjected humans to toxins that contribute to cancers, they say.

But new findings from researchers at South Africa's University of the Witwatersrand published in the South African Journal of Science challenge that assumption.

Paleontologists found a benign tumor in a 12 or 13-year-old boy specimen that dates back almost 2 million years.

More significantly, they also found a malignant tumor that's 1.7 million years old on the little toe bone of a left foot.

Previously the oldest discovered human cancer was between 780,000 and 120,000 years old.


. . .


(p. 2A) "The evidence is out there that these conditions have been with us a long time and we've been kind of hoodwinked that cancer is a modernity," said Patrick Randolph-Quinney, one of the study's authors. "These things are ancient."

The greatest predictor of cancer, the study argues, even in our ancestors, is longevity. The longer we live, the more chances something in our bodies goes wrong, the more chances that something is a tumor.



For the full story, see:

The Washington Post. "Ancient tumor upends notion of cancer as modern affliction; 1.7-million-year-old malignant growth is causing scientists to rethink diseases and human history." Omaha World-Herald (Sat., JUNE 20, 2016): 1A & 2A.

(Note: ellipsis added.)


The scientific article mentioned above, is:

Patrick, S. Randolph-Quinney, A. Williams Scott, Steyn Maryna, R. Meyer Marc, S. Smilg Jacqueline, E. Churchill Steven, J. Odes Edward, Augustine Tanya, Tafforeau Paul, and R. Berger Lee. "Osteogenic Tumour in Australopithecus Sediba: Earliest Hominin Evidence for Neoplastic Disease." South African Journal of Science (July/Aug. 2016), DOI: http://dx.doi.org/10.17159/sajs.2016/20150470.






August 25, 2016

"Doctors Often Do Not 'Know' What They Are Doing"



(p. A11) Into the "swift currents and roiling waters of modern medicine" plunges Dr. Steven Hatch, whose informative "Snowball in a Blizzard" adds an important perspective. Dr. Hatch believes that our health-care system can "champion patient autonomy" and facilitate "more humane treatment, less anxiety, and better care" by revealing to patients the "great unspoken secret of medicine." What's the secret? Simply stated, "doctors often do not 'know' what they are doing." In Dr. Hatch's view, despite spectacular advances in biomedical science, modern "doctors simply cannot provide the kind of confident predictions that are often expected of them."


. . .


He begins where Donald Rumsfeld ended: There will always be "known knowns, known unknowns, and unknown unknowns" in medicine. Dr. Hatch illustrates this spectrum of uncertainty with engaging exposés of popular screening tests like mammograms (attempting to detect breast cancer is like "finding a snowball in a blizzard"); common drug treatments, like those used to lower serum cholesterol or blood-pressure levels (about which expert national guidelines seem to change almost yearly); and health-care coverage in the lay media (whose "breaking news" too often ignores the uncertainty of the news being broken). Throughout his book, Dr. Hatch's message is "caveat emptor," warning his readers to beware not only the pseudoscientists, flim-flammers, anti-vacciners and celebrity doctors but also the all-too-certain pronouncements of the medical establishment.



For the full review, see:

BRENDAN REILLY. "BOOKSHELF; Give It To Me Straight, Doc; Doctors can't really be certain if any treatment will help a particular person. But patients are looking for prescriptions, not probabilities." The Wall Street Journal (Tues., March 15, 2016): A11.

(Note: the ellipsis between paragraphs, and the first two in the final quoted paragraph, are added; the third ellipsis in the final paragraph is in the original.)

(Note: ellipsis added.)

(Note: the online version of the review has the date March 14, 2016.)


The book under review, is:

Hatch, Steven. Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine. New York: Basic Books, 2016.






August 20, 2016

Iowa State Students Go Bananas to Save (or Harm?) African Children



(p. A11) Student activists at Iowa State University are up in arms after researchers offered to pay them almost a thousand bucks to eat some genetically modified banana. The bananas, created by an Australian scientist, contain high levels of beta carotene, which converts to vitamin A when eaten.


. . .


"Those students are acting out of ignorance," Jerome Kubiriba, the head of the National Banana Research Program in Uganda, tells me. "It's one thing to read about malnutrition; it's another to have a child who is constantly falling sick yet, due to limited resources, the child cannot get immediate and constant medical care. If they knew the truth about the need for vitamin A and other nutrients for children in Uganda and Africa, they'd get a change of heart."



For the full commentary, see:

JULIE KELLY. "Anti-GMO Students Bruise a Superbanana." The Wall Street Journal (Tues., March 15, 2016): A11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date March 14, 2016.)






August 18, 2016

Androgen Lengthens Telomeres



(p. A3) Androgens, a kind of sex hormone, have been used to treat certain genetic blood disorders for decades. But doctors haven't been able to pinpoint exactly why they seem to help some patients. A small study puts forth a theory behind androgens' disease-fighting mechanism: They help stabilize and even rebuild telomeres, which increasingly diminish in certain conditions and aging.


. . .


The authors of the study, published Wednesday [May 18, 2016] in the New England Journal of Medicine, treated telomere-disease patients who had a variety of conditions with a high dose of a synthetic androgen called danazol. The goal was to test whether the treatment would help keep telomeres intact longer. Instead, they saw them lengthen.


. . .


Experts, including the study's authors, . . . warned against concluding danazol is a fountain of youth for the healthy, based on research that suggests that shrinking telomeres may be involved in aging.

"That," said Dr. Agarwal, "would be purely in the realm of speculation."



For the full story, see:

DANIELA HERNANDEZ. "How Sex Hormones Might Treat Some Diseases." The Wall Street Journal (Thurs., May 19, 2016): A3.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date May 18, 2016, and has the title "How Sex Hormones Might Treat Certain Diseases." The print version starts with a one-sentence summary paragraph that is absent in the online version. The second paragraph in the print version differs slightly from the first paragraph in the online version. The version quoted as the first paragraph above, is the first paragraph of the online version.)


The academic article mentioned above (though the date given by the NYT above appears to be a day too early), is:

Townsley, Danielle M., Bogdan Dumitriu, Delong Liu, Angélique Biancotto, Barbara Weinstein, Christina Chen, Nathan Hardy, Andrew D. Mihalek, Shilpa Lingala, Yun Ju Kim, Jianhua Yao, Elizabeth Jones, Bernadette R. Gochuico, Theo Heller, Colin O. Wu, Rodrigo T. Calado, Phillip Scheinberg, and Neal S. Young. "Danazol Treatment for Telomere Diseases." New England Journal of Medicine 374, no. 20 (May 19, 2016): 1922-31.






August 16, 2016

Certificate-of-Need Regulations Protect Incumbents and Hurt Consumers



(p. A11) An important but overlooked debate is unfolding in several states: When governments restrict market forces in health care, who benefits? Legislative majorities in 36 states believe that consumers benefit, because restrictions help control health-care costs. But new research confirms what should be common sense: Preventing qualified health-care providers from freely plying their trade results in less access to care.

Most states enforce market restrictions through certificate-of-need programs, which mandate a lengthy, expensive application process before a health-care provider can open or expand a facility. The story goes: If hospitals or physicians could choose what services to provide, competition for patients would force providers to overinvest in equipment such as MRI machines--and the cost could be passed on to patients through higher medical bills.


. . .


These restrictions have largely failed to reduce costs, but they certainly reduce services. A 2011 study in the Journal of Health Care Finance found that certificate-of-need laws resulted in 48% fewer hospitals and 12% fewer hospital beds.



For the full commentary, see:

THOMAS STRATMANN and MATTHEW BAKER. "Certifiably Needless Health-Care Meddling." The Wall Street Journal (Tues., Jan. 12, 2016): A11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Jan. 11, 2016.)


The "new research" mentioned by Stratman in the passage quoted above, is:

Stratmann, Thomas, and Matthew C. Baker. "Are Certificate-of-Need Laws Barriers to Entry?: How They Affect Access to MRI, CT, and Pet Scans." Mercatus Working Paper, Jan. 2016.






August 11, 2016

Denmark Drones Saving Lives



(p. B1) Mr. McLinden is a member of a group of middle-aged emergency workers taking part in a trial to jump-start the use of unmanned aircraft by Europe's emergency services. The goal is to give the region a head start over the United States and elsewhere in using drones to tackle real-world emergencies.

The "drone school" builds on Europe's worldwide lead in giving public groups and companies relatively free rein to experiment with unmanned aircraft. If everything goes as planned, the project's backers hope government agencies in Europe and farther afield can piggyback on the experiences, helping to transform drones from recreational toys to lifesaving tools.

"For us, this technology is a game-changer," said Mr. McLinden, who traveled to Copenhagen (p. B4) for a three-day training course with two colleagues from the Mid and West Wales Fire and Rescue Service. They will start offering 24/7 drone support -- allowing colleagues, for example, to monitor accidents from 300 feet above -- across central Wales later this month.

"Drones aren't going to replace what we do," Mr. McLinden added. "But anything that we can do to give our crews an advantage, that's great."


. . .


In a somewhat stuffy classroom at a disused fire station in Copenhagen, Thomas Sylvest gave advice to Mr. McLinden and others from his two years of flying. As Denmark's first, and so far only, emergency service drone pilot, Mr. Sylvest has responded to things as varied as missing person cases and fires, often receiving calls late at night.

Mr. Sylvest, a fast-talking 50-year-old, offered tips on how best to share videos streamed directly from drones to commanders on the ground. During a recent fire in downtown Copenhagen, Mr. Sylvest said, he was able to beam high-definition images from high above, allowing his bosses to judge if a building's walls would collapse (they did not). And when the police called him out last year after a man was reported missing, he flew his drone along a stretch of train tracks to guide colleagues on where best to look. (The man was found.)



For the full story, see:

MARK SCOTT. "Emergency Workers Turn to Drones to Save Lives." The New York Times (Mon., JUNE 20, 2016): B1 & B4.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date JUNE 19, 2016, and has the title "Europe's Emergency Workers Turn to Drones to Save Lives.")






August 10, 2016

Crony Credentialism Is Regulatory Barrier to Telemedicine



(p. A11) Telemedicine has made exciting advances in recent years. Remote access to experts lets patients in stroke, neonatal and intensive-care units get better treatment at a lower cost than ever before. In rural communities, the technology improves timely access to care and reduces expensive medevac trips. Remote-monitoring technology lets patients with chronic conditions live at home rather than in an assisted-living facility.

Yet while telemedicine can connect a patient in rural Idaho with top specialists in New York, it often runs into a brick wall at state lines. Instead of welcoming the benefits of telemedicine, state governments and entrenched interests use licensing laws to make it difficult for out-of-state experts to offer remote care.


. . .


Using its power under the Commerce Clause of the Constitution, Congress could pass legislation to define where a physician practices medicine to be the location of the physician, rather than the location of the patient, as states currently do. Physicians would need only one license, that of their home state, and would work under its particular rules and regulations.

This would allow licensed physicians to treat patients in all 50 states. It would greatly expand access to quality medical care by freeing millions of patients to seek services from specialists around the country without the immense travel costs involved.



For the full commentary, see:


SHIRLEY SVORNY. "Telemedicine Runs Into Crony Doctoring; State medical-licensing barriers protect local MDs and deny patients access to remote-care physicians." The Wall Street Journal (Sat., July 23, 2016): A11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date JUNE 22, 2016.)






July 27, 2016

World Health Organization Praises Coffee, Reversing 1991 Warning



(p. A9) An influential panel of experts convened by the World Health Organization concluded on Wednesday [JUNE 15, 2016] that regularly drinking coffee could protect against at least two types of cancer, a decision that followed decades of research pointing to the beverage's many health benefits. The panel also said there was a lack of evidence that it might cause other types of cancer.

The announcement marked a rare reversal for the panel, which had previously described coffee as "possibly carcinogenic" in 1991 and linked it to bladder cancer. But since then a large body of research has portrayed coffee as a surprising elixir, finding lower rates of heart disease, Type 2 diabetes, neurological disorders and several cancers in those who drink it regularly.



For the full story, see:

ANAHAD O'CONNOR. "Coffee May Protect Against Cancer, W.H.O. Concludes, in Reversal of a 1991 Study." The New York Times (Thurs., JUNE 16, 2016): A9.

(Note: bracketed date added.)

(Note: the online version of the commentary has the date JUNE 15, 2016, and has the title "Coffee May Protect Against Cancer, W.H.O. Concludes.")






July 16, 2016

"Entrepreneurs Can Appear in the Most Unpromising Environments"



(p. A11) Adam Fifield's entertaining biography of the little-recognized Grant shows that entrepreneurs can appear in the most unpromising environments--such as within the dysfunctional bureaucracy of the United Nations.


. . .


While top-down planning is usually misguided in aid (and most everywhere else), it turned out to be suitable for the particular challenge of vaccinations. Unfortunately, the aid establishment learned the wrong lessons from Grant's career. Instead of seeing him as an entrepreneur who saw a very specific unrealized opportunity to spread vaccination and oral rehydration salts, they viewed his success as vindicating top-down planning in general.


. . .


Those who came after Grant . . . seem to have developed even more of the paternalistic savior complex than he had--his counterparts today are the likes of Bono, Jeffrey Sachs and Bill Gates. But the condescending image of a powerful white male as the savior of helpless nonwhite children is thankfully a lot less acceptable today than it was in Grant's time. Since 2000 we have witnessed the mainly homegrown economic growth of low- and middle-income countries surpassing that of rich countries--plus many other positive long-term trends from democratization to the explosion of cellphones. Aid alone cannot explain these large triumphs in poor countries. There is still room for humanitarian entrepreneurs like Grant to find new breakthroughs, but we can appreciate much more today that the poor are their own best saviors.​



For the full review, see:

WILLIAM EASTERLY. "BOOKSHELF; The Father of Millions; The Unicef breakthrough on vaccinations and oral rehydration salts is still cited today as one of the few successes in foreign aid." The Wall Street Journal (Fri., Oct. 16, 2015): A11.

(Note: ellipses added.)

(Note: the online version of the review has the date Oct. 15, 2015.)


The book under review, is:

Fifield, Adam. A Mighty Purpose: How Jim Grant Sold the World on Saving Its Children. New York: Other Press, 2015.






July 15, 2016

Majerus Did Not Need a Randomized Trial to Know that Aspirin Prevents Heart Attacks



(p. A21) Philip W. Majerus, a biochemist who was credited as being the first to theorize that taking small doses of aspirin regularly can prevent heart attacks and strokes in vulnerable patients, died last Wednesday [June 8, 2016] at his home in St. Louis. . . .


. . .


Even before his findings were confirmed in a study by other researchers a decade later, Dr. Majerus was taking aspirin daily.

"I was already convinced that aspirin prevented heart attacks," he recalled in the journal Advances in Biological Regulation in 2014. "I was unwilling to be randomized into a trial where I might end up with the placebo. I refused to participate."

Dr. Majerus recommended that "all adults should take an aspirin daily unless they are among the few percent of the population that cannot tolerate the drug." The cardiovascular benefit of aspirin was fully achieved by 50 to 75 milligrams daily, he said, and "there is no evidence that branded aspirin, which is much more expensive, is in any way superior to the generic version."

Later studies found that for people in their 50s who are vulnerable to heart disease, taking daily doses of aspirin reduces the risk of heart disease.


. . .


Investigating how aspirin inhibited clotting, Dr. Majerus concluded that the medicine modified an enzyme that leads to the formation of a platelet-made molecule that constricts blood vessels and aggregates platelets. The pills' effect lasts for the platelets' life span, typically about two weeks.

"Phil Majerus, more than any other individual, has produced the most original body of work on biochemistry of platelets as it relates to thrombosis," Prof. Joseph L. Goldstein, a Nobel laureate at the University of Texas Southwestern Medical Center in Dallas, said when the Bristol-Myers Squibb Award was announced.



For the full obituary, see:

SAM ROBERTS. "Dr. Philip Majerus, Who Recognized Heart Benefits of Aspirin, Is Dead at 79." The New York Times (Weds., JUNE 15, 2016): A23.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the obituary has the date JUNE 14, 2016, and has the title "Dr. Philip Majerus, Who Discerned Aspirin's Heart Benefits, Dies at 79.")






July 10, 2016

Tribe Uses Autonomy to Fight American Dental Association (A.D.A.) Credentialism



(p. A10) Mr. Kennedy, 56, a soft-spoken Tlingit Native Alaskan, is a dental therapist, the rough equivalent of a physician assistant. He is trained to perform the most common procedures that dentists do, from fillings to extractions. Since January, when he started at the Swinomish Dental Clinic, over 50 miles north of Seattle, he has been the only dental therapist on tribal land anywhere in the lower 48 states. He studied in Alaska, which has the nation's only program -- patterned after one in New Zealand -- aimed at training therapists specifically to work in underserved tribal areas.

Laws here in Washington and most other states bar dental therapists, who have long been opposed by the American Dental Association, so the tribe created its own licensing system. The federal Indian Health Service, which pays for medical care on Indian lands, cannot compensate therapists unless authorized by the state, so the Swinomish (pronounced SWIN-o-mish) needed private foundation support and meticulous accounting so that no law was violated.

"We had to take matters into our own hands," said Brian Cladoosby, the chairman of the Swinomish Senate and president of the National Congress of American Indians. The breaking point came in 2015, after Washington's Legislature -- pressured by the dental lobby, Mr. Cladoosby said -- declined for the fifth year in a row to pass a bill allowing a therapist program. Asserting tribal sovereignty, the tribe forged ahead anyway.

"The American Dental Association is no friend to American Indian tribes," Mr. Cladoosby said in an interview.


. . .


(p. A11) Dr. Rachael R. Hogan, a dentist who works at the Swinomish Clinic, supervises Mr. Kennedy's work. At first she did not think the arrangement would work. The A.D.A.'s safety concerns made sense, she said.

"I was leery," she said. But after watching Mr. Kennedy for the past four months and visiting the training school in Alaska, she has changed her mind. By practicing procedures over and over -- more than most dental school graduates, who must also study a broad range of diagnostic and disease issues -- therapists can hone procedures, she said, to an art.

"Their fillings are better," she said. "Are we providing substandard care by providing a therapist? Actually, I would say it's the opposite."



For the full story, see:

KIRK JOHNSON. "Asserting Tribal Sovereignty to Improve Indian's Dental Care." The New York Times (Mon., MAY 23, 2016): A10-A11.

(Note: ellipsis added.)

(Note: the online version of the story has the date MAY 22, 2016, and has the title "Where Dentists Are Scarce, American Indians Forge a Path to Better Care.")






June 28, 2016

If Rapamycin Works in Humans as in Mice, We Gain 20 Years in Good Health



KaeberleinMattWithDogDobby2016-05 -26.jpg"Dr. Matt Kaeberlein, a biology of aging researcher, with his dog Dobby in North Bend, Wash. He helped fund a drug study using his own money." Source of caption: p. A12 of print version of the NYT article quoted and cited below. Source of photo: online version of the NYT article quoted and cited below.



(p. A12) But scientists who champion the study of aging's basic biology -- they call it "geroscience" -- say their field has received short shrift from the biomedical establishment. And it was not lost on the University of Washington researchers that exposing dog lovers to the idea that aging could be delayed might generate popular support in addition to new data.

"Many of us in the biology of aging field feel like it is underfunded relative to the potential impact on human health this could have," said Dr. Kaeberlein, who helped pay for the study with funds he received from the university for turning down a competing job offer. "If the average pet owner sees there's a way to significantly delay aging in their pet, maybe it will begin to impact policy decisions."

The idea that resources might be better spent trying to delay aging rather than to cure diseases flies in the face of most disease-related philanthropy and the Obama administration's proposal to spend $1 billion on a "cancer moonshot." And many scientists say it is still too unproven to merit more investment.

The National Institutes of Health has long been organized around particular diseases, including the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. There is the National Institute on Aging, but about a third of its budget last year was directed exclusively to research on Alzheimer's disease, and its Division of Aging Biology represents a tiny fraction of the N.I.H.'s $30 billion annual budget. That is, in part, because the field is in its infancy, said the N.I.H. director, Dr. Francis Collins.


. . .


"The squirrels in my neighborhood have a 25-year life span, but they look like rats that live two years," said Gary Ruvkun, a pioneer in aging biology at Harvard Medical School. "If you look at what nature has selected for and allowed, it suggests that you might be able to get your hands on the various levers that change things."


. . .


Over 1,500 dog owners applied to participate in the trial of rapamycin, which has its roots in a series of studies in mice, the first of which was published in 2009. Made by a type of soil bacterium, rapamycin has extended the life spans of yeast, flies and worms by about 25 percent.

But in what proved a fortuitous accident, the researchers who set out to test it in mice had trouble formulating it for easy consumption. As a result, the mice were 20 months old -- the equivalent of about 60 human years -- when the trial began. That the longest-lived mice survived about 12 percent longer than the control groups was the first indication that the drug could be given later in life and still be effective.

Dr. Kaeberlein said he had since achieved similar benefits by giving 20-month-old mice the drug for only three months. (The National Institute on Aging rejected his request for funding to further test that treatment.) Younger mice, given higher doses, have lived about 25 percent longer than those not given the drug, and mice of varying ages and genetic backgrounds have been slower to develop some cancers, kidney disease, obesity and symptoms of Alzheimer's disease. In one study, their hearts functioned better for longer.

"If you do the extrapolation for people, we're probably talking a couple of decades, with the expectation that those years are going to be spent in relatively good health," Dr. Kaeberlein said.


. . .


. . . what dog lovers have long considered the sad fact that their pets age about seven times as fast as they do, Dr. Kaeberlein knew, would be a boon for a study of rapamycin that would have implications for both species. An owner of two dogs himself, he was determined to scrounge up the money for the pilot phase of what he and Dr. Promislow called the Dog Aging Project.

Last month, he reported at a scientific meeting that no significant side effects had been observed in the dogs, even at the highest of three doses. And compared with the hearts of dogs in the control group, the hearts of those taking the drug pumped blood more efficiently at the end. The researchers would like to enroll 450 dogs for a more comprehensive five-year study, but do not yet have the money.

Even if the study provided positive results on all fronts, a human trial would carry risks.

Dr. Kaeberlein, for one, said they would be worth it.

"I would argue we should be willing to tolerate some level of risk if the payoff is 20 to 30 percent increase in healthy longevity," he said. "If we don't do anything, we know what the outcome is going to be. You're going to get sick, and you're going to die."



For the full story, see:

AMY HARMON. "CHASING IMMORTALITY; Dogs Test Drug Aimed at Humans' Biggest Killer: Age." The New York Times (Tues., MAY 17, 2016): A1 & A12.

(Note: ellipses added.)

(Note: the online version of the story has the date MAY 16, 2016, and has the title "CHASING IMMORTALITY; Dogs Test Drug Aimed at Slowing Aging Process.")


An academic paper that discusses the wide variability in life span of different species in the order Rodentia (which includes short-lived rats and long-lived squirrels), is:

Gorbunova, Vera, Michael J. Bozzella, and Andrei Seluanov. "Rodents for Comparative Aging Studies: From Mice to Beavers." Age 30, no. 2-3 (June 25, 2008): 111-19.






June 5, 2016

Technology Can Restore Hand Control to Quadriplegic



(p. A1) Five years ago, a college freshman named Ian Burkhart dived into a wave at a beach off the Outer Banks in North Carolina and, in a freakish accident, broke his neck on the sandy floor, permanently losing the feeling in his hands and legs.

On Wednesday [April 13, 2016], doctors reported that Mr. Burkhart, 24, had regained control over his right hand and fingers, using technology that transmits his thoughts directly to his hand muscles and bypasses his spinal injury. The doctors' study, published by the journal Nature, is the first account of limb reanimation, as it is known, in a person with quadriplegia.

Doctors implanted a chip in Mr. Burkhart's brain two years ago. Seated in a lab with the implant connected through a computer to a sleeve on his arm, he was able to learn by repetition and arduous practice to focus his thoughts to make his hand pour from a bottle, and to pick up a straw and stir. He was even able to play a guitar video game.


. . .


"Watching him close his hand for the first time -- I mean, it was a surreal moment," Dr. Rezai said. "We all just looked at each other and thought, 'O.K., the work is just starting.'"

After a year of training, Mr. Burkhart was able to pick up a bottle and pour the contents into a jar, and to pick up a straw and stir. The doctors, though delighted, said that more advances would be necessary to make the bypass system practical, affordable and less invasive, most likely through wireless technology. But the improvement was significant enough, at least in the lab, that rehabilitation specialists could reclassify Mr. Burkhart's disability from a severe C5 function to a less severe C7 designation.

For now, the funding for the project, which includes money from Ohio State, Battelle and private donors, is set to run out this year -- and with it, Mr. Burkhart's experience of restored movement.

"That's going to be difficult, because I've enjoyed it so much," Mr. Burkhart said. "If I could take the thing home, it would give me so much more independence. Now, I've got to rely on someone else for so many things, like getting dressed, brushing my teeth -- all that. I just want other people to hear about this and know that there's hope. Something will come around that makes living with this injury better."



For the full story, see:

BENEDICT CAREY. "Quadriplegic Gets Use of Hand from Chip Placed in His Brain." The New York Times (Thurs., APRIL 14, 2016): A1 & A16.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story has the date APRIL 13, 2016, and has the title "Chip, Implanted in Brain, Helps Paralyzed Man Regain Control of Hand.")


The scientific article in Nature reporting the advance, is:

Bouton, Chad E., Ammar Shaikhouni, Nicholas V. Annetta, Marcia A. Bockbrader, David A. Friedenberg, Dylan M. Nielson, Gaurav Sharma, Per B. Sederberg, Bradley C. Glenn, W. Jerry Mysiw, Austin G. Morgan, Milind Deogaonkar, and Ali R. Rezai. "Restoring Cortical Control of Functional Movement in a Human with Quadriplegia." Nature 533, no. 7602 (May 12, 2016): 247-50.






June 2, 2016

Neurosurgical Establishment Waited Decade to Adopt Jannetta's Cure



(p. C6) Dr. Peter J. Jannetta, a neurosurgeon who as a medical resident half a century ago developed an innovative procedure to relieve an especially devastating type of facial pain, died on Monday [April 1?, 2016] in Pittsburgh.


. . .


"This was a condition that had been documented for a thousand years: There are references in the ancient literature to what was originally called 'tic douloureux,' " Mark L. Shelton, the author of "Working in a Very Small Place: The Making of a Neurosurgeon," a 1989 book about Dr. Jannetta, said in a telephone interview on Thursday. "People knew of this unexplained, very intense, episodic facial pain but didn't know the cause of it."


. . .


In the mid-1960s, Dr. Jannetta made a striking discovery while he was a neurosurgical resident at the University of California, Los Angeles. Dissecting a set of cranial nerves for a class presentation, he noticed something amiss: a tiny blood vessel pressing on the trigeminal nerve.

"It came to him as something of a flash of insight," Mr. Shelton said. "He saw this blood vessel literally impinging on the nerve so that there was actually a groove in the nerve where the vessel pressed."

What if, Dr. Jannetta wondered, this were the source of the nerve damage? Though his insight is universally accepted today, it was novel to the point of subversion in the 1960s.

"The idea that a very small blood vessel, the diameter of a mechanical pencil lead, could cause such outsize pain didn't resonate with people at the time," Mr. Shelton said.


. . .


If the vessel was a vein, it could simply be cauterized and excised. If it was an artery, however -- a more essential structure -- it would, Dr. Jannetta realized, have to be gently nudged out of the way.

He created a means of doing so that involved slipping a tiny pad of soft Teflon, about the size of a pencil eraser, between the artery and the nerve.

Dr. Jannetta performed the first microvascular decompression operation in 1966. The patient, a 41-year-old man, was relieved of his pain.

It took about a decade for the procedure to win acceptance from the neurosurgical establishment, owing partly to Dr. Jannetta's youth and partly to the novelty of his idea.

"He convinced many, many skeptics -- and there were a lot of skeptics in the early years -- because it seemed so counterintuitive as to what caused neurological disease," Mr. Shelton said.


. . .


His many laurels include the medal of honor from the World Federation of Neurological Societies; the Olivecrona Award, presented by the Karolinska Institute in Sweden; and the Horatio Alger Award, which honors perseverance in the face of adversity or opposition.



For the full obituary, see:

MARGALIT FOX. "Dr. Peter J. Jannetta, Neurosurgeon and Pioneer on Facial Pain, Dies at 84." The New York Times (Fri., APRIL 15, 2016): A22.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the obituary has the date APRIL 14, 2016, and has the title "Dr. Peter J. Jannetta, Pioneering Neurosurgeon on Facial Pain, Dies at 84.")


The book about Jannetta, mentioned above, is:

Shelton, Mark. Working in a Very Small Place: The Making of a Neurosurgeon. New York: Vintage Books, 1990.






May 8, 2016

Many Empirical Research Results Are False



(p. B7) Research on 100 studies in psychology found in 2015 that more than 60% couldn't be replicated. Similar results have been found in medicine and economics. Campbell Harvey, a professor at Duke University and president of the American Finance Association, estimates that at least half of all "discoveries" in investment research, and financial products based on them, are false.


. . .


Brian Nosek, a psychology professor at the University of Virginia and executive director of the Center for Open Science, a nonprofit seeking to improve research practices, has spent much of the last decade analyzing why so many studies don't stand up over time.

Because researchers have an incentive to come up with results that are "positive and clean and novel," he says, they often test a plethora of ideas, throwing out those that don't appear to work and pursuing those that confirm their own hunches.

If the researchers test enough possibilities, they may find positive results by chance alone -- and may fool themselves into believing that luck didn't determine the outcomes.



For the full commentary, see:

JASON ZWEIG. "Chasing Hot Returns in 'Smart-Beta' Can Be Dumb." The Wall Street Journal (Sat., Feb 13, 2016): B1 & B7.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Feb 12, 2016, and has the title "Chasing Hot Returns in 'Smart-Beta' Funds Can Be a Dumb Idea.")






May 4, 2016

Retail Clinics Provide Convenient Care



(p. A3) My wife and I both work. When one of our children wakes up complaining of a sore throat, we could begin a ritual stare-down to determine which of us is going to have to wait for the doctor's office to open, make the phone call, wait on hold, schedule an appointment (which will inevitably be in the middle of the day), take off work, pick up the child from school, sit in the waiting room (surrounded by other sick children), get the rapid strep test, find out if the child is infected and then go to the pharmacy or back to school, before returning to work.

Or, one of us could just take the child to a retail clinic on the way to work and be done in 30 minutes. Strep throat is incredibly easy to treat (Penicillin still works great!). There's a simple and very fast test for it. Moreover, physicians are really bad at diagnosing some of these common illnesses clinically; a study found that a doctor's guess as to whether a respiratory infection is bacterial or viral is right about 50 percent of the time -- no better than flipping a coin. The point is, you need to get the rapid strep test every time regardless, whether at your doctor's office or at a clinic.

Aimee and I choose the retail clinic every time.

Why? Convenience is the biggest reason. Many doctors' offices are open only on weekdays and during business hours. This also happens to be when most adults work and when children attend school. A 2010 survey of 11 countries found that Americans seek out after-hours care or care in a hospital's emergency room more often than citizens of almost any other industrialized nation. More than two-thirds of Americans with a below-average income did so. But this isn't just a problem for the poor. About 55 percent of those with an above-average income did so as well.

We complain all the time that people use the emergency room for primary care. But that's not always about lack of insurance. It's about access. The emergency room is open when people can actually go. Emergency room use has gone up, not down, since the passage of the Affordable Care Act. More people have insurance, and now can afford care when they need it.

That care is also coming from retail clinics, usually found either in stand-alone storefronts or inside pharmacies. Between 2007 and 2009, retail clinic use increased 10-fold. It turns out that my wife and I represent America pretty well. About 35 percent of retail visits for children are for pharyngitis -- sore throats. Add in ear infections and upper respiratory infections, and you've accounted for more than three-quarters of visits for children. Parents bring their children to retail clinics to take care of quick, acute problems. Swap ear infections for immunizations, and you've got the main reasons adults use retail clinics, too.

Researchers for a study published in the American Journal of Medical Quality talked to patients who sought out care at retail clinics. Patients who had a primary care physician, but still went to a retail clinic, did so because their primary care doctors were not available in a timely manner. A quarter of them said that if the retail clinic weren't available, they'd go to the emergency room.



For the full commentary, see:

Aaron E. Carroll. "The Hidden Cost of Retail Health Clinics." The New York Times (Thurs., APRIL 14, 2016): A3.

(Note: the online version of the commentary has the date APRIL 12, 2016, and has the title "The Undeniable Convenience and Reliability of Retail Health Clinics." Where the two versions differ, the quoted passages above follow the online version.)


The research on patient motivation for using retail clinics, is:

Wang, Margaret C., Gery Ryan, Elizabeth A. McGlynn, and Ateev Mehrotra. "Why Do Patients Seek Care at Retail Clinics, and What Alternatives Did They Consider?" American Journal of Medical Quality 25, no. 2 (March/April 2010): 128-34.







May 2, 2016

"Lifespan Research Really Should Be the Future of Medicine"



(p. D1) A research lab at a University of California campus has a big ambition--to extend the number of years people live disease-free. The animal model it uses for its experiments is decidedly smaller: the tiny fruit fly.

The Jafari Lab, located at UC Irvine, has run tests on substances as diverse as green tea, cinnamon and an Arctic plant called Rhodiola rosea, looking for an elixir of life. To pass muster, each experimental compound must help the fruit flies live longer and not have adverse effects.

The researchers are currently investigating the effects of cinnamon on lifespan. The spice passed the first test: A dose of 25 milligrams of cinnamon per milliliter of food resulted in fruit flies living up to 37% longer. But to be declared a success, the lab is putting cinnamon through three additional tests--does it harm reproductive ability and locomotion and what impact does it have on cognitive capacities such as memory.

"When you look at how we think about aging, we don't really consider it a disease--it's just considered a 'natural' thing. But I think aging and lifespan research really should be the future of medicine," says Mahtab Jafari, an associate professor of pharmaceutical sciences at UC Irvine for whom the lab is named.



For the full story, see:

ANGELA CHEN. "HEALTH & WELLNESS; In Search of Elixir of Life, Scientist Studies Fruit Flies." The Wall Street Journal (Tues., MARCH 8, 2016): D3.

(Note: italics in original.)

(Note: the online version of the story has the date MARCH 7, 2016, and has the title "HEALTH & WELLNESS; Seeking Elixir of Life, a Scientist Studies Fruit Flies.")


A relevant academic article discussing possible metabolic pathways to increased lifespan, is:

Barzilai, Nir, Derek M. Huffman, Radhika H. Muzumdar, and Andrzej Bartke. "The Critical Role of Metabolic Pathways in Aging." Diabetes 61, no. 6 (June 2012): 1315-22.






May 1, 2016

Those Who Suffer from a Problem, Can Invent to Solve It



(p. 1) Is it possible to extract blood from people without causing pain? For decades, this problem has stumped the medical industry. In an effort to replace the old-fashioned needle, companies are trying to deploy laser beams and tiny vacuums to draw blood.

In 2014, an engineer at Harvard named Ridhi Tariyal hit on a far simpler workaround. "I was trying to develop a way for women to monitor their own fertility at home," she told me, and "those kinds of diagnostic tests require a lot of blood. So I was thinking about women and blood. When you put those words together, it becomes obvious. We have an opportunity every single month to collect blood from women, without needles."

Together with her business partner, Stephen Gire, she has patented a method for capturing menstrual flow and transforming it into medical samples. "There's lots of information in there," Ms. Tariyal said, "but right now, it's all going in the trash."

Why did Ms. Tariyal see a possibility that had eluded so many engineers before her? You might say she has an unfair advantage: her gender.


. . .


(p. 4) Eric von Hippel, a scholar of innovation at M.I.T., has spent decades studying what seems like a truism: People who suffer from a problem are uniquely equipped to solve it. "What we find is that functionally novel innovations -- those for which a market is not yet defined -- tend to come from users," he said. He pointed out that young Californians pioneered skateboards so that they could "surf" the streets. And surgeons built the first heart-and-lung machines to keep patients alive during long operations. "The reason users are so inventive is twofold. One is that they know the needs firsthand," he said. The other is that they have skin in the game.



For the full commentary, see:

PAGAN KENNEDY. "The Tampon of the Future." The New York Times, SundayReview Section (Sun., APRIL 3, 2016): 1 & 4-5.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date APRIL 1, 2016.)


Pagan Kennedy's book, that is related to her commentary quoted above, is:

Kennedy, Pagan. Inventology: How We Dream up Things That Change the World. New York: Houghton Mifflin Harcourt Publishing Co., 2016.






April 28, 2016

How Health Insurance Slows Medical Innovation



(p. A8) A recent study led by Wendell Evans at the University of Sydney supports growing evidence that early tooth decay, before a cavity forms, can often be arrested and reversed with simple treatments that restore minerals in the teeth, rather than the more typical drill-and-fill approach.

The randomized, controlled trial followed 19 dental practices in Australia for three years, then researchers checked up on the patients again four years later. The result: After seven years, patients receiving remineralization treatment needed on average 30% fewer fillings.


. . .


There is a substantial body of research supporting remineralization as a treatment for early tooth decay, and little opposition in the dental profession, says Margherita Fontana, a professor of cariology at the University of Michigan School of Dentistry. Tradition, however, has been an obstacle to widespread use of the treatment. "For older generations [of dentists], it just feels wrong to leave decay and not remove it," Dr. Fontana says. "That's how they were trained."

Reimbursement is another obstacle. Insurance typically covers application of fluoride varnish in children, but not adults. The cost ranges from $25 to $55, according to the American Dental Association's Health Policy Institute. Other preventive treatments also generally aren't covered.



For the full story, see:

DANA WECHSLER LINDEN. "Simple Dental Treatments Can Help Reverse Decay." The Wall Street Journal (Tues., APRIL 12, 2016): D3.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 11, 2016, and has the title "Simple Dental Treatments May Reverse Decay.")






April 24, 2016

Government Regulations Protect Health-Care Incumbents Against Innovation



(p. A15) As people age, the main valve controlling the flow of blood out of the heart can narrow, causing heart failure, and sometimes death. In the past the only way to repair the damage was risky open-heart surgery. But an ingenious medical device now allows the heart to be repaired using a catheter that introduces a replacement valve through a main artery in the leg--another miracle of modern medicine.

In 2011, more than four years after they hit the European market, the Food and Drug Administration finally approved aortic heart valves for use in the U.S. The total cost of the new procedure is about the same as open-heart surgery. But government bureaucrats feared that the new replacement valve's lower risks and easier administration would mean that many more elderly patients would seek to fix their failing heart valves, pushing up Medicare's total spending. To limit their use, regulators created coverage rules based on a set of strained medical criteria. It was a budget prerogative masquerading as clinical reasoning.

This episode is a vivid example of the government's increasing practice to regulate medicine and ration care. A series of landmark studies published earlier this month in the Lancet and the New England Journal of Medicine, and presented at the annual meeting of the American College of Cardiology in Chicago, makes clear how contrived the original Medicare guidelines were.

For a patient to be qualified for the aortic valve device, Medicare required two cardiac surgeons to certify first that a patient wasn't a candidate for the open-heart repair. Also mandated was the presence of a cardiothoracic surgeon and an interventional cardiologist in the operating room during the procedure.



For the full commentary, see:

SCOTT GOTTLIEB. "Warning: Medicare May Be Bad for Your Heart; Aortic valve replacements are superior to open-heart surgery and less risky. So why are they hard to get?" The Wall Street Journal (Tues., April 12, 2016): A15.

(Note: the online version of the commentary has the date April 11, 2016.)


The Lancet article mentioned above, is:

Thourani, Vinod H., Susheel Kodali, Raj R. Makkar, Howard C. Herrmann, Mathew Williams, Vasilis Babaliaros, Richard Smalling, Scott Lim, S. Chris Malaisrie, Samir Kapadia, Wilson Y. Szeto, Kevin L. Greason, Dean Kereiakes, Gorav Ailawadi, Brian K. Whisenant, Chandan Devireddy, Jonathon Leipsic, Rebecca T. Hahn, Philippe Pibarot, Neil J. Weissman, Wael A. Jaber, David J. Cohen, Rakesh Suri, E. Murat Tuzcu, Lars G. Svensson, John G. Webb, Jeffrey W. Moses, Michael J. Mack, D. Craig Miller, Craig R. Smith, Maria C. Alu, Rupa Parvataneni, Ralph B. D'Agostino, Jr., and Martin B. Leon. "Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement in Intermediate-Risk Patients: A Propensity Score Analysis." The Lancet (April 3, 2016), DOI: 10.1016/S0140-6736(16)30073-3.


The New England Journal of Medicine article mentioned above, is:

Leon, Martin B., Craig R. Smith, Michael J. Mack, Raj R. Makkar, Lars G. Svensson, Susheel K. Kodali, Vinod H. Thourani, E. Murat Tuzcu, D. Craig Miller, Howard C. Herrmann, Darshan Doshi, David J. Cohen, Augusto D. Pichard, Samir Kapadia, Todd Dewey, Vasilis Babaliaros, Wilson Y. Szeto, Mathew R. Williams, Dean Kereiakes, Alan Zajarias, Kevin L. Greason, Brian K. Whisenant, Robert W. Hodson, Jeffrey W. Moses, Alfredo Trento, David L. Brown, William F. Fearon, Philippe Pibarot, Rebecca T. Hahn, Wael A. Jaber, William N. Anderson, Maria C. Alu, and John G. Webb. "Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients." New England Journal of Medicine (April 2, 2016), DOI: 10.1056/NEJMoa1514616.







April 18, 2016

Government Limits Hospital Competition



(p. A9) When the 124-bed StoneSprings Hospital Center opened in December, it became the first new hospital in Loudoun County, Va., in more than a century. That's more remarkable than it might at first seem: In the past two decades, Loudoun County, which abuts the Potomac River and includes growing Washington suburbs, has tripled in population. Yet not a single new hospital had opened. Why? One big reason is that StoneSprings had to fight through years of regulatory reviews and court challenges before laying the first brick.

County officials and the Hospital Corporation of America, or HCA, began talking about building a new hospital in 2001. But Virginia is one of the 36 states with a "certificate of need" law, which requires health-care providers to obtain a state license before opening a new facility. Getting a license is supposed to take about nine months, according to the state Health Department. HCA first submitted an application in July 2002 but didn't win approval for a new facility until early 2004.

Then the plan faced a series of legal challenges from the Inova Health System, an entrenched, multibillion-dollar competitor. Over decades Inova has become the dominant player in the Virginia suburbs.


. . .


It's not hard to understand why Inova might fight so hard to keep out challengers: There's a direct correlation between prices and competition. In a paper released in December, economists with Yale, Carnegie Mellon and the London School of Economics evaluated claims data from Aetna, Humana and UnitedHealth. They found that rates were 15.3% higher, on average, in areas with one hospital, compared with those serviced by four or more. In markets with a two-hospital duopoly, prices were 6.4% higher. Where only three hospitals compete they were 4.8% higher.

Research by Chris Koopman of the free-market Mercatus Center suggests that Virginia could have 10,000 more hospital beds and 40 more hospitals offering MRIs if the certificate of need restrictions did not exist. "In many instances, they create a quasi-monopoly," he says. "In essence, it's a government guarantee that no one will compete with you, until you get notice and an opportunity to challenge that person's entry into that market."



For the full commentary, see:

ERIC BOEHM. "CROSS COUNTRY; For Hospital Chains, Competition Is a Bitter Pill; Building a new medical center in Virginia can take a decade, because state laws favor entrenched players." The Wall Street Journal (Sat., Jan. 30, 2016): A9.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Jan. 29, 2016.)


The academic paper mentioned above that relates hospital charges to the number of hospitals in the area, is:

Cooper, Zack, Stuart V. Craig, Martin Gaynor, and John Van Reenen. "The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured." NBER Working Paper # 21815. National Bureau of Economic Research, Inc., 2015.


Chris Koopman's research, mentioned above, can be found in:

Koopman, Christopher, and Thomas Stratmann. "Certificate-of-Need Laws: Implications for Virginia." In Mercatus on Policy: Mercatus Center, George Mason University, 2015.






March 31, 2016

After Wife's Cancer, F.D.A. Regulator Cuts Decision Time from Six to Five Months (Beyond Years Spent Testing)



(p. 1) BETHESDA, Md. -- Mary Pazdur had exhausted the usual drugs for ovarian cancer, and with her tumors growing and her condition deteriorating, her last hope seemed to be an experimental compound that had yet to be approved by federal regulators.

So she appealed to the Food and Drug Administration, whose oncology chief for the last 16 years, Dr. Richard Pazdur, has been a man denounced by many cancer patient advocates as a slow, obstructionist bureaucrat.

He was also Mary's husband.

In her struggle with cancer and ultimately her death in November, Ms. Pazdur had a part, her husband and a number of cancer specialists now say, in a profound change at the F.D.A.: a speeding up of the drug approval process. Ms. Pazdur's three-year battle with cancer was a factor, they say, in Dr. Pazdur's willingness to swiftly approve risky new treatments and passion to fight the disease that patient advocates thought he lacked.


. . .


(p. 13) Certainly there has been a change at the powerful agency. Since Ms. Pazdur learned she had ovarian cancer in 2012, approvals for drugs have been faster than at any time in the F.D.A.'s modern history. Although companies go through a yearslong discovery and testing process with new drugs before filing a formal application with the F.D.A., the average decision time on drugs by Dr. Pazdur's oncology group has come down to five months from six months. That is a major acceleration in a pharmaceutical industry where every month's delay can mean thousands of lives lost and sometimes hundreds of millions of dollars in sales that, given limited patent times, can never be recovered.

When asked specifically how his wife's illness had changed his work at the F.D.A., Dr. Pazdur said he was intent on making decisions more quickly.

"I have a much greater sense of urgency these days," Dr. Pazdur, 63, said in an interview. "I have been on a jihad to streamline the review process and get things out the door faster. I have evolved from regulator to regulator-advocate."



For the full story, see:

GARDINER HARRIS. "A Wife's Cancer Prods the F.D.A." The New York Times, First Section (Sun., JAN. 3, 2016): 1 & 13.

(Note: ellipsis added.)

(Note: the online version of the story has the date JAN. 2, 2016, and has the title "F.D.A. Regulator, Widowed by Cancer, Helps Speed Drug Approval.")






March 26, 2016

The Value of Longer Life



(p. C6) With the seeker's restlessness that seems not to have left him until his last breath, . . . [Dr. Paul Kalanthi accrued] two B.A.s and an M.A. in literature at Stanford, then a Master of Philosophy at Cambridge, before graduating cum laude from the Yale School of Medicine. He returned to Stanford for a residency in neurological surgery and a postdoctoral fellowship in neuroscience. His training was almost complete when the bad diagnosis hit.


. . .


And then everything changes. In a single moment of recognition, everything Dr. Kalanithi has imagined for himself and his wife evaporates, and a new future has to be imagined.
. . . A job at Stanford for which he was the prime candidate? Not happening. Another good job that would require the Kalanithis to move to Wisconsin? Too far from his oncologist. Long-term plans of any kind? Well, what does long-term mean now? Does he have a day, a month, a year, six years, what? He's heard the advice about living one day at a time, but what's he supposed to do with that day when he doesn't know how many others remain?



For the full review, see:

JANET MASLIN. "Books of The Times; Singularly Striving Until Life Steps In."The New York Times (Tues., July 7, 2015): C1 & C6.

(Note: ellipses, and bracketed words, added.)

(Note: the online version of the review has the date July 6, 2015, and has the title "Books of The Times; Review: In 'When Breath Becomes Air,' Dr. Paul Kalanithi Confronts an Early Death.")


The book under review, is:

Kalanithi, Paul. When Breath Becomes Air. New York: Random House, 2016.






March 21, 2016

Ugly, Invasive, Depressing Federal LEDs Disrupt Sleep and Increase Risk of Breast Cancer



(p. B1) In my repellently contented middle age, I don't seek blue light. Like most sane people, I spurn restaurants whose lighting glares. I recoil from mirrors under fluorescent tubes. I switch on an overhead only to track down a water bug while wielding a flip-flop. Yet each evening from March onward, in the Brooklyn neighborhood where I live part of the year, it seems as if the overhead is always on.

Along with other parts of South Brooklyn, Windsor Terrace is an early recipient of the Department of Transportation's new light-emitting diode streetlights. New Yorkers who have not yet been introduced to these lights: We are living in your future.

Our new street "lamps" -- too cozy a word for the icy arrays now screaming through our windows -- are meant to be installed across all five boroughs by 2017. Indeed, any resident of an American municipality that has money problems (and what city doesn't?) should take heed.

In interviews with the media, my fellow experimental subjects have compared the nighttime environment under the new streetlights to a film set, a prison yard, "a strip mall in outer space" and "the mother ship coming in for a landing" in "Close Encounters of the Third Kind." Although going half-blind at 58, I can read by the beam that the new lamp blasts into our front room without tapping our own Con Ed service. Once the LEDs went in, our next-door neighbor began walking her dog at night in sunglasses.

Medical research has firmly established that blue-spectrum LED light can disrupt sleep patterns. This is the same illumination that radiates in far smaller doses from smartphone and computer screens, to which we're advised to avoid exposure for at least an hour before bed, because it can suppress the production of melatonin. . . .

While the same light has also been associated with increased risk of breast cancer and mood disorders, in all honesty my biggest beef with LEDs has nothing to do with health issues. These lights are ugly. They're invasive. They're depressing. New York deserves better.


. . .


Even fiscally and environmentally conscientious California has compromised on this point. Berkeley, Oakland and San Francisco have all opted for yellow-rich LEDs. These cities have willingly made the modest 10-15 percent sacrifice in efficiency for an ambience that more closely embodies what Germans call Gemütlichkeit and Danes call hygge: an atmosphere of hospitality, homeyness, intimacy and well-being.


. . .


As currently conceived, the D.O.T.'s streetlight plan amounts to mass civic vandalism. If my focus on aesthetics makes this issue sound trivial, the sensory experience of daily life is not a frivolous matter. Even in junior high school, I understood that lighting isn't only about what you see, but how you feel.



For the full commentary, see:

LIONEL SHRIVER. "Ruining That Moody Urban Glow." The New York Times, SundayReview Section (Sun., OCT. 18, 2015): 5.

(Note: ellipses added.)

(Note: the online version of the commentary has the date OCT. 17, 2015.)






March 19, 2016

Regulatory Costs Slow Development of Lifesaving Antibiotics



(p. A13) In the 1980s, 29 new antibiotics were approved; another 23 were approved during the 1990s. But only nine new drugs made it to market from 2000-10, and a study by the Pew Charitable Trusts shows few drugs in development for the most serious microbial threats such as multidrug resistant Acinetobacter and Pseudomonas aeruginosa.


. . .


To revitalize the search for lifesaving antibiotics, the Food and Drug Administration needs a new way to approve them. Legislation proposed in both the House and the Senate would create a new regulatory pathway that would enable the FDA to approve drugs specifically for patients whose serious infections can't be treated with existing drugs, and for whom there are few or no other treatment options.

For these patients, the FDA would be empowered to approve new drugs based on fewer or smaller clinical studies than for antibiotics intended for broader use. The goal is to reduce the cost of development and accelerate the availability of new drugs for a targeted public health need.



For the full commentary, see:

JONATHAN LEFF And ALLAN COUKELL. "How to End the Regulatory Slowdown for New Antibiotics; With the threat from lethal drug-resistant bacteria growing, the FDA needs to speed up its approval process." The Wall Street Journal (Fri., July 3, 2015): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date July 2, 2015.)






March 13, 2016

More Evidence for Stigler's Capture Theory



(p. A15) WASHINGTON -- Marilyn B. Tavenner, the former Obama administration official in charge of the rollout of HealthCare.gov, was chosen on Wednesday to be the top lobbyist for the nation's health insurance industry.

Ms. Tavenner, who stepped down from her federal job in February, will become president and chief executive of America's Health Insurance Plans, the trade group whose members include Aetna, Anthem, Humana, Kaiser Permanente and many Blue Cross and Blue Shield companies.

As the new voice for insurers, Ms. Tavenner will lead the industry in a time of tumultuous changes and challenges, including delicate negotiations with Congress over the future of the Affordable Care Act.


. . .


The board of America's Health Insurance Plans unanimously elected Ms. Tavenner at a meeting here on Wednesday, according to Mark B. Ganz, the board chairman, who is also the chief executive of Cambia Health Solutions, based in Portland, Ore.


. . .


Mr. Ganz said that Ms. Tavenner had "the trust and respect of members of Congress from both sides of the aisle."

Senator John Barrasso, Republican of Wyoming, described the selection in more negative terms. "While millions of Americans are still being hurt by Obamacare's soaring costs and fewer choices," he said, "Ms. Tavenner's appointment shows how the law has created a cozy and profitable relationship for some."



For the full story, see:

ROBERT PEAR. "Head of Obama's Health Care Rollout to Lobby for Insurers." The New York Times (Thurs., JULY 16, 2015): A15.

(Note: ellipses added.)

(Note: the online version of the story has the date JULY 15, 2015.)






March 11, 2016

Feds' Dietary Policy Is "an Obstacle to Sensible Change"



(p. A25) BOSTON -- SINCE the publication of the federal government's 1980 Dietary Guidelines, dietary policy has focused on reducing total fat in the American diet -- specifically, to no more than 30 percent of a person's daily calories. This fear of fat has had far-reaching impacts, from consumer preferences to the billions of dollars spent by the military, government-run hospitals and school districts on food. As we argue in a recently published article in The Journal of the American Medical Association, 35 years after that policy shift, it's long past time for us to exonerate dietary fat.


. . .


Recent research has established the futility of focusing on low-fat foods. Confirming many other observations, large randomized trials in 2006 and 2013 showed that a low-fat diet had no significant benefits for heart disease, stroke, diabetes or cancer risks, while a high-fat, Mediterranean-style diet rich in nuts or extra-virgin olive oil -- exceeding 40 percent of calories in total fat -- significantly reduced cardiovascular disease, diabetes and long-term weight gain. Other studies have shown that high-fat diets are similar to, or better than, low-fat diets for short-term weight loss, and that types of foods, rather than fat content, relate to long-term weight gain.


. . .


The limit on total fat is an outdated concept, an obstacle to sensible change that promotes harmful low-fat foods, undermines efforts to limit refined grains and added sugars, and discourages the food industry from developing products higher in healthy fats.



For the full commentary, see:

DARIUSH MOZAFFARIAN and DAVID S. LUDWIG. "Stop Fearing Fat." The New York Times (Thurs., JULY 9, 2015): A25.

(Note: ellipses added.)

(Note: the online version of the commentary has the title "Why Is the Federal Government Afraid of Fat?")






March 9, 2016

The Wealth of Project Entrepreneurs Is Fragile



The stories of Alfred E. Mann (below) as well as that of Malcom McLean, the entrepreneur behind standardized shipping containers, support George Gilder's point that innovative project entrepreneurs have most of their wealth tied up in their projects. Their wealth only stays large as long as the projects continue to go well.



(p. A20) Alfred E. Mann, who started medical device companies that pioneered in the development of pacemakers for erratic hearts, insulin pumps for diabetics, cochlear implants for the deaf and retinal implants for the blind, died on Thursday [February 25, 2016] in Las Vegas. He was 90.


. . .


Mr. Mann, who spent most of his career in the Los Angeles area, became a billionaire from his entrepreneurial activities. His biggest success was MiniMed, which became the leader in insulin pumps, wearable devices that deliver insulin throughout the day, allowing people with diabetes to more precisely control their blood sugar levels.


. . .


In all, Mr. Mann started and largely financed 14 companies, nine of which were acquired for a total of almost $8 billion, according to MannKind.


. . .


In 1979, while running Pacesetter, Mr. Mann was visiting a cardiac ward and was challenged by a doctor there to work on diabetes, which caused many of the heart problems in patients. That led to the creation of MiniMed and later to MannKind, which developed a form of insulin that is inhaled instead of injected.

MannKind, Mr. Mann's last big venture, may also have been his Waterloo, eating up much of his fortune.

The pharmaceutical giant Pfizer suffered a costly marketing flop with an inhaled form of insulin in 2007. After that, other big insulin manufacturers dropped their own plans for similar products.

But Mr. Mann, who was chief executive of MannKind for many years, would not give up. He insisted MannKind's inhaler was better than Pfizer's and that its insulin had desirable medical characteristics beyond being inhalable. He put about $1 billion of his own money into the company he had named for himself, keeping it afloat through years of setbacks.

"I believe this is one of the most valuable products in history in the drug industry, and I'm willing to back it up with my estate," Mr. Mann told The New York Times in 2007.

The inhaled insulin, called Afrezza, was finally approved by the Food and Drug Administration in 2014, but sales have been dismal. In January, Sanofi, the big French drug company, pulled out of an agreement to market the product. MannKind is now in danger of going out of business, though it is vowing to survive.

"Our resolve is now stronger than ever to continue Al's legacy of medical innovation, as a tribute to this remarkable man, who did so much to help mankind," Matthew Pfeffer, chief executive of MannKind, said in a statement Friday.

Mr. Mann, who worked seven days a week even when he was in his 80s, was divorced three times.



For the full story, see:

ANDREW POLLACK. "Alfred E. Mann, 90, Pioneer in Medical Devices, Is Dead." The New York Times (Sat., FEB. 27, 2016): A20.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date FEB. 26, 2016, and has the title "Alfred E. Mann, Pioneer in Medical Devices, Dies at 90.")


Gilder defends entrepreneurial wealth in:

Gilder, George. "The Enigma of Entrepreneurial Wealth." Inc. 14, no. 10 (Oct. 1992): 161-64, 66 & 68.






March 4, 2016

Technology Extends Capabilities of Older Japanese



(p. A1) TOKYO--At an office-building construction site in the center of Japan's capital, 67-year-old Kenichi Saito effortlessly stacks 44-pound boards with the ease of a man half his age.

His secret: a bendable exoskeleton hugging his waist and thighs, with sensors attached to his skin. The sensors detect when Mr. Saito's muscles start to move and direct the machine to support his motion, cutting his load's effective weight by 18 pounds.

"I can carry as much as I did 10 years ago," says the hard-hatted Mr. Saito.

Mr. Saito is part of an experiment by Obayashi Corp. , the construction giant handling the building project, to confront one of the biggest problems facing the company and the country: a chronic labor shortage resulting from a rapidly aging population. The exoskeleton has allowed Mr. Saito to extend his working life--and Obayashi to keep building.


. . .


(p. A14) The Fujisawa Aikoen nursing home about an hour outside Tokyo started leasing the "hybrid assistive limb," or HAL, exoskeletons from maker Cyberdyne Inc. in June.

In Hokkaido, 60-year-old potato-pickers use rubber "smart suits" making it easier to bend over. Baggage handlers at Tokyo's Haneda airport employ similar assistance.

In cases where older people simply can't do the job or aren't available, Japanese manufacturers are turning to robots, which help them keep costs down and continue growing.

Bank of Tokyo Mitsubishi UFJ, Japan's largest bank, employs a small robot speaking 19 languages to greet customers, while a Nagasaki hotel staffed mainly by robots opened in July. Komatsu Ltd. is developing self-driving vehicles for construction sites, while industrial robot maker Fanuc Corp. is designing machines that repair each other.

Toyota Motor Corp. is testing in homes its "human support robot," a videophone/remote-controlled android that allows family and friends to perform tasks for distant elderly people as if they were in the same home. In one demonstration, a young man uses a tablet to look around a bed-bound older man's room, then directs the robot to open the curtains and bring the older man a drink.

SoftBank Group Corp. earlier this year drew global attention when it put on sale in Japan an automaton called Pepper, which it called the world's first robot capable of understanding emotions. One of the earliest uses for the 4-foot-tall white humanoid is as a nursing helper.

In a Kanagawa Prefecture test, Pepper entertained a room of 30 80- to 90-year-olds for 40 minutes. He led them in light exercises and tested their ability to recognize colors and letters. Women patted his head like a grandchild.

Showing a video of Pepper with a dementia patient on another occasion, Shunji Iyama, one of the developers, says the robot may sometimes work better than people. "That man keeps repeating himself over and over again," Mr. Iyama said. "If Pepper were human, he'd get fed up, but he just repeats the same reaction and doesn't get tired."



For the full story, see:

Jacob M. Schlesinger and Alexander Martin. "Graying Japan Tries to Embrace the Golden Years." The Wall Street Journal (Mon., Nov. 30, 2015): A1 & A14.

(Note: ellipsis added.)

(Note: the online version of the story has the date Nov. 29, 2015, and has the title "Graying Japan Tries to Embrace the Golden Years.")






February 10, 2016

Serendipitous Fix for Colorblindness



(p. 3) The eyeglass lenses that Don McPherson invented were meant for surgeons. But through serendipity he found an entirely different use for them: as a possible treatment for colorblindness.

Mr. McPherson is a glass scientist and an avid Ultimate Frisbee player. He discovered that the lenses he had invented, which protect surgeons' eyes from lasers and help them differentiate human tissue, caused the world at large to look candy-colored -- including the Frisbee field.

At a tournament in Santa Cruz, Calif., in 2002, while standing on a grassy field dotted with orange goal-line cones, he lent a pair of glasses with the lenses to a friend who happened to be colorblind. "He said something to the effect of, 'Dude, these are amazing,' " Mr. McPherson says. "He's like, 'I see orange cones. I've never seen them before.' "

Mr. McPherson was intrigued. He said he did not know the first thing about colorblindness, but felt compelled to figure out why the lenses were having this effect. Mr. McPherson had been inserting the lenses into glasses that he bought at stores, then selling them through Bay Glass Research, his company at the time.

Mr. McPherson went on to study colorblindness, fine-tune the lens technology and start a company called EnChroma that now sells glasses for people who are colorblind. His is among a range of companies that have brought inadvertent or accidental inventions to market. Such inventions have included products as varied as Play-Doh, which started as a wallpaper cleaner, and the pacemaker, discovered through a study of hypothermia.


. . .


EnChroma was still struggling to solve its marketing conundrum when another serendipitous event occurred: A paint company wanted to finance an ad campaign featuring the glasses. The idea was to introduce color to the colorblind. To that end, videos were made of EnChroma users wearing the glasses for the first time while looking at things like sunsets, colorful artwork and, of course, paint samples.

The ad campaign increased EnChroma's sales and spurred a trend: New EnChroma customers began filming and sharing their experiences online. The company placed inserts in its eyeglass boxes encouraging customers to participate.

Prompted by the insert, Bob Balcom, a 60-year-old retired high school science teacher and labor relations specialist in Chatham, N.Y., uploaded his first YouTube video in March. Shot by his wife, it shows Mr. Balcom putting the glasses over his own eyeglasses and staring up at the sky quietly for several seconds. "The blue sky is deeper than I've ever seen," he says. "It reminds me of Colorado. And the pine trees, they're just so green." Tears stream down his cheeks and into his gray beard.



For the full story, see:

CLAIRE MARTIN. "Finding a Niche for the Accidental Spectacles." The New York Times, SundayBusiness Section (Sun., AUG. 16, 2015): 3.

(Note: ellipsis, and bracketed dates, added.)

(Note: the online version of the story has the date AUG. 15, 2015, and has the title "EnChroma's Accidental Spectacles Find Niche Among the Colorblind." )






February 7, 2016

Communist Chinese One Child Laws Violated Basic Human Rights



On Sat., Jan. 17, 2016 I caught the re-broadcast of an interview with Mei Fong that C-SPAN's web site suggests was first broadcast on Jan. 11, 2016. The interview focused on Fong's book on the history, causes and effects of China's one child laws. Fong is understated in her style, but it is clear that the Chinese communist government violated the rights of many Chinese citizens by forcing them to have unwanted abortions, and to undergo unwanted sterilizations. In many cases, when their "one child" died in a disaster, or of natural causes, parents desperately rushed to try to have the forced sterilization reversed.

Fong's book, that she discussed on C-SPAN, is:

Fong, Mei. One Child: The Story of China's Most Radical Experiment. Boston, MA: Houghton Mifflin Harcourt, 2016.






February 5, 2016

Health Spending Rises Faster



HealthCostGrowthGraphs2016-01-21.jpgSource of graph: online version of the WSJ article quoted and cited below.



(p. A3) WASHINGTON--Growth in U.S. health-care spending is accelerating after reaching historic lows, a pickup largely attributed to the millions of Americans who have gotten health coverage under the Affordable Care Act.

Spending on all health care increased 5.3% in 2014, according to a report Wednesday [Dec. 2, 2015] from actuaries at the Centers for Medicare and Medicaid Services. That compares with the 2.9% growth in 2013, which marked the lowest rate since the government began tracking the gains 55 years ago.

The return to more robust growth after a slowdown in spending had been anticipated by economists. Still, it is likely to add to criticism that the 2010 health law isn't doing enough to rein in costs. The report, based on 2014 government numbers and published in the journal Health Affairs, follows five consecutive years where average spending growth was less than 4% annually.



For the full story, see:

STEPHANIE ARMOUR. "Health Spending Picks Up." The Wall Street Journal (Thurs., Dec. 3, 2015): A3.

(Note: bracketed date added.)

(Note: the online version of the article has the date Dec. 2, 2015, and has the title "Growth in U.S. Health-Care Spending Picks Up.")






February 4, 2016

Medical Establishment Relies on "Accepted Dogma"



(p. A3) The Food and Drug Administration and leading cardiologists are warning that aortic heart valves from animal tissue--implanted surgically in thousands of patients world-wide--can develop tiny blood clots, causing the valves to function improperly.

The findings hit the field of cardiology as something of a shock, as these valves from pig and cow tissue have been used for three decades in patients with malfunctioning valves. In addition, the tissue valves have been regarded as less likely to produce blood clots than mechanical valves made of synthetic materials.


. . .


Cardiologist Eric Topol, chief academic officer at Scripps Health in San Diego, called it "remarkable" that such a finding could emerge after three decades of use of the animal-tissue valves. The idea that they lead to less clotting, he said, was "accepted dogma that wasn't looked at."



For the full story, see:

THOMAS M. BURTON. "Clot Risk Is Seen in Some Heart Valves." The Wall Street Journal (Tues., Oct. 6, 2015): A3.

(Note: ellipsis added.)

(Note: the online version of the article has the date Oct. 5, 2015, and has the title "Clot Risk Is Seen in Some Heart Valves." Where there were minor differences between the print and online versions, the passages quoted above follow the online version.)


Eric Topol, quoted above, has written persuasively for more medical innovation, in his:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






February 3, 2016

Unusual Array of Groups Strongly Push Breast-Feeding



C-SPAN on Sat., Jan. 17, 2016 broadcast a thought-provoking presentation by Courtney Jung on her book Lactivism. Jung argues that an unusual array of groups strongly advocate breast-feeding for reasons that are independent of the fairly modest health benefits, for baby and mother, that result from breast-feeding.

Jung's book, that she discussed on C-SPAN, is:

Jung, Courtney. Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy. New York: Basic Books, 2015.






February 2, 2016

Gene Therapy Again Showing Promise



(p. B2) Biotechnology startup Spark Therapeutics Inc. said its experimental gene therapy improved vision among patients with hereditary vision impairment in a clinical trial, without the serious safety problems that have dogged the emerging field of gene therapy in the past.


. . .


Spark said it plans to seek U.S. Food and Drug Administration approval to market its treatment next year, which could make it the first gene therapy to reach the U.S. market if regulators approve it for sale. . . .

Gene therapy involves the injection of genetic material into a person's cells to treat or prevent a disease. The research stalled after some study participants died or developed cancer after receiving gene therapies in the late 1990s and 2000s.

But gene therapy is gaining ground again. In 2012, the European Commission approved the Western world's first gene therapy, UniQure NV's Glybera, for the treatment of patients with a rare enzyme deficiency. The therapy hasn't been approved for sale in the U.S.



For the full story, see:

PETER LOFTUS. "Eye Gene Therapy Shows Promise." The Wall Street Journal (Tues., Oct. 6, 2015): B2.

(Note: ellipses added.)

(Note: the online version of the article has the date Oct. 5, 2015, and has the title "Gene Therapy for Visually Impaired Shows Promise." Where there were minor differences between the print and online versions, the passages quoted above follow the online version.)






January 29, 2016

"Good News for the Grumpy": Happiness Does Not Lengthen Life



(p. A6) A study published on Wednesday [Dec. 9, 2015] in The Lancet, following one million middle-aged women in Britain for 10 years, finds that the widely held view that happiness enhances health and longevity is unfounded.

"Happiness and related measures of well-being do not appear to have any direct effect on mortality," the researchers concluded.

"Good news for the grumpy" is one way to interpret the findings, said Sir Richard Peto, an author of the study and a professor of medical statistics and epidemiology at the University of Oxford.

He and his fellow researchers decided to look into the subject because, he said, there is a widespread belief that stress and unhappiness cause disease.

Such beliefs can fuel a tendency to blame the sick for bringing ailments on themselves by being negative, and to warn the well to cheer up or else.

"Believing things that aren't true isn't a good idea," Professor Peto said in an interview. "There are enough scare stories about health."

The new study says earlier research confused cause and effect, suggesting that unhappiness made people ill when it is actually the other way around.


. . .


Professor Peto said particularly important data came from 500,000 women who reported on their baseline surveys that they were in good health, with no history of heart disease, cancer, stroke or emphysema.

A "substantial minority" of these healthy women said they were stressed or unhappy, he said, but over the next decade they were no more likely to die than were the women who were generally happy.



For the full story, see:

DENISE GRADY. "Happiness Doesn't Bring Good Health, Study Finds." The New York Times (Thurs., DEC. 10, 2015): A6.

(Note: bracketed date added.)

(Note: the online version of the story has the date DEC. 9, 2015, and has the title "Happiness Doesn't Bring Good Health, Study Finds.")


The research summarized in the passages quoted above, appeared in:


Liu, Bette, Sarah Floud, Kirstin Pirie, Jane Green, Richard Peto, and Valerie Beral. "Does Happiness Itself Directly Affect Mortality? The Prospective UK Million Women Study." The Lancet (Dec. 9, 2015) DOI: http://dx.doi.org/10.1016/S0140-6736(15)01087-9.







January 28, 2016

Frustrating Failure to Cure Cancer



PiersonEmmaAndGrandfather2016-01-20.jpg"Emma Pierson as a child playing chess with her grandfather, whose cancer she is trying to fight." Source of caption: print version of the NYT article quoted and cited below. Source of photo: online version of the NYT article quoted and cited below.



(p. D4) . . . in the four years since I learned I carried a BRCA mutation, I have watched my attempts to do something about it repeatedly miss the mark. I joined a laboratory to do cancer research, but the paper we wrote had little to do with cancer; I joined a company that offered the cheapest BRCA tests on the market, and its service was shut down a month after I arrived. I am 24 years old; at 25, I will have to choose between aggressive screening and prophylactic mastectomy. I had hoped to use my brain to protect my body, but I am running out of time.

If life's complexities confound a 20-year-old's desperate idealism, cancer's do as well. The more I learn, the more I worry that we may never find a singular cure for cancer: that each cancer's unique biological filigree necessitates a brutal and byzantine combination of treatments.

I also worry that the end goal is so far away that we sometimes lose sight of its importance, and view biological research as a competitive game rather than a means of saving lives. I feared being the worst student in my first cancer class, even though a roomful of researchers better than I am is exactly what I should want. Since then, I've seen many indications of the competitiveness in cancer research -- a teacher who made us promise not to steal other students' final projects, scientists who snipe at one another or falsify work -- that make me think I am not the only one who sometimes forgets what is at stake.


. . .


I am not going to cure cancer, not even the BRCA cancers. And I am going to watch the people I love die from diseases I cannot understand or prevent. I would be lying if I told you I have made my peace with that. It gives me hope only to fight, as my grandfather did, for futures unseen: to strive, to seek, to find and not to yield.



For the full commentary, see:

EMMA PIERSON. "Leaving No Move Untried." The New York Times (Tues., Dec.. 1, 2015): D4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date NOV. 30, 2015, and has the title "Seeking a Cancer-Free World." The last words in Pierson's commentary quote the final line of Alfred Lord Tennyson's great poem "Ulysses.")






January 25, 2016

Recording a Pain of "5" and Then Leaving Without Relieving



If health care was provided by free market companies whose success depended on voluntarily attracting customers, instead of by bureaucratic, hyper-regulated, CYA incentivized, and competition-insulated bureaucracies, would the surreal experience reported below be as common as it is?



(p. 11) A FRIEND was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10.

She mumbled, "4 to 5." The student put 5 into the computer -- and then they left, without further inquiring about, or relieving, my friend's pain.

This is not an anecdote about nurses not doing their jobs; it's an illustration of what our jobs have become in the age of electronic health records. Computer documentation in health care is notoriously inefficient and unwieldy, but an even more serious problem is that it has morphed into more than an account of our work; it has replaced the work itself.

Our charting, rather than our care, is increasingly what we are evaluated on. When my hospital switched to bar code scanning for medication administration, not only were the nurses on my floor rated as "red," "yellow" or "green" based on the percentage of meds we scanned, but those ratings were prominently and openly displayed on printouts left at the nurses' station.


. . .


We need to streamline our records so that they serve just one master: the patient. We should focus on the most important information in guaranteeing accuracy of diagnosis, efficacy of treatment, continuity of care and patient safety. Otherwise the content of our care will be increasingly warped by the demands of our e-record systems -- and patients like my poor friend will lie in hospital beds in pain, uncomforted by the knowledge that the electronic record of that pain is satisfyingly and exactingly complete.



For the full commentary, see:

THERESA BROWN. "Patients vs. Paperwork." The New York Times, SundayReview Section (Sun., DEC. 20, 2015): 11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date DEC. 19, 2015, and has the title "When Hospital Paperwork Crowds Out Hospital Care.")






January 23, 2016

Cooking Over Indoor Wood Fires Kills Millions



(p. A13) Indoor air pollution, caused mainly by cooking over wood fires indoors, is the world's biggest cause of environmental death. It kills an estimated four million people every year, as noted by the nonprofit science news website, SciDev.Net. Getting fossil-fueled electricity and gas to them is the cheapest and quickest way to save their lives. To argue that the increasingly small risk of dangerous climate change many decades hence is something they should be more worried about is positively obscene.


For the full commentary, see:

MATT RIDLEY. "The Green Scare Problem; Raising constant alarms--about fracking, pesticides, GMO food--in the name of safety is a dangerous game." The Wall Street Journal (Fri., Aug. 13, 2015): A13.

(Note: the online version of the commentary has the date Aug. 13, 2015.)






January 22, 2016

Regulations Slow Eradication of Cancer



(p. D3) . . . the triumph of chemotherapy for Hodgkin's and then for many other tumors opened an interlocking series of dilemmas. In the clinic and the hospital, the new protocols demanded that doctors muster the courage to make their patients very sick in order to make them well. But how sick was too sick? The risks and benefits of the powerful treatments now needed careful, deliberate assessment at every stage of the disease.

Similar questions dogged those who developed, evaluated and regulated the drugs. How poisonous could these agents safely be? How assiduously should desperate patients be saved by their government from pharmaceutical risk?

Dr. DeVita stands firmly among those affirming cancer patients' right to aggressive treatment. One particular exchange summarizes his philosophy: "Do your patients speak to you after you do this to them?" one skeptic asked him early on. "The answer is yes," he replied, "and for a lot longer."

The regulatory caution of the Food and Drug Administration has been a thorn in his side for decades: "I'd like to be able to say that as cancer drugs have become increasingly more complex and sophisticated, the F.D.A. has as well. But it has not." In fact, he writes, "the rate-limiting step in eradicating cancer today is not the science but the regulatory environment we work in."



For the full review, see:

ABIGAIL ZUGER, M.D. "An Unbowed Warrior." The New York Times (Tues., Dec.. 1, 2015): D3.

(Note: ellipsis added.)

(Note: the online version of the review has the date NOV. 30, 2015, and has the title "Review: Science and Politics Collide in 'The Death of Cancer'.")


The book under review, is:

DeVita, Vincent T., and Elizabeth DeVita-Raeburn. The Death of Cancer: After Fifty Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer Is Winnable--and How We Can Get There. New York: Sarah Crichton Books, 2015.






January 21, 2016

Anti-GMO Chipotle No Longer Wears Health Halo



(p. A13) . . . if you need an anecdote for how the year unfolded for the anti-GMO movement, look no further than Chipotle. Last spring the fast food company announced with great fanfare that it would take GMO ingredients off its menu. It was all downhill after that. As was quickly pointed out, Chipotle wasn't being fully truthful, since its soft drinks and cheese contain genetically modified ingredients, and its meat comes from animals fed genetically modified grains. A lawsuit filed in California, which is pending, accused Chipotle of false advertising and deceptive marketing.

Then cases of food-borne illnesses hit Chipotle locations across the country. Supporters of traditional agriculture, who have felt maligned by the burrito company, started keeping a tally of the number of people sickened by Chipotle's food (ongoing, but more than 300) versus the number sickened by GMOs (zero). As the year winds to a close, the company that once wore the restaurant industry's health halo is apologizing, preparing for lawsuits, recentralizing its vegetable preparation and cutting locally sourced ingredients.



For the full commentary, see:

JULIE KELLY. "The March of Genetic Food Progress; 'Farmaceuticals' and other GM products are slowly being approved, despite political scare campaigns." The Wall Street Journal (Weds., Dec. 30, 2015): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Dec. 29, 2015.)






January 16, 2016

Parents Set Up For-Profit Companies for Quicker Cures



(p. B1) Karen Aiach was working as a management consultant when she learned that her first daughter, Ornella, had Sanfilippo syndrome, a rare disease in which a missing enzyme causes toxic substances to build up in the body.

Ornella was 6 months old, and the prognosis was grim: She would develop mentally and physically to between ages 2 and 4, plateau and then lose whatever she had learned. She would become extremely hyperactive and develop sleeping disorders. Most likely she would not live past 15.

Within two years of the diagnosis, Ms. Aiach, who lives in a Paris suburb, had quit her consulting job to learn everything she could about the disease. She hired a neurobiologist to guide her in the world of medical research. And when she learned that few treatments were in the works, she founded a company called Lysogene to focus on genetic therapy.

Instead of raising money and awareness by setting up a nonprofit foundation, a more typical route, she opted to start a for-profit company to seek treatments, if not a cure. Far from common, what Ms. Aiach and other parents like her are trying is to leverage their wealth, contacts and the hope of sophisticated investors to jump-start research into rare diseases.


. . .


(p. B4) . . . with some rare diseases, where minimal research has been done, a little effort goes a long way.

Nicole Boice, who founded Global Genes, one of the leading rare-disease patient advocacy organizations, said even small investments can have meaningful impacts.

"You can start moving the needle with $3,500," she said. "That leads you to the next $25,000, and then to innovation grants and funding at $100,000. That starts the interest from biotech."

Gradually, parents like Matt Wilsey, a technology entrepreneur, have made headway. First, his family spent the better part of four years trying to figure out what afflicted his daughter, Grace, now 6. Even after her genome was sequenced, the first diagnosis turned out to be wrong. Grace, it finally was determined, was the second person in the world known to have a deficiency in the gene known as NGLY1.

"We went around the country," Mr. Wilsey said. "We were just trying to find one doctor who had seen another patient with these symptoms." After years of efforts, several dozen children have been found to have the same deficiency.

"Our goal is to find a cure," said Mr. Wilsey, who lives in the San Francisco area.

"A lot of people in science dismiss that because cures are rare. But when I say cures, they're not going to be astronauts. They're going to be leading some sort of independent life. They're going to be able to eat without choking. They're going to be able to take a bath without drowning. They're going to be able to communicate, whether with some assistive device or not."

These parents also had a successful model to follow. In 1998, John Crowley left his job at Bristol-Myers Squibb to start a biotechnology company to search for a treatment for Pompe disease, a neuromuscular disorder that two of his children had. Within four years, the company, Novazyme Pharmaceuticals, had devised a treatment that he credits with saving their lives. His story was immortalized in the 2010 film "Extraordinary Measures," starring Harrison Ford. And his company was bought by the pharmaceutical giant Genzyme for $137.5 million in 2001.



For the full story, see:

PAUL SULLIVAN. "Wealth Matters; Parents of Children With Rare Diseases Find Hope in For-Profit Companies." The New York Times (Sat., DEC. 26, 2015): B1 & B4.

(Note: ellipsis added.)

(Note: the online version of the story has the date DEC. 25, 2015, and has the title "Wealth Matters; Building a Company to Treat a Rare Disease.")






December 31, 2015

Consumers Vote "No" on Costly Organic Smoothies "Made of Swiss Chard, Cashew Milk and Himalayan Salt"



(p. D1) As recently as last month, one could hardly throw a lentil in New York City without hitting an Organic Avenue storefront, with its orange banner, stick-figure logo and promise of better living through $9 cayenne-infused lemonade.

Kat Schamens, a yoga teacher and fitness-apparel designer, liked it that way. "I would always think, 'I can't wait to go in and get my chickpea soup,' " she said.

In mid-October, Ms. Schamens learned that Organic Avenue's 10 stores had been shuttered and that the company had filed for bankruptcy. "I kind of freaked out," she said. "I was distraught. I lost my yoga for a minute."


. . .


(p. D7) The loyalty of devotees like Ms. Schamens and Ms. Kerin notwithstanding, there is an admitted emperor's new clothes quality to paying $25 for a lunch of vegetable shavings and a smoothie made of Swiss chard, cashew milk and Himalayan salt.

"You can't get people to crave this food," the former investor said. "You can't build a long-term business off what Gwyneth Paltrow likes."

Some researchers began to publish studies questioning the necessity and safety of juice cleanses. And the fashion world started to feel pushback from nutritionists and eating-disorder activists against its support of juicing in early 2013, after the Council of Fashion Designers of America announced a 50 percent discount for models on Organic Avenue juices during New York Fashion Week.



For the full story, see:

KATHERINE ROSMAN. "How Organic Avenue Lost All Its Juice." The New York Times (Sun., NOV. 5, 2015): D1 & D7.

(Note: ellipsis added.)

(Note: the online version of the story has the date NOV. 4, 2015.)







December 29, 2015

FDA Forces Child to Go to London to Get Drug to Fight His Cancer



(p. A15) How far would you go to get a drug that could save your child's life? Across an ocean? That is exactly what the federal government is forcing some American families with dying children to do.

In 2012, when Diego Morris was 11 years old, he was diagnosed with a deadly cancer in his leg called osteosarcoma. Doctors at St. Jude Children's Research Hospital in Memphis, Tenn., removed the tumor, but the prognosis was poor. There was a significant risk that even extensive chemotherapy after surgery would not prevent the cancer from returning.

Fortunately, a team of doctors at MD Anderson Cancer Center in Houston and Memorial Sloan Kettering Cancer Center in New York City had developed a revolutionary new drug, mifamurtide (MTP), that can prevent osteosarcoma from coming back. A study by Dr. Eugenie Kleinerman of MD Anderson and Dr. Paul Meyers of Sloan Kettering showed the drug resulted in a 30% reduction in the osteosarcoma mortality rate at eight years after diagnosis.

The drug was approved in 2009 by the European Medicines Agency and is currently the standard of care in Europe, Israel and many other countries. In 2012 it received the prestigious Prix Galien Award, the gold medal for pharmaceutical research and development in the United Kingdom.

MPT was exactly what Diego needed. But there was one problem: The drug was not available in America because the Food and Drug Administration had rejected it, demanding additional studies. That meant that Diego had to travel from Phoenix to London to get the drug he needed to save his life--a drug that was available in almost every industrialized nation and should have been available in the U.S.



For the full commentary, see:


DARCY OLSEN. "Winning the Right to Save Your Own Life; As the FDA dawdles, 24 states pass 'right-to-try' laws giving terminally ill patients access to drugs." The Wall Street Journal (Fri., Nov. 27, 2015): A15.

(Note: the online version of the commentary has the date Nov. 26, 2015.)


Olsen's commentary is related to her book:

Olsen, Darcy. The Right to Try: How the Federal Government Prevents Americans from Getting the Lifesaving Treatments They Need. New York: HarperCollins Publishers, 2015.






December 26, 2015

Cuomo Bans the Fracking that Could Revive New York's Southern Tier



(p. A25) CONKLIN, N.Y. -- The main grocery store here was replaced by a Family Dollar store, already faded. The historic front of the town hall, a castle no less, is crumbling, and donations are being solicited. The funds earmarked to strip off the lead paint from the castle's exterior went instead to clear mold from the basement.

This town of roughly 5,500 residents looks alarmingly like dozens of other towns and cities in New York's Southern Tier, a vast part of the state that runs parallel to Pennsylvania. Years ago, the region was a manufacturing powerhouse, a place where firms like General Electric and Westinghouse thrived. But over time companies have downsized, or left altogether, lured abroad or to states with lower taxes and fewer regulations.


. . .


In western New York, . . . , Gov. Andrew M. Cuomo, a Democrat, pledged $1 billion in 2012 to support economic development. Since then, he has poured hundreds of millions of dollars into numerous Buffalo-area projects.

The Southern Tier has proved to be a harder fix. It is predominantly rural and lacks a significant population core that typically attracts the private sector.

The region is resource rich, but landowners are angry the government will not let them capitalize on it. Some had pinned their hopes of an economic revival on the prospect of the state's authorizing hydraulic fracturing, known as fracking; many of them can recite the payment formula gas companies were proposing: $500 a month per acre.

But the Cuomo administration, citing health risks, decided last year to ban the practice, leaving some farmers contemplating logging the timber on their land, a move that could destroy swaths of pristine forest.



For the full story, see:

SUSANNE CRAIG. "Former Hub of Manufacturing Ponders Next Act." The New York Times (Weds., SEPT. 30, 2015): A20-A21.

(Note: ellipses added.)

(Note: the online version of the story has the date SEPT. 29, 2015, and has the title "New York's Southern Tier, Once a Home for Big Business, Is Struggling.")






December 22, 2015

FDA Has No Right to Stop the Terminally Ill from Seeking Cures



(p. C4) Ms. Olsen notes that "today, about 40 percent of cancer patients attempt to enroll in clinical trials, but only about 3 percent end up participating. That means that the vast majority don't make the cut, whether because they fail to meet the strict criteria, or a trial is thousands of miles from their home." Many of those who don't get these experimental drugs are the sickest patients because they are deemed "too sick to be useful for the study."

Ms. Olsen argues that terminally ill patients should be able to access such drugs--at their own risk and outside the context of FDA-required studies--if the companies are willing to provide them, and the book's title alludes to her proposed remedy: the state-by-state campaign the Goldwater Institute is leading to pass "Right to Try" legislation. The bills would allow terminally ill patients who have "exhausted all conventional treatment options" to access an experimental treatment if their doctors believe it is "the best medical option to extend or save the patients' life" and "the treatment has successfully completed basic safety testing and is part of the FDA's ongoing evaluation and approval process." Insurers, critically, would not be required to cover the treatment--a significant hurdle, largely unexplored here, since such costs could be significant.

The think tank's campaign has been incredibly successful, with 24 states passing Right to Try laws to date. Still, Ms. Olsen doesn't present such laws as a panacea. She doesn't expect experimental treatments to always--or even often--work for terminally ill patients. But she believes that some chance is better than the alternative. "If you have the Right to Die, you have the Right to Try," Ms. Olsen writes. "And you don't have to wait on Washington to secure it."

Yet therein lies the book's main shortcoming. Washington, it turns out, has a fair bit of say here. Courts have found that the FDA's powers to regulate drug development are extraordinarily broad. Many changes Ms. Olsen champions won't be possible without congressional action to revamp the FDA's drug development process and find new ways of paying for experimental drugs that would make widespread access sustainable for patients, companies and insurers. These issues, though touched on, are not grappled with in detail.



For the full review, see:

PAUL HOWARD. "BOOKSHELF; Hail Mary Medicine; Patients spend their last days pleading with reluctant drug companies and the FDA to get access to treatments that could save their lives." The Wall Street Journal (Fri., Nov. 13, 2015): C4.

(Note: ellipses added.)

(Note: the online version of the review has the date Nov. 12, 2015.)


The book under review, is:

Olsen, Darcy. The Right to Try: How the Federal Government Prevents Americans from Getting the Lifesaving Treatments They Need. New York: HarperCollins Publishers, 2015.






December 14, 2015

Health Care Mandate "Freezes You at a Time When You Need to Be Moving Fast"



(p. B4) When LaRonda Hunter opened a Fantastic Sams hair salon 10 years ago in Saginaw, Tex., a suburb of Fort Worth, she envisioned it as the first of what would eventually be a small regional collection of salons. As her sales grew, so did her business, which now encompasses four locations -- but her plans for a fifth salon are frozen, perhaps permanently.

Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company's profit and the five-figure salary she pays herself from it, she said.

"The margins are not big enough within our industry to support it," she said. "It's not that I don't want to -- I love my employees, and I want to do everything I can for them -- but the numbers just don't work."


. . .


For some business owners on the edge of the cutoff, the mandate is forcing them to weigh very carefully the price of growing bigger.

"There's kind of a deer-in-headlights moment for those who say, 'I have this new potential client, but if I bring them on, I have to hire five additional people,'" said Philip P. Noftsinger, the payroll unit president at CBIZ, a financial services provider for businesses. "They're really trying to assess how much the 50th employee is going to cost."


. . .


For businesses that use many seasonal, variable-hour or temporary workers, like those in the hospitality industry, simply figuring out how many qualifying employees they have can be a challenge.

"I think companies are going to have to work with their payroll processor for the basic data, and then their accountant or attorney about what certain items mean," Mr. Prince said.

The expense and distraction of all that paperwork is one of the biggest frustrations for one business owner, Joseph P. Sergio. His industrial cleaning company, Polar Clean, which is based in South Bend, Ind., but dispatches teams nationally, has just under 50 core employees. One of its business lines is disaster restoration, and after a flood or hurricane, its temporary staff balloons.

Mr. Sergio offers health insurance to his permanent staff, but the premiums have risen so quickly that he had to switch to a more restrictive plan, with a higher deductible. He is reluctant to go over the 50-employee line and incur all of the new rules that come with it. That makes bidding for new jobs an arduous and risky exercise.

"I've had to pull my controller and a couple of top people to sit and spend days going through this," he said. "If you ramp up, and it pushes you over 50, there's all these unknown costs and complicated rules. Are we really going to be able to benefit from going after that opportunity? It freezes you at a time when you need to be moving fast."



For the full story, see:

STACY COWLEY. "ENTREPRENEURSHIP; Health Care Law Leads Business Owners to Rethink Plans for Growth." The New York Times (Thurs., NOV. 19, 2015): B4.

(Note: ellipses added.)

(Note: the online version of the story has the date NOV. 18, 2015, and has the title "ENTREPRENEURSHIP; Health Care Law Forces Businesses to Consider Growth's Costs.")






December 3, 2015

Bike Helmet Regulations Hurt Health



(p. D1) . . . many cycling advocates have taken a surprising position: They are pushing back against mandatory bike-helmet laws in the U.S. and elsewhere. They say mandatory helmet laws, particularly for adults, make cycling less convenient and seem less safe, thus hindering the larger public-health gains of more people riding bikes.

All-ages helmet laws might actually make cycling more dangerous, some cyclists say, by decreasing ridership. Research shows that the more cyclists there are on the road, the fewer crashes there are. Academics theorize that as drivers become used to seeing bikes on a street, they watch more closely for them.

. . .


Piet de Jong, a professor in the department of applied finance and actuarial studies at Sydney's Macquarie University, actually calculated the trade-off of mandatory helmet laws. In a 2012 paper in the journal Risk Analysis, he weighed the reduction of head injuries against increased morbidity due to foregone exercise from reduced cycling.

Dr. de Jong concluded that mandatory bike-helmet laws "have a net negative health impact." That is in part because many people cycle to work or for errands, experts say. People tend to replace that type of cycling not with another physical activity such as a trip to the gym, but with a ride in a car.



For the full story, see:

RACHEL BACHMAN. "The Helmet-Law Backlash." The Wall Street Journal (Tues., Oct. 13, 2015): D1 & D4.

(Note: ellipses added.)

(Note: the online version of the article was dated Oct. 12, 2015, and has the title "Do Bike Helmet Laws Do More Harm Than Good?")






December 2, 2015

Humans Suffered from Plague by at Least 5,000 Years Ago



(p. D4) Historians and microbiologists alike have searched for decades for the origins of plague. Until now, the first clear evidence of Yersinia pestis infection was the Plague of Justinian in the 6th century, which severely weakened the Byzantine Empire.

But in a new study, published on Thursday [Oct. 22, 2015] in the journal Cell, researchers report that the bacterium was infecting people as long as 5,000 years ago.



For the full story, see:

"Archaeology: Plagues Said to Have Hit During Bronze Age." The New York Times (Tues., OCT. 27, 2015): D4.

(Note: bracketed date added.)

(Note: the much shorter online version of the story has the date OCT. 22 (sic), 2015, and has the title "In Ancient DNA, Evidence of Plague Much Earlier Than Previously Known." The passage quoted above is from the online version.)


The academic article mentioned in the passages quoted above, is:

Rasmussen, Simon, Morten Erik Allentoft, Kasper Nielsen, Ludovic Orlando, Martin Sikora, Karl-Göran Sjögren, Anders Gorm Pedersen, Mikkel Schubert, Alex Van Dam, Christian Moliin Outzen Kapel, Henrik Bjørn Nielsen, Søren Brunak, Pavel Avetisyan, Andrey Epimakhov, Mikhail Viktorovich Khalyapin, Artak Gnuni, Aivar Kriiska, Irena Lasak, Mait Metspalu, Vyacheslav Moiseyev, Andrei Gromov, Dalia Pokutta, Lehti Saag, Liivi Varul, Levon Yepiskoposyan, Thomas Sicheritz-Pontén, Robert A Foley, Marta Mirazón Lahr, Rasmus Nielsen, Kristian Kristiansen, and Eske Willerslev. "Early Divergent Strains of Yersinia Pestis in Eurasia 5,000 Years Ago." Cell 163, no. 3 (Oct. 2015): 571-82.






November 27, 2015

What If Steve Jobs Ran the I.C.U.?




We'd like to think that medical intensity and competence in the real world mirror the intensity and competence of television shows like ER and House. But too often it is like the horrible surreal story told below. What if we deregulated medicine to open it to the product and process innovations of intense innovative entrepreneurs like Steve Jobs, Jeff Bezos, and Sam Walton?



(p. 7) Omaha -- I've been watching the monitor for hours. Natalie's asleep now and I'm worried about her pulse. It's edging above 140 beats per minute again and her blood oxygen saturation is becoming dangerously low. I'm convinced that she's slipping into shock. She needs more fluids. I ring for the nurse.

I know about stuff like septic shock because for more than 20 years I was a transplant surgeon, and some of our patients got incredibly sick after surgery. So when I'm sitting in an I.C.U. in Omaha terrified that Natalie, my 17-year-old daughter, might die, I know what I'm talking about. I tell the nurse that Natalie needs to get another slug of intravenous fluids, and fast.

The nurse says she'll call the doctor. Fifteen minutes later I find her in the lounge at a computer, and over her shoulder I see a screen full of makeup products. When I ask if we can get that fluid going, I startle her. She says she called the resident and told him the vital signs, but that he thought things were stable.

"He said to hold off for now," she says.

"Get me two bags of saline. Now," I tell her.

She says, "I'm calling my supervisor," and she runs out of the lounge.


. . .


I know I shouldn't be my daughter's doctor. They taught us the problems with that during my first week in medical school.


. . .


But right now, I don't care about any of that. I'm the one with experience taking care of really sick patients, and if I know she needs more fluids, she's going to get them.

I break into the crash cart, a box on wheels full of stuff they use to resuscitate patients. I pull out two liters of saline solution and run both into Natalie's IV in less than 20 minutes. Natalie's pulse slows and her blood pressure rises. An hour later, after the nursing supervisor and on-call resident finally arrive, I've finished infusing a third liter. Natalie finally looks better.

This wasn't the first time during Natalie's illness eight years ago that I broke my promise to just be her dad. It started a week earlier when she came into the den and showed me the blood she'd coughed up. I suspect a father without my experience might have chalked it up to flu. Maybe because I was a transplant surgeon, and always considered the worst possible cause whenever a patient had a hiccup, I took her to the hospital. I was worried the blood meant she had a bacterial pneumonia, a bad one. And it did.

On the way to the hospital, Natalie took a deep breath and looked at me. "Am I going to die?" she asked. I'm convinced that she would have been dead before morning had I not been a doctor, and one who could recognize septic shock when it affected a normal teenager.



For the full commentary, see:

BUD SHAW. "A Doctor at His Daughter's Hospital Bed." The New York Times, SundayReview Section (Sun., SEPT. 6, 2015): 7.

(Note: ellipses added.)

(Note: the online version of the commentary has the date SEPT. 5, 2015.)


The commentary quoted above is adapted from the book:

Shaw, Bud. Last Night in the Or: A Transplant Surgeon's Odyssey. New York: Plume, 2015.






November 20, 2015

FTC Retaliated Against, and Destroyed, Innocent Firm that Stood Up for Rule of Law



(p. A17) Sometimes winning is still losing. That is certainly true for companies that find themselves caught in the cross hairs of the federal government. Since 2013, my organization has defended one such company, the cancer-screening LabMD, against meritless allegations from the Federal Trade Commission. Last Friday, [November 13, 2015] the FTC's chief administrative-law judge dismissed the agency's complaint. But it was too late. The reputational damage and expense of a six-year federal investigation forced LabMD to close last year.


. . .


Unlike many other companies in similar situations, . . . , LabMD refused to cave and in 2012 went public with the ordeal. In what appeared to be retaliation, the FTC sued LabMD in 2013, alleging that the company engaged in "unreasonable" data-security practices that amounted to an "unfair" trade practice by not taking reasonable steps to protect patient information. FTC officials publicly attacked LabMD and imposed arduous demands on the doctors who used the company's diagnostic services. In just one example, the FTC subpoenaed a Florida oncology lab to produce documents and appear for depositions before government lawyers--all at the doctors' expense.

Yet after years of investigation and enforcement action, the FTC never produced a single patient or doctor who suffered or who alleged identity theft or harm because of LabMD's data-security practices. The FTC never claimed that LabMD violated HIPAA regulations, and until 2014--four years after its investigation began--never offered any data-security standards with which LabMD failed to comply.


. . .


. . . , the FTC is likely to simply disregard the 92-page decision--which weighed witness credibility and the law--and side with commission staff. That's the still greater injustice: The FTC is not bound by administrative-law judge rulings. In fact, the agency has disregarded every adverse ruling over the past two decades, according to a February analysis by former FTC Commissioner Joshua Wright. Defendants' only recourse is appealing in federal court, a fresh burden in legal fees.

That's what happens when a federal agency serves as its own detective, prosecutor, judge, jury and executioner. As Mr. Wright observed, the FTC's record is "a strong sign of an unhealthy and biased institutional process." And he puts it perhaps most powerfully: "Even bank robbery prosecutions have less predictable outcomes than administrative adjudication at the FTC." Winning against the federal government should never require losing so much.



For the full commentary, see:

DAN EPSTEIN. "Hounded Out of Business by Regulators; The company LabMD finally won its six-year battle with the FTC, but vindication came too late." The Wall Street Journal (Fri., Nov. 20, 2015): A17.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the commentary was updated on Nov. 19, 2015.)






November 6, 2015

Lives Lost Due to Peer Review Delays



(p. A25) In this age of instant information, medicine remains anchored in the practice of releasing new knowledge at a deliberate pace. It's time for medical scientists to think differently about how quickly they alert the public to breakthrough findings.

Last week the National Institutes of Health announced that it had prematurely ended a large national study of how best to treat people with high blood pressure because of its exceptional results.

In this trial of more than 9,000 people age 50 and older with high blood pressure, an aggressive treatment strategy to keep systolic blood pressure below 120 was compared with a conventional one aimed at keeping it below 140. The subjects all had a high risk of heart attacks, stroke and heart failure. The N.I.H. concluded, six years into a planned eight-year study, that for these patients, pushing blood pressure down far below currently recommended levels was very beneficial.


. . .

The new information may justify a more vigorous strategy for treating blood pressure, but for now doctors and patients have been left with incomplete results, some headlines and considerable uncertainty about whether to modify current treatments.

Medicine needs to change its approach to releasing new, important information. Throughout science we are seeing more rapid modes of communication. The traditional approach was not to publish until everything was finalized and ready to be chiseled in stone. But these sorts of delays are unnecessary with the Internet. Moreover, although all the trial data has yet to be tabulated, an analysis was considered sufficiently definitive to lead independent experts to stop the multimillion-dollar study.

We believe that when there is such strong evidence for a major public health condition, there should be rapid release of the information that led to the decision to stop the trial. This approach could easily be accomplished by placing the data on the N.I.H. website or publishing the data on such platforms as bioRxiv.org, which enables fast, open review by the medical community.


. . .


Kudos to the scientists who conducted such a large, complex and important study with what will be likely to have lifesaving consequences for a condition that can be treated easily in most patients. Now the medical community needs to adopt a new approach in situations like this one to disseminate lifesaving results in a timely, comprehensive and transparent way. Lives depend on it.



For the full commentary, see:

ERIC J. TOPOL and HARLAN M. KRUMHOLZ. "Don't Sit on Medical Breakthroughs." The New York Times (Fri., SEPT. 17, 2015): A25.

(Note: ellipses added.)

(Note: the online version of the commentary has the date SEPT. 17, 2015, and the title "Don't Delay News of Medical Breakthroughs.")






October 23, 2015

"Strong-Willed Scientists Overstated the Significance of Their Studies"




The New York Times seems open to the idea that strong-willed scientists might overstate their results in science food studies. I wonder if The New York Times would be open to the same possibility in science climate studies?



(p. A19) For two generations, Americans ate fewer eggs and other animal products because policy makers told them that fat and cholesterol were bad for their health. Now both dogmas have been debunked in quick succession.


. . .


Epidemiological data can be used to suggest hypotheses but not to prove them.

Instead of accepting that this evidence was inadequate to give sound advice, strong-willed scientists overstated the significance of their studies.

Much of the epidemiological data underpinning the government's dietary advice comes from studies run by Harvard's school of public health. In 2011, directors of the National Institute of Statistical Sciences analyzed many of Harvard's most important findings and found that they could not be reproduced in clinical trials.

It's no surprise that longstanding nutritional guidelines are now being challenged.

In 2013, government advice to reduce salt intake (which remains in the current report) was contradicted by an authoritative Institute of Medicine study. And several recent meta-analyses have cast serious doubt on whether saturated fats are linked to heart disease, as the dietary guidelines continue to assert.

Uncertain science should no longer guide our nutrition policy. Indeed, cutting fat and cholesterol, as Americans have conscientiously done, may have even worsened our health.



For the full commentary, see:

NINA TEICHOLZ. "The Government's Bad Diet Advice." The New York Times (Sat., FEB. 21, 2015): A19.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date FEB. 20, 2015.)






October 15, 2015

Entrepreneurs Creating Healthy, Tasty Meat, Without Killing Animals



(p. B2) "The next couple of years will be exciting ones," says Joseph D. Puglisi, a Stanford University professor of structural biology who is working on meat alternatives. "We can use a broad range of plant protein sources and create a palette of textures and tastes -- for example, jerky, cured meats, sausage, pork."

"The true challenge will be to recreate more complex pieces of meat that are the pinnacle of the meat industry," he added. "I believe that plausible, good-tasting steaks and pork loins are only a matter of time."

Puglisi is advising Beyond Meat, a start-up that is a leader in the field, with investments from Bill Gates and both Biz Stone and Ev Williams of Twitter fame, not to mention Kleiner Perkins Caufield & Byers, the venture capital firm that backed Google and Amazon. Beyond Meat says its sales are doubling each year.

"We're really focused on the mainstream," said Ethan Brown, the founder of Beyond Meat, over a lunch of fake chili, meatballs and hamburgers.


. . .


"We want to create the next great American meat company," Brown says. "That's the dream."


. . .


The mainstream food industry isn't saying much publicly. But recently released documents from the American Egg Board, a quasi-governmental body, show it regarded Hampton Creek's egg-free "Just Mayo" spread as a "major threat." In one internal email, an Egg Board executive jokingly suggests hiring a hit man to deal with Hampton Creek.


. . .


. . . if I can still enjoy a juicy burger now and then, while boosting my health, helping the environment and avoiding the brutalizing of farm animals, hey, I'm in!



For the full commentary, see:

Nicholas Kristof. "The (Fake) Meat Revolution." The New York Times, SundayReview Section (Sun., SEPT. 20, 2015): 11.

(Note: the online version of the commentary has the date SEPT. 19, 2015.)






October 14, 2015

John Paul Stapp Thumbed His Nose at the Precautionary Principle



(p. C7) In the early 19th century, a science professor in London named Dionysus Lardner rejected the future of high-speed train travel because, he said, "passengers, unable to breathe, would die of asphyxia." A contemporary, the famed engineer Thomas Tredgold, agreed, noting "that any general system of conveying passengers . . . [traveling] at a velocity exceeding 10 miles an hour, or thereabouts, is extremely improbable."

The current land speed for a human being is 763 miles an hour, or thereabouts, thanks in large part to the brilliance, bravery and dedication of a U.S. Air Force lieutenant colonel named John Paul Stapp, a wonderfully iconoclastic medical doctor, innovator and renegade consumer activist who repeatedly put his own life in peril in search of the line beyond which human survival at speed really was "extremely improbable."


. . .


Initial tests were carried out on a crash-test dummy named Oscar Eightball, then chimpanzees and pigs. There was plenty of trial and error--the term "Murphy's Law" was coined during the Gee Whiz experiments--until Stapp couldn't resist strapping himself into the Gee Whiz to experience firsthand what the cold data could never reveal: what it felt like. On May 5, 1948, for example, he "took a peak deceleration of an astounding twenty-four times the force of gravity," the author writes. "This was the equivalent of a full stop from 75 miles per hour in just seven feet or, in other words, freeway speed to zero in the length of a very tall man."

Stapp endured a total of 26 rides on the Gee Whiz over the course of 50 months, measuring an array of physiological factors as well as testing prototype helmets and safety belts. Along the way he suffered a broken wrist, torn rib cartilage, a bruised collarbone, a fractured coccyx, busted capillaries in both eyes and six cracked dental fillings. Colleagues became increasingly concerned for his health every time he staggered, gamely, off the sled, but, according to Mr. Ryan, he never lost his sense of humor, nor did these ordeals stop Dr. Stapp from voluntarily making house calls at night for families stationed on the desolate air base.


. . .


After 29 harrowing trips down the track, Stapp prepared for one grand finale, what he called the "Big Run," hoping to achieve 600 miles per hour, the speed beyond which many scientists suspected that human survivability was--really, this time--highly improbable. On Dec. 10, 1954, Sonic Wind marked a speed of 639 miles per hour, faster than a .45 caliber bullet shot from a pistol. Film footage of the test shows the sled rocketing past an overhead jet plane that was filming the event. The Big Run temporarily blinded Stapp, and he turned blue for a few days, but the experiment landed him on the cover of Time magazine as the fastest man on earth. The record stood for the next 30 years.



For the full review, see:

PATRICK COOKE. "Faster Than a Speeding Bullet--Really." The Wall Street Journal (Sat., Aug. 22, 2015): C7.

(Note: first ellipsis, and bracketed word, in original; other ellipses added.)

(Note: the online version of the review has the date Aug. 21, 2015.)


The book under review, is:

Ryan, Craig. Sonic Wind: The Story of John Paul Stapp and How a Renegade Doctor Became the Fastest Man on Earth. New York: Liveright Publishing Corp., 2015.






September 19, 2015

Increasing Recalls of Organic Food Due to Bacterial Contamination



(p. B3) New data collected by Stericycle, a company that handles recalls for businesses, shows a sharp jump in the number of recalls of organic food products.

Organic food products accounted for 7 percent of all food units recalled so far this year, compared with 2 percent of those recalled last year, according to data from the Food and Drug Administration and the Department of Agriculture that Stericycle uses to compile its quarterly report on recalls.

In 2012 and 2013, only 1 percent of total units of food recalled were organic.

Kevin Pollack, a vice president at Stericycle, said the growing consumer and corporate demand for organic ingredients was at least partly responsible for the increase.

"What's striking is that since 2012, all organic recalls have been driven by bacterial contamination, like salmonella, listeria and hepatitis A, rather than a problem with a label," Mr. Pollack said. "This is a fairly serious and really important issue because a lot of consumers just aren't aware of it."



For the full story, see:

STEPHANIE STROM. "Private Analysis Shows a Sharp Increase in the Number of Organic Food Recalls." The New York Times (Fri., Aug. 21, 2015): B3.

(Note: the online version of the story has the date AUG. 20, 2015, and has the title "Recalls of Organic Food on the Rise, Report Says." The last paragraph quoted above differs in the print and online versions; the version quoted is the print version. The online version of the paragraph is: "According to Stericycle, 87 percent of organic recalls since 2012 were for bacterial contamination, like salmonella and listeria, rather than a problem with a label. "This is a fairly serious and really important issue because a lot of consumers just aren't aware of it," Mr. Pollack said.")






August 30, 2015

In Health Care We Need More than Incremental Steps; We Need Cures



(p. 8A) In 1998, I went to the doctor so fatigued I was unable to get out of bed. He sent me home diagnosed with multiple sclerosis but without so much as a treatment plan, a prescription or what I needed most: hope. Come back when it gets worse, he said, the medical equivalent of a pat on the head.


. . .


We need advocates unwilling to tolerate the old silos who insist on pushing neurologic science into a new era of breakthroughs. We need private funders with the vision to place big bets, often on long odds, with bigger payouts, perhaps a vaccine for MS or Alzheimer's, on the other side.

At a time when the horizons of science have never spread wider, researchers and their supporters must rethink both the goals and the model of scientific research. It is a time for bold ambitions, not incremental steps.

Millions have experienced moments like the one I did in 1998. We owe these patients more than incremental progress. Ultimately, we owe them cures.



For the full commentary, see:

Ann Romney. "Bold Innovators Needed to Boost Health Research." USA Today (Mon., October 16, 2014): 4A.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date October 16, 2014, and the title "Ann Romney: Health Research Needs Boost from Bold Innovators.")







July 18, 2015

Conflict-of-Interest Politics Reduces Medical Collaboration with Industry and Slows Down Cures



(p. A15) The reality of modern medicine, Dr. Stossel argues, is that private industry is the engine of innovation, with productivity and new advances dependent on relationships between commercial interests and academic and research medicine. Companies, not universities or research with federal funding, run 85% of the medical-products pipeline. "We all inevitably have conflicts all the time. You only stop having conflicts when you're dead. The only conflict-free situation is the grave," he says.

The pursuit of the illusion "to be pure, to be priestly, to be supposedly uncorrupted by the profit motive," Dr. Stossel says, often has the effect of banishing or else discounting the expertise of the people who know the most but whose integrity and objectivity are allegedly compromised by industry ties. What ought to matter more, he adds, is simply "Results. Competence. LeBron James--it's putting the ball in the basket."


. . .


Zero-tolerance conflict-of-interest editorial policies, Dr. Stossel says, suppress and distort debate by withholding positions of authority. "If you have an industry connection, if you really understand the topic, you can't say anything," he notes. "If you're an editor, and you have an ideological predilection, you have all this power and you can say anything you want."

Dr. Stossel is equally scorching about the drug and device companies and their trade organizations, which he says drift around like Rodney Dangerfield, complaining they don't get no respect. They prefer not to be confrontational, they rarely fight back against the conflict-of-interest scolds. "They're laying responsibility by default to the patients, the people who actually have a first-hand connection to whatever the disease is: 'Goddammit, I want a cure.' "

Which is the larger point: The to-and-fro between publications not meant for lay readers can seem arcane, but the product of conflict-of-interest politics is fewer cures and new therapies. The predisposition against selling out to industry is pervasive, while reputations can be ruined overnight when researchers find themselves in a page-one exposé or hauled before Congress, even if there is no evidence of misconduct or bias.

Better, then, to conform in the cloisters than risk offending the conflict-of-interest orthodoxy--or translating some basic-research insight into a new treatment for patients. Dr. Rosenbaum reports: "The result is a stifling of honest discourse and potential discouragement of productive collaborations. . . . More strikingly, some of the young, talented physician-investigators I spoke with expressed worry about how any industry relationship would affect their careers."


. . .


'Pharmaphobia"--part polemic, part analytic investigation, a history of medicine and a memoir--deserves a wide readership. . . . "I'd rather get a conversation started with people who are smarter than I am about how complicated and granular and nuanced and unpredictable discovery is. Let's not slow it down."



For the full interview, see:

JOSEPH RAGO. "The Weekend Interview with Tom Stossel; A Cure for 'Conflict of Interest' Mania; A crusading physician says medical progress is hampered by a holier-than-thou 'moralistic bullying.'." The Wall Street Journal (Sat., June 27, 2015): A15.

(Note: ellipses added.)

(Note: the online version of the interview has the date June 26, 2015, and has the title "A Cure for 'Conflict of Interest' Mania; A crusading physician says medical progress is hampered by a holier-than-thou 'moralistic bullying.'.")


The book mentioned in the interview, is:

Stossel, Thomas P. Pharmaphobia: How the Conflict of Interest Myth Undermines American Medical Innovation. Lanham, MS: Rowman & Littlefield Publishers, 2015.






June 30, 2015

How to Be an Effective Expert Witness



(p. B16) Dr. David Sackett, whose clinical trials proved the value of taking aspirin in preventing heart attacks and strokes, and who helped pioneer the use of exacting statistical data in treating patients, died on May 13 [2015] in Markdale, Ontario.


. . .


His colleagues also appreciated his sense of humor. He recalled that while he was testifying in a case as an expert witness, a lawyer handed him a research paper supposedly proving the safety of a drug that was in dispute. He read the paper and concluded that it was flawed.

"Well, I could take several more days and show you dozens more papers on this topic, but the jury would probably want to lynch me," the lawyer insisted.

"I would welcome that," Dr. Sackett said.

"Well, we could meet after the trial and go over these papers together," the lawyer suggested.

To which Dr. Sackett replied, "No, I meant that I would welcome the lynching."



For the full obituary, see:

SAM ROBERTS. "Dr. David Sackett, a Health Care Innovator, Dies at 80." The New York Times (Thurs., May 21, 2015): B16.

(Note: ellipsis, and bracketed year, added.)

(Note: the date of the online version of the obituary is MAY 19, 2015, and has the title "Dr. David Sackett, Who Proved Aspirin Helps Prevent Heart Attacks, Dies at 80.")






June 28, 2015

The Bureaucratic Absurdities of Socialized Medicine



(p. 13) Reading "Do No Harm," Henry Marsh's frank and absorbing narrative of his life in neurosurgery, it was easy to imagine him at the table. The men, and increasingly women, who slice back the scalp, open the skull and enter the brain to extract tumors, clip aneurysms and liberate nerves, share a certain ego required for such work. They typically are bold and blunt, viewing themselves as emperors of the clinical world. Marsh adds irony to this characterization, made clear in the opening line of the book, "I often have to cut into the brain and it is something I hate doing."


. . .


Britain's National Health Service is a socialized system, and Marsh chafes at new rigid rules imposed by its administrators. He is particularly incensed by a mandatory dress code: Neurosurgeons are subject to disciplinary action for wearing a wristwatch. There is scant evidence that this item contributes to hospital infections, but he is shadowed on ward rounds by a bureaucrat who takes notes on his dress and behavior. The reign of the emperor is ending, but Marsh refuses to comply and serve as a myrmidon.

Clinical practice is becoming a theater of the absurd for patients as well. Hospital charts are filled with N.H.S. forms detailing irrelevant aspects of care. Searching for a patient's operative note, Marsh finds documentation she passed a "Type 4 turd." He shows her an elaborate stool chart "colored a somber and appropriate brown, each sheet with a graphically illustrated guide to the seven different types of turd. . . . She looked at the document with disbelief and burst out laughing."



For the full review, see:

JEROME GROOPMAN. "Consider the Comma." The New York Times Book Review (Sun., MAY 24, 2015): 13.

(Note: ellipsis between paragraphs, added; ellipsis within paragraph, in original.)

(Note: the online version of the review has the date MAY 21, 2015, and has the title "'Do No Harm,' by Henry Marsh.")





(p. C6) Amid the life-or-death dramas of neurosurgery in this book are some blackly comic scenes recounting the absurdities of hospital bureaucracy in the National Health Service: not just chronic bed shortages (which mean long waits and frantic juggling of surgery schedules), but also what Dr. Marsh calls a "loss of regimental spirit" and ridiculous meetings, like a slide presentation from "a young man with a background in catering telling me I should develop empathy, keep focused and stay calm."


For the full review, see:

MICHIKO KAKUTANI. "From a Surgeon, Exhilarations and Regrets." The New York Times (Tues., MAY 19, 2015): C1 & C6.

(Note: the online version of the review has the date MAY 18, 2015, and has the title "Books of The Times; Review: In 'Do No Harm,' a Brain Surgeon Tells All.")




The book under review, in both reviews, is:

Marsh, Henry. Do No Harm: Stories of Life, Death, and Brain Surgery. New York: Thomas Dunne Books/St. Martin's Press, 2015.







June 21, 2015

Empathy for the Absent



In Practical Wisdom the authors argue for empathy and against rules. There is something to be said for their argument.

But we tend to empathize with those who are present and not those we do not see or even know.

For example in academic tenure and promotion decisions, slack is often cut for colleagues who already have their foot in the door. We know them, their troubles and challenges. So they are tenured and promoted and given salary increases and perks even though there are others outside the door who may have greater productivity and even greater troubles and challenges.

Charlie Munger in an interview at the University of Michigan spoke of how hard it is for physicians to hold their peers responsible when they are incompetent or negligent. They have empathy for their peers, knowing their troubles and challenges. And Munger also says few physicians are willing to suffer the long-lasting "ill will" from their peers who have been held accountable. They do not know so well the patients who suffer, and one way or another, the patients are soon out of sight.

Just as in academics we do not know so well the students who suffer; or the able scholars who suffer, standing outside the door.

Following rules seems unsympathetic and lacking in empathy. But it may be the best way to show empathy for the absent.


The book mentioned is:

Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.


The interview with Munger is:

Quick, Rebecca (interviewer). "A Conversation with Charlie Munger." University of Michigan Ross School of Business, Sept. 14, 2010.






June 19, 2015

It Takes Longer to Explain a Medical Bill than It Takes to Explain Newton's Second Law



(p. 4) I CONFESS I filed this column several weeks late in large part because I had hoped first to figure out a medical bill whose serial iterations have been arriving monthly like clockwork for half a year.

As medical bills go, it's not very big: $225, from a laboratory. But I don't really want to pay it until I understand what it's for. It's not that the bill contains no information -- there is lots of it. Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others. It tells me I'm being billed $29.90 for each of nine things, but there is an "adjustment" to one of $14.20.

At first, I left messages on the lab's billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: "I'm sorry, this is what I'm told, and I don't want to lose my job."


. . .


One recent study found that up to 90 percent of hospital bills contain errors.


. . .


Before you embark on the journey of decoding your bill, you might also want to have a look at a tutorial -- Understanding Your Medical Bill -- produced by the Khan Academy, an online educator, and the Brookings Institution in Washington. It's a bit over 12 minutes. That's about five minutes longer than the Khan Academy's tutorial explaining Newton's second law.



For the full commentary, see:

ELISABETH ROSENTHAL. "The Medical Bill Mystery." The New York Times, SundayReview Section (Sun., MAY 3, 2015): 4.

(Note: ellipses added.)

(Note: the date of the online version of the commentary is MAY 2, 2015.)






May 25, 2015

To FDA Aging Is Not a Disease, So FDA Will Not Approve Drugs that Extend Life



(p. D1) Some of the top researchers on aging in the country are trying to get an unusual clinical trial up and running.


. . .


The trial aims to test the drug metformin, a common medication often used to treat Type 2 diabetes, and see if it can delay or prevent other chronic diseases. (The project is being called Targeting/Taming Aging With Metformin, or TAME.) Metformin isn't necessarily more promising than other drugs that have shown signs of extending life and reducing age-related chronic diseases. But metformin has been widely and safely used for more than 60 years, has very few side effects and is inexpensive.

The scientists say that if TAME is a well-designed, large-scale study, the Food and Drug Administration might be persuaded to consider aging as an indication, or preventable condition, a move that could spur drug makers to target factors that contribute to aging.


. . .


(p. D4) Fighting each major disease of old age separately isn't winnable, said S. Jay Olshansky, another TAME project planner and a professor at the school of public health at the University of Illinois at Chicago. "We lower the risk of heart disease, somebody lives long enough to get cancer. If we reduce the risk of cancer, somebody lives long enough to get Alzheimer's disease."

"We are suggesting that the time has arrived to attack them all by going after the biological process of aging," Dr. Olshansky said.

Sandy Walsh, an FDA spokeswoman, said the agency's perspective has long been that "aging" isn't a disease. "We clearly have approved drugs that treat consequences of aging," she said. Although the FDA currently is inclined to treat diseases prevalent in older people as separate medical conditions, "if someone in the drug-development industry found something that treated all of these, we might revisit our thinking."



For the full story, see:

SUMATHI REDDY. "To Grow Old Without Disease." The Wall Street Journal (Tues., March 17, 2015): D1 & D4.

(Note: ellipses added.)

(Note: the online version of the story has the date March 16, 2015, and has the title "Scientists' New Goal: Growing Old Without Disease.")






May 9, 2015

Incandescents Better than LEDs at Allowing a Good Night's Sleep



(p. D6) Studies have shown that such light, especially from the blue part of the spectrum, inhibits the body's production of melatonin, a hormone that helps people fall asleep.


. . .


Devices such as smartphones and tablets are often illuminated by light-emitting diodes, or LEDs, that tend to emit more blue light than incandescent products.



For the full story, see:

KATE GALBRAITH. "WIRED WELL; Can Orange Glasses Help You Sleep Better?" The New York Times (Tues., APRIL 7, 2015): D6.

(Note: ellipsis added.)

(Note: the online version of the story has the title "WIRED WELL; Can Orange Glasses Help You Sleep Better?")






March 31, 2015

Brin: Regulatory Burden Discourages Health Entrepreneurs



(p. A13) Earlier this month, at a private conference for the CEOs of his portfolio companies, venture capitalist Vinod Khosla interviewed Google co-founders Sergey Brin and Larry Page, asking them if the company might jump into health care. "It's just a painful business to be in," Mr. Brin replied, later noting that "the regulatory burden in the U.S. is so high that I think it would dissuade a lot of entrepreneurs."

Mr. Brin is right. As a neurosurgeon-scientist and entrepreneur who co-founded a bioelectronic medicine company that deploys implantable technology to supplant drugs, I wish he were wrong.


. . .


. . . entrepreneurs should be allowed to carve out their own turf and let patients choose their own level of risk.

Consider the case of Goran Ostovich, a burly, 47-year-old truck driver from Mostar, Bosnia. Mr. Ostovich has suffered from long-standing rheumatoid arthritis and needed near-permanent bed rest. With his hands and wrists swollen and aching, he could no longer hold on to a wheel or even play with his small children. He tried a variety of medications. None worked.

When I met Goran at his doctor's office in 2012, however, he didn't seem at all afflicted with the disease. That's because, one year earlier, he had been offered the opportunity to be the first participant in a clinical trial of a new therapy based on my invention. He received a bioelectronic implant and rapidly improved.


. . .


Since news of this clinical trial's success became public, people from all over the U.S. stricken with rheumatoid arthritis have emailed, called and sent letters pressing for their shot at potentially effective--but not yet FDA-approved--treatments.


. . .


Some patients are very willing to take a calculated risk, . . .



For the full commentary, see:

KEVIN J. TRACEY. "Let Patients Decide How Much Risk They'll Take; Take a tip from Sergey Brin: The health-care regulatory burden stops entrepreneurs from getting into the game." The Wall Street Journal (Mon., July 28, 2014): A13.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 27, 2014, and has the title "Let Patients Decide How Much Risk They'll Take; Take a tip from Sergey Brin: The health-care regulatory burden stops entrepreneurs from getting into the game.")






March 30, 2015

How a Chavista Uses Her Chávez T-Shirt



(p. A1) CARACAS, Venezuela -- Mary Noriega heard there would be chicken.

She hated being herded "like cattle," she said, standing for hours in a line of more than 1,500 people hoping to buy food, as soldiers with side arms checked identification cards to make sure no one tried to buy basic items more than once or twice a week.

But Ms. Noriega, a laboratory assistant with three children, said she had no choice, ticking off the inventory in her depleted refrigerator: coffee and corn flour. Things had gotten so bad, she said, that she had begun bartering with neighbors to put food on the table.

"We always knew that this year would start badly, but I think this is super bad," Ms. Noriega said.

Venezuelans have put up with shortages and long lines for years. But as the price of oil, the country's main export, has plunged, the situation has grown so dire that the government has sent troops to patrol huge lines snaking for blocks. Some states have barred people from waiting outside stores overnight, and government officials are posted near entrances, ready to arrest shoppers who cheat the rationing system.


. . .


One of the nation's most prestigious public hospitals shut down its heart surgery unit for weeks (p. A12) because of shortages of medical supplies. Some drugs have been out of stock for months, and at least one clinic performed heart operations only by smuggling in a vital drug from the United States. Diapers are so coveted that some shoppers carry the birth certificates of their children in case stores demand them.


. . .


The shortages and inflation present another round of political challenges for President Nicolás Maduro, who has vowed to continue the Socialist-inspired revolution begun by his predecessor, the charismatic leftist Hugo Chávez.

"I've always been a Chavista," said Ms. Noriega, using a term for a loyal Chávez supporter. But "the other day, I found a Chávez T-shirt I'd kept, and I threw it on the ground and stamped on it, and then I used it to clean the floor. I was so angry. I don't know if this is his fault or not, but he died and left us here, and things have been going from bad to worse."



For the full commentary, see:

WILLIAM NEUMAN. "Oil Cash Waning, Venezuelan Shelves Lie Bare." The New York Times (Fri., JAN. 30, 2015): A1 & A12.

(Note: ellipses added.)

(Note: the online version of the commentary has the date JAN. 29, 2015.)






March 23, 2015

How Air Conditioning Can Improve Metabolism



(p. 14) Sleep is essential for good health, as we all know. But a new study hints that there may be an easy but unrealized way to augment its virtues: lower the thermostat. Cooler bedrooms could subtly transform a person's stores of brown fat -- what has lately come to be thought of as "good fat" -- and consequently alter energy expenditure and metabolic health, even into daylight hours.


. . .


"These were all healthy young men to start with," . . . [senior author Francesco S. Celi] says, "but just by sleeping in a colder room, they gained metabolic advantages" that could, over time, he says, lessen their risk for diabetes and other metabolic problems. The men also burned a few more calories throughout the day when their bedroom was chillier (although not enough to result in weight loss after four weeks).


. . .


The message of these findings, Celi says, is that you can almost effortlessly tweak your metabolic health by turning down the bedroom thermostat a few degrees. His own bedroom is moderately chilled, as is his office -- which has an added benefit: It "keeps meetings short."



For the full story, see:

GRETCHEN REYNOLDS. "Let's Cool It in the Bedroom." The New York Times Magazine (Sun., JULY 20, 2014): 14.

(Note: ellipses added.)

(Note: the online version of the story has the date JULY 17, 2014.)


The academic paper discussed above, is:

Lee, Paul, Sheila Smith, Joyce Linderman, Amber B. Courville, Robert J. Brychta, William Dieckmann, Charlotte D. Werner, Kong Y. Chen, and Francesco S. Celi. "Temperature-Acclimated Brown Adipose Tissue Modulates Insulin Sensitivity in Humans." Diabetes 63, no. 11 (Nov. 2014): 3686-98.






March 16, 2015

Fishing with Mosquito Nets, Where Food Is the Binding Constraint



(p. 1) BANGWEULU WETLANDS, Zambia -- Out here on the endless swamps, a harsh truth has been passed down from generation to generation: There is no fear but the fear of hunger.

With that always weighing on his mind, Mwewa Ndefi gets up at dawn, just as the first orange rays of sun are beginning to spear through the papyrus reeds, and starts to unclump a mosquito net.

Nets like his are widely considered a magic bullet against malaria -- one of the cheapest and most effective ways to stop a disease that kills at least half a million Africans each year. But Mr. Ndefi and countless others are not using their mosquito nets as global health experts have intended.

Nobody in his hut, including his seven children, sleeps under a net at night. Instead, Mr. Ndefi has taken his family's supply of anti-malaria nets and sewn them together into a gigantic sieve that he uses to drag the bottom of the swamp ponds, sweeping up all sorts of life: baby catfish, banded tilapia, tiny mouthbrooders, orange fish eggs, water bugs and the occasional green frog.

"I know it's not right," Mr. Ndefi said, "but without these nets, we wouldn't eat."

Across Africa, from the mud flats of Nigeria to the coral reefs off Mozambique, mosquito-net fishing is a growing problem, an unintended consequence of one of the biggest and most celebrated public health campaigns in recent years.

The nets have helped save millions of lives, but scientists worry about the collateral damage: Africa's fish.


. . .


"The nets go straight out of the bag into the sea," said Isabel Marques da Silva, a marine biologist at Universidade Lúrio in Mozambique. "That's why the inci-(p. 10)dence for malaria here is so high. The people don't use the mosquito nets for mosquitoes. They use them to fish."

But the unsparing mesh, with holes smaller than mosquitoes, traps much more life than traditional fishing nets do. Scientists say that could imperil already stressed fish populations, a critical food source for millions of the world's poorest people.


. . .


In many places, fish are dried for hours in direct sunlight on treated mosquito nets. Direct sunlight can break down the insecticide coating. Anthony Hay, an associate professor of environmental toxicology at Cornell University, said fish could absorb some of the toxins, leaving people to ingest them when they eat the fish.

"It's just another one of these 'white man's burdens,' " Mr. Hay said, referring to William Easterly's well-known book critical of foreign aid by the West. "We think we have a solution to everybody's problems, and here's an example of where we're creating a new problem."


. . .


For Mr. Ndefi, it is a simple, if painful, matter of choice. He knows all too well the dangers of malaria. His own toddler son, Junior, died of the disease four years ago. Junior used to always be there, standing outside his hut, when Mr. Ndefi came home from fishing.

Mr. Ndefi hopes his family can survive future bouts of the disease. But he knows his loved ones will not last long without food.



For the full story, see:

JEFFREY GETTLEMAN. "Meant to Keep Mosquitos Out, Nets Are Used to Haul Fish In." The New York Times, First Section (Sun., JAN. 25, 2015): 1 & 10.

(Note: ellipses are added.)

(Note: the online version of the story has the date JAN. 24, 2015, and has the title "Meant to Keep Malaria Out, Mosquito Nets Are Used to Haul Fish In.")


The book referenced by Professor Hay, is:

Easterly, William. The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good. New York: The Penguin Press, 2006.






March 15, 2015

Regulations Reduce Biotech Innovation



(p. A15) Modern genetic engineering, also called genetic modification or GM, has been around since the 1970s. Yet with the notable exception of biopharmaceuticals--beginning with the marketing of human insulin in 1982 and now accounting for more than 20% of U.S. drug expenditures--genetic engineering has failed to realize anything approaching its potential for vertical progress.

The reason is plain: In the non-pharmaceutical sectors, federal regulators for years seemingly have done everything they can to prevent U.S. researchers and companies from employing genetic engineering to create the "next big thing."


. . .


Regulatory disincentives are potent. It costs about $136 million to bring a genetically engineered crop plant to market. This is the primary reason more than 99% of such crop plants are those that are grown at huge scale: . . .


. . .


"Biopharming"--the once-promising biotechnology area that uses genetic engineering techniques to induce crops such as corn, tomatoes and tobacco to produce high concentrations of high-value pharmaceuticals (one of which is the Ebola drug, ZMapp)--is moribund because of the Agriculture Department's extraordinary regulatory burdens. Thanks to EPA's policies, which discriminate against organisms modified with the most precise and predictable techniques, the high hopes for genetically engineered "biorational" microbial pesticides and microorganisms to clean up toxic wastes have evaporated.



For the full commentary, see:

HENRY I. MILLER. "Regulators Put the Brakes On Biotech; Thanks to EPA, hopes have evaporated for genetically engineered microorganisms to clean up toxic wastes." The Wall Street Journal (Weds., Jan. 14, 2015): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Jan. 13, 2015.)






March 14, 2015

Serendipitous Discovery that Titanium Fuses with Bone, Leads to Implants



(p. 24) Implants have been a major advance in dentistry, liberating millions of elderly people from painful, ill-fitting dentures, a diet of soft foods and the ignominy of a sneeze that sends false teeth flying out of the mouth. But addressing those problems was not Dr. Branemark's initial intent.

At the start of his career, he was studying how blood flow affects bone healing.

In 1952, he and his team put optical devices encased in titanium into the lower legs of rabbits in order to study the healing process. When the research period ended and they went to remove the devices, they discovered to their surprise that the titanium had fused into the bone and could not be removed.

Dr. Branemark called the process "osseointegration," and his research took a whole new direction as he realized that if the body could tolerate the long-term presence of titanium, the metal could be used to create an anchor for artificial teeth.


. . .


. . . , Dr. Branemark's innovation was poorly received. After Dr. Branemark gave a lecture on his work in 1969, Dr. Albrektsson recalled, one of the senior academics of Swedish dentistry rose and referred to an article in Reader's Digest describing Dr. Branemark's research, adding, "This may prove to be a popular article, but I simply do not trust people who publish themselves in Reader's Digest."

As it happened, that senior academic was well known to the Swedish public for recommending a particular brand of toothpick. So Dr. Branemark immediately rose and struck back, saying, "And I don't trust people who advertise themselves on the back of boxes of toothpicks."



For the full story, see:

TAMAR LEWIN. "Per-Ingvar Branemark, Dental Innovator, Dies at 85." The New York Times, First Section (Sun., DEC. 28, 2014): 24.

(Note: ellipses are added.)

(Note: the online version of the story has the date JAN. 27, 2015.)






March 7, 2015

Innovation and Jobs Destroyed by Tax



(p. 7A) I was humbled to receive in November the National Medal of Technology and Innovation at the White House for the development of life-changing medical devices. Traveling to our nation's capital, I couldn't help but think: There is no way I could have had the same impact if the tax on medical devices was in place when I got started over 50 years ago.

Simply put, the medical device tax is destroying job creation and innovation, and as a result, patient care is suffering.


. . .


Every day, I see firsthand the difficult choices innovators must make as a result of this ill-conceived tax. Perhaps worst of all, the medical device tax is helping cause a steep drop of investments in promising therapies.


. . .


It's time to put an end to this disastrous policy so that medical device entrepreneurs can do what America does best -- innovate.



For the full commentary, see:

Tom Fogarty. "Opposing View: Tax Destroys Jobs and Innovation." USA Today (Mon., January 5, 2015): 7A.

(Note: ellipses added.)

(Note: the online version of the commentary has the date January 4, 2015, and has the title "Tax Destroys Jobs and Innovation: Opposing View.")






March 2, 2015

"It's My Life, and I Want the Chance to Save It"



(p. 18) LYONS, Colo. -- Since May [2014], a string of states have passed laws that give critically ill patients the right to try medications that have not been approved by the Food and Drug Administration.

Deemed "Right to Try" laws, they have passed quickly and often unanimously in Colorado, Michigan, Missouri, Louisiana and Arizona, bringing hope to patients like Larry Kutt, who lives in this small town at the edge of the Rocky Mountains. Mr. Kutt, 65, has an advanced blood cancer and says his state's law could help him gain access to a therapy that several pharmaceutical companies are testing. "It's my life," he said, "and I want the chance to save it."

The laws do not seem to have helped anyone obtain experimental medicine, as the drug companies are not interested in supplying unapproved medications outside the supervision of the F.D.A. But that seems almost beside the point to the Goldwater Institute, the libertarian group behind legislative efforts to pass Right to Try laws. "The goal is for terminally ill patients to have choice when it comes to end-stage disease," said Craig Handzlik, state policy coordinator for the Goldwater Institute, based in Arizona. "Right to Try is something that will help terminally ill people all over the country."



For the full story, see:

JULIE TURKEWITZ. "Patients Seek 'Right to Try' New Drugs." The New York Times, First Section (Sun., JAN. 11, 2015): 18.

(Note: the bracketed year is added.)

(Note: the online version of the story has the date JAN. 10, 2015.)






February 19, 2015

Mandated Health Treatment Regulations Are Often Reversed



(p. A25) After spending nearly two decades in medicine, I am still amazed by how spare the evidence is on which we doctors base our medical decisions. Treatment guidelines, often accompanied by a de facto mandate, are frequently reversed.

Only a few years ago, for example, beta-blocker drugs were routinely recommended for almost all patients undergoing noncardiac surgery. Since then, research has shown that these drugs may significantly increase the risk of stroke at the time of surgery. I remember colleagues questioning the beta-blocker recommendation for certain patients and being admonished for not being "evidence-based." I shudder to think how many patients were left disabled by strokes because of the blanket adoption of this standard.

What is in vogue today is often discarded tomorrow. Hormone replacement therapy for women after menopause is an example of a once widely implemented treatment that we have now largely abandoned. In September, in response to new research, the American College of Cardiology revoked a major recommendation on heart-attack treatment. "Science is not static but rather constantly evolving," said its president, Patrick T. O'Gara, in explaining the decision.


. . .


Instead of being allowed to deliver "patient-centered" care, many physicians feel they are being co-opted by regulations. Some feel pressured to prescribe "mandated" treatment, even to frail older adults who may not benefit. Guidelines are supposed to assist and advise. But all too often, recommended care in certain situations becomes mandated care in all situations.



For the full commentary, see:

SANDEEP JAUHAR. "Don't Homogenize Health Care." The New York Times (Thurs., DEC. 11, 2014): A25.

(Note: the online version of the commentary has the date DEC. 10, 2014.)






February 16, 2015

Smart Phones Bring Power to the Patient



(p. A11) We instinctively reach for our smartphones when we need to take pictures, get directions, deposit checks or reserve a table. Eric Topol, a cardiologist and digital pioneer, thinks that they are ready to perform at least one more task: revolutionize health care. In "The Patient Will See You Now," he argues that smartphones will democratize medicine by bringing data and control directly to the people.

The power of doctors, says Dr. Topol, "can be likened to that of religious leaders and nobility" in centuries past, when knowledge and authority belonged to a small elite. He notes that we've never seen "a discrete challenge to the medical profession" akin to Luther 's challenge to the Roman Catholic Church or democracy's challenge to monarchy and despotism. "But we've not had the platform or landscape for that to be accomplished. Until now." Smartphones, he says, enable a range of medical applications to move from the hospital to the home, and they shift medicine's locus of control from doctor to patient.



For the full review, see:

DAVID A. SHAYWITZ. "BOOKSHELF; Doctor Android; In the same way that Luther challenged the Catholic Church, smartphones are poised to upend the medical profession." The Wall Street Journal (Tues., Jan. 13, 2015): A11.

(Note: the online version of the review has the date Jan. 12, 2015.)


The book under review is:

Topol, Eric. The Patient Will See You Now: The Future of Medicine Is in Your Hands. New York: Basic Books, 2015.






January 26, 2015

Double-Blind Clinical Trials Are NOT the Only Source of Good Evidence



(p. 16) Back in her office, . . . [rheumatologist Jennifer Frankovich] found that the scientific literature had no studies on patients like this to guide her. So she did something unusual: She searched a database of all the lupus patients the hospital had seen over the previous five years, singling out those whose symptoms matched her patient's, and ran an analysis to see whether they had developed blood clots. "I did some very simple statistics and brought the data to everybody that I had met with that morning," she says. The change in attitude was striking. "It was very clear, based on the database, that she could be at an increased risk for a clot."

The girl was given the drug, and she did not develop a clot. "At the end of the day, we don't know whether it was the right decision," says Chris Longhurst, a pediatrician and the chief medical information officer at Stanford Children's Health, who is a colleague of Frankovich's. But they felt that it was the best they could do with the limited information they had.

A large, costly and time-consuming clinical trial with proper controls might someday prove Frankovich's hypothesis correct. But large, costly and time-consuming clinical trials are rarely carried out for uncommon complications of this sort. In the absence of such focused research, doctors and scientists are increasingly dipping into enormous troves of data that already exist -- namely the aggregated medical records of thousands or even millions of patients to uncover patterns that might help steer care.


. . .


(p. 17) . . . , developing a "learning health system" -- one that can incorporate lessons from its own activities in real time -- remains tantalizing to researchers. Stefan Thurner, a professor of complexity studies at the Medical University of Vienna, and his researcher, Peter Klimek, are working with a database of millions of people's health-insurance claims, building networks of relationships among diseases. As they fill in the network with known connections and new ones mined from the data, Thurner and Klimek hope to be able to predict the health of individuals or of a population over time. On the clinical side, Longhurst has been advocating for a button in electronic medical-record software that would allow doctors to run automated searches for patients like theirs when no other sources of information are available.

With time, and with some crucial refinements, this kind of medicine may eventually become mainstream. Frankovich recalls a conversation with an older colleague. "She told me, 'Research this decade benefits the next decade,' " Frankovich says. "That was how it was. But I feel like it doesn't have to be that way anymore."



For the full story, see:

VERONIQUE GREENWOOD. "Eureka; Dr. DATA; Can Statistical Analysis Tell Us What Clinical Trials Cannot?" The New York Times Magazine (Sun., OCT. 5, 2014): 16-17.

(Note: ellipses, and bracketed name, added.)

(Note: the online version of the story has the date OCT. 3, 2014, and has the title "Eureka; Can Big Data Tell Us What Clinical Trials Don't?")






January 25, 2015

26 Different Drugs Lengthen Healthy Life Span in Mice



(p. F5) For thousands of years, people have sought to escape or outrun their mortality with potions, pills and elixirs, often blended with heavy doses of hope and will.

In the "Epic of Gilgamesh," a Mesopotamian king searched for the secret of immortality after the death of his best friend. At least three Chinese emperors in the Tang dynasty died after consuming treatments containing lead and mercury that they hoped would make them immortal. In the late 19th century, a French-American physiologist seemed to have found the elixir of life by injecting the elderly and himself with extracts from animal testicles.


. . .


"By targeting fundamental aging processes, we might be able to delay the major age-related chronic diseases instead of picking them off one at time," said Dr. James Kirkland, a professor of aging research and head of the Robert and Arlene Kogod Center on Aging at the Mayo Clinic. "For example, we don't want to have situation where we, say, cure cancer and then people die six months later of Alzheimer's disease or a stroke. It would be better to delay all of these things together."

This is where the field known as the biology of aging is moving -- to develop drugs that will increase life span and what researchers refer to as health span, the period of life when people are able to live independently and free from disease.

Dr. Kirkland said that at least six drugs had been written up in peer-reviewed journals and that he knew of about 20 others that appear to affect life span or health span in mice. The goal is to see if those benefits can be translated into humans to increase their longevity, "to find interventions that we can use in people that might, say, make a person who's 90 feel like they're 60 or a person who's 70 feel like they're 40 or 50."

Other researchers are studying centenarians, seeking to understand whether certain genes have carried them past 100 years old and kept them in good health.



For the full story, see:

TRACEY SAMUELSON. "Science (and Quacks) vs. the Aging Process." The New York Times (Weds., Nov. 19, 2014): F5.

(Note: ellipsis added.)

(Note: the online version of the story has the date NOV. 18, 2014.)






January 21, 2015

Obamacare Advisor Says Obscure Law Passed Due to "Stupidity of the American Voter"



(p. A4) Jonathan Gruber, the economist at the heart of a fresh debate about the Affordable Care Act, has had more than a dozen appointments to visit the White House since Democrats began drafting the health law in 2009, records show.

The visits included at least one group meeting with President Barack Obama , as well as appointments with senior administration officials who helped shape the 2010 law that expanded health insurance to millions of Americans.

The White House in recent days has tried to distance itself from Mr. Gruber, a 49-year-old Massachusetts Institute of Technology economist, since a 2013 video surfaced last week in which he said the law passed because of the "huge political advantage" of the legislation's lacking transparency. He also referred to the "stupidity of the American voter."

Republicans have seized on the comments as evidence that supporters of the law purposely misled the public about its costs.

"It is amusing to watch Washington liberals discount Mr. Gruber's truth-telling as a gaffe and disown" his involvement in the law, said Sen. Orrin Hatch (R., Utah).



For the full story, see:

STEPHANIE ARMOUR and COLLEEN MCCAIN NELSON. "Health Adviser Gruber Logged Regular White House Visits." The Wall Street Journal (Tues., Nov. 18, 2014): A4.

(Note: the online version of the story has the date Nov. 17, 2014.)






January 20, 2015

Outsiders Persevere to Pursue Breakthroughs



(p. 315) Despite all the examples given, mainstream medical research stubbornly continues to assume that new drugs and other advances will follow exclusively from a predetermined research path. Many, in fact, will. Others, if history is any indication, will not. They will come not from a committee or a research team but from an individual, a maverick who views a problem with fresh eyes. Serendipity will strike and be seized upon by a well-trained scientist or clinician who also dares to rely upon intuition, imagination, and creativity. Unbound by traditional theory, willing to suspend the usual set of beliefs, unconstrained by the requirement to obtain approval or funding for his or her pursuits, this outsider will persevere and lead the way to a dazzling breakthrough. Eventually, once the breakthrough becomes part of accepted medical wisdom, the insiders will pretend that the outsider was one of them all along.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






January 13, 2015

While Looking for Spotted Fever, He Found the Cause of Lyme Disease



(p. A25) Willy Burgdorfer, a medical entomologist who in 1982 identified the cause of what had been a mysterious affliction, Lyme disease, died on Monday [November 17, 2014] at a hospital in Hamilton, Mont. He was 89.


. . .


In the early 1980s, Dr. Burgdorfer was analyzing deer ticks from Long Island that were suspected to have caused spotted fever when he stumbled on something unexpected under his microscope: spirochetes, disease-causing bacteria shaped like corkscrews. They were located in only one section of the ticks, the so-called midguts. He had studied spirochetes in graduate school.

"Once my eyes focused on these long, snakelike organisms, I recognized what I had seen a million times before: spirochetes," he said in a 2001 oral history for the National Institutes of Health, which include the National Institute of Allergy and Infectious Diseases.

He had not been working on Lyme disease, but he had spoken with the doctor who helped discover it, Dr. Allen Steere of Yale. After he saw the spirochetes in the Long Island ticks, he quickly realized that the bacteria might also be in the deer ticks believed to be playing a role in Lyme disease in Connecticut and elsewhere, including Long Island.



For the full obituary, see:

WILLIAM YARDLEY. "Willy Burgdorfer, Who Found Bacteria That Cause Lyme Disease, Is Dead at 89." The New York Times (Thurs., NOV. 20, 2014): A25.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the obituary has the date NOV. 19, 2014.)






December 30, 2014

"Bad Ideas Die Hard, Especially Those that Flatter Our Vanity"



(p. C5) Mütter was one of the first plastic surgeons in America.


. . .


Mütter was also a pioneer of burn surgery.


. . .


Every hero needs a good antagonist and Mütter had a great one, a professor and blowhard named Charles D. Meigs who was as contrary as a Missouri mule. Meigs was a highly regarded obstetrician and one of Mütter's colleagues at Jefferson. He rejected Mütter's namby-pamby notions by reflex. Anesthesia? Pshaw! Men and women are put on earth to suffer. Handwashing? Humbug! The very idea that physicians could spread disease was preposterous. As Meigs wrote, "a gentleman's hands are clean." Unfortunately, bad ideas die hard, especially those that flatter our vanity. The fight to make medicine as humane as possible continues long after Mütter's premature death from tuberculosis in 1859.



For the full review, see:

JOHN ROSS. "The Doctor Will See You Now." The Wall Street Journal (Sat., Aug. 30, 2014): C5.

(Note: ellipses added.)

(Note: the online version of the review has the date Aug. 29, 2014, and has the title "Book Review: 'Dr. Mütter's Marvels' by Cristin O'Keefe Aptowicz.")


The book under review is:

Aptowicz, Cristin O'Keefe. Dr. Müt­ters Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. New York: Gotham Books, 2014.






December 21, 2014

Embryo Stem-Cells Improve Sight in Severe Vision Loss Patients



(p. A7) Researchers have used stem cells from human embryos to treat patients suffering from severe vision loss, the first time the technique has been shown to be both safe and potentially effective in a sustained way.


. . .


. . . , Dr. Lanza and his colleagues first obtained an eight-cell embryo from a fertility clinic. (The embryo was left over from fertility treatments and was destined for destruction.)


. . .


Vision tests suggested that 10 of the 18 treated eyes had improved sight, with eight patients reading more than 15 additional letters on a reading chart in the first year after transplant. Visual acuity remained the same or improved in seven patients, though it decreased by more than ten letters in one patient.



For the full story, see:

GAUTAM NAIK. "Vision Improves in Stem-Cell Trial." The Wall Street Journal (Weds., OCT. 15, 2014): A7.

(Note: ellipses added.)

(Note: the online version of the story has the date OCT. 14, 2014, and has the title "Stem Cells Show Potential Benefits for Eye Diseases.")






December 7, 2014

Forssmann's Courage Rewarded with "Professional Criticism and Scorn"



(p. 197) Forssmann's report in the leading German medical journal garnered him not hosannas but instead fierce professional criticism and scorn. In response to a senior physician who claimed undocumented priority for the procedure, the twenty-five-year-old Forssmann was forced to provide an addendum to his publication one month later. Rigid dogmatism and an authoritarian hierarchy characterized the German medicine of that day. The human heart, as the center of life, was considered inviolable by instrumentation and surgery.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






December 3, 2014

Denied Approval to Catheterize Hearts, Forssmann Catheterized His Own



(p. 195) Forssmann received his medical degree from the University of Berlin in 1929. That year, he interned at a small hospital northwest of Berlin, the Auguste-Viktoria-Heim in Eberswalde. He pleaded with his superiors for approval to try a new procedure--to inject drugs directly into the heart--but was unable to persuade them of his new concept's validity. Undaunted, Forssmann proceeded on his own. His goal was to improve upon the administration of drugs into the central circulation during emergency operations.

The circumstances of the incident on November 5, 1929, revealed by Forssmann in his autobiography, could hardly have been (p. 196) more dramatic. The account reflects Forssmann's dogged determination, willpower, and extraordinary courage. He gained the trust of the surgical nurse who provided access to the necessary instruments. So carried away by Forssmann's vision, she volunteered herself to undergo the experiment. Pretending to go along with her, Forssmann strapped her down to the table in a small operating room while his colleagues took their afternoon naps. When she wasn't looking, he anesthetized his own left elbow crease. Once the local anesthetic took effect, Forssmann quickly performed a surgical cutdown to expose his vein and boldly manipulated a flexible ureteral catheter 30 cm toward his heart. This thin sterile rubber tubing used by urologists to drain urine from the kidney was 65 cm long (about 26 inches). He then released the angry nurse.

They walked down two flights of stairs to the X-ray department, where he fearlessly advanced the catheter into the upper chamber (atrium) on the right side of his heart, following its course on a fluoroscopic screen with the aid of a mirror held by the nurse. (Fluoroscopy is an X-ray technique whereby movement of a body organ, an introduced dye, or a catheter within the body can be followed in real time.) He documented his experiment with an X-ray film. Forssmann was oblivious to the danger of abnormal, potentially fatal heart rhythms that can be provoked when anything touches the sensitive endocardium, the inside lining of the heart chambers.



Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






November 25, 2014

Major Cancer Drugs Have Come from Unexpected Sources



(p. 182) Starting in the last decades of the twentieth century, last decades of the twentieth century, sophisticated genetics and molecular biology have been aimed toward a more precise understanding of the cell's mechanisms. Yet, even here, chance has continued to be a big factor. Surprising discoveries led to uncovering cancer-inducing genes (oncogenes) and tumor-suppressing genes, both of which are normal cellular genes that, when mutated, can induce a biological effect that predisposes the cell to cancer development. A search for blood substitutes led to anti-angiogenesis drugs. Veterinary medicine led to oncogenes and vaccine preparations to tumor-suppressor genes. In one of the greatest serendipitous discoveries of (p. 183) modern medicine, stem cells were stumbled upon during research on radiation effects on the blood.

Experience has clearly shown that major cancer drugs have been discovered by independent, thoughtful, and self-motivated researchers--the cancer war's "guerrillas," to use the reigning metaphor--from unexpected sources: from chemical warfare (nitrogen mustard), nutritional research (methotrexate), medicinal folklore (the vinca alkaloids), bacteriologic research (cisplatin), biochemistry research (sex hormones), blood storage research (angiogenic inhibitors), clinical observations (COX-2 inhibitors), and embryology (thalidomide).



Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






November 24, 2014

Affordable Care Act Reduces GDP, Employment and Labor Income



(p. A17) Whether the Affordable Care Act lives up to its name depends on how, or whether, you consider its consequences for the wider economy.


. . .


I estimate that the ACA's long-term impact will include about 3% less weekly employment, 3% fewer aggregate work hours, 2% less GDP and 2% less labor income. These effects will be visible and obvious by 2017, if not before. The employment and hours estimates are based on the combined amount of the law's new taxes and disincentives and on historical research on the aggregate effects of each dollar of taxation. The GDP and income estimates reflect lower amounts of labor as well as the law's effects on the productivity of each hour of labor.


. . .


The Affordable Care Act is weakening the economy. And for the large number of families and individuals who continue to pay for their own health care, health care is now less affordable.



For the full commentary, see:

CASEY B. MULLIGAN. "OPINION; The Myth of ObamaCare's Affordability; The law's perverse incentives will have the nation working fewer hours, and working those hours less productively." The Wall Street Journal (Tues., SEPTEMBER 9, 2014): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date SEPTEMBER 8, 2014.)


Mulligan's research on the effects of Obamacare is detailed in his Kindle e-book:

Mulligan, Casey B. Side Effects: The Economic Consequences of the Health Reform. Flossmoor, IL: JMJ Economics, 2014.






November 21, 2014

Cancer Gains Have Not Come from "Centralized Direction"



(p. 180) The truth remains that over the course of the twentieth century, the greatest gains in the battle against cancer came from independent research that was not under any sort of centralized direction and that did not have vast resources at its disposal. As we have seen, such research led to momentous chance discoveries in cancer chemotherapy and a greater understanding of the mechanisms of the disease that have resulted in exciting new therapeutic approaches.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






November 17, 2014

War on Cancer Was "Profoundly Misconceived"



(p. 179) Following the testing of nearly half a million drugs, the number of useful anticancer agents remains disappointingly small. Expressions of discontent with the methodology of research and of research and the appalling paucity of results were, over the years, largely restricted to the professional literature. However, in 2001 they broke through to the popular media. In an impassioned article in the New Yorker magazine entitled "The Thirty Years' War: Have We Been Fighting Cancer the Wrong Way?" Jerome Groopman, a respected clinical oncologist and cancer researcher at Harvard Medical School in Boston, fired a devastating broadside. "The war on cancer," he wrote, "turned out to be profoundly misconceived--both in its rhetoric and in its execution. The high expectations of the early seventies seem almost willfully naïve." Regarding many of the three-phased clinical trials, with their toxic effects, he marveled at "how little scientific basis there was and how much sensationalism surrounded them." Groopman concluded that hope for progress resided in the "uncertainty inherent in scientific discovery."


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: italics in original.)






November 13, 2014

In 1971 Nixon "Launched an All-Out War on Cancer"



(p. 173) In 1971 the U.S. government finally launched an all-out "war on cancer." In his State of the Union address in January 1971, President Richard Nixon declared: "The time has come in America when the same kind of concerted effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal."

As the country debated a bill known as the National Cancer Act, the air was filled with feverish excitement and heady optimism. Popular magazines again trumpeted the imminent conquest of cancer. However, some members of the committee of the Institute of Medicine, a part of the National Academy of Sciences, which was asked by the NCI to review the cancer plan envisioned by the act, expressed concern regarding the centralization of planning of research and that "the lines of research... could turn out to be the wrong leads." The plan fails, the reviewers said in their confidential report, because

It leaves the impression that all shots can be called from a national headquarters; that all, or nearly all, of the really important ideas are already in hand, and that given the right kind of administration and organization, the hard problems can be solved. It fails to allow for the surprises which must surely lie ahead if we are really going to gain an understanding of cancer.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: ellipsis in original.)






November 9, 2014

"Discovery Cannot Be Achieved by Directive"



(p. 170) As early as 1945 the medical advisory committee reporting to the committee reporting to the federal government on a postwar program for scientific research emphasized the frequently unexpected nature of discoveries:

Discoveries in medicine have often come from the most remote and unexpected fields of science in the past; and it is probable that this will be equally true in the future. It is not unlikely that significant progress in the treatment of cardiovascular disease, kidney disease, cancer, and other refractory conditions will be made, perhaps unexpectedly, as the result of fundamental discoveries in fields unrelated to these diseases.... Discovery cannot be achieved by directive. Further progress requires that the entire field of medicine and the underlying sciences of biochemistry, physiology, pharmacology, bacteriology, pathology, parasitology, etc., be developed impartially.

Their statement "discovery cannot be achieved by directive" would prove to be sadly prophetic.



Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: italics in original.)






November 5, 2014

"Folkman Persisted in His Genuinely Original Thinking"



(p. 141) As detailed by Robert Cooke in his 2001 book Dr. Folkman's War, the successful answers to these basic questions took Folkman through diligent investigations punctuated by an astonishing series of chance observations and circumstances. Over decades, Folkman persisted in his genuinely original thinking. His concept was far in advance of technological and other scientific advances that would provide the methodology and basic knowledge essential to its proof, forcing him to await verification and to withstand ridicule, scorn, and vicious competition for grants. Looking back three decades later, Folkman would ruefully reflect: "I was too young to realize how much trouble was in store for a theory that could not be tested immediately."


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: italics in original.)






November 1, 2014

Centrally Planned War on Cancer "Fails to Allow for Surprises"



(p. 115) It leaves the impression that all shots can be called from a national headquarters; that all, or nearly all, of the really important ideas are already in hand.... It fails to allow for the surprises which must surely lie ahead if we are really going to gain an understanding of cancer. --A COMMITTEE OF THE INSTITUTE OF MEDICINE, NATIONAL ACADEMY OF SCIENCES, ON THE NATIONAL CANCER ACT AND THE "WAR ON CANCER"


Source:

As quoted in Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: ellipsis in original.)






October 30, 2014

British Parents Jailed by Nationalized Health Service for Trying to Sell Home to Pay for Son's Cancer Treatment



(p. A4) . . . , no Briton is ever entirely happy with the taxpayer-funded service, and now the case of a 5-year-old boy with a brain tumor has thrown a harsh light on the $170 billion-a-year system.

Critics are asking whether the service was justified in refusing a cancer treatment for the boy, Ashya King, sought by his desperate parents in an effort to save his life, and whether it overstepped in trying to impose its decision on his family.

The refusal set off a chain of events that enthralled and horrified the British public, as Ashya's parents removed their son from University Hospital Southampton in England on Aug. 28 without the consent of British doctors, setting off a highly publicized international hunt. Concern for the child, however, turned into public outrage when the parents, Brett and Naghemeh King, were arrested and jailed in Madrid, where they had traveled to sell their holiday home so they could pay for the treatment, called proton beam therapy.


. . .


"They treated us like terrorists," Mr. King, 51, said during an emotional news conference in Spain, where he and his wife were held for three days, separated from their critically ill son, as British authorities pursued University Hospital Southampton's recommendation that Ashya be made a ward of the court.


. . .


(p. A10) Professor Hunter . . . said that, because the health service is publicly accountable, doctors tend to be reluctant to recommend innovative solutions for fear of lawsuits if things go wrong.

Mrs. Anderton, too, said that, despite the excellent care her son received, the N.H.S. is not always at the cutting edge. "The only downside is that we don't have advanced types of treatments that could be lifesaving," she said.



For the full story, see:

KIMIKO DE FREYTAS-TAMURA. "Health Care for Britain in Harsh Light." The New York Times (Weds., SEPT. 17, 2014): A4 & A10.

(Note: ellipses added.)

(Note: the online version of the story has the date SEPT. 16, 2014.)






October 28, 2014

In Finding Cure for Ulcers, Marshall Was Not Constrained by the Need to Obtain Approval or Funding



(p. 113) Marshall was a youthful maverick, not bound by traditional theory and not professionally invested in a widely held set of beliefs. There is such a thing as being too much of an insider. Marshall viewed the problem with fresh eyes and was not constrained by the requirement to obtain approval or funding for his pursuits. It is also noteworthy that his work was accomplished not at a high-powered academic ivory tower with teams of investigators but instead far from the prestigious research centers in the Western Hemisphere.

The delay in acceptance of Marshall's revolutionary hypothesis reflects the tenacity with which long-held concepts are maintained. Vested interests--intellectual, financial, commercial, status--keep these entrenched. Dogmatic believers find themselves under siege by a new set of explanations.



Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






October 24, 2014

Ideas Should Not Be Rejected Just Because They Disagree with Reigning Theory



(p. 107) . . . Claude Bernard, the nineteenth-century founder of experimental medicine, . . . famously said, "If an idea presents itself to us, we must not reject it simply because it does not agree with the logical deductions of a reigning theory."


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: ellipses added.)






October 19, 2014

Fleck Made Two Versions of His Typhus Vaccine: A Worthless Version for the SS Troops and an Effective Version for His Fellow Buchenwald Inmates



(p. C7) Ludwik Fleck (1896-1961), who earned a doctorate at Lwów University while studying under Weigl, also became interested in typhus during World War I, when he too was drafted by Austria-Hungary. Fleck's specialty was immunology, and in 1919 he joined Weigl's institute. Somewhere between 1921 and 1923 he crafted a way to diagnose typhus, but despite this achievement, Polish anti-Semitism denied him the academic recognition that his talent merited. During this period, he would occupy government posts (until 1935, when anti-Semitic policies made it impossible for Jews to hold such positions) and, with his wife's dowry, opened his own laboratory.

By August 1942, Fleck, though confined to Lwów's Jewish ghetto, managed to create a vaccine from the urine of typhus patients. (Fleck's vaccine may have been easier to produce than Weigl's.) Six months later, he was sent to Auschwitz, where he worked in a bacteriological research unit and where he was treated somewhat better than most camp inmates. In December 1943, Fleck was dispatched to the Buchenwald concentration camp to work on a typhus vaccine.

The Germans wanted the Buchenwald typhus-vaccine prisoner unit--some were physicians and scientists, some weren't--to follow instructions for making a vaccine that had originated at the Pasteur Institute in Paris. It was a convoluted process that involved rabbit lungs and the organs of other animals. The unit's inmates, including Fleck, who understood immunology better than anyone else at Buchenwald, conspired to produce two kinds of vaccine: large quantities of worthless serum that were shipped to SS troops at the front; and much smaller doses of effective vaccine that were used to secretly immunize prisoners. Their daring sabotage could have led to their execution, of course, but their Nazi overseers in the camp were too medically ignorant to understand what was transpiring. If senior SS officials elsewhere became suspicious, the prisoners would supply the real vaccine for testing by the skeptical parties.



For the full review, see:

HOWARD SCHNEIDER. "The Fever that Gripped Europe." The Wall Street Journal (Sat., July 19, 2014): C7.

(Note: the online version of the review has the date July 18, 2014, and has the title "Book Review: 'The Fantastic Laboratory of Dr. Weigl' by Arthur Allen; Two scientists who worked to beat typhus and sabotage the Nazis.")


The book being reviewed:

Allen, Arthur. The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis. New York: W. W. Norton & Company, 2014.


My dissertation adviser, Stephen Toulmin, recommended a philosophy of science book by Ludwig Fleck that I have owned for several decades, but never gotten around to reading. It is said to anticipate some of the issues discussed by Thomas Kuhn in his classic The Structure of Scientific Revolutions. The Fleck book is:

Fleck, Ludwik. Genesis and Development of a Scientific Fact. pb ed. Chicago, IL: University of Chicago Press, 1981 [first published in German in 1935].






October 16, 2014

Medical Innovator "Maintained a Healthy Skepticism Toward Accepted Wisdom"



(p. 103) Barry Marshall, a lanky twenty-nine-year-old resident in internal medicine at Warren's hospital, was assigned to was assigned to gastroenterology for six months as part of his training and was looking for a research project. The eldest son of a welder and a nurse, Marshall grew up in a remote area of Western Australia where self-sufficiency and common sense were essential characteristics. His personal qualities of intelligence, tenacity, open-mindedness, and self-confidence would serve him and Warren well in bringing about a conceptual revolution. Relatively new to gastroenterology, he did not hold a set of well-entrenched beliefs. Marshall could maintain a healthy skepticism toward accepted wisdom. Indeed, the concept that bacteria caused stomach inflammation, and even ulcers, was less alien to him than to most gastroenterologists.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






October 12, 2014

"It Is Often Essential to Spot the Exceptions to the Rule"




Baruch Blumberg was awarded the Nobel Prize in 1976:


(p. 98) . . ., Blumberg learned an invaluable lesson: "In research, it is often essential to spot the exceptions to the rule--those cases that do not fit what you perceive as the emerging picture.... Frequently the most interesting findings grow out of the 'chance' or unanticipated results."


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: ellipsis added.)






October 11, 2014

Variable Gene Expression Gives Us "Surprising Resilience"



(p. 11) As a physician who researches and treats rare genetic disorders, Sharon Moalem, the author of "Inheritance," sees firsthand how sharply DNA can constrain our lives. Yet "our genes aren't as fixed and rigid as most of us have been led to believe," he says, for while genetic defects often create havoc, variable gene expression (our genes' capacity to respond to the environment with a flexibility only now being fully recognized) can give our bodies and minds surprising resilience. In his new book, Moalem describes riveting dramas emerging from both defective genes and reparative epigenetics.


. . .


Moalem's earthy, patient-focused account reminds us that whatever its promise, genetics yet stands at a humble place.



For the full review, see:

DAVID DOBBS. "The Fault in Our DNA." The New York Times Book Review (Sun., July 13, 2014): 11.

(Note: ellipsis added.)

(Note: the online version of the review has the date July 10, 2014.)


Book under review:

Moalem, Sharon. Inheritance: How Our Genes Change Our Lives--and Our Lives Change Our Genes. New York: Grand Central Publishing, 2014.






October 8, 2014

Why Did Waksman Not Pursue the Streptomycin Antibiotic?




What did Waksman lack to pursue the streptomycin antibiotic sooner? Enough independent funding? Alertness? Enough desire to make a ding in the universe? Enough unhappiness about unnecessary death? Willingness to embrace the hard work of embracing dissonant facts?


(p. 83) Waksman missed several opportunities to make the great discovery earlier in his career, but his single-mindedness did not allow for, in Salvador Luria's phrase, "the chance observation falling on the receptive eye." In 1975 Waksman recalled that he first brushed past an antibiotic as early as 1923 when he observed that "certain actinomycetes produce substances toxic to bacteria" since it can be noted at times that "around an actinomycetes colony upon a plate a zone is formed free from fungous and bacterial growth." In 1935 Chester Rhines, a graduate student of Waksman's, noticed that tubercle bacilli would not grow in the presence of a soil organism, but Waksman did not think that this lead was worth pursuing: "In the scientific climate of the time, the result did not suggest any practical application for treatment of tuberculosis." The same year, Waksman's friend Fred Beau-dette, the poultry pathologist at Rutgers, brought him an agar tube with a culture of tubercle bacilli killed by a contaminant fungus growing on top of them. Again, Waksman was not interested: "I was not moved to jump to the logical conclusion and direct my efforts accordingly.... My major interest at that time was the subject of organic matter decomposition and the interrelationships among soil micro-organisms responsible for this process."


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: ellipsis in original.)






October 5, 2014

Feds Protect Us from Baby Photos



(p. 1) Pictures of smiling babies crowd a bulletin board in a doctor's office in Midtown Manhattan, in a collage familiar to anyone who has given birth. But the women coming in to have babies of their own cannot see them. They have been moved to a private part of the office, replaced in the corridors with abstract art.

"I've had patients ask me, 'Where's your baby board?' " said Dr. Mark V. Sauer, the director of the office, which is affiliated with Columbia University Medical Center. "We just tell them the truth, which is that we no longer post them because of concerns over privacy."

For generations, obstetricians and midwives across America have proudly posted photographs of the babies they have delivered on their office walls. But this pre-digital form of social media is gradually going the way of cigars in the waiting room, because of the federal patient privacy law known as Hipaa.

Under the law, the Health Insurance Portability and Accountability Act, baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services. Even if a parent sends in the photo, it is considered private unless the parent also sends written authorization for its posting, which almost no one does.



For the full story, see:

ANEMONA HARTOCOLLIS. "Baby Pictures at the Doctor's? Cute, Sure, but Illegal." The New York Times, First Section (Sun., AUG. 10, 2014): 1 & 19.

(Note: the online version of the story has the date AUG. 9, 2014.)






October 4, 2014

Cancer Will Likely Be Cured by "Lone Wolves, Awkward Individualists, Nonconformists"




Morton Meyers quotes Ernst Chain, who received the Nobel Prize in 1945, along with Fleming and Florey, for developing penicillin:


(p. 81) But do not let us fall victims of the naive illusion that problems like cancer, mental illness, degeneration or old age... can be solved by bulldozer organizational methods, such as were used in the Manhattan Project. In the latter, we had the geniuses whose basic discoveries made its development possible, the Curies, the Rutherfords, the Einsteins, the Niels Bohrs and many others; in the biologic field... these geniuses have not yet appeared.... No mass attack will replace them.... When they do appear, it is our job to recognize them and give them the opportunities to develop their talents, which is not an easy task, for they are bound to be lone wolves, awkward individualists, nonconformists, and they will not very well fit into any established organization.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: ellipses in original.)






September 29, 2014

For Health Entrepreneurs "the Regulatory Burden in the U.S. Is So High"



(p. A11) Yo is a smartphone app. MelaFind is a medical device. Yo sends one meaningless message: "Yo!" MelaFind tells you: "biopsy this and don't biopsy that." MelaFind saves lives. Yo does not. Guess which firm found it easier to put their product in consumers hands?


. . .


In January 2010, Jeffrey Shuren, a veteran FDA official, was appointed director of the FDA's Center for Devices and Radiological Health, the division responsible for evaluating MelaFind. Dr. Shuren, Dr. Gulfo writes, had "a reputation for being somewhat anti-industry" and "an aggressive agenda to completely revamp the device approval process." Thus in March MELA Sciences was issued something called a "Not Approvable letter" raising various questions about MelaFind.


. . .


The letter sent the author into survival mode. He battled the FDA, calmed investors, and defended against the lawsuit all while trying to keep the company afloat. Under stress, Dr. Gulfo's health began to decline: He lost 29 pounds, his hair began to fall out, and the pain in his gut became so intense he needed an endoscopy.


. . .


The climax to this medical thriller comes when, in "the greatest 15 minutes of [his] life," Dr. Gulfo delivers an impassioned speech, à la "Twelve Angry Men," to the FDA's advisory committee. The committee voted for approval, 8 to 7, and, perhaps with the congressional hearing in mind, the FDA approved MelaFind in September 2011.

It was a major triumph for the company, but Dr. Gulfo was beat. He retired from the company in June 2013-- . . .


. . .


Google's Sergey Brin recently said that he didn't want to be a health entrepreneur because "It's just a painful business to be in . . . the regulatory burden in the U.S. is so high that I think it would dissuade a lot of entrepreneurs." Mr. Brin won't find anything in Dr. Gulfo's book to persuade him otherwise. Until we get our regulatory system in order, expect a lot more Yo's and not enough life-saving innovations.



For the full review, see:

ALEX TABARROK. "BOOKSHELF; It's Broke. Fix It. MelaFind's breakthrough optical technology promised earlier, more accurate detection of melanoma. Then the FDA got involved." The Wall Street Journal (Tues., Aug. 12, 2014): A11.

(Note: ellipses added, except for the one internal to the final paragraph, which is in the original.)

(Note: the online version of the review has the date Aug. 11, 2014, and has the title "BOOKSHELF; Book Review: 'Innovation Breakdown' by Joseph V. Gulfo; MelaFind's breakthrough optical technology promised earlier, more accurate detection of melanoma. Then the FDA got involved.")


The book under review is:

Gulfo, Joseph V. Innovation Breakdown: How the FDA and Wall Street Cripple Medical Advances. Franklin, TN: Post Hill Press, 2014.






September 22, 2014

Funding Policies Constrain or Enable Serendipitous Discoveries



(p. xiv) Casting a critical eye on the way in which our society spends its research dollars, Happy Accidents offers new benchmarks for deciding how to spend future research funds. We as a society need to take steps to foster the kind of creative, curiosity-driven research that will certainly result in more lifesaving medical breakthroughs. Fostering an openness to serendipity has the potential to accelerate medical discovery as never before.


Source:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

(Note: italics in original.)






September 19, 2014

Curing Cancer Requires Enabling Serendipity, Not a Centrally Planned War



Happy Accidents is a wonderful book on serendipitous discovery that I ran across serendipitously. I had never heard of the author, but was interested in serendipity, so I started to collect books that Amazon says have something to do with serendipity. I let Happy Accidents sit on my shelf for about four years before starting to read.

The author is a retired, distinguished physician. The book is mainly a compendium of cases where major medical advances resulted from chance discoveries. Of course, the discoveries usually required more than just good luck. They usually required that someone was alert to the unexpected, and was willing to work in order to turn the unexpected into a cure. Their efforts are often made all the harder because of resistance from powerful incumbent "experts" and institutions. Often the discoveries go against the current theory, and are discovered by underfunded marginal outsiders.

Meyers points out that the centrally planned War on Cancer has cost the taxpayer a lot of money, and has largely failed to achieve its intended and predicted results. The reason is that you cannot centrally plan serendipity.

During the next several weeks, I will be quoting some of Meyers' more revealing examples or thought-provoking comments.


Book discussed:

Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.






September 15, 2014

Drugs May Rebuild Muscle in Frail Elderly



(p. B1) In 1997, scientist Se-Jin Lee genetically engineered "Mighty Mice" with twice as much muscle as regular rodents. Now, pharmaceutical companies are using his discovery to make drugs that could help elderly patients walk again and rebuild muscle in a range of diseases.


. . .


"I am very optimistic about these new drugs," says Dr. Lee, a professor of molecular biology at Johns Hopkins University in Baltimore, who isn't involved in any of the drug trials. "The fact that they're so far along means to me they must have seen effects."

Myostatin is a naturally occurring protein that curbs muscle growth. The drugs act by blocking it, or blocking the sites where it is detected in the body, potentially rebuilding muscle.



For the full story, see:

HESTER PLUMRIDGE and MARTA FALCONI. "Drugs Aim to Treat Frailty in Aging." The Wall Street Journal (Mon., April 28, 2014): B1-B2.

(Note: ellipsis added.)

(Note: the second paragraph quoted above is divided into two mini-paragraphs in the online, but not in the print, version.)

(Note: the online version of the story has the date April 27, 2014, and has the title "Drugs Aim to Help Elderly Rebuild Muscle.")






September 12, 2014

3.2 Million Waiting for Care Under England's Single-Payer Socialized Medicine



(p. A13) . . . even as the single-payer system remains the ideal for many on the left, it's worth examining how Britain's NHS, established in 1948, is faring. The answer: badly. NHS England--a government body that receives about £100 billion a year from the Department of Health to run England's health-care system--reported this month that its hospital waiting lists soared to their highest point since 2006, with 3.2 million patients waiting for treatment after diagnosis. NHS England figures for July 2013 show that 508,555 people in London alone were waiting for operations or other treatments--the highest total for at least five years.

Even cancer patients have to wait: According to a June report by NHS England, more than 15% of patients referred by their general practitioner for "urgent" treatment after being diagnosed with suspected cancer waited more than 62 days--two full months--to begin their first definitive treatment.


. . .


The socialized-medicine model is struggling elsewhere in Europe as well. Even in Sweden, often heralded as the paradigm of a successful welfare state, months-long wait times for treatment routinely available in the U.S. have been widely documented.

To fix the problem, the Swedish government has aggressively introduced private-market forces into health care to improve access, quality and choices. Municipal governments have increased spending on private-care contracts by 50% in the past decade, according to Näringslivets Ekonomifakta, part of the Confederation of Swedish Enterprise, a Swedish employers' association.



For the commentary, see:

SCOTT W. ATLAS. "OPINION; Where ObamaCare Is Going; The government single-payer model that liberals aspire to for the U.S. is increasingly in trouble around the world." The Wall Street Journal (Thur., Aug. 14, 2014): A13.

(Note: the online version of the commentary has the date Aug. 13, 2014.)






September 11, 2014

The Health Hazards of Government Guidelines on Salt



SaltIntakeGuidelinesGraphic2014-08-17.jpgSource of graphic: online version of the WSJ article quoted and cited below.



(p. A1) A long-running debate over the merits of eating less salt escalated Wednesday when one of the most comprehensive studies yet suggested cutting back on sodium too much actually poses health hazards.

Current guidelines from U.S. government agencies, the World Health Organization, the American Heart Association and other groups set daily dietary sodium targets between 1,500 and 2,300 milligrams or lower, well below the average U.S. daily consumption of about 3,400 milligrams.

The new study, which tracked more than 100,000 people from 17 countries over an average of more than three years, found that those who consumed fewer than 3,000 milligrams of sodium a day had a 27% higher risk of death or a serious event such as a heart attack or stroke in that period than those whose intake was estimated at 3,000 to 6,000 milligrams. Risk of death or other major events increased with intake above 6,000 milligrams.

The findings, published in the (p. A2) New England Journal of Medicine, are the latest to challenge the benefit of aggressively low sodium targets--especially for generally healthy people. Last year, a report from the Institute of Medicine, which advises Congress on health issues, didn't find evidence that cutting sodium intake below 2,300 milligrams reduced risk of cardiovascular disease.



For the story, see:

RON WINSLOW. "Low-Salt Diets May Pose Health Risks, Study Finds." The Wall Street Journal (Thur., Aug. 14, 2014): A1-A2.

(Note: the online version of the story has the date Aug. 13, 2014, an has the title "Low-Salt Diets May Pose Health Risks, Study Finds.")






August 26, 2014

Butter Is Back



(p. B1) Changing views of nutrition are turning butter into one of the great comeback stories in U.S. food history.


. . .


The revival flows in part from new legions of home gourmets inspired by celebrity chefs and cooking shows with butter-rich recipes. Butter makers have encouraged the trend, using food channels and websites to promote what they say is their products' natural simplicity.

Butter's shifting fortunes also reflect the vicissitudes of thinking on healthy eating that rattle the national diet. Families for decades opted for vegetable spreads because of concerns about butter's high concentration of saturated fat, only to be told more recently that the trans fats traditionally contained in margarine are just as unhealthy. Many Americans also have altered their thinking on how important reducing all fat is for controlling weight.



For the full story, see:

KELSEY GEE. "Butter Makes Comeback as Margarine Loses Favor." The Wall Street Journal (Thurs., June 26, 2014): B1-B2.

(Note: ellipsis added.)

(Note: the last quoted sentence was in the online, but not the print, version.)

(Note: the online version of the review has the date June 25, 2014, and has the title "Butter Makes Comeback as Margarine Loses Favor.")






August 18, 2014

"The Lone Commando Who Answers to No One and Breaks Rules to Save Patients Is No Longer a Viable Job Description"



(p. D5) A keen sense of loss permeates "Code Black," an affecting love letter from a young doctor to his hospital. Over the years, plenty of similar romances have been immortalized in book form, but this may be the first to play out as a documentary, and is surely the first to emerge from our newly reformed health care climate. You'd think you'd be in for some celebration.

But not in the least. In fact, among all its familiar themes, the film's most striking is the profound sense of estrangement between the young doctors on the screen and all the recent efforts at improving the health care system. The spirit that brought them to medicine and keeps them there, they say over and over, was never even part of the national discussion.


. . .


. . . , as their department chairman points out, the day of the cowboy doctor is over; the lone commando who answers to no one and breaks rules to save patients is no longer a viable job description. Newly smothered in paperwork and quality control, many of these young doctors grieve for a self-image that has ridden off into the sunset.



For the full review, see:

ABIGAIL ZUGER, M.D.. "Saving Lives and Pushing Paper." The New York Times (Tues., July 1, 2014): D5.

(Note: ellipses added.)

(Note: the online version of the review has the date JUNE 30, 2014.)






July 19, 2014

"Long, Lonely Odyssey "from Heresy to Orthodoxy""



MadnessAndMemoryBK2014-06-05.jpg












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








(p. D5) As the Nobel committee put it in the 1997 citation for Dr. Prusiner's prize in physiology or medicine, he had established "a novel principle of infection" -- one so controversial that a few experts in the field still continue to search for that elusive virus. But as far as Dr. Prusiner is concerned, the Nobel confirmed that his long, lonely odyssey "from heresy to orthodoxy" was over.

The journey he details was full of hurdles. Some were of the kind likely to befall any researcher: insufficient laboratory space, poor correlation between needs and resources. (At one point, Dr. Prusiner calculated that for a single year's worth of experiments he would have to house and feed 72,000 mice, an impossible multimillion-dollar proposition.) He submitted a grant application that was not just rejected for funding but actually "disapproved," often the kiss of death for a train of scientific thought.

Some of his problems were a little darker but still universal -- graduate students captured by competing labs, data appropriated and misrepresented by erstwhile colleagues, bitter authorship battles.

Some of Dr. Prusiner's shoals, however, seem more particular to his personal operating style. As a teenager he was blessed with what he describes as indefatigable self-confidence, and this trait apparently endures, to the considerable irritation of others.



For the full review, see:

ABIGAIL ZUGER, M.D. "Books; A Victory Lap for a Heretical Neurologist." The New York Times (Sat., May 20, 2014): D5.

(Note: the online version of the review has the date May 19, 2014.)


The book under review is:

Prusiner, Stanley B. Madness and Memory: The Discovery of Prions--a New Biological Principle of Disease. New Haven, CT: Yale University Press, 2014.






July 2, 2014

The Opportunity Cost of Surgeons Dictating and Documenting Health Records



(p. A13) Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?


For the full commentary, see:

DANIEL F. CRAVIOTTO JR. "A Doctor's Declaration of Independence; It's time to defy health-care mandates issued by bureaucrats not in the healing profession." The Wall Street Journal (Tues., April 29, 2014): A13.

(Note: the online version of the commentary has the date April 28, 2014.)






June 20, 2014

How Medicaid Rewards Doctors Who Mistreat Patients



(p. A13) I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT, code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled.

During the surgery, I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes.

However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment. Ironically, the code-listed payment for the procedure I ultimately performed was an amount 40% less than the amount approved for the initially authorized surgery. For over a year, I challenged Medicaid about its decision to deny payment. I wrote numerous letters and spoke to many Medicaid employees explaining the predicament. Eventually I gave up fighting what had obviously become a losing battle.



For the full commentary, see:

ZANE F. POLLARD. "The Bureaucrat Sitting on Your Doctor's Shoulder; When I'm operating on a child, I shouldn't have to wonder if Medicaid will OK a change in the surgical plan.." The Wall Street Journal (Thurs., May 22, 2014): A13.

(Note: the online version of the commentary has the date May 21, 2014.)






June 9, 2014

Government Regulations Favor Health Care Incumbents



WhereDoesItHurtBK2014-05-28.jpg





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





(p. A11) The rise in U.S. health-care costs, to nearly 18% of GDP today from around 6% of GDP in 1965, has alarmed journalists, inspired policy wonks and left patients struggling to find empathy in a system that tends to view them as "a vessel for billing codes," as the technologist Dave Chase has put it.

Enter Jonathan Bush, dyslexic entrepreneur, . . .


. . .


. . . , Mr. Bush touts technology as a driver of change. It has revolutionized the way we shop for books and select hotels, but health-care delivery has been stubbornly resistant. Mr. Bush notes that the number of people supporting each doctor has climbed to 16 today from 10 in 1990--half of whom, currently, are administrators handling the mounting paperwork. Astonishingly, as Mr. Bush observes, the government had to pay doctors billions of dollars, via the 2009 HITECH Act, to incentivize them to upgrade from paper to computers. Meanwhile, fast-food chains discovered computers on their own, because the market demanded it.


. . .


Let entrepreneurs loose on these challenges, Mr. Bush believes, and they will come up with solutions.

Mr. Bush identifies three major obstacles to the kinds of change he has in mind. First, large hospital systems leverage their market position to charge hefty premiums for basic services, then use the proceeds to buy more regional hospitals and local practices. "As big ones take over the small," Mr. Bush laments, "prices shoot up. Choices vanish." Second, government regulations, especially state laws, favor powerful incumbents, shielding "imaging centers and hospitals from competition." Third, heath care suffers from a risk-avoidant culture. The maxim "do no harm," Mr. Bush says, should not be an excuse for clinging to a flawed status quo.



For the full review, see:

David A. Shaywitz. "BOOKSHELF; A System Still in Need of Repair; Routine medical services can be done for less cost--one of many obvious realities that current health-care practices studiously ignore." The Wall Street Journal (Mon., May 19, 2014): A11.

(Note: ellipses added.)

(Note: the online version of the review has the date May 18, 2014, and has the title "BOOKSHELF; Book Review: 'Where Does It Hurt?' by Jonathan Bush; Routine medical services can be done for less cost--one of many obvious realities that current health-care practices studiously ignore.")


The book under review is:

Bush, Jonathan, and Stephen Baker. Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care. New York: Portfolio, 2014.






May 30, 2014

Young Inca Woman Was Probably Murdered



MurderedIncanYoungWoman2014-04-28.jpg "The Incan mummy." Source of caption and photo: online version of the NYT article quoted and cited below.


Hobbes famously wrote that for most of human existence, life has been "poor, nasty, brutish, and short." Further evidence:


(p. D4) Scientists who have examined the mummy of a young Inca say that her death was most likely a homicide and that it was not because of Chagas disease, the tropical parasitic infection that she had.


For the full story, see:

"Observatory; A Verdict of Murder." The New York Times (Tues., MARCH 4, 2014): D4.

(Note: the online version of the story has the date MARCH 3, 2014.)




The famous Hobbes quote can be found on p. 70 of:

Hobbes, Thomas. Leviathan, Dover Philosophical Classics. Mineola, New York: Dover Publications, Inc., 2006 [first published 1651].






May 26, 2014

Crispr Molecular System Allows Scientists to Edit Genes



CrisprEditsGenes2014-04-28.jpgSource of graph: online version of the NYT article quoted and cited below.



(p. D1) In the late 1980s, scientists at Osaka University in Japan noticed unusual repeated DNA sequences next to a gene they were studying in a common bacterium. They mentioned them in the final paragraph of a paper: "The biological significance of these sequences is not known."

Now their significance is known, and it has set off a scientific frenzy.

The sequences, it turns out, are part of a sophisticated immune system that bacteria use to fight viruses. And that system, whose very existence was unknown until about seven years ago, may provide scientists with unprecedented power to rewrite the code of life.

In the past year or so, researchers have discovered that the bacterial system can be harnessed to make precise changes to the DNA of humans, as well as other animals and plants.

This means a genome can be edited, much as a writer might change words or fix spelling errors. It allows "customizing the genome of any cell or any species at will," said Charles Gersbach, an assistant professor of biomedical engineering at Duke University.



For the full story, see:

ANDREW POLLACK. "A Powerful New Way to Edit DNA." The New York Times (Tues., MARCH 4, 2014): D1 & D5.

(Note: the online version of the story has the date MARCH 3, 2014.)







May 23, 2014

30,000 Year Old Virus Revived from Permafrost



(p. D5) From Siberian permafrost more than 30,000 years old, [French and Russian researchers] have revived a virus that's new to science.

"To pull out a virus that's 30,000 years old and actually grow it, that's pretty impressive," said Scott O. Rogers of Bowling Green State University who was not involved in the research. "This goes well beyond what anyone else has done."


. . .


Measuring 1.5 micrometers long, the viruses are 25 percent bigger than any virus previously found.


. . .


"Sixty percent of its gene content doesn't resemble anything on earth," Dr. Abergel said. She and her colleagues suspect that pithoviruses may be parasitic survivors of life forms that were very common early in the history of life.


. . .


"Its potential implications for evolutionary theory and health are quite astonishing," said Eske Willerslev, an evolutionary biologist at the University of Copenhagen.



For the full story, see:

Carl Zimmer. "Out of Siberian Ice, a Virus Revived." The New York Times (Tues., MARCH 4, 2014): D5.

(Note: ellipses, and bracketed words, added.)

(Note: the online version of the story has the date MARCH 3, 2014.)







May 22, 2014

In France "'Liberté, Égalité, Fraternité' Means that What's Yours Should Be Mine"



SantacruzGuillaumeFrenchEntrepreneurInLondon2014-04-27.jpgGuillaume Santacruz is among many French entrepreneurs now using London as their base. He said of his native France, "The economy is not going well, and if you want to get ahead or run your own business, the environment is not good." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. 1) Guillaume Santacruz, an aspiring French entrepreneur, brushed the rain from his black sweater and skinny jeans and headed down to a cavernous basement inside Campus London, a seven-story hive run by Google in the city's East End.


. . .


A year earlier, Mr. Santacruz, who has two degrees in finance, was living in Paris near the Place de la Madeleine, working in a boutique finance firm. He had taken that job after his attempt to start a business in Marseille foundered under a pile of government regulations and a seemingly endless parade of taxes. The episode left him wary of starting any new projects in France. Yet he still hungered to be his own boss.

He decided that he would try again. Just not in his own country.

"A lot of people are like, 'Why would you ever leave France?' " Mr. Santacruz said. "I'll tell you. France has a lot of problems. There's a feeling of gloom that seems to be growing deeper. The economy is not going well, and if you want to get ahead or run your own business, the environment is not good."


. . .


(p. 5) "Making it" is almost never easy, but Mr. Santacruz found the French bureaucracy to be an unbridgeable moat around his ambitions. Having received his master's in finance at the University of Nottingham in England, he returned to France to work with a friend's father to open dental clinics in Marseille. "But the French administration turned it into a herculean effort," he said.

A one-month wait for a license turned into three months, then six. They tried simplifying the corporate structure but were stymied by regulatory hurdles. Hiring was delayed, partly because of social taxes that companies pay on salaries. In France, the share of nonwage costs for employers to fund unemployment benefits, education, health care and pensions is more than 33 percent. In Britain, it is around 20 percent.

"Every week, more tax letters would come," Mr. Santacruz recalled.


. . .


Diane Segalen, an executive recruiter for many of France's biggest companies who recently moved most of her practice, Segalen & Associés, to London from Paris, says the competitiveness gap is easy to see just by reading the newspapers. "In Britain, you read about all the deals going on here," Ms. Segalen said. "In the French papers, you read about taxes, more taxes, economic problems and the state's involvement in everything."


. . .


"It is a French cultural characteristic that goes back to almost the revolution and Robespierre, where there's a deep-rooted feeling that you don't show that you make money," Ms. Segalen, the recruiter, said. "There is this sense that 'liberté, égalité, fraternité' means that what's yours should be mine. It's more like, if someone has something I can't have, I'd rather deprive this person from having it than trying to work hard to get it myself. That's a very French state of mind. But it's a race to the bottom."



For the full story, see:

LIZ ALDERMAN. "Au Revoir, Entrepreneurs." The New York Times, SundayBusiness Section (Sun., MARCH 23, 2014): 1 & 5.

(Note: ellipses added.)

(Note: the online version of the story has the date MARCH 22, 2014.)




SegalenDianeFrenchEntrepreneurInLondon2014-04-27.jpg 'Diane Segalen moved most of her executive recruiting practice to London from Paris. In France, she says, "there is this sense that 'liberté, égalité, fraternité' means that what's yours should be mine."" Source of caption and photo: online version of the NYT article quoted and cited above.






May 12, 2014

Heart Pioneer Bailey Kept Moving from Hospital to Hospital Due to His Failures



ExtemeMedicineBK2014-04-25.jpg

















Source of book image:
http://media.npr.org/assets/bakertaylor/covers/e/extreme-medicine/9781594204708_custom-14713d8588e54f066a6abf7b5a13e4c9de832ea1-s6-c30.jpg



(p. C8) In "Extreme Medicine," physician Kevin Fong reminds us that virtually everything we take for granted in lifesaving medical intervention was once unthinkable. Over the past century, as technology has allowed man to conquer hostile environments and modernize warfare, medical pioneers have been on a parallel journey, confronting what had once been fatal in man's boldest pursuits and making it survivable.


. . .


As Dr. Fong notes, many of today's commonplace treatments were once dangerously experimental. One pioneer in the early postwar years, a Philadelphia surgeon named Charles Bailey, killed several patients while trying to repair problems of the mitral valve, which if damaged can cause blood to flow backward into the hear chamber, decreasing flow to the rest of the body. Bailey moved from hospital to hospital to avoid scrutiny of his successive failures.



For the full review, see:

LAURA LANDRO. "BOOKS; They Died So We Might Live; Hypothermia, which killed explorers like Scott, is now induced in heart patients to allow time for surgery." The Wall Street Journal (Sat., Feb. 15, 2014): C8.

(Note: ellipsis added.)

(Note: the online version of the review has the date Feb. 14, 2014, and has the title "BOOKSHELF; Book Review: 'Extreme Medicine' by Kevin Fong; Explorers, astronauts and soldiers all pushed the limits of doctors' abilities to heal and repair.")


The book under review is:

Swidey, Neil. Trapped under the Sea: One Engineering Marvel, Five Men, and a Disaster Ten Miles into the Darkness. New York: Crown Publishers, 2014.






May 3, 2014

Sweden Shows ObamaCare Will Cause Health Care Delays and Rationing



(p. A11) President Obama has declared the Affordable Care Act a success--a reform that is "here to stay." The question remains, however: What should we expect to come out of it, and do we want the effects to stay? If the experiences of Sweden and other countries with universal health care are any indication, patients will soon start to see very long wait times and difficulty getting access to care.


. . .


Rationing is an obvious effect of economic planning in place of free-market competition. Free markets allow companies and entrepreneurs to respond to demand by offering people what they want and need at a better price. Effective and affordable health care comes from decentralized innovation and risk-taking as well as freedom in pricing and product development. The Affordable Care Act does the opposite by centralizing health care, minimizing or prohibiting differentiation in pricing and offerings, and mandating consumers to purchase insurance. It effectively overrides the market and the signals it sends about supply and demand.

Stories of people in Sweden suffering stroke, heart failure and other serious medical conditions who were denied or unable to receive urgent care are frequently reported in Swedish media. Recent examples include a one-month-old infant with cerebral hemorrhage for whom no ambulance was made available, and an 80-year-old woman with suspected stroke who had to wait four hours for an ambulance.

Other stories include people waiting many hours before a nurse or anyone talked to them after they arrived in emergency rooms and then suffering for long periods of time before receiving needed care. A 42-year-old woman in Karlstad seeking care for meningitis died in the ER after a three-hour wait. A woman with colon cancer spent 12 years contesting a money-saving decision to deny an abdominal scan that would have found the cancer earlier. The denial-of-care decision was not made by an insurance company, but by the government health-care system and its policies.



For the full commentary, see:

PER BYLUND. "OPINION; What Sweden Can Teach Us About ObamaCare; Universal public health care means the average Swede with 'high risk' prostate cancer waits 220 days for treatment." The Wall Street Journal (Fri., April 18, 2014): A11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date April 17, 2014.)






April 28, 2014

Research on Dogs that Benefits Both Humans and Dogs



MooreEricaExaminesAkyra2014-04-24.jpg "Erica Moore examined Akyra, a shih tzu, in August before the dog was enrolled in Penn Vet's canine mammary tumor program. She had surgery there." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. D6) Akyra's mammary glands were riddled with tumors, including one the size of a golf ball. She would be hard to place in a home, and the medical care she needed would be expensive. The tumors could be cancerous.

"When my husband called and said they were going to leave one of the dogs behind because she had mammary tumors, I said, 'No, you're not!' " said Bekye Eckert, 49, a dog lover who lives outside Baltimore and has cared for several animals with mammary cancer.

Ms. Eckert arranged for Akyra to be enrolled in an innovative program at the University of Pennsylvania, where veterinary oncologists are learning about the progression of human breast cancer by treating mammary tumors in shelter dogs.


. . .


Generally, two sets of tumor samples are taken from each dog, one for the pathology lab and one for Dr. Troyanskaya to use for molecular analysis. Astrid, for example, had tumors in seven mammary glands that were mostly benign. The largest proved to be malignant.

Such a large set of samples is a gold mine for Dr. Troyanskaya, who is looking for changes in the expression of a specific gene or group of genes, or pathways linking groups of genes as the tumor becomes malignant.


. . .


In the meantime, stray dogs are getting free cancer treatment that makes it easier to find them permanent homes, and they are promised care for any recurrence. More than 100 dogs have been through the program; several have been adopted by women who also survived breast cancer.

For Akyra, there was good news. She had surgery in August, and veterinarians removed the large tumor and three smaller lesions. The pathology report gave her a clean bill of health: None were cancerous. She was adopted by Beth Gardner, a relocation consultant in Devon, Pa.



For the full story, see:

RONI CARYN RABIN. "By Treating Dogs, Answers About Breast Cancer." The New York Times (Tues., April 1, 2014): D6.

(Note: ellipses added.)

(Note: the online version of the commentary has the date MARCH 31, 2014, and has the title "From Dogs, Answers About Breast Cancer.")






April 17, 2014

Re-Use of Plastic Bags Increases E. Coli Infections



(p. A13) Though reducing plastic-bag use might be good for the environment, encouraging the re-use of plastic bags for food-toting may not be so healthy for humans. After San Francisco introduced its ban on non-compostable plastic bags in large grocery stores in 2007, researchers discovered a curious spike in E. coli infections, which can be fatal, and a 46% increase in deaths from food-borne illnesses, according to a study published in November 2012 by the University of Pennsylvania and George Mason University. "We show that the health costs associated with the San Francisco ban swamp any budgetary savings from reduced litter," the study's authors observed.

Affirming this yuck factor, a 2011 study from the University of Arizona and Loma Linda University found bacteria in 99% of reusable polypropylene bags tested; 8% of them were carrying E. coli. The study, though it mainly focused on plastic bags, also looked at two cotton reusable bags--and both contained bacteria.

Bag-ban boosters counter that consumers just need to wash their bags and use separate bags for fish and meat. If only my washing machine had a "reusable bag vinegar rinse cycle." A paltry 3% of shoppers surveyed in that same 2011 study said they washed their reusable bags. Has anybody calculated the environmental impact of drought-ravaged Californians laundering grocery bags?



For the full commentary, see:

JUDY GRUEN. "Becoming a Bagless Lady in Los Angeles." The Wall Street Journal (Sat., March 8, 2014): A13.

(Note: the online version of the commentary has the date March 7, 2014.)


The 2012 study mistakenly labelled above as "published" is:

Klick, Jonathan and Wright, Joshua D., Grocery Bag Bans and Foodborne Illness (November 2, 2012). U of Penn, Inst for Law & Econ Research Paper No. 13-2. Available at SSRN: http://ssrn.com/abstract=2196481 or http://dx.doi.org/10.2139/ssrn.2196481


The 2011 article mentioned above, is:

Williams, David L., Charles P. Gerba, Sherri Maxwell, and Ryan G. Sinclair. "Assessment of the Potential for Cross-Contamination of Food Products by Reusable Shopping Bags." Food Protection Trends 31, no. 8 (Aug. 2011): 508-13.






April 13, 2014

Solitary Swimming Helps Creativity and Problem-Solving



(p. 5) Ms. Nyad has spent a lifetime in the water, chasing an elusive mark in marathon swimming, and she has written about the exhilarating out-of-body experience she has when powering through long distances. The medium makes it necessary to unplug; the blunting of the senses by water encourages internal retreat. Though we don't all reach nirvana when we swim, swimming may well be that last refuge from connectivity -- and, for some, the only way to find the solitary self.


. . .


For better or worse, the mind wanders: We are left alone with our thoughts, wherever they may take us. A lot of creative thinking happens when we're not actively aware of it. A recent Carnegie Mellon study shows that to make good decisions, our brains need every bit of that room to meander. Other research has found that problem-solving tends to come most easily when our minds are unfocused, and while we're exercising. The neurologist Oliver Sacks has written books in his head while swimming. "Theories and stories would construct themselves in my mind as I swam to and fro, or round and round Lake Jeff," he writes in the essay "Water Babies." Five hundred lengths in a pool were never boring or monotonous; instead, Dr. Sacks writes, "swimming gave me a sort of joy, a sense of well-being so extreme that it became at times a sort of ecstasy." The body is engaged in full physical movement, but the mind itself floats, untethered. Beyond this, he adds, "there is all the symbolism of swimming -- its imaginative resonances, its mythic potentials."

Dr. Sacks describes a sublime state that is accessible to all, from his father, with his "great whalelike bulk," who swam daily and elegantly until 94 years of age, to the very young.   . . .


. . .


I asked Dara Torres, who has logged countless training hours for her five Olympics, what she thinks about when she's swimming. "I'm always doing five things at once," she told me by phone (at the time, she was driving a car). "So when I get in the water, I think about all the things that I have to do. But sometimes I go into a state -- I don't really think about anything." The important thing, she says, is that the time is yours. "You can use it for anything. It depends where your head is at -- it's a reflection of where you are."

The reflection of where you are: in essence, a status update to you, and only you. The experience is egalitarian. You don't have to be a great swimmer to appreciate the benefits of sensory solitude and the equilibrium the water can bring.



For the full commentary, see:

Justin Gillis. "BY DEGREES; Freezing Out the Bigger Picture." The New York Times (Tues., FEB. 11, 2014): D3.

(Note: ellipses added.)

(Note: the online version of the commentary has the date FEB. 10, 2014.)






April 6, 2014

Some Geographical Clusters Are Due to Chance (It Is Not Always a Miracle, When Good, Or the Environment, When Bad)



HandDavidStatistiician2014-04-04.jpg











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




(p. 12) Your latest book, "The Improbability Principle," aims to prove that extremely improbable events are in fact commonplace. Can you explain that a bit? Things like roulette wheels coming up in strange configurations or the same lottery numbers hitting two weeks in a row are clearly very rare events, but if you look at the number of lotteries and the number of roulette wheels, then you realize that you should actually expect these sorts of things to happen. I think within the statistical community people accept this. They're aware of the impact of the law of truly large numbers.


. . .


You also write that geographical clusters of people with diseases might not necessarily be a result of environmental issues. It could just be a coincidence. Well, they could be due to some sort of pollution or infectious disease or something like that, but you can expect clusters to occur just by chance as well. So it's an interesting statistical problem to tease these things out. Is this a genuine cluster in the sense that there's a cause behind it? Or is it a chance cluster?



For the full interview, see:

Chozick, Amy, interviewer. "'The Wonder Is Still There'; The Statistician David J. Hand on Eerie Coincidences and Playing the Lottery." The New York Times Magazine (Sun., FEB. 23, 2014): 12.

(Note: ellipsis added; bold in original.)

(Note: the online version of the interview has the date FEB. 21, 2014, and has the title "David J. Hand's Lottery Tips.")


Hand's book is:

Hand, David J. The Improbability Principle: Why Coincidences, Miracles, and Rare Events Happen Every Day. New York: Scientific American/Farrar, Straus and Giroux, 2014.






March 29, 2014

If Lack of Focus and Poverty Go Together, Which Is the Cause and Which the Effect?



ScarcityBK2014-03-06.jpg











Source of book image: http://www.scientificamerican.com/sciam/cache/file/BF860CC7-371A-46BB-8ACCECD4289565A8.jpg




Are the poor poor partly because they concentrate less, or do they concentrate less partly because they are poor? Samantha Power discusses one of her favorite books of 2013:



(p. C11) In "Scarcity," Sendhil Mullainathan and Eldar Shafir offer groundbreaking insights into, among other themes, the effects of poverty on (p. C12) cognition and our ability to make choices about our lives. The authors persuasively show that the mental space--or "bandwidth"--of the poor is so consumed with making ends meet that they may be more likely to lose concentration while on a job or less likely to take medication on time.


For the full article, see:

"12 Months of Reading; We asked 50 of our friends--from April Bloomfield to Mike Tyson--to name their favorite books of 2013." The Wall Street Journal (Sat., Dec. 14, 2013): C6 & C9-C12.

(Note: the online version of the article has the date Dec. 13, 2013.)


The book that Power praises is:

Mullainathan, Sendhil, and Eldar Shafir. Scarcity: Why Having Too Little Means So Much. New York: Times Books, 2013.






January 22, 2014

Regulators Forbid Doctor from Curing Dentist's Pelvic Pain



DavidsonDaneilPelvicPain2014-01-16.jpg "Dr. Daniel Davidson, an Idaho dentist, has pelvic pain so severe that he cannot sit, and can stand for only limited periods." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A18) After visiting dozens of doctors and suffering for nearly five years from pelvic pain so severe that he could not work, Daniel Davidson, 57, a dentist in Dalton Gardens, Idaho, finally found a specialist in Phoenix who had an outstanding reputation for treating men like him.

Dr. Davidson, whose pain followed an injury, waited five months for an appointment and even rented an apartment in Phoenix, assuming he would need surgery and time to recover.

Six days before the appointment, it was canceled. The doctor, Michael Hibner, an obstetrician-gynecologist at St. Joseph's Hospital and Medical Center, had learned that members of his specialty were not allowed to treat men and that if he did so, he could lose his board certification -- something that doctors need in order to work.

The rule had come from the American Board of Obstetrics and Gynecology. On Sept. 12, it posted on its website a newly stringent and explicit statement of what its members could and could not do. Except for a few conditions, gynecologists were prohibited from treating men. Pelvic pain was not among the exceptions.

Dr. Davidson went home, close to despair. His condition has left him largely bedridden. The pain makes it unbearable for him to sit, and he can stand for only limited periods before he needs to lie down.

"These characters at the board jerked the rug out from underneath me," he said.



For the full story, see:

DENISE GRADY. "Men With Pelvic Pain Find a Path to Treatment Blocked by a Gynecology Board." The New York Times (Weds., December 11, 2013): A18.

(Note: the online version of the story has the date December 10, 2013.)






January 20, 2014

AquaBounty Has Waited More than 17 Years for FDA Approval



EnviropigDevelopedAtGuelph2013-12-31.jpg

"The Enviropig Scientists at the University of Guelph, in Canada, developed these pigs to produce more environmentally friendly waste than conventional pigs. But the pigs were killed because the scientists could not get approval to sell them as food." Source of caption and photo: online version of the NYT article quoted and cited below.




(p. 4) If patience is a virtue, then AquaBounty, a Massachusetts biotech company, might be the most virtuous entity on the planet.

In 1993, the company approached the Food and Drug Administration about selling a genetically modified salmon that grew faster than normal fish. In 1995, AquaBounty formally applied for approval. Last month, more than 17 years later, the public comment period, one of the last steps in the approval process, was finally supposed to conclude. But the F.D.A. has extended the deadline -- members of the public now have until late April to submit their thoughts on the AquAdvantage salmon. It's just one more delay in a process that's dragged on far too long.

The AquAdvantage fish is an Atlantic salmon that carries two foreign bits of DNA: a growth hormone gene from the Chinook salmon that is under the control of a genetic "switch" from the ocean pout, an eel-like fish that lives in the chilly deep. Normally, Atlantic salmon produce growth hormone only in the warm summer months, but these genetic adjustments let the fish churn it out year round. As a result, the AquAdvantage salmon typically reach their adult size in a year and a half, rather than three years.


. . .


We should all be rooting for the agency to do the right thing and approve the AquAdvantage salmon. It's a healthy and relatively cheap food source that, as global demand for fish increases, can take some pressure off our wild fish stocks. But most important, a rejection will have a chilling effect on biotechnological innovation in this country.


. . .


Then there's the Enviropig, a swine that has been genetically modified to excrete less phosphorus. Phosphorus in animal waste is a major cause of water pollution, and as the world's appetite for meat increases, it's becoming a more urgent problem. The first Enviropig, created by scientists at the University of Guelph, in Canada, was born in 1999, and researchers applied to both the F.D.A. and Health Canada for permission to sell the pigs as food.

But last spring, while the applications were still pending, the scientists lost their funding from Ontario Pork, an association of Canadian hog farmers, and couldn't find another industry partner. (It's hard to blame investors for their reluctance, given the public sentiment in Canada and the United States, as well as the uncertain regulatory landscape.) The pigs were euthanized in May.

The F.D.A. must make sure that other promising genetically modified animals don't come to the same end. Of course every application needs to be painstakingly evaluated, and not every modified animal should be approved. But in cases like AquaBounty's, where all the available evidence indicates that the animals are safe, we shouldn't let political calculations or unfounded fears keep these products off the market. If we do that, we'll be closing the door on innovations that could help us face the public health and environmental threats of the future, saving countless animals -- and perhaps ourselves.



For the full commentary, see:

EMILY ANTHES. "Don't Be Afraid of Genetic Modification." The New York Times, SundayReview Section (Sun., March 10, 2013): 4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 9, 2013.)


Emily Anths, who is quoted above, has written a related book:

Anthes, Emily. Frankenstein's Cat: Cuddling up to Biotech's Brave New Beasts. New York: Scientific American / Farrar, Straus and Giroux, 2013.






January 18, 2014

Patent Allows Mechanic to Profit from Invention to Ease Births



OdonDeviceEasesBirth2014-01-16.jpg "With Jorge Odón's device, a plastic bag inflated around a baby's head is used to pull it out of the birth canal." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A1) The idea came to Jorge Odón as he slept. Somehow, he said, his unconscious made the leap from a YouTube video he had just seen on extracting a lost cork from a wine bottle to the realization that the same parlor trick could save a baby stuck in the birth canal.

Mr. Odón, 59, an Argentine car mechanic, built his first prototype in his kitchen, using a glass jar for a womb, his daughter's doll for the trapped baby, and a fabric bag and sleeve sewn by his wife as his lifesaving device.


. . .


(p. A4) In a telephone interview from Argentina, Mr. Odón described the origins of his idea.

He tinkers at his garage, but his previous inventions were car parts. Seven years ago, he said, employees were imitating a video showing that a cork pushed into an empty bottle can be retrieved by inserting a plastic grocery bag, blowing until it surrounds the cork, and drawing it out.


. . .


With the help of a cousin, Mr. Odón met the chief of obstetrics at a major hospital in Buenos Aires. The chief had a friend at the W.H.O., who knew Dr. Merialdi, who, at a 2008 medical conference in Argentina, granted Mr. Odón 10 minutes during a coffee break.

The meeting instead lasted two hours. At the end, Dr. Merialdi declared the idea "fantastic" and arranged for testing at the Des Moines University simulation lab, which has mannequins more true-to-life than a doll and a jar.

Since then, Mr. Odón has continued to refine the device, patenting each change so he will eventually earn royalties on it.


. . .


Dr. Merialdi said he endorsed a modest profit motive because he had seen other lifesaving ideas languish for lack of it. He cited magnesium sulfate injections, which can prevent fatal eclampsia, and corticosteroids, which speed lung development in premature infants.

"But first, this problem needed someone like Jorge," he said. "An obstetrician would have tried to improve the forceps or the vacuum extractor, but obstructed labor needed a mechanic. And 10 years ago, this would not have been possible. Without YouTube, he never would have seen the video."



For the full story, see:

DONALD G. McNEIL Jr. "Promising Tool in Difficult Births: A Plastic Bag." The New York Times (Thurs., November 14, 2013): A1 & A4. [National Edition]

(Note: ellipses added.)

(Note: the online version of the story has the date November 13, 2013, and has the title "Car Mechanic Dreams Up a Tool to Ease Births.")






January 10, 2014

"Pretty Cool" Cochlear Implant: "It Helps Me Hear"



CochlearImplant2013-11-15.jpg "The cochlear implant." Source of caption and photo: online version of the WSJ commentary quoted and cited below.


(p. A15) . . . , three pioneering researchers-- Graeme Clark, Ingeborg Hochmair and Blake Wilson --shared the prestigious Lasker-DeBakey Award for Clinical Medical Research for their work in developing the [cochlear] implant. . . . The award citation says the devices have "for the first time, substantially restored a human sense with medical intervention" and directly transformed the lives of hundreds of thousands.

I've seen this up close. My 10-year-old son, Alex, is one of the 320,000 people with a cochlear implant.


, , ,


"What's that thing on your head?" I heard a new friend ask Alex recently.

"It helps me hear," he replied, then added: "I think it's pretty cool."

"If you took it off, would you hear me?" she asked.

"Nope," he said. "I'm deaf."

"Cool," she agreed. Then they talked about something else.

Moments like that make me deeply grateful for the technology that allows Alex to have such a conversation, but also for the hard-won aplomb that lets him do it so matter-of-factly.



For the full commentary, see:

Denworth, Lydia. "OPINION; What Cochlear Implants Did for My Son; Researchers who were just awarded the 'American Nobel' have opened up the world of sound to the deaf." The Wall Street Journal (Fri., Sept. 20, 2013): A15.

(Note: ellipses, and bracketed word, added.)

(Note: the online version of the article has the date Sept. 19, 2013.)






December 19, 2013

Regulators Harass Saucy and Irreverent Buckyball Entrepreneur



ZuckerCraigBuckyballs2013-12-07.jpg










"Craig Zucker, former head of Maxfield & Oberton, which made Buckyballs, sells Liberty Balls to raise a legal-defense fund against an unusual action by federal regulators." Source of caption and photo: online version of the NYT article quoted and cited below.



(p. B1) Over the last three weeks, more than 2,200 people have placed orders for $10-to-$40 sets of magnetic stacking balls, rising to the call of a saucy and irreverent social media campaign against a government regulatory agency.


. . .


It involves an effort by the federal Consumer Product Safety Commission to recall Buckyballs, sets of tiny, powerfully magnetic stacking balls that the magazines Rolling Stone and People once ranked on their hot products lists.

Last year, the commission declared the balls a swallowing hazard to young children and filed an administrative action against the company that made the product, demanding it recall all Buckyballs, and a related product called Buckycubes, and refund consumers their money. The company, Maxfield & Oberton Holdings, challenged the action, saying labels on the packaging clearly warned that the product was unsafe for children.

But the fuss now has less to do with safety. After Maxfield & Oberton went out of business last December, citing the financial toll of the recall battle, lawyers for the product safety agency took the highly unusual step of adding the chief executive of the dissolved firm, Craig Zucker, as a respondent in the recall action, arguing that he con-
(p. B6)trolled the company's activities. Mr. Zucker and his lawyers say the move could ultimately make him personally responsible for the estimated recall costs of $57 million.

While the "responsible corporate officer" doctrine (also known as the Park doctrine) has been used frequently in criminal cases, allowing for prosecutions of individual company officers in cases asserting corporate wrongdoing, experts say its use is virtually unheard-of in an administrative action where no violations of law or regulations are claimed.


. . .


Three well-known business organizations -- the National Association of Manufacturers, the National Retail Federation and the Retail Industry Leaders Association -- banded together this summer to file a brief urging the administrative law judge reviewing the recall case to drop Mr. Zucker as a respondent.

The groups argue that holding an individual responsible for a widespread, expensive recall sets a disturbing example and runs counter to the business desire for limited liability. They contend that such risk would have a detrimental effect on entrepreneurism and openness in dealing with regulatory bodies.


. . .


Conservative legal groups like Cause of Action, a nonprofit that targets what it considers governmental overreach, have been watching the proceedings with interest and weighing taking some action.

"This really punishes entrepreneurship and establishes a bad precedent for businesses working to create products for consumers," said Daniel Z. Epstein, the group's executive director. "It undermines the business community's ability to rely upon the corporate form."


For the full story, see:

HILARY STOUT. "In Regulators' Sights; Magnetic-Toy Recall Gives Rise to Wider Legal Campaign." The New York Times (Fri., November 1, 2013): B1 & B6.

(Note: ellipses added.)

(Note: the online version of the article has the date October 31, 2013, and has the title "Buckyball Recall Stirs a Wider Legal Campaign.")






December 18, 2013

Buffett's Berkshire Buys More of Dubious DaVita



A case has been made on CNN that DaVita has committed Medicare fraud costing taxpayers many millions of dollars. DaVita has been discussed in previous blog entries on November 30, 2012, May 18, 2013, and June 11, 2013.



(p. 3D) Omaha investor Warren Buffett's company bought nearly 3.7 million more shares of DaVita Inc. after the dialysis provider reported its earnings . . . [in the first week of November 2013].

Berkshire Hathaway Inc. said in documents filed with the Securities and Exchange Commission on Friday that it owns 35.1 million shares of DaVita.



For the full story, see:

THE ASSOCIATED PRESS. "Berkshire buys 3.7 million more shares of DaVita after report." Omaha World-Herald (Mon., November 11, 2013): 3D.

(Note: ellipsis and bracketed words added.)






December 17, 2013

Stem Cells Used to Create Tiny, Simple Human Livers



LiverBudsMadeFromStemCells2013-10-27.jpg "Researchers from Japan used human stem cells to create "liver buds," rudimentary livers that, when transplanted into mice, grew and functioned." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A3) Researchers in Japan have used human stem cells to create tiny human livers like those that arise early in fetal life. When the scientists transplanted the rudimentary livers into mice, the little organs grew, made human liver proteins, and metabolized drugs as human livers do.

They and others caution that these are early days and this is still very much basic research. The liver buds, as they are called, did not turn into complete livers, and the method would have to be scaled up enormously to make enough replacement liver buds to treat a patient. Even then, the investigators say, they expect to replace only 30 percent of a patient's liver. What they are making is more like a patch than a full liver.

But the promise, in a field that has seen a great deal of dashed hopes, is immense, medical experts said.

"This is a major breakthrough of monumental significance," said Dr. Hillel Tobias, director of transplantation at the New York University School of Medicine. Dr. Tobias is chairman of the American Liver Foundation's national medical advisory committee.



For the full story, see:

GINA KOLATA. "Scientists Fabricate Rudimentary Human Livers." The New York Times (Thurs., July 4, 2013): A3.

(Note: the online version of the story has the date July 3, 2013.)


The research article is:

Takebe, Takanori, Keisuke Sekine, Masahiro Enomura, Hiroyuki Koike, Masaki Kimura, Takunori Ogaeri, Ran-Ran Zhang, Yasuharu Ueno, Yun-Wen Zheng, Naoto Koike, Shinsuke Aoyama, Yasuhisa Adachi, and Hideki Taniguchi. "Vascularized and Functional Human Liver from an iPSC-Derived Organ Bud Transplant." Nature (July 3, 2013) DOI: 10.1038/nature12271.






December 2, 2013

Paper Towels Are Better than Air Dryers at Removing Bacteria




Green environmentalists have forced hot air hand dryers on us in many public restrooms. They are slow and noisy and frustrating, and many of us leave the restroom with still-wet hands. But did you also know that by taking away our paper towels, the environmentalists are helping to spread disease? Read the article abstract below:


(p. 791) The transmission of bacteria is more likely to occur from wet skin than from dry skin; therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care. This article systematically reviews the research on the hygienic efficacy of different hand-drying methods. A literature search was conducted in April 2011 using the electronic databases PubMed, Scopus, and Web of Science. Search terms used were hand dryer and hand drying. The search was limited to articles published in English from January 1970 through March 2011. Twelve studies were included in the review. Hand-drying effectiveness includes the speed of drying, degree of dryness, effective removal of bacteria, and prevention of cross-contamination. This review found little agreement regarding the relative effectiveness of electric air dryers. However, most studies suggest that paper towels can dry hands efficiently, remove bacteria effectively, and cause less contamination of the washroom environment. From a hygiene viewpoint, paper towels are superior to electric air dryers. Paper towels should be recommended in locations where hygiene is paramount, such as hospitals and clinics.


Source:

Cunrui, Huang, Ma Wenjun, and Susan Stack. "The Hygienic Efficacy of Different Hand-Drying Methods: A Review of the Evidence." Mayo Clinic Proceedings 87, no. 8 (Aug. 2012): 791-98.






November 28, 2013

Beer Was Safer than Water



(p. C24) . . . what would beer be without water? . . . New York City, at least until the opening of the Croton Aqueduct in 1842, had no clean, reliable source. In fact, since hops have a preservative quality, and brewing requires boiling, "beer was once considered safer to drink than water."


For the full review, see:

EDWARD ROTHSTEIN. "EXHIBITION REVIEW; A Tipple or Two? It Was Safer Than Water." The New York Times (Fri., May 25, 2012): C19 & C24.

(Note: ellipses added.)

(Note: the online version of the review has the date May 24, 2012.)






November 17, 2013

Foreign Aid Frees Despots from Having to Seek the Consent of the Governed



TheGreatEscapeBK2013-10-24.jpg











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






(p. 4) IN his new book, Angus Deaton, an expert's expert on global poverty and foreign aid, puts his considerable reputation on the line and declares that foreign aid does more harm than good. It corrupts governments and rarely reaches the poor, he argues, and it is high time for the paternalistic West to step away and allow the developing world to solve its own problems.

It is a provocative and cogently argued claim. The only odd part is how it is made. It is tacked on as the concluding section of "The Great Escape: Health, Wealth, and the Origins of Inequality" (Princeton University Press, 360 pages), an illuminating and inspiring history of how mankind's longevity and prosperity have soared to breathtaking heights in modern times.


. . .


THE author has found no credible evidence that foreign aid promotes economic growth; indeed, he says, signs show that the relationship is negative. Regretfully, he identifies a "central dilemma": When the conditions for development are present, aid is not required. When they do not exist, aid is not useful and probably damaging.

Professor Deaton makes the case that foreign aid is antidemocratic because it frees local leaders from having to obtain the consent of the governed. "Western-led population control, often with the assistance of nondemocratic or well-rewarded recipient governments, is the most egregious example of antidemocratic and oppressive aid," he writes. In its day, it seemed like a no-brainer. Yet the global population grew by four billion in half a century, and the vast majority of the seven billion people now on the planet live longer and more prosperous lives than their parents did.



For the full review, see:

FRED ANDREWS. "OFF THE SHELF; A Surprising Case Against Foreign Aid." The New York Times, SundayBusiness Section (Sun., October 13, 2013): 4.

(Note: ellipsis added.)

(Note: the online version of the review has the date October 12, 2013.)



The book reviewed is:

Deaton, Angus. The Great Escape: Health, Wealth, and the Origins of Inequality. Princeton, N.J.: Princeton University Press, 2013.






October 10, 2013

Gene-Altered Mice Live 20% Longer



MouseGeneAltertedLivesLonger2013-09-27.jpg "NIH researchers found that lowering the expression of a single gene helped extend the life of mice by about 20%. A mouse with a manipulated gene on the right and an unchanged mouse on the left." Source of caption and photo: online version of the WSJ article quoted and cited below.



(p. A3) By reducing the activity of one type of gene, scientists said they increased the average life span of mice by about 20%, a feat that in human terms is akin to extending life by about 15 years.

Moreover, the researchers at the National Institutes of Health found that memory, cognition and some other important traits were better preserved in the mice as they aged, compared with a control group of mice that had normal levels of a protein put out by the gene.

The findings, published Thursday [August 29, 2013] in the journal Cell Reports, strengthen the case that the gene, called mTOR, is a major regulator of the aging process.


. . .


The results . . . build on a growing body of research challenging the belief that aging is an intractable biological process, prompting scientists to think of slowing aging as a possible way to prevent disease.

"What we need right now is for scientists and the public to wake up to the concept that you can slow aging," said Brian Kennedy, president of the Buck Institute for Aging Research in Novato, Calif., who wasn't involved in the new study. "If you do, you prevent many of the diseases that we're so scared of and that are associated with aging." They include cardiovascular disease, cancer and Alzheimer's disease.



For the full story, see:

RON WINSLOW. "Altered Gene Points Toward Longer Life Spans; Successful Experiment With Mice May One Day Play Role in Slowing Human Aging; Side Effects Could Be Problematic." The Wall Street Journal (Fri, August 30, 2013): A3.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story has the date August 29, 2013, and has the title "Genetic Manipulation Extends Life of Mice 20%; But Translating Findings to Humans Faces Many Hurdles.")


The scientific article being discussed above, is:

Wu, J.  Julie, Jie Liu, Edmund B Chen, Jennifer J Wang, Liu Cao, Nisha Narayan, Marie M Fergusson, Ilsa I Rovira, Michele Allen, Danielle A Springer, Cory U Lago, Shuling Zhang, Wendy DuBois, Theresa Ward, Rafael deCabo, Oksana Gavrilova, Beverly Mock, and Toren Finkel. "Increased Mammalian Lifespan and a Segmental and Tissue-Specific Slowing of Aging after Genetic Reduction of mTor Expression." Cell Reports 4, no. 5 (Aug. 29, 2013): 913-20.






August 28, 2013

Salt May NOT Be Bad for Our Health, After All



(p. A7) An influential government panel said there is no evidence that very low-salt diets prevent heart disease, calling into question current national dietary guidelines on sodium intake.

The Institute of Medicine, in a report released Tuesday [May 14, 2013], said there isn't sufficient evidence that cutting sodium intake below 2,300 milligrams per day cuts the risk of heart disease. The group of medical experts also said there is no evidence that people who already have heart disease or diabetes should cut their sodium intake even lower.



For the full story, see:

JENNIFER CORBETT DOOREN. "U.S. NEWS; Low-Salt Benefits Questioned." The Wall Street Journal (Weds., May 15, 2013): A7.

(Note: bracketed date added.)

(Note: the online version of the story has the date May 14, 2013.)


For a summary of the Institute of Medicine report, see:

Institute of Medicine of the National Academies. "Sodium Intake in Populations: Assessment of Evidence." Report Brief. Washington, D.C.: National Academy of Sciences, 2013.







August 4, 2013

Hunter-Gatherers Had High Child Mortality and Died Before Age 40



(p. 31) Child mortality in foraging tribes was severe. A survey of 25 hunter-gatherer tribes in historical times from various continents revealed that, on average, 25 percent of children died before they were 1, and 37 percent died before they were 15. In one traditional hunter-gatherer tribe, child mortality was found to be 60 percent. Most historical tribes had a population growth rate of approximately zero. This stagnation is evident, says Robert Kelly in his survey of hunting-gathering peoples, because "when formerly mobile people become sedentary, the rate of population growth increases." All things being equal, the constancy of farmed food breeds more people.

While many children died young, older hunter-gatherers did not have (p. 32) it much better. It was a tough life. Based on an analysis of bone stress and cuts, one archaeologist said the distribution of injuries on the bodies of Neanderthals was similar to that found on rodeo professionals--lots of head, trunk, and arm injuries like the ones you might get from close encounters with large, angry animals. There are no known remains of an early hominin who lived to be older than 40. Because extremely high child mortality rates depress average life expectancy, if the oldest outlier is only 40, the median age was almost certainly less than 20.



Source:

Kelly, Kevin. What Technology Wants. New York: Viking Adult, 2010.






July 30, 2013

The French and Japanese Believe Water Cleans the Anus Better than Dry Paper



TheBigNecessityBK2013-07-21.jpg

















Source of the book image: http://jacketupload.macmillanusa.com/jackets/high_res/jpgs/9780805090833.jpg



(p. C34) Ms. George's book is lively . . . . It is hard not to warm to a writer who can toss off an observation like this one: "I like engineers. They build things that are useful and sometimes beautiful -- a brick sewer, a suspension bridge -- and take little credit. They do not wear black and designer glasses like architects. They do not crow."


. . .


In Japan, where toilets are amazingly advanced -- most of even the most basic have heated seats and built-in bidet systems for front and rear -- the American idea of cleaning one's backside with dry paper is seen as quaint at best and disgusting at worst. As Ms. George observes: "Using paper to cleanse the anus makes as much sense, hygienically, as rubbing your body with dry tissue and imagining it removes dirt."



For the full review, see:

DWIGHT GARNER. "BOOKS OF THE TIMES; 15 Minutes of Fame for Human Waste and Its Never-Ending Assembly Line." The New York Times (Fri., December 12, 2008): C34.

(Note: ellipses added.)

(Note: the online version of the review has the date December 11, 2008.)


The book under review, is:

George, Rose. The Big Necessity: The Unmentionable World of Human Waste and Why It Matters. New York: Metropolitan Books, 2008.






July 19, 2013

The Precautionary Principle Is Biased Against the New, and Ignores the Risks of the Old



(p. 250) In general the Precautionary Principle is biased against anything new. Many established technologies and "natural" processes have unexamined faults as great as those of any new technology. But the Precautionary Principle establishes a drastically elevated threshold for things that are new. In effect it grandfathers in the risks of the old, or the "nat-(p. 251)ural." A few examples: Crops raised without the shield of pesticides generate more of their own natural pesticides to combat insects, but these indigenous toxins are not subject to the Precautionary Principle because they aren't "new." The risks of new plastic water pipes are not compared with the risks of old metal pipes. The risks of DDT are not put in context with the old risks of dying of malaria.


Source:

Kelly, Kevin. What Technology Wants. New York: Viking Adult, 2010.






July 11, 2013

Millions Die Due to Precautionary Principle Ban of DDT



(p. 248) . . . , malaria infects 300 million to 500 million people worldwide, causing 2 million deaths per year. It is debilitating to those who don't die and leads to cyclic poverty. But in the 1950s the level of malaria was reduced by 70 percent by spraying the insecticide DDT around the insides of homes. DDT was so successful as an insecticide that farmers eagerly sprayed it by the tons on cotton fields--and the molecule's by-products made their way into the water cycle and eventually into fat cells in animals. Biologists blamed it for a drop in reproduction rates for some predatory birds, as well as local die-offs in some fish and aquatic life species. Its use and manufacture were banned in the United States in 1972. Other countries followed suit. Without DDT spraying, however, malaria cases in Asia and Africa began to rise again to deadly pre-1950s levels. Plans to reintroduce programs for household spraying in malarial Africa were blocked by the World Bank and other aid agencies, who refused to fund them. A treaty signed in 1991 by 91 countries and the EU agreed to phase out DDT altogether. They were relying on the precautionary principle: DDT was probably bad; better safe than sorry. In fact DDT had never been shown to hurt humans, and the environmental harm from the miniscule amounts of DDT applied in homes had not been measured. But nobody could prove it did not cause harm, despite its proven ability to do good.


Source:

Kelly, Kevin. What Technology Wants. New York: Viking Adult, 2010.

(Note: ellipsis added.)






June 18, 2013

Heart Disease Affected Ancients Who Differed in Culture, Class and Diet



EgyptologistPreparesMummy2013-06-16.jpg "Egyptologist Dr. Gomaa Abd el-Maksoud prepares the mummy Hatiay (New Kingdom, 18th Dynasty, 1550-1295 BCE) for scanning. Hatiay was found to have evidence of extensive vascular disease." Source of caption and photo: online version of the WSJ article quoted and cited below.



(p. A4) SAN FRANCISCO--It turns out there is nothing new about heart disease.

Researchers who examined 137 mummies from four cultures spanning 4,000 years said Sunday they found robust evidence of atherosclerosis, or hardening of the arteries, challenging widely held assumptions that cardiovascular disease is largely a malady of current times.

An international research team of cardiologists, radiologists and archeologists used CT scanners to evaluate the mummies, hunting for deposits of calcium in arterial walls that are a telltale sign of hardening of the arteries that can lead to heart attacks and strokes. They found that 47, or 34%, of the mummies had such deposits, suggesting, they said, that cardiovascular disease was more common in historic times than many experts think.


. . .


The same researchers reported similar findings in 2009 from Egyptian mummies. Because those specimens were believed to have been from the upper echelons of society, the researchers surmised their calcified arteries could have developed from high-fat diets. But by expanding the research to other cultures, including Puebloans of what is now the U.S. Southwest, the researchers believe all levels of society were at risk, regardless of diet.



For the full story, see:

RON WINSLOW. "U.S. NEWS; Telltale Finding on Heart Disease." The Wall Street Journal (Mon., March 11, 2013): A6.

(Note: the online version of the story has the date March 10, 2013.)






June 14, 2013

Federal Food Regs Drive Sharon Penner to Stop Baking for Nebraska Children



PennerSharonSlicesHerBakedBread2013-06-11.jpg "Sharon Penner slices fresh bread, which she bakes a few times a week for Hampton, Neb., students. Penner, who has fed the town's schoolchildren for 43 years, saw new school nutrition rules that cut many of her goodies as a sign it was time to retire. With her in the school kitchen is assistant Judy Hitzemann." Source of caption and photo: online version of the Omaha World-Herald article quoted and cited below.



Have we gone too far when the preferences of Michelle Obama rule over the preferences of the parents of Hampton, Nebraska? And is it clear that the parents are wrong in thinking that fresh-baked bread (see photo above) and a timely pat on the shoulder (see photo below), are worth some extra calories?



(p. 1A) HAMPTON, Neb. -- Blame the broccoli. Blame the mandarin oranges. Blame all their cousins, from apples to yams, for removing Mrs. Penner's butter bars from the school lunch counter.

Then blame Mrs. Obama for removing Mrs. Penner.

So goes the thinking in this no-stoplight village of 423 people about 20 minutes northwest of York.

When the new federal school nutrition mandates went into effect this year, championed by first lady Michelle Obama, fresh-baked brownies, cookies and other sugary goodies disappeared from the school menu. And Sharon Penner, who has been feeding schoolchildren here for 43 years, decided it was a sign from above to retire.

Friday [May 17, 2013] will be the last school lunch the 70-year-old prepares for the Hampton Hawks.

Mrs. Penner is hanging up her apron.

"She is?" asked an incredulous sixth-grader named Treavar Pekar. (p. 2A) He stopped cold from scrubbing some of the six tables in the small cafeteria when I broke the news after lunch.

"NOOOOO!!!!!"

That about sums up the community response.



For the full story, see:

Grace, Erin. "Time to Hang Up Her Purple Apron." Omaha World-Herald (FRIDAY, MAY 17, 2013): 1A-2A.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the article has the title "Grace: Hampton lunch lady ready to hang up apron.")




PennerSharonComfortsBryceJoseph2013-06-11.jpg "Sharon Penner with Bryce Joseph, who needed some help after dropping his breakfast tray." Source of caption and photo: online version of the Omaha World-Herald article quoted and cited above.






June 11, 2013

Berkshire Agrees to Buy No More than 25% of DaVita, Firm Accused of Medicare Fraud




Warren Buffett's Berkshire Hathaway has agreed to cap its ownership of DaVita Healthcare Partners at 25%. A previous entry on this blog quoted a story saying that Ted Weschler is behind Berkshire's purchases of DaVita stock. An even earlier entry on this blog discussed accusations that DaVita Healthcare Partners has committed substantial healthcare fraud by charging the taxpayer millions of dollars for medicine that is needlessly thrown away.



(p. 2D) Berkshire agreed not to buy more than 25 percent of DaVita HealthCare Partners Inc., a national network of medical infusion clinics.

Berkshire investment manager Ted Weschler has been buying DaVita stock for Berkshire since joining the Omaha investment company last year, totaling about 14 percent of the company, Bloomberg reported.

Weschler and DaVita President Javier Rodriguez signed a "standstill agreement" last week, a document often intended to clarify whether an investor wants to acquire controlling interest in a business. Some have speculated that Berkshire wants to acquire all of DaVita's stock, which artificially inflates the price of its shares.

DaVita legal officer Kim Rivera said Berkshire is a "supportive investor with a long-term view."



For the full story, see:

Steve Jordon. "WARREN WATCH; At Berkshire meeting, See's candymaker outshines Warren Buffett." Omaha World-Herald (SUNDAY, MAY 12, 2013): 1D & 2D.






May 27, 2013

How Electricity Matters for Life



TheSparkOfLifeBK2013-05-05.jpg

















Source of book image:
http://media.npr.org/assets/bakertaylor/covers/t/the-spark-of-life/9780393078039_custom-86637e64da2201ed3081e0f26f40e0d139cbbf9d-s6-c10.jpg




(p. C9) Top-drawer scientists always are excited about their field, but many have difficulty conveying this to a general audience. Not so Frances Ashcroft. She is a distinguished physiologist at Oxford University whose work has provided crucial insight into how insulin secretion is connected to electrical activity in cells. Her research has meant that children born with one form of diabetes can control it using oral medication instead of regular and painful insulin injections.

After Ms. Ashcroft made her breakthrough in 1984, she felt as if she were "dancing in the air, shot high into the sky on the rocket of excitement with the stars exploding in vivid colours all around me," she writes in her engaging and informative "The Spark of Life: Electricity in the Human Body." Even today, thinking of it "sends excitement fizzing through my veins."

Like so much else in our bodies, insulin secretion depends on crucial proteins in the cell walls that regulate the flow of ions (electrically charged atoms or molecules) between the interior of the cell and the fluids that surround it. The ions, mostly sodium, potassium and calcium, literally provide "the spark of life." Ms. Ashcroft uses her research into cellular "ion channels" as an overture to a rich and stimulating account of how electricity and the varied ways in which animals and plants produce it explain so much of evolutionary biology.


. . .


. . . all of Ms. Ashcroft's themes and variations represent facets of the same underlying ionic mechanism. In describing its wonders, she has produced a gem that sparkles.



For the full review, see:

WILLIAM BYNUM. "Singing the Body Electric." The Wall Street Journal (Sat., September 29, 2012): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date September 28, 2012.)



The book under review, is:

Ashcroft, Frances. The Spark of Life: Electricity in the Human Body. New York: W. W. Norton & Company, 2012.






May 19, 2013

Cooking Allowed the Toothless to Live



ConsiderTheForkBK.jpg
















Source of book image: http://d.gr-assets.com/books/1344733081l/13587130.jpg




(p. C12) . . . the narrative, ragtag though it may be, is a good one and it starts with the single greatest achievement in cookware--the cooking pot. Originally made of clay, this simple invention allowed previously inedible foods to be cooked in water, a process that removed toxins, made them digestible and reduced the need for serious chewing, a deadly problem for the toothless. (Archaeologists find adult skeletons without teeth only at sites dating from after the invention of the cooking pot.)


. . .


When "Consider the Fork" turns to cultural history, Ms. Wilson's points sometimes contradict one another. On one hand, she slyly condemns the rich throughout history and their use of cheap cooking labor. Yet she also relates how the Lebanese writer Anissa Helou remembers kibbé being made in Beirut by her mother and grandmother: They pounded the lamb in a mortar and pestle for an hour, a process described in loving terms. So is cooking labor a bedrock of family values or class exploitation?



For the full review, see:

CHRISTOPHER KIMBALL. "The World on a Plate." The Wall Street Journal (Sat., October 6, 2012): C12.

(Note: ellipses added.)

(Note: the online version of the review has the date October 5, 2012.)



The book under review, is:

Wilson, Bee. Consider the Fork: A History of How We Cook and Eat. New York: Basic Books, 2012.






May 18, 2013

Berkshire Buys Big into DaVita, Firm Accused of Medicare Fraud




Warren Buffett's Berkshire Hathaway apparently has a large stake in DaVita Healthcare Partners. An earlier entry on this blog discussed accusations that DaVita Healthcare Partners has committed substantial healthcare fraud by charging the taxpayer millions of dollars for medicine that is needlessly thrown away. Apparently the DaVita investment is due to Ted Weschler, one of two deputies to whom Buffett has delegated the investment of some of Berkshire's funds.


(p. 3D) Weschler is believed to be behind Berkshire's aggressive move into DaVita Healthcare Partners -- a stock he owned when he ran his own hedge fund. Berkshire bought 10.9 million shares last year, becoming Da-Vita's largest stakeholder with 15.7 percent of the company. DaVita provides kidney dialy­sis services and is seen as a consistent cash-flow genera­tor. In November, the company closed its $4.7 billion purchase of Healthcare Partners, one of the country's largest operators of medical groups and physi­cian networks. DaVita shares rose more than 35 percent in the past 12 months.


For the full story, see:


MarketWatch . "Buffett was avid hunter of 6 stocks last year; Wells Fargo, GM and DirecTV top Berkshire's list." Omaha World-Herald (Tues., March 12, 2013): 1D & 3D.






May 17, 2013

21st Century Person Would Be Sick in Dickens' 1850 London



NancyFromOliverTwist2013-05-04.jpg "Anderson found Dickens World to be "surprisingly grisly" for a park that markets itself to children; he noted several severed heads and a gruesome performance of "Oliver Twist" in the courtyard. Here, a mannequin of Nancy from "Oliver Twist."" Source of caption and photo: online version of the NYT article quoted and cited below.


(p. 48) . . . even if it were possible to create a lavish simulacrum of 1850s London -- with its typhus and cholera and clouds of toxic corpse gas, its sewage pouring into the Thames, its (p. 49) average life span of 27 years -- why would anyone want to visit? ("If a late-20th-century person were suddenly to find himself in a tavern or house of the period," Peter Ackroyd, a Dickens biographer, has written, "he would be literally sick -- sick with the smells, sick with the food, sick with the atmosphere around him.")


For the full story, see:

SAM ANDERSON. "VOYAGES; The Pippiest Place on Earth." The New York Times Magazine (Sun., February 7, 2012): 48-53.

(Note: ellipsis added.)

(Note: the online version of the story has the date February 7, 2012 (sic), and has the title "VOYAGES; The World of Charles Dickens, Complete With Pizza Hut.")






May 14, 2013

Much of Human Genome Consists of Usually-Inactive Ancient Retrovirus Genes



(p. C4) Might some forms of neurological illness, such as multiple sclerosis and schizophrenia, be caused at least partly by bacteria, viruses or other parasites? A largely Danish team has recently published evidence of a strong association between multiple sclerosis and a retrovirus, together with hints that a gene called TRIM5, which is used by cells to fight viruses, is especially active in people with MS.


. . .


The virus implicated in multiple sclerosis is called HERV-Fc1, a bizarre beast called an "endogenous" retrovirus. What this means is that its genes are part of the human genome. For millions of years, they have been integrated into our own DNA and passed on by normal heredity. It was one of the shocks of genomic science to find that the human genome contains more retroviral than "human" genes: some 5% to 8% of the entire genome.

Normally, the genes of endogenous retroviruses remain dormant, but--a bit like a computer virus that springs into action on a trigger--something wakes them up sometimes, and actual viruses are made from them, which then infect other cells in the body. The Danish scientists suggest that this is what happens in multiple sclerosis. Bjørn Nexø of Aarhus University writes that "retroviral infections often develop into running battles between the immune system and virus, with the virus mutating repeatedly to avoid the immune system, and the immune system repeatedly catching up. One can see the episodic nature of multiple sclerosis as such a running battle."



For the full commentary, see:

MATT RIDLEY. "MIND & MATTER; The Good News About the Virus in Your Genes." The Wall Street Journal (Sat., March 10, 2012): C4.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date March 9, 2012.)





May 10, 2013

Stem-Cell Researchers Developing Experimental Personalized Medicine



(p. C4) Last month a team at Johns Hopkins University and the Sloan-Kettering Institute for Cancer Research, using a version of Dr. Yamanaka's technique, successfully grew nerve cells from a patient suffering from a rare disease called Riley-Day syndrome, which is linked to early mortality, seizures and other symptoms and caused by a fault in one gene.

But the purpose was not to put these cells back into the patient. Instead the scientists tested 6,912 chemical compounds on the cells to see if they could find one that "rescued" the "expression" of the gene: that is to say, caused it to produce the protein it is supposed to produce. One of the compounds worked, inducing the gene to be actively transcribed by the cell.

In the not-very-distant future, when something is going wrong in one of your organs, one treatment may be to create some stem cells from your body in the laboratory, turn them into cells of that organ, or even rudimentary structures, and then subject them to experimental treatments to see if something cures the problem. The goal of personalized medicine, in other words, may be reached by stem-cell researchers before it's reached by geneticists.



For the full commentary, see:

MATT RIDLEY. "MIND & MATTER; Stem-Cell Cures Without the Controversy." The Wall Street Journal (Sat., December 8, 2012): C4.

(Note: the online version of the commentary has the date December 7, 2012.)





April 26, 2013

Longer Life Spans "Allowed More Time to Invent New Tools"



(p. 33) The primary long-term consequence of . . . slightly better nutrition was a steady increase in longevity. Anthropologist Rachel Caspari studied the dental fossils of 768 hominin individuals in Europe, Asia, and Africa, dated from 5 million years ago until the great leap. She determined that a "dramatic increase in longevity in the modern humans" began about 50,000 years ago. Increasing longevity allowed grandparenting, creating what is called the grandmother effect: In a virtuous circle, via the communication of grandparents, ever more powerful innovations carried forward were able to lengthen life spans further, which allowed more time to invent new tools, which increased population. Not only that: Increased longevity "provide[d] a selective advantage promoting further population increase," because a higher density of humans increased the rate and influence of innovations, which contributed to increased populations. Caspari claims that the most fundamental biological factor that underlies the behavioral innovations of modernity maybe the increase in adult survivorship. It is no coincidence that increased longevity is the most measurable consequence of the acquisition of technology. It is also the most consequential.


Source:

Kelly, Kevin. What Technology Wants. New York: Viking Adult, 2010.

(Note: ellipsis added; bracketed "d" in Kelly's original.)






April 24, 2013

Working Rat Kidney Is Created in Lab



(p. A10) Researchers at Massachusetts General Hospital in Boston have made functioning rat kidneys in the laboratory, a bioengineering achievement that may one day lead to the ability to create replacement organs for people with kidney disease.

The scientists said the rat kidneys produced urine in the laboratory as well as when transplanted into rats. The kidneys were made by stripping donor kidneys of their cells and putting new cells that regenerate tissue into them. Stripping an organ leaves a natural scaffold of collagen and other compounds, called the extracellular matrix, which provides a framework for new cells and preserves the intricate internal architecture of the kidney as well as its basic shape.

Dr. Harald C. Ott, senior author of a paper describing the research that was published online Sunday by the journal Nature Medicine, said that the work was still in its early stages and that there were many hurdles to creating fully functional kidneys for people. But he noted that replacement organs made in this way would have advantages over those made with artificial scaffolds or other techniques.



For the full story, see:

HENRY FOUNTAIN. "Rat Kidneys Made in Lab Point to Aid for Humans." The New York Times (Mon., April 15, 2013): A10.

(Note: the online version of the story has the date April 14, 2013.)









April 18, 2013

Hunter-Gatherers Complained of Hunger and Food Monotony



(p. 30) Based on numerous historical encounters with aboriginal tribes, we know [hunter-gatherers] often, if not regularly, complained about being hungry. Famed anthropologist Colin Turnbull noted that although the Mbuti frequently sang to the goodness of the forest, they often complained of hunger. Often the com-(p. 31)plaints of hunter-gathers were about the monotony of a carbohydrate staple, such as mongongo nuts, for every meal; when they spoke of shortages, or even hunger, they meant a shortage of meat, and a hunger for fat, and a distaste for periods of hunger. Their small amount of technology gave them sufficiency for most of the time, but not abundance.


Source:

Kelly, Kevin. What Technology Wants. New York: Viking Adult, 2010.

(Note: "hunter-gathers" substituted for "they" by AMD.)






April 3, 2013

Liver Transplant Pioneer Roy Calne Has a "Rebellious Nature"



CalneRoyLiverTransplantPioneer2013-03-09.jpg











"Roy Y. Calne" Source of caption and photo: online version of the NYT interview quoted and cited below.





(p. D2) Sir Roy Calne is a pioneer of organ transplants -- the surgeon who in the 1950s found ways to stop the human immune system from rejecting implanted hearts, livers and kidneys. In 1968 he performed Europe's first liver transplant, and in 1987 the world's first transplant of a liver, heart and lung.


. . .


When you were studying medicine in early-1950s Britain, what was the prevailing attitude toward organ transplantation?

It didn't exist! While a medical student, I recall being presented with a young patient with kidney failure. I was told to make him as comfortable as possible because he would die in two weeks.

This troubled me. Some of our patients were very young, very deserving. Aside from their kidney disease, there was nothing else wrong with them. I wondered then if it might be possible to do organ transplants, because kidneys are fairly simple in terms of their plumbing. I thought in gardening terms. Might it not be possible to do an organ graft, replacing a malfunctioning organ with a healthy one? I was told, "No, that's impossible."

Well, I've always tended to dislike being told that something can't be done. I've always had a somewhat rebellious nature. Just ask my wife.



For the full interview, see:

CLAUDIA DREIFUS, interviewer. "A CONVERSATION WITH ROY Y. CALNE; "I've always tended to dislike being told that something can't be done. I've always had a somewhat rebellious nature."" The New York Times (Weds., November 27, 2012): D2.

(Note: ellipsis added; bold in original to indicate interviewer (Dreifus) question.)

(Note: the online version of the interview has the date November 26, 2012 and has the title "A CONVERSATION WITH ROY Y. CALNE; Organ Transplant Pioneer Talks About Risks and Rewards.")






March 31, 2013

Energy-Efficient Buildings Increase Indoor CO2 Pollution and Impair Decision-Making



(p. C4) Carbon dioxide at levels normally found indoors is usually considered benign, especially compared with carbon monoxide. But a study finds that even modestly elevated CO2 can impair decision-making.


. . .


Given the emphasis on energy-efficient buildings, which are often more airtight, the study suggests that carbon dioxide might be an indoor pollutant to worry about--especially in conference rooms, where important decisions are hashed out.



For the full story, see:

Daniel Akst. "WEEK IN IDEAS; Week in Ideas: Daniel Akst; POLLUTANTS; Blame It on the Air." The Wall Street Journal (Sat., October 27, 2012): C4.

(Note: ellipsis added.)

(Note: the online version of the story has the date October 26, 2012.)


The study summarized is:

Satish, Usha, Mark J. Mendell, Krishnamurthy Shekhar, Toshifumi Hotchi, Douglas Sullivan, Siegfried Streufert, and William J. Fisk. "Is Co2 an Indoor Pollutant? Direct Effects of Low-to-Moderate Co2 Concentrations on Human Decision-Making Performance." Environmental Health Perspectives (Sept. 20, 2012): 1-35.

(Note: it is not clear to me if Environmental Health Perspectives is an online journal or an online working paper series. Whatever it is, it is affiliated with the National Institute of Environmental Health Sciences.)





March 29, 2013

Greater Efforts to Save Premature Babies Inflates U.S. Infant-Mortality



(p. A13) The federally chartered Institute of Medicine issued a comprehensive report last month on the state of American health. Saying that "Other high-income countries outrank the United States on most measures of health," the report concluded that the U.S. "is among the wealthiest nations in the world, but it is far from the healthiest."


. . .


As the report's authors point out, the U.S. has the highest infant-mortality rate among high-income countries.


. . .


Doctors in the U.S. are much more aggressive than foreign counterparts about trying to save premature babies. Thousands of babies that would have been declared stillborn in other countries and never given a chance at life are saved in the U.S. As a result, the percentage of preterm births in America is exceptionally high--65% higher than in Britain, and about double the rates in Finland and Greece.

Unfortunately, some of the premature babies that American hospitals try to save don't make it. Their deaths inflate the overall infant mortality rate.



For the full commentary, see:

SALLY C. PIPES. "OPINION; Those Misleading World Health Rankings; The numbers are distorted because, for instance, U.S. doctors try so hard to save premature babies." The Wall Street Journal (Tues., February 5, 2013): A13.

(Note: ellipses added.)

(Note: the online version of the commentary has the date February 4, 2013.)





March 27, 2013

Jobs' Protest Against Mortality: Omit the On-Off Switches on Apple Devices



(p. 571) . . . [Jobs] admitted that, as he faced death, he might be overestimating the odds out of a desire to believe in an afterlife. "I like to think that something survives after you die," he said. "It's strange to think that you accumulate all this experience, and maybe a little wisdom, and it just goes away. So I really want to believe that something survives, that maybe your consciousness endures."

He fell silent for a very long time. "But on the other hand, perhaps it's like an on-off switch," he said. "Click! And you're gone."

Then he paused again and smiled slightly. "Maybe that's why I never liked to put on-off switches on Apple devices."



Source:

Isaacson, Walter. Steve Jobs. New York: Simon & Schuster, 2011.

(Note: ellipsis and bracketed "Jobs" added; italics in original.)






March 21, 2013

Unemployment Increases Risk of Heart Attack



As a defender of the process of innovation through creative destruction, I try to be alert to evidence on creative destruction's benefits and costs. The highest cost is usually viewed as technological unemployment. The evidence below will have to be examined and, if sound, added to the costs.


(p. D6) Unemployment increases the risk of heart attack, a new study reports, and repeated job loss raises the odds still more.


. . .


After adjusting for well-established heart attack risks -- age, sex, smoking, income, hypertension, cholesterol screening, exercise, depression, diabetes and others -- the researchers found that being unemployed also increased the risk of a heart attack, by an average of 35 percent.



For the full story, see:

NICHOLAS BAKALAR. "Job Loss Raises Threat of Heart Attack." The New York Times (Tues., November 27, 2012): D6.

(Note: ellipsis added.)

(Note: the online version of the story has the date November 26, 2012.)



The Dupre article mentioned above, is:

Dupre, Matthew E., Linda K. George, Guangya Liu, and Eric D. Peterson. "The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction." Archives of Internal Medicine 172, no. 22 (Dec. 10, 2012): 1731-37.

(Note: the Archives of Internal Medicine has been re-named JAMA Internal Medicine.)






March 12, 2013

Resveratrol Activates Sirtuins to Switch on Energy Producing Mitochondria




A new study, just published in the prestigious journal Science, appears to substantially vindicate the recently beleaguered resveratrol longevity research of David Sinclair:


. . . a new study led by David Sinclair of the Harvard Medical School, who in 2003 was a discoverer resveratrol's role in activating sirtuins, found that resveratrol did indeed influence sirtuin directly, though in a more complicated way than previously thought.    . . .    . . . activated, the sirtuins do several things, one of which is to switch on a second protein that spurs production of the mitochondria, which provide the cell's energy. This would explain why mice treated with resveratrol ran twice as far on a treadmill before collapsing from exhaustion as untreated mice.


For the full story, see:

NICHOLAS WADE. "New Optimism on Resveratrol." New York Times "Well" Blog    Posted on MARCH 11, 2013. URL: http://well.blogs.nytimes.com/2013/03/11/new-optimism-on-resveratrol/

(Note: ellipses added.)


The Sinclair article (see last-listed co-author) is:

Hubbard, Basil P., Ana P. Gomes, Han Dai, Jun Li, April W. Case, Thomas Considine, Thomas V. Riera, Jessica E. Lee, Sook Yen E (sic), Dudley W. Lamming, Bradley L. Pentelute, Eli R. Schuman, Linda A. Stevens, Alvin J. Y. Ling, Sean M. Armour, Shaday Michan, Huizhen Zhao, Yong Jiang, Sharon M. Sweitzer, Charles A. Blum, Jeremy S. Disch, Pui Yee Ng, Konrad T. Howitz, Anabela P. Rolo, Yoshitomo Hamuro, Joel Moss, Robert B. Perni, James L. Ellis, George P. Vlasuk, and David A. Sinclair. "Evidence for a Common Mechanism of Sirt1 Regulation by Allosteric Activators." Science 339, no. 6124 (March 8, 2013): 1216-19.






March 8, 2013

Most in NYC Oppose Bloomberg's Nanny State Soda Ban



OgunbiyiRocheDrinksLargeSodaTimesSquare2013-02-23.jpg "Theodore Ogunbiyi-Roche, 10, who is visiting from London, drank a large soda in Times Square . . . " Source of caption and photo: online version of the NYT article quoted and cited below.



(p. A18) . . . , New Yorkers are cool to Mayor Michael R. Bloomberg's plan to prohibit sales of large sugary drinks in city restaurants, stadiums and movie theaters, according to a . . . poll by The New York Times.

Six in 10 residents said the mayor's soda plan was a bad idea, compared with 36 percent who called it a good idea. A majority in every borough was opposed; Bronx and Queens residents were more likely than Manhattanites to say the plan was a bad idea.


. . .


. . . those opposed overwhelmingly cited a sense that Mr. Bloomberg was overreaching with the plan and that consumers should have the freedom to make a personal choice . . .

"The ban is at the point where it is an infringement of civil liberties," Liz Hare, 43, a scientific researcher in Queens, said in a follow-up interview. "There are many other things that people do that aren't healthy, so I think it's a big overreach."

Bob Barocas, 64, of Queens, put it more bluntly: "This is like the nanny state going off the wall."



For the full story, see:

MICHAEL M. GRYNBAUM and MARJORIE CONNELLY. "60% in City Oppose Soda Ban, Calling It an Overreach by Bloomberg, Poll Finds." The New York Times (Thurs., August 23, 2012): A18.

(Note: ellipses in caption and article added.)

(Note: the online version of the story has the date August 22, 2012, and the title "60% in City Oppose Bloomberg's Soda Ban, Poll Finds.")






March 4, 2013

Stanford Meta-Study Finds Organic Food Is No More Nutritious than Much Cheaper Non-organic Food



StrawberriesNonorganicWatsonvilleCalifornia2013-02-23.jpg "Conventional strawberries in Watsonville, California. Researchers say organic foods are no more nutritious and no less likely to be contaminated." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A20) Does an organic strawberry contain more vitamin C than a conventional one?

Maybe -- or maybe not.

Stanford University scientists have weighed in on the "maybe not" side of the debate after an extensive examination of four decades of research comparing organic and conventional foods.

They concluded that fruits and vegetables labeled organic were, on average, no more nutritious than their conventional counterparts, which tend to be far less expensive. Nor were they any less likely to be contaminated by dangerous bacteria like E. coli.

The researchers also found no obvious health advantages to organic meats.


. . .


The conclusions will almost certainly fuel the debate over whether organic foods are a smart choice for healthier living or a marketing tool that gulls people into overpaying. The production of organic food is governed by a raft of regulations that generally prohibit the use of synthetic pesticides, hormones and additives.

The organic produce market in the United States has grown quickly, up 12 percent last year, to $12.4 billion, compared with 2010, according to the Organic Trade Association. Organic meat has a smaller share of the American market, at $538 million last year, the trade group said.


. . .


In the study -- known as a meta-analysis, in which previous findings are aggregated but no new laboratory work is conducted -- researchers combined data from 237 studies, examining a wide variety of fruits, vegetables and meats. For four years, they performed statistical analyses looking for signs of health benefits from adding organic foods to the diet.

The researchers did not use any outside financing for their research. "I really wanted us to have no perception of bias," Dr. Bravata said.



For the full story, see:

KENNETH CHANG. "Stanford Scientists Cast Doubt on Advantages of Organic Meat and Produce." The New York Times (Tues., September 4, 2012): A20.

(Note: ellipses added.)

(Note: the online version of the story has the date September 3, 2012.)






March 2, 2013

Organic Food May Be Less Healthy than Non-Organic Food



Schwarcz, Joe - The Right Chemistry BK 2013-01-12.jpeg

















Source of book image: http://www.leckeragency.com/sites/default/files/books/Schwarcz,%20Joe%20-%20The%20Right%20Chemistry%20Cover.jpeg



(p. D7) . . . , when did "chemical" become a dirty word? That's a question raised by one of Canada's brightest scientific minds: Joe Schwarcz, director of the Office for Science and Society at McGill University in Montreal. Dr. Schwarcz, who has received high honors from Canadian and American scientific societies, is the author of several best-selling books that attempt to set the record straight on a host of issues that commonly concern health-conscious people.

I've read two of his books, "Science, Sense and Nonsense" (published in 2009) and "The Right Chemistry" (2012), and recently attended a symposium on the science of food that Dr. Schwarcz organized at McGill.

What follows are tips from his books and the symposium that can help you make wiser choices about what does, and does not, pass your lips in 2013.


. . .


ORGANIC OR NOT? Wherever I shop for food these days, I find an ever-widening array of food products labeled "organic" and "natural." But are consumers getting the health benefits they pay a premium for?

Until the 20th century, Dr. Schwarcz wrote, all farming was "organic," with manure and compost used as fertilizer and "natural" compounds of arsenic, mercury and lead used as pesticides.

Might manure used today on organic farms contain disease-causing micro-organisms? Might organic produce unprotected by insecticides harbor cancer-causing molds? It's a possibility, Dr. Schwarcz said. But consumers aren't looking beyond the organic sales pitch.

Also questionable is whether organic foods, which are certainly kinder to the environment, are more nutritious. Though some may contain slightly higher levels of essential micronutrients, like vitamin C, the difference between them and conventionally grown crops may depend more on where they are produced than how.

A further concern: Organic producers disavow genetic modification, which can be used to improve a crop's nutritional content, enhance resistance to pests and diminish its need for water. A genetically modified tomato developed at the University of Exeter, for example, contains nearly 80 times the antioxidants of conventional tomatoes. Healthier, yes -- but it can't be called organic.



For the full story, see:

JANE E. BRODY. "PERSONAL HEALTH; What You Think You Know (but Don't) About Wise Eating." The New York Times (Tues., January 1, 2013): D7.

(Note: ellipses added; bold in original.)

(Note: the online version of the article has the date DECEMBER 31, 2012.)



The Schwarcz books mentioned above, are:

Schwarcz, Joe. The Right Chemistry: 108 Enlightening, Nutritious, Health-Conscious and Occasionally Bizarre Inquiries into the Science of Daily Life. Toronto, Ontario: Doubleday Canada, 2012.

Schwarcz, Joe. Science, Sense & Nonsense. Toronto, Ontario: Doubleday Canada, 2009.






February 24, 2013

Entrepreneur Mackey Says Whole Foods Drops Prices as Larger Size Creates Economies of Scale



MackeyJohnWholeFoodsCEO2013-02-23.jpg











"John Mackey." Source of caption and photo: online version of the NYT article quoted and cited below.





(p. 16) In your new book, "Conscious Capitalism," you write that Whole Foods sees its customers as its "most important stakeholders" and that the company is obsessed with their happiness. The biggest complaint I hear about Whole Foods is how expensive it is. Why not drop prices to make your customers happier? People always complain about prices being too high. Whole Foods prices have dropped every year as we get to be larger and we have economies of scale. Also, people are not historically well informed about food prices. We're only spending about 7 percent of our disposable personal income on food. Fifty years ago, it was nearly 16 percent.


. . .


In 2009, some Whole Foods customers organized boycotts after you wrote an op-ed in The Wall Street Journal expressing opposition to Obama's health care proposals. Do you wish you hadn't written it?
No, I don't. I regret that a lot of people didn't actually read it and it got taken out of context. President Obama asked for ideas about health care reform, and I put my ideas out there. Whole Foods has a good health care plan. It's not a solution to America's health care problems, but it's part of the solution.

So did you vote for Romney?
I did.

I imagine a certain percentage of Whole Foods customers will also boycott because of this.
I don't know what to say except that I'm a capitalist, first. There are many things I don't like about Romney, but more things I don't like about Obama. This is America, and people disagree on things.



For the full interview, see:

Andrew Goldman, Interviewer. "TALK; The Kale King." The New York Times Magazine (Sun., January 20, 2013): 16.

(Note: ellipsis added; bold in original, indicating interviewer questions.)

(Note: the online version of the interview has the date January 18, 2013, and has the title "TALK; John Mackey, the Kale King.")


Mackey's book is:

Mackey, John, and Rajendra Sisodia. Conscious Capitalism: Liberating the Heroic Spirit of Business. Boston, MA: Harvard Business Review Press, 2013.






February 23, 2013

Admiring Jobs' New Products, Gates Wistfully Wondered If "Maybe I Should Have Stayed in That Game"



(p. 553) Bill Gates had never lost his fascination with Jobs. In the spring of 2011 I was at a dinner with him in Washington, where he had come to discuss his foundation's global health endeavors. He expressed amazement at the success of the iPad and how Jobs, even while sick, was focusing on ways to improve it. "Here I am, merely saving the world from malaria and that sort of thing, and Steve is still coming up with amazing new products," he said wistfully. "Maybe I should have stayed in that game." He smiled to make sure that I knew he was joking, or at least half joking.


Source:

Isaacson, Walter. Steve Jobs. New York: Simon & Schuster, 2011.






February 20, 2013

Entrepreneur Kurzweil Says If He Gets Cancer, He Will Invent a Cure



KurzweilRay2013-02-03.jpg











"Ray Kurzweil." Source of caption and photo: online version of the NYT article quoted and cited below.


















(p. 12) As a futurist, you are famous for making predictions of when technological innovations will actually occur. Are you willing to predict the year you will die? My plan is to stick around. We'll get to a point about 15 years from now where we're adding more than a year every year to your life expectancy.

To clarify, you're predicting your immortality.
The problem is I can't get on the phone with you in the future and say, "Well, I've done it, I have lived forever," because it's never forever.


. . .


You've said that if you woke up one day with a terminal disease, you'd be forced to invent a cure. Were you being serious?
I absolutely would try. I'm working now on a cancer project with some scientists at M.I.T., and if I develop cancer, I do have some ideas of what I would do.

I imagine a lot of people would hear that and say, Ray, if you think you're capable of curing yourself, why don't you go ahead and start curing others?
Well, I mean, I do have to pick my priorities. Nobody can do everything. What we spend our time on is probably the most important decision we make. I don't know if you're aware, but I'm joining Google as director of engineering.



For the full interview, see:

Andrew Goldman, Interviewer. "TALK; The Life Robotic; The Futurist Ray Kurzweil Says We're Going to Live Forever. Really." The New York Times Magazine (Sun., January 27, 2013): 12.

(Note: ellipsis added; bold in original, indicating interviewer questions.)

(Note: the online version of the interview has the date January 25, 2013, and has the title "TALK; Ray Kurzweil Says We're Going to Live Forever.")






February 18, 2013

Entrepreneur Peter Thiel Says We Should Fight for Longer Lives



100PlusBK2013-01-12.jpg











Source of book image: http://si.wsj.net/public/resources/images/OB-PJ926_bkrv10_DV_20110829191924.jpg







(p. C13) Sonia Arrison's "100 Plus" was first published in 2011, but its message is evergreen: how scientists are directly attacking the problem of aging and death and why we should fight for life instead of accepting decay as inevitable. The goal of longer life doesn't just mean more years at the margin; it means a healthier old age. There is nothing to fear but our own complacency.


For the full review essay, see:

Peter Thiel (author of passage quoted above, one of 50 contributors to whole article). "Twelve Months of Reading; We asked 50 of our friends to tell us what books they enjoyed in 2012--from Judd Apatow's big plans to Bruce Wagner's addictions. See pages C10 and C11 for the Journal's own Top Ten lists." The Wall Street Journal (Sat., December 15, 2012): passim (Thiel's contribution is on p. C13).

(Note: the online version of the review essay has the date December 14, 2012.)



The book Thiel endorses 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.






February 12, 2013

The War on Drugs Likely "Increased the Rate of Addiction"



DrugPrisonerGraph2013-02-03.jpg






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







(p. C1) President Richard Nixon declared a "war on drugs" in 1971. The expectation then was that drug trafficking in the United States could be greatly reduced in a short time through federal policing--and yet the war on drugs continues to this day. The cost has been large in terms of lives, money and the well-being of many Americans, especially the poor and less educated. By most accounts, the gains from the war have been modest at best.

The direct monetary cost to American taxpayers of the war on drugs includes spending on police, the court personnel used to try drug users and traffickers, and the guards and other resources spent on imprisoning and punishing those convicted of drug offenses. Total current spending is estimated at over $40 billion a year.

These costs don't include many other harmful effects of the war on drugs that are difficult to quantify. For example, over the past 40 years the fraction of students who have dropped out of American high schools has remained large, at about 25%. Dropout rates are not high for middle-class white children, but they are very high for black and Hispanic children living in poor neighborhoods. Many factors explain the high dropout rates, especially bad schools and weak family support. But another important factor in inner-city neighborhoods is the temptation to drop out of school in order to profit from the drug trade.

The total number of persons incarcerated in state and federal prisons in the U.S. has grown from 330,000 in 1980 to about 1.6 million today. Much of the increase in this population is directly due to the war on drugs and the severe punishment for persons convicted of drug trafficking. About 50% of the inmates in federal prisons and 20% of those in state prisons have been convicted of either selling or using drugs. The many minor drug traffickers and drug users who spend time in jail find fewer opportunities for legal employment after they get out of prison, and they develop better skills at criminal activities.


. . .


(p. C2) It is generally harder to break an addiction to illegal goods, like drugs. Drug addicts may be leery of going to clinics or to nonprofit "drugs anonymous" groups for help. They fear they will be reported for consuming illegal substances. Since the consumption of illegal drugs must be hidden to avoid arrest and conviction, many drug consumers must alter their lives in order to avoid detection.

Usually overlooked in discussions of the effects of the war on drugs is that the illegality of drugs stunts the development of ways to help drug addicts, such as the drug equivalent of nicotine patches. Thus, though the war on drugs may well have induced lower drug use through higher prices, it has likely also increased the rate of addiction. The illegality of drugs makes it harder for addicts to get help in breaking their addictions. It leads them to associate more with other addicts and less with people who might help them quit.


. . .


The decriminalization of both drug use and the drug market won't be attained easily, as there is powerful opposition to each of them. The disastrous effects of the American war on drugs are becoming more apparent, however, not only in the U.S. but beyond its borders. Former Mexican President Felipe Calderon has suggested "market solutions" as one alternative to the problem. Perhaps the combined efforts of leaders in different countries can succeed in making a big enough push toward finally ending this long, enormously destructive policy experiment.



For the full commentary, see:

GARY S. BECKER and KEVIN M. MURPHY. "Have We Lost the War on Drugs? After more than four decades of a failed experiment, the human cost has become too high. It is time to consider the decriminalization of drug use and the drug market." The Wall Street Journal (Sat., January 5, 2013): C1 & C2.

(Note: the online version of the commentary has the date January 4, 2013.)






February 8, 2013

Lichen Fungi May Never Age



PringleAnneLichenResearch2013-01-12.jpg "ANNUAL VISITOR; For the last eight years, Anne Pringle of Harvard has been collecting data about the lichens on the gravestones at a cemetary in Petersham, Mass." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. D3) PETERSHAM, Mass. -- On a sparkling New England afternoon, as hawks coasted overhead and yellow leaves drifted to the ground, Anne Pringle stood before a large granite obelisk that marked the graves of a family called French.


. . .


For eight years, Dr. Pringle, 42, has been returning to this cemetery each fall, to measure, sketch and scrutinize the lichens, which belong to the genus Xanthoparmelia. She wants to know whether they deteriorate with the passage of time, leaving them more susceptible to death.


. . .


Lichens are not individuals but tiny ecosystems, composed of one main fungus, a group of algae and an assortment of smaller fungi and bacteria.


. . .


While lichens are communities, Dr. Pringle is largely interested in the fungi. Mycologists, the scientists who study fungi -- not the most glamorous corridor of biology -- have long assumed that many of these organisms don't age.

. . .


"What you know is based on the organisms you study," she said. "What would you say about the evolution of senescence if instead of working with insects, you worked with modular organisms, which is what lichen are?"

Daniel Doak, a University of Colorado ecologist, agrees that the question is worth asking. Research like Dr. Pringle's -- along with other studies of species including the bristlecone pine tree and the wandering albatross, a bird, both of which may avoid senescence -- suggests another possible path.

"It's saying something fundamental," Dr. Doak said, "that senescence is not an inevitable part of life. Which means there might be ways to prevent it." That idea could eventually have implications for human medicine.


. . .


Dr. Pringle's preliminary results show that as a lichen grows older and larger, it is less likely to die. "If you made me answer the question now," she said, "I'd say there can be senescence of parts of an individual. But I don't think an individual ever senesces."



For the full story, see:

HILLARY ROSNER. "In a Place for the Dead, Studying a Seemingly Immortal Species." The New York Times (Tues., January 1, 2013): D3.

(note: ellipses added.)

(Note: the online version of the story has the date December 31, 2012.)



LichenCommunity2013-01-12.jpg"THRIVING; Dr. Pringle's initial results show that as a lichen grows older and larger, it is less likely to die." Source of caption and photo: online version of the NYT article quoted and cited above.






January 31, 2013

Dr. William House "Faced Stern Opposition" to Bring Cochlear Implants to the Deaf



HouseAndHustedFirstCochlearImplant2013-01-12.jpg "Dr. William F. House in 1981 with Tracy Husted, the first pre-school-age child to get a cochlear implant." Source of caption and photo: online version of the NYT obituary quoted and cited below.


(p. 34) Dr. William F. House, a medical researcher who braved skepticism to invent the cochlear implant, an electronic device considered to be the first to restore a human sense, died on Dec. 7 at his home in Aurora, Ore. He was 89.

. . .


Dr. House pushed against conventional thinking throughout his career. Over the objections of some, he introduced the surgical microscope to ear surgery. Tackling a form of vertigo that doctors had believed was psychosomatic, he developed a surgical procedure that enabled the first American in space to travel to the moon. Peering at the bones of the inner ear, he found enrapturing beauty.


. . .


More than a decade would pass before the Food and Drug Administration approved the cochlear implant, but when it did, in 1984, Mark Novitch, the agency's deputy commissioner, said, "For the first time a device can, to a degree, replace an organ of the human senses."

One of Dr. House's early implant patients, from an experimental trial, wrote to him in 1981 saying, "I no longer live in a world of soundless movement and voiceless faces."

But for 27 years, Dr. House had faced stern opposition while he was developing the device. Doctors and scientists said it would not work, or not work very well, calling it a cruel hoax on people desperate to hear. Some said he was motivated by the prospect of financial gain. Some criticized him for experimenting on human subjects. Some advocates for the deaf said the device deprived its users of the dignity of their deafness without fully integrating them into the hearing world.


. . .


When his brother returned from West Germany with a surgical microscope, Dr. House saw its potential and adopted it for ear surgery; he is credited with introducing the device to the field. But again there was resistance. As Dr. House wrote in his memoir, "The Struggles of a Medical Innovator: Cochlear Implants and Other Ear Surgeries" (2011), some eye doctors initially criticized his use of a microscope in surgery as reckless and unnecessary for a surgeon with good eyesight.



For the full obituary, see:

DOUGLAS MARTIN. "Dr. William F. House, Inventor of Pioneering Ear-Implant Device, Dies at 89." The New York Times, First Section (Sun., December 16, 2012): 34.

(Note: ellipses added.)

(Note: the online version of the obituary has the date December 15, 2012.)



Dr. House's memoir is:

House, William F. The Struggles of a Medical Innovator: Cochlear Implants and Other Ear Surgeries. CreateSpace Independent Publishing Platform, 2011.

(Note: the copyright page of the book gives neither city nor name of publisher; the publisher in the reference is as given by Amazon.com.)



HouseWilliamInventorOfCochlearImplant2013-01-12.jpg













"Dr. William F. House sitting at an operating microscope." Source of caption and photo: online version of the NYT obituary quoted and cited above.








January 30, 2013

Rupert Murdoch and Steve Jobs "Hit It Off Well"



(p. 508) Murdoch and Jobs hit it off well enough that Murdoch went to his Palo Alto house for dinner twice more during the next year. Jobs joked that he had to hide the dinner knives on such occasions, because he was afraid that his liberal wife was going to eviscerate Murdoch when (p. 509) he walked in. For his part, Murdoch was reported to have uttered a great line about the organic vegan dishes typically served: "Eating dinner at Steve's is a great experience, as long as you get out before the local restaurants close." Alas, when I asked Murdoch if he had ever said that, he didn't recall it.


Source:

Isaacson, Walter. Steve Jobs. New York: Simon & Schuster, 2011.






January 26, 2013

The Project Entrepreneur: Never Say Die



(p. 485) . . . [Jobs] chafed at not being in control, and he sometimes hallucinated or be-(p. 486)came angry. Even when he was barely conscious, his strong personality came through. At one point the pulmonologist tried to put a mask over his face when he was deeply sedated. Jobs ripped it off and mumbled that he hated the design and refused to wear it. Though barely able to speak, he ordered them to bring five different options for the mask and he would pick a design he liked. The doctors looked at Powell, puzzled. She was finally able to distract him so they could put on the mask. He also hated the oxygen monitor they put on his finger. He told them it was ugly and too complex. He suggested ways it could be designed more simply. "He was very attuned to every nuance of the environment and objects around him, and that drained him," Powell recalled.


Source:

Isaacson, Walter. Steve Jobs. New York: Simon & Schuster, 2011.

(Note: ellipsis and bracketed "Jobs" added.)






January 23, 2013

David Koch Institute for Integrative Cancer Research



LangerRobertResearchLab2013-01-12.jpg "Dr. Robert Langer's research lab is at the forefront of moving academic discoveries into the marketplace." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. 1) HOW do you take particles in a test tube, or components in a tiny chip, and turn them into a $100 million company?

Dr. Robert Langer, 64, knows how. Since the 1980s, his Langer Lab at the Massachusetts Institute of Technology has spun out companies whose products treat cancer, diabetes, heart disease and schizophrenia, among other diseases, and even thicken hair.

The Langer Lab is on the front lines of turning discoveries made in the lab into a range of drugs and drug delivery systems. Without this kind of technology transfer, the thinking goes, scientific discoveries might well sit on the shelf, stifling innovation.

A chemical engineer by training, Dr. Langer has helped start 25 companies and has 811 patents, issued or pending, to his name. More than 250 companies have licensed or sublicensed Langer Lab patents.

Polaris Venture Partners, a Boston venture capital firm, has invested $220 million in 18 Langer Lab-inspired businesses. Combined, these businesses have improved the health of many millions of people, says Terry McGuire, co-founder of Polaris.


. . .


(p. 7) Operating from the sixth floor of the David H. Koch Institute for Integrative Cancer Research on the M.I.T. campus in Cambridge, Mass., Dr. Langer's lab has a research budget of more than $10 million for 2012, coming mostly from federal sources.


. . .


David H. Koch, executive vice president of Koch Industries, the conglomerate based in Wichita, Kan., wrote in an e-mail that "innovation and education have long fueled the world's most powerful economies, so I can't think of a better or more natural synergy than the one between academia and industry." Mr. Koch endowed Dr. Langer's professorship at M.I.T. and is a graduate of the university.



For the full story, see:

HANNAH SELIGSON. "Hatching Ideas, and Companies, by the Dozens at M.I.T." The New York Times, SundayBusiness Section (Sun., November 25, 2012): 1 & 7.

(Note: ellipses added.)

(Note: the online version of the story has the date November 24, 2012.)






December 26, 2012

Students Protest (and Toss) Federally Mandated "Healthy" ("Gross") Food



GarbageCanVegetables2012-12-18.jpg "Lunch hour at Middle School 104 in Manhattan, where, on Friday, several seventh graders pronounced vegetables "gross." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A1) Outside Pittsburgh, they are proclaiming a strike, taking to Twitter and Facebook to spread the word. In a village near Milwaukee, hundreds staged a boycott. In a small farming and ranching community in western Kansas, they have produced a parody video. And in Parsippany, N.J., the protest is six days old and counting.

They are high school students, and their complaint is about lunch -- healthier, smaller and more expensive than ever.

The Healthy, Hunger-Free Kids Act of 2010, which required public schools to follow new nutritional guidelines this academic year to receive extra federal lunch aid, has created a nationwide version of the age-old parental challenge: persuading children to eat what is good for them.

Because the lunches must now include fruits and vegetables, those who clamor for more cheese-laden nachos may find string beans and a peach cup instead. Because of limits on fat and sodium, some of those who crave French fries get baked sweet-potato wedges. Because of calorie restrictions, meat and carbohydrate portions are smaller. Gone is 2-percent chocolate milk, replaced by skim.

"Before, there was no taste and no flavor," said Malik Barrows, a senior at Automotive High School in Brooklyn, who likes fruit but said his classmates threw away their mandatory helpings on the cafeteria floor. "Now there's no taste, no flavor and it's healthy, which makes it taste even worse."

Students organized lunch strikes in a suburb of Pittsburgh, where in late August the hashtag "brownbagginit" was trending on Twitter, and outside Milwaukee, where the Mukwonago High School principal, Shawn McNulty, said participation in the lunch program had fallen 70 percent.


. . .


(p. A3) In Sharon Springs, Kan., lunch protesters at Wallace County High School posted a video on YouTube, "We Are Hungry"; in it, students faint in the hallways and during physical education class, acting as if they had been done in by meager helpings of potato puff casserole and chicken nuggets. To the tune of the song "We Are Young" by Fun, one student on the video sings, "My friends are at the corner store, getting junk so they don't waste away."

Since it was uploaded three weeks ago, "We Are Hungry" has had nearly 900,000 views.

Callahan Grund, a junior who stars in the video, said, "My opinion as a young farmer and rancher is that we produced this protein and it's not being used to its full advantage." He wakes up early every morning to do chores, stays after school for two hours of football practice and returns home for another round of chores. If it were not for the lunches his mother now packs him, he said, he would be hungry again just two hours after lunch.

In New York City, where school officials introduced whole-wheat breads, low-fat milk and other changes several years ago, the most noticeable change this year is the fruit and vegetable requirement, which has resulted in some waste, according to Eric Goldstein, the Education Department official who oversees food services. It is not hard to see why. At Middle School 104 in Gramercy Park on Friday, several seventh graders pronounced vegetables "gross."

"I just throw them out," said Danielson Gutierrez, 12, carrying a slice of pizza, which he had liberally sprinkled with seasonings, and a pear. He also offered his opinion on fruit: "I throw them out, too. I only like apples."



For the full story, see:

VIVIAN YEE. "No Appetite for Good-for-You School Lunches." The New York Times (Sat., October 6, 2012): A1 & A3.

(Note: ellipsis added.)

(Note: the online version of the article has the date October 5, 2012.)


LunchYouTubeParody2012-12-18.jpg "Dissatisfied with healthier school lunches, some Kansas students made a video parody." Source of caption and photo: online version of the NYT article quoted and cited above.





December 20, 2012

Chernobyl May Have Caused No Long-Term Increase in Cancer



VisitSunnyChenobylBK2012-12-18.jpg














Source of book image: http://luxuryreading.com/wp-content/uploads/2012/07/9781605294452.jpg




(p. C11) . . . Andrew Blackwell, a journalist and self-described "sensitive, eco-friendly liberal," deserves praise for producing an environmentalist book that avoids the usual hyperventilation, upending stubborn myths with prosaic facts.


. . .


His Geiger counter convulses on a visit to the abandoned areas around Chernobyl, but Mr. Blackwell reacts soberly. While the initial disaster provoked a justifiable public panic, it also inspired scare-mongering from groups like Greenpeace, which claimed that the fallout would cause 270,000 cancer cases. He points to a study commissioned by the United Nations concluding that, after an initial spike in thyroid cancer, "no measurable increase has yet been demonstrated in the region's cancer rates." The author is also sure to irritate certain readers with the claim that "paradoxically, perversely, the accident may have actually been good" for the local environment, since the evacuation created an accidentally verdant nature reserve.



For the full review, see:

MICHAEL C. MOYNIHAN. "A Guided Tour of Catastrophe" The Wall Street Journal (Sat., May 26, 2012): C11.

(Note: ellipses added.)

(Note: the online version of the review has the date May 25, 2012.)


The book being reviewed, is:

Blackwell, Andrew. Visit Sunny Chernobyl: And Other Adventures in the World's Most Polluted Places. New York: Rodale Books, 2012.






December 15, 2012

Why Health Care Costs So Much in McAllen



(p. 235) Atul Gawande lays out "The Cost Conundrum: What a Texas town can teach us about health care." "It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it's a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. 'Lonesome Dove' was set around here. McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami--which has much higher labor and living costs--spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns."


Gawande as quoted in:

Taylor, Timothy. "Recommendations for Further Reading." Journal of Economic Perspectives 24, no. 2 (Fall 2009): 231-38.


The full Gawande article can be viewed online at:

Gawande, Atul. "Annals of Medicine; the Cost Conundrum; What a Texas Town Can Teach Us About Health Care." The New Yorker 85, no. 16 (June 2009): 36-44.


A later Gawande article, that asks why the health care system cannot be run as well as The Cheesecake Factory, can be viewed online at the link below. (Spoiler alert: I haven't read this article yet, but I'm guessing it has something to do with the feedback and incentives provided by the free market.)

Gawande, Atul. "Annals of Health Care; Big Med; Restaurant Chains Have Managed to Combine Quality Control, Cost Control, and Innovation. Can Health Care?" The New Yorker 88, no. 24 (August 2012): 52-63.






December 11, 2012

Health Care Costs Can Be Lowered by Less Waste and More Cost-Reducing Innovation



(p. 234) Melinda Beeuwkes Buntin and David Cutler discuss "The Two Trillion Dollar Solution: Saving Money by Modernizing the Health Care System." "Two sorts of savings are possible in health care. The first is eliminating waste and inefficiency. The most commonly cited estimate is that 30 percent of the money spent on medical care does not buy care worth its cost. Medicare costs per capita in Minneapolis, for example, are about half those in Miami, yet Miami does not have better health outcomes. International comparisons yield the same conclusion. . . . Second, reform might stimulate cost-reducing innovation instead of the continuous cost increases that accompany current innovation. For nearly 20 years, scholars have argued that generous reimbursement policies for medical care have led to innovations that almost always increase health care costs. Changing that dynamic by investing in research about what works and rewarding health care providers who choose efficient treatments could have a dramatic effect on cost growth. . . . Reducing costs by 30 percent will take time and effort, but it is not inconceivable over the long term. Experience in the health care sector and other industries suggests that cost reductions on the order of 1.5-to-2.0 percentage points per year are within reach."


Buntin and Cutler as quoted in:

Taylor, Timothy. "Recommendations for Further Reading." Journal of Economic Perspectives 24, no. 2 (Fall 2009): 231-38.

(Note: ellipses in original.)


The Buntin and Cutler report is:

Buntin, Melinda Beeuwkes, and David Cutler. "The Two Trillion Dollar Solution: Saving Money by Modernizing the Health Care System." Washington, D.C.: Center for American Progress, 2009.






November 30, 2012

DaVita Threw Out Medicine and Billed Taxpayer: Huge Medicare Fraud



DaVitaMedicareFraudDrewGriffin2012-11-29.jpg



























I saw this clip broadcast on Wolf Blitzer's "Situation Room" broadcast on 11/29/12 (if memory serves--it might have been the day before).

The clip shows the magnitude of the fraud, but also emphasizes that there were significant incentives for those who knew about the fraud to keep their mouths shut.

This is one huge case of over-billing, but over-billing happens all the time. Taxpayers could have used that money for other purposes. The opportunity cost is huge.



A link to the clip posted on CNN, is:

http://ac360.blogs.cnn.com/2012/11/29/company-accused-of-giant-medicare-fraud/?iref=allsearch

(Note: I believe the November 29, 2012 date in the image above is the date that Drew Griffin posted the clip to the CNN blog, not necessarily the date of the broadcast.)






November 29, 2012

Personal DNA Data, Smart Phones, and the Social Network Can Democratize Medicine



(p. 236) With the personal montage of your DNA, your cell phone, your social network---aggregated with your lifelong health information and physiological and anatomic data---you are positioned to reboot the future of medicine. Who could possibly be more interested and more vested in your data? For the first time, the medical world is getting democratized. Think of the priests before the Gutenberg printing press. Now, nearly six hundred years later, think of physicians and the creative destruction of medicine.


Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






November 25, 2012

Progress Will Slow If Consumers Wait for Doctors to Creatively Destroy Medicine



(p. 195) . . . it remains unclear whether there is adequate plasticity of a plurality of physicians to embrace the digital world and acknowledge that the era of paternalism is passé. My sense is that young physicians who are digital natives will be likely to assimilate but that it will be quite difficult for the vast majority who are in practice and inculcated with an older idea of how medical care should be rendered. Eventually there will be enough digital native physicians to take charge, but that will take decades to be accomplished. In the meantime, consumers are fully capable of leading the movement and contributing to medicine's creative destruction. And so they must.


Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

(Note: ellipsis added.)






November 21, 2012

Sclerotic Doctors Resist Change



(p. 177) Atherosclerosis, referring to a progressive and degenerative process of artery walls, is typically translated for a lay audience as "hardening of the arteries." We've never needed a similar word to describe the medical community. It came with sclerosis built in. Of all the professions represented on the planet, perhaps none is more resistant to change than physicians. If there were ever a group defined by lacking plasticity, it would first apply to doctors.

(p. 178) The inherent "hardness" of physicians and the medical community suggests they will have a difficult time adapting to the digital world. Before the emergence of the Internet, physicians were high priests, holding all the knowledge and expertise, not to be challenged or questioned by the lowly consumer patient. "Doctor knows best" was the pervasive sentiment, shared by patients and especially physicians.



Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






November 17, 2012

AMA Resists the Democratization of DNA




The "Walgreens flap" mentioned below was the episode in 2010 when Walgreens announced that it would cell a genome testing saliva kit, but was pressured by government regulatory agencies, and withdrew the kit from the market within two days of the announcement.


(p. 119) . . . there will likely never be a "right time"---after we have passed some imaginary tipping point giving us critical, highly actionable, and perfectly accurate information---for it to be available to the public. The logical conclusion is that the tests should be made available. What's more, the fact that they have been available has meant that democratization of DNA is real. Consumers now realize that they have the right to obtain data on their DNA. As a blogger wrote in response to the Walgreens flap, "To say that this information has to be routed through your doctor is a little like the Middle Ages, when only priests were allowed (or able) to read the Bible. Gutenberg came along with the printing press even though few people were able to read. This triggered a literacy/literature spiral that had incredible benefits for civilization, even if it reduced the power of the priestly class."

The American Medical Association (AMA) sees things differently. In a pointed letter to the FDA in 2011, the AMA wrote: "We urge the Panel ... that genetic testing, except under the most limited circumstances, should carried out under the personal supervision of a qualified health professional." The FDA has indicated it is likely to accept the AMA recommendations, which will clearly limit consumer direct access to their DNA information. But this arrangement ultimately appears untenable, and eventually there will need to be full democratization of DNA for medicine to (p. 120) be transformed. Of course, health professionals can be consulted as needed, but it is the individual who should have the decision authority and capacity to drive the process.

The physician and entrepreneur Hugh Rienhoff, who has spent years attempting to decipher his daughter's unexplained cardiovascular genetic defect and formed the online community MyDaughtersDNA.org, had this to say: "Doctors are not going to drive genetics into clinical practice. It's going to be consumers .... The user interface, whether software or whatever will be embraced first by consumers, so it has to be pitched at that level, and that's about the level doctors are at. Cardiologists do not know dog shit about genetics."



Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

(Note: first ellipsis added; other ellipses in original.)






November 13, 2012

Personal Genomics Startups Struggle Under a "Circus" of Government Regulation



(p. 118) Government regulation of consumer genomics companies has been centerpiece (and the semblance of a circus) in their short history. Back in 2008, the states of California and New York sent "cease and desist" letters to the genome scan companies. State officials were concerned that the laboratories that generated the results were not certified as CLIA (Clinical Laboratory Improvement Amendments) and that the tests were being performed without a physician's order. All three companies developed work-around plans in California and remained operational but were unable to market the tests in New York.

In 2010, the regulation issues escalated to the federal level. In May it was announced that 7,500 Walgreens drugstores throughout the United States would soon sell Pathway Genomics's saliva kit for disease susceptibility and pharmacogenomics. While the tests produced by all four companies had been widely available via the Internet for three years, the announcement of wide-scale availability in drugstores (which was cancelled by Walgreens within two days) appeared to "cross the line" and set off a cascade of investigations and hearings by the FDA, the Government Accountability Office (GAO), and the Congressional House Committee on Energy and Commerce. The FDA's Alberto Gutierrez said, "We don't think physi-(p. 119)cians are going to be able to interpret the results," and "genetic tests are medical devices and must be regulated." The GAO undertook a "sting" operation with its staff posing as consumers who bought genetic tests and detailed significant inconsistencies, misleading test results, and deceptive marketing practices in its report.

All four personal genomics companies are struggling.



Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






November 9, 2012

"The Resistance from the Priesthood of Medicine Is at Its Height"



(p. 77) In December 2010 in Milwaukee, Wisconsin, Nicholas Volker, a five-year-old boy with a gastrointestinal condition that had not previously been seen, who had undergone over a hundred surgical operations and was almost constantly hospitalized and intermittently septic, was virtually on death's door. But when his DNA sequence was determined, his doctors found the culprit mutation. That discovery led to the proper treatment, and now Nicholas is healthy and thriving. Even though this was only the first clearly documented case of the life-saving power of human genomics in medicine, (p. 78) few could now deny that the field was going to have a vital role in the future of medicine. Some would argue that the treatment led to an even bigger breakthrough: health insurance coverage of sequencing costs for select cases.

It took the better part of a decade from the completion of the first draft of the Human Genome Project for genomics to reach the clinic in such a dramatic way. To make treatment like Volker's common will likely take more time still. Even if that's the ultimate prize, the creative destruction of medicine still has various other, less comprehensive, genomic tools for us to use, based on investigations of things like single-nucleotide polymorphisms, the exome, and more. The material can be a bit heady, but it's worth pushing through: these tools could effect not just dramatic corrections of faulty genes but a better, more scientific understanding of disease susceptibility and what drugs to take. Moreover, as they empower patients and democratize medicine, they make medical knowledge available to all and deep knowledge of ourselves available to each of us. Nevertheless, at this level, perhaps more than anywhere else in this ongoing medical revolution, the resistance from the priesthood of medicine is at its height. The fight might be tougher than the material, but in neither case can we afford to give up.



Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






November 7, 2012

Health Inefficiencies Free-Ride on "Home Run Innovations"



The article quoted below is a useful antidote to those economists who sometimes seem to argue that health gains fully justify the rise in health costs.


(p. 645) In the United States, health care technology has contributed to rising survival rates, yet health care spending relative to GDP has also grown more rapidly than in any other country. We develop a model of patient demand and supplier behavior to explain these parallel trends in technology growth and cost growth. We show that health care productivity depends on the heterogeneity of treatment effects across patients, the shape of the health production function, and the cost structure of procedures such as MRIs with high fixed costs and low marginal costs. The model implies a typology of medical technology productivity: (I) highly cost-effective "home run" innovations with little chance of overuse, such as anti-retroviral therapy for HIV, (II) treatments highly effective for some but not for all (e.g., stents), and (III) "gray area" treatments with uncertain clinical value such as ICU days among chronically ill patients. Not surprisingly, countries adopting Category I and effective Category II treatments gain the greatest health improvements, while countries adopting ineffective Category II and Category III treatments experience the most rapid cost growth. Ultimately, economic and political resistance in the United States to ever-rising tax rates will likely slow cost growth, with uncertain effects on technology growth.


Source of abstract:

Chandra, Amitabh, and Jonathan Skinner. "Technology Growth and Expenditure Growth in Health Care." Journal of Economic Literature 50, no. 3 (Sept. 2012): 645-80.







November 5, 2012

When Bibliometrics Are a Matter of Life and Death



(p. 51) . . . it is essential, if at all possible, to have a go-to physician expert and authority when one has a newly diagnosed, serious condition, such as a brain or, neurologic conditions like multiple sclerosis and Parkinson's disease, heart valve abnormality. How do you find that individual doctor?

In order to leverage the Internet and gain access to state-of-the-art expertise, you need to identify the physician who conducts the leading research in the field. Let's pick pancreatic cancer as an example of a serious condition that often proves to be rapidly fatal. The first step is to go to Google Scholar and find the top-cited articles for that condition by typing in "pancreatic cancer." They are generally listed in order by descending number of citations. Look for the senior, last author of the articles. The last author of the top-listed paper in the Journal of Clinical Oncology from 1997 is Daniel D. Von Hoff, with over 2,000 citations ("cited by ... " appears at the end of each hit). Now you may have identified an expert. Enter "Daniel Von Hoff" into PubMed (www.ncbi.nlm.nih.gov/sites/pubmed) to see how many papers he has published: 567. Most are related to pancreatic cancer or cancer research.

(p. 52) Now go back to Google Scholar and enter his name, and you'll see over 24,000 hits--this number includes papers that cite his work. There are some problems with these websites, since getting citations by other peer-reviewed publications takes time; if a breakthrough paper is published, it will be years to accumulate hundreds, if not thousands, of citations. Thus, the lag time or incubation phase of citations may result in missing a rising star. If it is a common name, there may be admixture of citations of different researchers with the same name, albeit different topics, so it is useful to enter in all elements including the middle initial and to scan the topic list to alleviate that problem. For perspective, a paper that has been cited 1,000 times by others is rare and would be considered a classic. In this example, the top paper by Von Hoff in 1997 is a long time ago, and he is no longer at the University of Texas, San Antonio-he moved to Phoenix, Arizona. How would you find that out? Look for Daniel D. Von Hoff using a search engine such as Google or Bing, and look up his profile on Wikipedia. Without any help from any doctor, you will have found the country's leading authority on pancreatic cancer. And you will have also identified some backups at Johns Hopkins using the same methodology.




Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

(Note: initial ellipsis added; parenthetical ellipsis in original.)






November 1, 2012

FDA and ACS Wrongly Endorsed Sunscreen with Retinyl Palmitate



Some consumers let their guard down on medical issues, assuming that the government Food and Drug Administration (FDA), and large incumbent bureaucratic non-profits, like the American Cancer Society (ACS), will protect them---it ain't necessarily so. Caveat emptor should remain the rule for consumers.


(p. 39) Of note, one of the reasons for the lack of updating the rules and acknowledging UVA rays has been heavy pressure from sunscreen manufacturers, which include Johnson and Johnson (Neutrogena), Merck-Schering Plough (Coppertone), Proctor and Gamble (Olay), and L'Oreal. Interestingly, in Europe products that provide solid UVA protection have been available for years. The concerns run even deeper because many of the products (41 percent in the United States) contain a form of vitamin A known as retinyl palmitate, which has been associated with increased likelihood of skin cancer. There are, however, no randomized studies, but biological plausibility and the observational findings of a rising incidence of basal cell (p. 40) carcinoma and melanoma, despite the widespread use of sunscreens. In mid-2011, the FDA finally unveiled some new rules about sunscreen claims.

This issue really hit home when my wife brought out a tube of Neutrogena Ultra Sheer Dry-Tough SPF 30 Sunblock. It claims "Broad Spectrum UVNUVB Protection" despite repeatedly failing UVA tests. But the real eye-opener is to find the American Cancer Society logo on the front of the tube with the message "Help Block Out Skin Cancer." Now what is the American Cancer Society logo doing on the tube of Neutrogena? The fine print on the bottom reads: "The American Cancer Society (ACS) and Neutrogena, working together to help prevent skin cancer, support the use of sunscreen. The ACS does not endorse any specific product. Neutrogena pays a royalty to the ACS for the use of its logo."



Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






October 28, 2012

The Kairos of Creative Destruction in Medicine



Wikipedia tells us that "Kairos" "is an ancient Greek word meaning the right or opportune moment (the supreme moment)."


(p. x) With a medical profession that is particularly incapable of making a transition to practicing individualized medicine, despite a new array of powerful tools, isn't it time for consumers to drive this capability? The median of human beings is not the message. The revolution in technology that is based on the primacy of individuals mandates a revolution by consumers in order for new medicine to take hold.

Now you've probably thought "creative destruction" is a pretty harsh term to apply to medicine. But we desperately need medicine to he Schumpetered, to be radically transformed. We need the digital world to invade (p. xi) the medical cocoon and to exploit the newfound and exciting technological capabilities of digitizing human beings. Some will consider this to be a unique, opportune moment in medicine, a veritable once-in-a-lifetime Kairos.

This book is intended to arm consumers to move us forward.



Source:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

(Note: italics in original.)






October 27, 2012

Instead of Fixing "Inadequate Schools," Adderall Is Prescribed to "Struggling" Students



RocafortAmandaAndSonQuintn2012-10-12.jpg "Amanda Rocafort and her son Quintn in Woodstock, Ga. Quintn takes the medication Risperdal." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A1) CANTON, Ga. -- When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder "made up" and "an excuse" to prescribe the pills to treat what he considers the children's true ill -- poor academic performance in inadequate schools.



For the full story, see:

ALAN SCHWARZ. "Attention Disorder or Not, Pills to Help in School." The New York Times (Tues., October 9, 2012): A1 & A18.






October 19, 2012

Openness to Creative Destruction Will Speed Health Care Progress



CreativeDestructionOfMedicineBK2012-10-11.jpg












Source of book image: http://si.wsj.net/public/resources/images/OB-RQ412_bkrvme_DV_20120202132402.jpg





Eric Topol has bucked the medical establishment before. In entries on August 20, 2006 and on December 26, 2006 on this blog, he was quoted as arguing that stents were being overused. Now he argues that the medical establishment is slowing progress that could reduce disability and extend life. He advocates the sequencing of each of our genomes and a medical revolution that will fine-tune treatment to our genomic differences.

Many agree with Topol's view of the future of medicine, but many medical schools are neglecting teaching future doctors about the therapeutic implications of individual genomics.

Topol calls for the creative destruction of medical education and other medical institutions.

The early part of the book is weak because it discusses subjects on which Topol is not an expert---such as the history and applications of information technology. In these sections, he too often tediously explains the obvious and widely known. Sometimes in this section of the book, he is just wrong, as when (p. 14) he claims that Werner Sombart originated "creative destruction."

After the early chapters the book comes into its own when Topol discusses medical advances and challenges. While his early prose may be aimed too low, his later prose may be aimed too high---but it is better to be talked up to than down to, and the best of the later chapters contain some fascinating descriptions of what is happening on the frontiers of medicine, and what could be happening if we change policies and institutions to make medicine more open to creative destruction.

In the following few weeks, I will be quoting several of the more important or thought-provoking passages.


Book discussed:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






October 11, 2012

Garfield's Doctors "Basically Tortured Him to Death"



DestinyOfTheRepublicBK2012-09-02.jpeg

















Source of book image: http://rsirving.files.wordpress.com/2012/04/destinyrepublic.jpeg


(p. 15) Had Garfield been left where he lay, he might well have survived; the bullet failed to hit his spine or penetrate any vital organs. Instead, he was given over to the care of doctors, who basically tortured him to death over the next 11 weeks. Two of them repeatedly probed his wound with their unsterilized fingers and instruments before having him carted back to the White House on a hay-and-horsehair mattress.

There, control of the president was seized by a quack with the incredible name of Dr. Doctor Willard Bliss. Dr. Doctor Bliss insisted on stuffing Garfield with heavy meals and alcohol, which brought on protracted waves of vomiting. He and his assistants went on probing the wound several times a day, causing infections that burrowed enormous tunnels of pus throughout the president's body.

Garfield's medical "care" is one of the most fascinating, if appalling, parts of Millard's narrative. Joseph Lister had been demonstrating for years how his theories on the prevention of infection could save lives and limbs, but American doctors largely ignored his advice, not wanting to "go to all the trouble" of washing hands and instruments, Millard writes, enamored of the macho trappings of their profession, the pus and blood and what they referred to fondly as the "good old surgical stink" of the operating room.

Further undermining the president's recovery was his sickroom in the White House -- then a rotting, vermin-ridden structure with broken sewage pipes. Outside, Washington was a pestilential stink hole; besides the first lady, four White House servants and Guiteau himself had contracted malaria. Hoping to save Garfield from the same, Bliss fed him large doses of quinine, causing more intestinal cramping.

The people rallied around their president even as his doctors failed him. The great Western explorer and geologist John Wesley Powell helped design Ameri­ca's first air-conditioning system to relieve Garfield's agony. Alexander Graham Bell worked tirelessly to invent a device that could locate the bullet. (It failed when Dr. Bliss insisted he search only the wrong side of Garfield's torso.) Two thousand people worked overnight to lay 3,200 feet of railroad track, so the president might be taken to a cottage on the Jersey Shore. When the engine couldn't make the grade, hundreds of men stepped forward to push his train up the final hill.

The president endured everything with amazing fortitude and patience, even remarking near the end, when he learned a fund was being taken up for his family: "How kind and thoughtful! What a generous people!"

"General Garfield died from malpractice," Guiteau claimed, defending himself at his spectacle of a trial. This was true, but not enough to save Guiteau from the gallows.



For the full review, see:

KEVIN BAKER. "Death of a President." The New York Times Book Review (Sun., October 2, 2011): 14-15.

(Note: the online version of the review has the date September 30, 2011, and has the title "The Doctors Who Killed a President.")


The full reference for the book under review, is:

Millard, Candice. Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President. New York: Doubleday, 2011.






September 8, 2012

People "Reward the Providers of Dangerously Misleading Information"



(p. 262) As Nassim Taleb has argued, inadequate appreciation of the uncertainty of the environment inevitably leads economic agents to take risks they should avoid. However, optimism is highly valued, socially and in the market; people and firms reward the providers of dangerously misleading information more than they reward truth tellers. One of the lessons of the financial crisis that led to the Great Recession is that there are periods in which competition, among experts and among organizations, creates powerful forces that favor a collective blindness to risk and uncertainty.

The social and economic pressures that favor overconfidence are not (p. 263) restricted to financial forecasting. Other professionals must deal with the fact that an expert worthy of the name is expected to display high confidence. Philip Tetlock observed that the most overconfident experts were the most likely to be invited to strut their stuff in news shows. Overconfidence also appears to be endemic in medicine. A study of patients who died in the ICU compared autopsy results with the diagnosis that physicians had provided while the patients were still alive. Physicians also reported their confidence. The result: "clinicians who were 'completely certain' of the diagnosis antemortem were wrong 40% of the time." Here again, expert overconfidence is encouraged by their clients: "Generally, it is considered a weakness and a sign of vulnerability for clinicians to appear unsure. Confidence is valued over uncertainty and there is a prevailing censure against disclosing uncertainty to patients." Experts who acknowledge the full extent of their ignorance may expect to be replaced by more confident competitors, who are better able to gain the trust of clients. An unbiased appreciation of uncertainty is a cornerstone of rationality--but it is not what people and organizations want. Extreme uncertainty is paralyzing under dangerous circumstances, and the admission that one is merely guessing is especially unacceptable when the stakes are high. Acting on pretended knowledge is often the preferred solution.



Source:

Kahneman, Daniel. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux, 2011.





August 25, 2012

Environmental "Witch-Hunt" Kills "Golden Rice"



(p. C4) Vitamin A deficiency affects the immune system, leading to illness and frequently to blindness. It probably causes more deaths than malaria, HIV or tuberculosis, killing as many people every single day as the Fukushima tsunami. It can be solved by eating green vegetables and meat, but for many poor Asians, who can afford only rice, that remains an impossible dream. To deal with the problem, "biofortification" with genetically modified food plants is 1/10th as costly as dietary supplements.

"Golden rice"--with two extra genes to make beta-carotene, the raw material for vitamin A--was a technical triumph, identical to ordinary rice except in color. Painstaking negotiations led to companies waiving their patent rights so the plant could be grown and regrown free by anybody.

Yet today, 14 years later, it still has not been licensed to growers anywhere in the world. The reason is regulatory red tape deliberately imposed to appease the opponents of genetic modification, which Adrian Dubock, head of the golden rice project, describes as "a witch-hunt for suspected theoretical environmental problems...[because] many activist NGOs thought that genetically engineered crops should be opposed as part of their anti-globalization agenda."

It is surprising to find that an effective solution to the problem consistently rated by experts as the poor world's highest priority has been stubbornly opposed by so many pressure groups supposedly acting on behalf of the poor.



For the full commentary, see:

MATT RIDLEY. "MIND & MATTER; Red Tape Hobbles a Harvest of Life-Saving Rice." The Wall Street Journal (Sat., May 18, 2012): C4.

(Note: ellipsis in original.)

(Note: the online version of the article has the date May 18, 2012.)






August 9, 2012

In Cancer Treatment "a Breakthrough Moment"?



(p. A1) CHICAGO--Medical science efforts to harness the power of the immune system against cancer are beginning to bear fruit after decades of frustration, opening up a hopeful new front in the long battle against the disease.

In studies being presented Saturday, researchers said two experimental drugs by Bristol-Myers Squibb Co. . . . significantly shrank tumors in some patients with advanced skin, lung and kidney cancers.

Especially promising was that the drugs worked against several types of cancer, researchers said of the early findings. Most of the patients whose tumors responded significantly to the treatment saw long-term results.


. . .


(p. A2) Taken together, the findings are provoking excitement among researchers and the drug industry that immunotherapy has finally arrived as a viable cancer-fighting strategy.

"Those of us in the field really see this as a breakthrough moment," said Suzanne Topalian, a researcher at Johns Hopkins School of Medicine and lead author of one of the studies. Both are being presented by Hopkins researchers at the annual meeting of the American Society of Clinical Oncology and published online by the New England Journal of Medicine.



For the full story, see:

RON WINSLOW. "New Cancer Drugs Use Body's Own Defenses." The Wall Street Journal (Sat., June 2, 2012): A1-A2.

(Note: ellipses added.)

(Note: the online version of the story has the date June 1, 2012.)





August 5, 2012

In Health Care, He Who Pays the Piper, Calls the Tune



(p. A15) Under the Bloomberg plan, any cup or bottle of sugary drink larger than 16 ounces at a public venue would be verboten, beginning early next year.


. . .


Here is the ultimate justification for the Bloomberg soft-drink ban, not to mention his smoking ban, his transfat ban, and his unsuccessful efforts to enact a soda tax and prohibit buying high-calorie drinks with food stamps: The taxpayer is picking up the bill.

Call it the growing chattelization of the beneficiary class under government health-care programs. Bloombergism is a secular trend. Los Angeles has sought to ban new fast-food shops in neighborhoods disproportionately populated by Medicaid recipients, Utah to increase Medicaid copays for smokers, Arizona to impose a special tax on Medicaid recipients who smoke or are overweight.



For the full commentary, see:

HOLMAN W. JENKINS, JR. "BUSINESS WORLD; The 5th Avenue to Serfdom; Nobody thought about taking away your Big Gulp until the government began to pay for everyone's health care." The Wall Street Journal (Sat., June 2, 2012): A15.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date June 1, 2012.)





August 4, 2012

Veterinarians Can Suggest Innovative Hypotheses to Doctors



ZoobiquityBK2012-08-01.jpg














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





Vets face less government regulation and so are freer to rapidly innovate. They may thus be a promising source of innovative hypotheses for medical doctors.


(p. D2) Cardiologist Barbara Natterson-Horowitz made her first foray into the world of animal medicine when she was asked to treat Spitzbuben, an exceedingly cute emperor tamarin suffering from heart failure.

But first, the veterinarian at the Los Angeles Zoo warned Dr. Natterson-Horowitz: Mere eye contact with the tiny primate could trigger a potentially fatal surge of stress hormones. What she learns from that experience spurs a journey to examine the links between the human and animal condition--and the discovery that the species are closer than she ever imagined.


. . .


The authors recommend that doctors, who often look with disdain on veterinarians, go the next step and collaborate with them in a cross-disciplinary "zoobiquitous" approach--using knowledge about how animals live, die and heal to spark innovative hypothesis for advancing medicine.



For the full review, see:

LAURA LANDRO. "Healthy Reader." The Wall Street Journal (Tues., June 12, 2012): D2.

(Note: ellipsis added.)

(Note: the online version of the review has the date June 11, 2012.)


The book being reviewed, is:

Natterson-Horowitz, Barbara, and Kathryn Bowers. Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing. New York: Alfred A. Knopf, 2012.





August 1, 2012

Take U.S.D.A. and C.D.C. Advice with a Grain of Salt



(p. 8) When I spent the better part of a year researching the state of the salt science back in 1998 -- already a quarter century into the eat-less-salt recommendations -- journal editors and public health administrators were still remarkably candid in their assessment of how flimsy the evidence was implicating salt as the cause of hypertension.

"You can say without any shadow of a doubt," as I was told then by Drummond Rennie, an editor for The Journal of the American Medical Association, that the authorities pushing the eat-less-salt message had "made a commitment to salt education that goes way beyond the scientific facts."

While, back then, the evidence merely failed to demonstrate that salt was harmful, the evidence from studies published over the past two years actually suggests that restricting how much salt we eat can increase our likelihood of dying prematurely. Put simply, the possibility has been raised that if we were to eat as little salt as the U.S.D.A. and the C.D.C. recommend, we'd be harming rather than helping ourselves.


. . .


When researchers have looked at all the relevant trials and tried to make sense of them, they've continued to support Dr. Stamler's "inconsistent and contradictory" assessment. Last year, two such "meta-analyses" were published by the Cochrane Collaboration, an international nonprofit organization founded to conduct unbiased reviews of medical evidence. The first of the two reviews concluded that cutting back "the amount of salt eaten reduces blood pressure, but there is insufficient evidence to confirm the predicted reductions in people dying prematurely or suffering cardiovascular disease." The second concluded that "we do not know if low salt diets improve or worsen health outcomes."


. . .


(p. 9) A 1972 paper in The New England Journal of Medicine reported that the less salt people ate, the higher their levels of a substance secreted by the kidneys, called renin, which set off a physiological cascade of events that seemed to end with an increased risk of heart disease. In this scenario: eat less salt, secrete more renin, get heart disease, die prematurely.

With nearly everyone focused on the supposed benefits of salt restriction, little research was done to look at the potential dangers. But four years ago, Italian researchers began publishing the results from a series of clinical trials, all of which reported that, among patients with heart failure, reducing salt consumption increased the risk of death.

Those trials have been followed by a slew of studies suggesting that reducing sodium to anything like what government policy refers to as a "safe upper limit" is likely to do more harm than good. These covered some 100,000 people in more than 30 countries and showed that salt consumption is remarkably stable among populations over time.


. . .


One could still argue that all these people should reduce their salt intake to prevent hypertension, except for the fact that four of these studies -- involving Type 1 diabetics, Type 2 diabetics, healthy Europeans and patients with chronic heart failure -- reported that the people eating salt at the lower limit of normal were more likely to have heart disease than those eating smack in the middle of the normal range. Effectively what the 1972 paper would have predicted.


. . .


Maybe now the prevailing beliefs should be changed. The British scientist and educator Thomas Huxley, known as Darwin's bulldog for his advocacy of evolution, may have put it best back in 1860. "My business," he wrote, "is to teach my aspirations to conform themselves to fact, not to try and make facts harmonize with my aspirations."



For the full commentary, see:

GARY TAUBES. "OPINION; Salt, We Misjudged You." The New York Times, SundayReview Section (Sun., June 3, 2012): 8-9.

(Note: ellipses added.)

(Note: the online version of the commentary has the date June 2, 2012.)







July 29, 2012

Neural Implants "Restored Their Human Functionality"



KurzweilRay2012-07-28.jpg




Ray Kurzweil. Source of photo: online version of the WSJ article quoted and cited below.






(p. C12) Inventor and entrepreneur Ray Kurzweil is a pioneer in artificial intelligence--the principal developer of the first print-to-speech reading machine for the blind, and the first text-to-speech synthesizer, among other breakthroughs. He is also a writer who explores the future of information technology and how it is changing our world.

In a wide-ranging interview, Mr. Kurzweil and The Wall Street Journal's Alan Murray discussed advances in artificial intelligence, nanotechnology, and what it means to be human. Here are edited excerpts of their conversation:


. . .


MR. MURRAY: What about life expectancy? Is there a limit?

MR. KURZWEIL: No. We're constantly pushing back life expectancy. Now it's going to go into high gear because of the inherent exponential progression of information technology. According to my models, within 15 years we'll be adding more than a year to your remaining life expectancy each year.

MR. MURRAY: So if you play the odds right, you never hit the endpoint.

MR. KURZWEIL: Right. If you can hang in there for another 15 years, we could get to that point.


What Is Human?

MR. MURRAY: What does it mean to be human in a post-2029 world?

MR. KURZWEIL: It's a slippery slope. But we've already gone down that slope. I've talked to people who have neural implants in their brain, for Parkinson's, and I've asked them, "Are you still human? Are you less human?"

Generally speaking, they say, "It's part of me." And they're very proud of it, because it restored their human functionality.



For the full interview, see:

Alan Murray, interviewer. "Man or Machine? Ray Kurzweil on how long it will be before computers can do everything the brain can do." The Wall Street Journal (Fri., June 29, 2012): C12.

(Note: ellipsis added; bold in original.)






July 9, 2012

Bicyclists Create Negative Externalities for Pedestrians



BicyclistsSanFrancisco2012-06-22.jpg "Bicyclists weave through pedestrians and motor traffic on Friday in San Francisco, where a fatal bike-pedestrian collision has sparked debate." Source of caption and photo: online version of the WSJ article quoted and cited below.


(p. A3) SAN FRANCISCO--City prosecutors said they would file felony vehicular-manslaughter charges against a bicyclist who allegedly hit and killed a pedestrian, in a case that has become a flash point for debate over bicyclists' rights in the city.

The manslaughter charges--unusually stiff for a bicycle accident--stem from a March 29 incident, when 36-year-old bicyclist Chris Bucchere allegedly ran a red traffic light and plowed into 71-year-old Sutchi Hui in a crosswalk. Mr. Hui died April 2 of injuries related to the collision.


. . .


The bicycle backlash has come to a head after a series of pedestrian deaths in the San Francisco Bay area. A 67-year-old woman died last August after a bicyclist allegedly hit her in a crosswalk after running a red light; the cyclist was convicted of a misdemeanor. Earlier this month, a cyclist allegedly struck and killed a 92-year-old woman in the suburb of El Cerrito while crossing a street; that case is under investigation.



For the full story, see:

JIM CARLTON. "U.S. NEWS; Reckless Riders Spur Backlash; Fatal Collision in San Francisco Leads to Manslaughter Charges Against Cyclist." The Wall Street Journal (Sat., June 16, 2012): A3.

(Note: ellipsis added.)






July 4, 2012

93% of Donated Eyeglasses Are Not Usable



(p. D6) Giving used eyeglasses to poor countries may please the donors, but it is not worth the high delivery costs, a new study has concluded, and a $10 donation would do more good.

The study, led by Australian scientists and published in March in Optometry and Vision Science, found that only 7 percent of a test sample of 275 donated spectacles were usable. That raised the delivery cost to over $20 per usable pair. A simple eye exam and a set of ready-made glasses from China can be provided for just $10, the authors said.



For the full story, see:

DONALD G. McNEIL Jr. "GLOBAL UPDATE; Donations for Eyeglasses in Poor Nations Are Better Than Recycling Used Pairs." The New York Times (Tues., April 24, 2012): D6.

(Note: the online version of the article has the date April 23, 2012.)


(Note: a more extended analysis of this example appears in an online article by Virginia Postrel. I am grateful for Dale Eesley for sending me a link to Postrel's article.)






June 17, 2012

Same Government that Allows Violence, Prioritizes Taxing Soda



BoozeCourtlandRichmondCityCouncil2012-06-11.jpg "One vocal opponent of the tax is Courtland Boozé, a City Council member who calls it a hardship on poor people." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. 14) Even here at a sweaty Zumba class sponsored by a nonprofit group called Weigh of Life, the city's proposal for a one-cent-per-ounce tax on sugar-sweetened beverages, which is to appear on the November ballot, meets up against the hard realities of residents' lives.

"What don't I have?" asked Rita Cerda, a longtime soda devotee, ticking off her ailments, including diabetes, high blood pressure and asthma. She is also overweight.

"I have problems drinking water," she said. "I don't like water."

The proposed tax, a license fee on businesses selling sweetened drinks, would require owners of bodegas, theaters, convenience stores and other outlets to tally ounces sold and, presumably, pass the cost on to customers.


. . .


Courtland Boozé is a City Council member and a vocal opponent of the soda tax. "We are primarily an economically suppressed community," he said. "It will be a huge hardship.

"I eat sweet potato pie and candied yams," continued Mr. Boozé, who is from Louisiana. "And what about cupcakes? Are they going to tax those?"

The city's Chamber of Commerce is also opposed to the tax. A group fighting the tax that includes the beverage industry has begun dropping off "Community Coalition Against Beverage Taxes" placards at La Flore de Jalisco Market, a small, cheerful grocery store where soda bottles in dozens of hues match the colorful piñatas hanging from the ceiling.


. . .


Charles Finnie, known as Chuck, a vice president of BMWL, a San Francisco lobbying firm, called the tax "an administrative nightmare for local businesses" that would also put them at a competitive disadvantage, with customers opting for cheaper soda in nearby cities.


. . .


At the RYSE Youth Center, founded 12 years ago after the killing of four high school students, the soda issue seemed both close to the heart and far away.

Kayla Miller, an 18-year-old college freshman, said that if complexion problems from too much sugar would not deter her friends from drinking sodas, neither would a tax.

Shivneel Sen, 14, does not favor the tax but knows how the money should be spent if it passes.

"The police came heck of late," he said, recalling the recent death of a best friend. "We need more of them."

Kimberly Aceves, the center's executive director, says that too often, the burden for making healthy choices falls unfairly on young people. Society may say "go exercise," she said, "but if the community isn't safe, how many kids are going to go out running?"

"Soda is bad for you," Ms. Aceves said. "So is violence."



For the full story, see:

PATRICIA LEIGH BROWN. "RICHMOND JOURNAL; Plan to Tax Soda Gets a Mixed Reception." The New York Times, First Section (Sun., June 3, 2012): 14.

(Note: ellipses added.)

(Note: the online version of the article has the date June 2, 2012.)






June 11, 2012

For Federal Regulators "It's Easier Not to Approve than to Approve"



LauthXavierAquacultureScientist2012-06-04.jpg "Xavier Lauth, a scientist, working with zebra fish in a lab at the Center for Aquaculture Technologies." Source of caption and photo: online version of the NYT article quoted and cited below.



(p. B1) SAN DIEGO -- If Americans ever eat genetically engineered fast-growing salmon, it might be because of a Soviet biologist turned oligarch turned government minister turned fish farming entrepreneur.

That man, Kakha Bendukidze, holds the key to either extinction or survival for AquaBounty Technologies, the American company that is hoping for federal approval of a type of salmon that would be the first genetically engineered animal in the human food supply.

But 20 months since the Food and Drug Administration tentatively concluded that the fish would be safe to eat and for the environment, there has been no approval. And AquaBounty is running out of money.

Mr. Bendukidze, the former economics minister of Georgia and AquaBounty's largest shareholder, says the company can stay afloat a while longer. But he is skeptical that genetically altered salmon will be approved in the United States in an election year, given the resistance from environmental and consumer groups.

"I understand politically that it's easier not to approve than to approve," Mr. Bendukidze said during a recent visit to a newly acquired laboratory in San Diego, where jars of tiny zebra fish for use in genetic engineering experiments are stacked on shelves. While many people would be annoyed by the approval, he said, "There will be no one except some scientists who will be annoyed if it is not approved."


. . .


(p. B6) Mr. Bendukidze, 56, began his career as a molecular biologist in a research institute outside Moscow, working on genetically engineering viruses for vaccine use. He later started a company selling biology supplies. When parts of the Soviet economy were privatized, he earned a reputation as a corporate raider, building through acquisitions and leading United Heavy Machinery, a large maker of equipment for mining, oil drilling and power generation.

In 2004, Mr. Bendukidze returned to his native Georgia as economics minister under Mikheil Saakashvili, the newly elected president. With a free-market philosophy and a penchant for insulting those who disagreed with him, Mr. Bendukidze earned his share of enemies as he moved to deregulate and privatize the economy.

He still lives in Georgia and now spends his time as chairman of the Free University of Tbilisi, which he founded. He also set up Linnaeus Capital Partners to manage his money. It has increasingly focused on aquaculture, with stakes in companies in Greece, Israel and Britain, in addition to AquaBounty.



For the full story, see:

ANDREW POLLACK. "An Entrepreneur Bankrolls a Genetically Engineered Salmon." The New York Times (Tues., May 22, 2012): B1 & B6.

(Note: ellipsis added.)

(Note: the online version of the article has the date May 21, 2012.)



BendukidzeKakhaEntrepreneur2012-06-04.jpg "Kakha Bendukidze acquired the lab after agreeing to give AquaBounty more cash." Source of caption and photo: online version of the NYT article quoted and cited above.






June 7, 2012

Rats, Motivated by Cheese, and Stimulated by Electricity and Chemicals, Grow Neurons and Walk Again



RatSpineInjuryExperiment2012-06-04.jpg "After several weeks of neurorehabilitation, previously paralyzed rats initiated a walking gait and soon began sprinting, climbing stairs and avoiding obstacles." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A13) Rats with a spinal cord injury that left their hind legs completely paralyzed learned to walk again on their own after an intensive training course that included electrical stimulation of the brain and the spine, scientists reported on Thursday.


. . .


The report, published online on Thursday in the journal Science, provides a striking demonstration of what until recently few scientists thought possible: complete rehabilitation after a disabling blow to the spinal cord. After weeks of training, many of the rats could walk as well as before the injury, and some could run.


. . .


The rats then began a daily regimen. Outfitted with tiny vests, held upright on their back legs but left to bear their full weight, the rats tried to move toward a piece of cheese that beckoned nearby. They lurched forward like furry paratroopers, unsteady on their feet after a hard landing.

The scientists provided stimulation in three places: electrically, in the motor area of the brain and in the spinal cord below the injury, and chemically, infusing the wound area with drugs thought to promote growth.

And growth is what they got. After two to three weeks of 30-minute daily sessions, the rats began to take their first voluntary steps. After six weeks, all of the rats could walk on their own, and some could run and climb stairs.


. . .


In effect, . . . , the training forces the brain to recruit what is left of the neural system to get the job done. Neurons sprout like seedlings on a Chia Pet when they are seeking new connections, and the scientists found increases of 300 percent and more in projections in the brain stem and around the injury -- evidence that the nervous system was remapping its connections.



For the full story, see:

BENEDICT CAREY. "In Rat Experiment, New Hope for Spine Injuries." The New York Times (Fri., June 1, 2012): A13.

(Note: online version of the story is dated May 31, 2012.)






May 1, 2012

Global Warming Would Reduce Deaths from Flu



(p. 4) According to the National Oceanic and Atmospheric Administration, this January was the fourth warmest in the documented history of weather in the contiguous United States.


. . .


. . . , our warm winter may have one unforeseen and felicitous consequence: a drastic reduction in the incidence of influenza.


. . .


This year's flu season, . . . , didn't officially begin until late last month. And while a true number is difficult to reach -- not every sick person is tested, for instance, and the cause of a death in the hospital can be clouded by co-morbidities -- it is likely that no more than a few hundred people in America, and possibly far fewer, have died of the flu this winter. Indeed, by any measurement, the statistics are historic and heartening. For every individual who has been hospitalized this season, 22 people were hospitalized in the 2010-11 flu season. Even more strikingly, 122 children died of flu last season and 348 during the flu outbreak of 2009-10 -- while this time around that number is 3.



For the full commentary, see:

CHARLES FINCH. "OPINION; The Best Part About Global Warming." The New York Times (Tues., March 4, 2012): 4.

(Note: ellipses added.)

(Note: the online version of the review is dated March 2, 2012.)





April 14, 2012

Libertarian Law Professor Defends Free Choice in Health Care



BarnettRandyLibertarianLawProfessor2012-03-31.jpg





"Randy E. Barnett has argued against the health care law." Source of caption and photo: online version of the NYT article quoted and cited below.




(p. A1) WASHINGTON -- When Congress passed legislation requiring nearly all Americans to obtain health insurance, Randy E. Barnett, a passionate libertarian who teaches law at Georgetown, argued that the bill was unconstitutional.


. . .


. . . over the past two years, through his prolific writings, speaking engagements and television appearances, Professor Barnett has helped drive the question of the health care law's constitutionality from the fringes of academia into the mainstream of American legal debate and right onto the agenda of the United States Supreme Court.


. . .


. . . the challenge championed by Professor Barnett: that Congress's power to set rules for commerce does not extend to regulating "inactivity," like choosing not to be insured.


. . .


(p. A14) He is a fierce advocate of economic freedom who is accustomed to being a legal underdog. In 2004, in his first (and, he says, probably his last) appearance before the Supreme Court, he argued that Congress could not criminalize the production of home-grown marijuana for personal medical use. There again, critics said he would lose 8 to 1. He did lose, but took satisfaction in the actual vote, 6 to 3.


. . .


Professor Barnett's work on the health care law fits into a much broader intellectual project, his defense of economic freedom. He has long argued that the Supreme Court went too far in upholding New Deal economic laws -- a position that concerns his liberal critics.

Even a close friend and fellow Georgetown law professor, Lawrence B. Solum, says that Professor Barnett is aware of the "big divide between his views and the views of lots of other people," and that his political philosophy is "much more radical" than his legal argument in the health care case. Professor Barnett, for his part, insists that if the health law is struck down, it will not "threaten the foundation of the New Deal." But, he allowed, it would be "a huge symbolic victory for limited government."



For the full story, see:

SHERYL GAY STOLBERG and CHARLIE SAVAGE. "Libertarian's Pet Cause Reaches Supreme Court." The New York Times (Tues., March 27, 2012): A1 & A14.

(Note: ellipses added.)

(Note: the online version of the story is dated March 26, 2012 and has the title "Vindication for Challenger of Health Care Law.")





March 31, 2012

Quantum Computers May Revolutionize Nanotechnology and Drug Design



AaronsonScottMIT201-03-11.jpg










"Scott Aaronson." Source of caption and photo: online version of the NYT commentary quoted and cited below.




(p. D5) When people hear that I work on quantum computing -- one of the most radical proposals for the future of computation -- their first question is usually, "So when can I expect a working quantum computer on my desk?" Often they bring up breathless news reports about commercial quantum computers right around the corner. After I explain the strained relationship between those reports and reality, they ask: "Then when? In 10 years? Twenty?"

Unfortunately, this is sort of like asking Charles Babbage, who drew up the first blueprints for a general-purpose computer in the 1830s, whether his contraption would be hitting store shelves by the 1840s or the 1850s. Could Babbage have foreseen the specific technologies -- the vacuum tube and transistor -- that would make his vision a reality more than a century later? Today's quantum computing researchers are in a similar bind. They have a compelling blueprint for a new type of computer, one that could, in seconds, solve certain problems that would probably take eons for today's fastest supercomputers. But some of the required construction materials don't yet exist.


. . .


While code-breaking understandably grabs the headlines, it's the more humdrum application of quantum computers -- simulating quantum physics and chemistry -- that has the potential to revolutionize fields from nanotechnology to drug design.


. . .


Like fusion power, practical quantum computers are a tantalizing possibility that the 21st century may or may not bring -- depending on the jagged course not only of science and technology, but of politics and economics.



For the full commentary, see:

SCOTT AARONSON. "ESSAY; Quantum Computing Promises New Insights, Not Just Supermachines." The New York Times (Tues., December 6, 2011): D5.

(Note: ellipses added.)

(Note: the online version of the commentary is dated December 5, 2011.)





March 25, 2012

Purging Senescent Cells Makes Mice More Youthful and Vigorous



SubdermalFatInMousePurgedOfSenescentCells2012-03-10.jpg




"CELL SUICIDE. A subdermal fat layer, middle, in a mouse purged of senescent cells. These mice can run much longer and have larger fat deposits." Source of caption and photo: online version of the NYT article quoted and cited below.





(p. D3) Until recently, few people gave much thought to senescent cells. They are cells that linger in the body even after they have lost the ability to divide.

But on Nov. 2, in what could be a landmark experiment in the study of aging, researchers at the Mayo Clinic reported that if you purge the body of its senescent cells, the tissues remain youthful and vigorous.


. . .


. . . the startling result is plausible because it ties together an emerging body of knowledge about senescent cells. And it raises the possibility that attacks on the cells might postpone the diseases of aging and let people live out more of their life span in good health.


. . .


The finding was made in a strain of mice that age fast and usually die of heart arrhythmia. So despite their healthier tissues, the mice purged of senescent cells died at the usual age of heart problems. Dr. van Deursen's team is now testing to see whether normal mice will live longer when purged of senescent cells.

The treatment was started when the normal mice were a year old, and they have now been treated for five months. Next month they will run treadmill tests to see if they are in better shape than a comparison group of untreated mice, Dr. van Deursen said.

The genetic method used to purge mice of senescent cells cannot be used in people. Instead of trying to remove senescent cells from elderly people, Dr. Peeper believes, it may be more effective to identify which of the factors that the senescent cells secrete are the source of their ill effects and to develop drugs that block these factors.

But Dr. van Deursen thinks it would be better to go after the senescent cells themselves. In his view it should be easy enough by trial and error to find chemicals that selectively destroy senescent cells, just like the targeted chemicals now used to treat certain kinds of cancer. And unlike the cancer cells, which proliferate so fast that they soon develop resistance, the senescent cells cannot replicate, so they should be easy targets.

Several companies and individuals have already approached the Mayo Clinic to explore developing such drugs. "They think it's possible, and they are very enthusiastic," Dr. van Deursen said. "So I can guarantee that there will be initiatives to find drugs that kill senescent cells and mimic the system that we have developed in the mouse."


. . .


"If you remove the senescent cells you improve things considerably, but you can't reverse the process or completely stop the aging because it has other causes," Dr. van Deursen said. "Personally I think we can slow aging down, and over time we will become more and more successful.



For the full story, see:

NICHOLAS WADE. "In Body's Shield Against Cancer, a Culprit in Aging May Lurk." The New York Times (Tues., November 22, 2011): D3.

(Note: ellipses added.)

(Note: the online version of the story is dated November 21, 2011.)





March 18, 2012

Simple Heuristics Can Work Better than Complex Formulas



(p. C4) Most business people and physicians privately admit that many of their decisions are based on intuition rather than on detailed cost-benefit analysis. In public, of course, it's different. To stand up in court and say you made a decision based on what your thumb or gut told you is to invite damages. So both business people and doctors go to some lengths to suppress or disguise the role that intuition plays in their work.

Prof. Gerd Gigerenzer, the director of the Max Planck Institute for Human Development in Berlin, thinks that instead they should boast about using heuristics. In articles and books over the past five years, Dr. Gigerenzer has developed the startling claim that intuition makes our decisions not just quicker but better.


. . .


The economist Harry Markowitz won the Nobel prize for designing a complex mathematical formula for picking fund managers. Yet when he retired, he himself, like most people, used a simpler heuristic that generally works better: He divided his retirement funds equally among a number of fund managers.

A few years ago, a Michigan hospital saw that doctors, concerned with liability, were sending too many patients with chest pains straight to the coronary-care unit, where they both cost the hospital more and ran higher risks of infection if they were not suffering a heart attack. The hospital introduced a complex logistical model to sift patients more efficiently, but the doctors hated it and went back to defensive decision-making.

As an alternative, Dr. Gigerenzer and his colleagues came up with a "fast-and-frugal" tree that asked the doctors just three sequential yes-no questions about each patient's electrocardiographs and other data. Compared with both the complex logistical model and the defensive status quo, this heuristic helped the doctors to send more patients to the coronary-care unit who belonged there and fewer who did not.



For the full commentary, see:

By MATT RIDLEY. "MIND & MATTER; All Hail the Hunch--and Damn the Details." The Wall Street Journal (Sat., December 24, 2011): C4.

(Note: ellipsis added.)


A couple of Gigerenzer's relevant books are:

Gigerenzer, Gerd. Gut Feelings: The Intelligence of the Unconscious. New York: Penguin Books, 2007.

Gigerenzer, Gerd. Rationality for Mortals: How People Cope with Uncertainty. New York: Oxford University Press, USA, 2008.





February 22, 2012

Adipotide Kills Fat Cells in Obese Mice and Monkeys



AdipotideObesityGraphic2012-02-05.jpg











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


(p. A6) A drug that kills a type of fat cell by choking off its blood supply caused significant weight loss in obese monkeys, potentially setting the stage for a new pharmaceutical approach to attacking obesity, according to a study released Wednesday.

After four weeks of treatment, obese monkeys given daily injections of the drug, called adipotide, lost an average of 11% of their body weight. They also had big reductions in waist circumference and body-mass index and, importantly, striking improvement in their ability to process insulin, researchers said. The drug had no effect on weight when given to lean monkeys.

Results of the study, performed at M.D. Anderson Cancer Center in Houston and published online by the journal Science Translational Medicine, confirmed a 2004 report from the same research team showing marked weight loss in mice treated with the agent.


. . .


The researchers' 2004 paper showing a 30% weight loss in obese mice drew skepticism. Randy J. Seeley, director of the diabetes and obesity center at the University of Cincinnati, figured destroying white fat cells would make animals--and people--sick. But his own lab eventually replicated the mouse study, using rats instead, and now he is intrigued.

"This is really new stuff," Dr. Seeley said of the latest results. "There's no way to know if this will become a therapy or not, but at least it opens up a new way to think about therapies, and we have not had a lot of those." He isn't involved with the research.



For the full story, see:

RON WINSLOW. "Drug Offers Hope in Obesity Fight; Treatment Targeting Fat Cells Caused Significant Weight Loss in Monkeys; Human Trials to Begin Soon." The Wall Street Journal (Thurs., November 10, 2011): A6.

(Note: ellipsis added.)

(Note: the last two sentences quoted above appeared in the online, but not the print, version of the article.)




ObeseMonkeyLostWeight2012-02-06.jpg "One of the monkeys used in the study. Obese monkeys lost an average of 11% of their body weight after four weeks of treatment." Source of caption and photo: online version of the WSJ article quoted and cited above.






February 10, 2012

Creative Destruction Helps Us Be Well



CreativeDestructionOfMedicine2012-02-04.jpg










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








Dr. Eric Topol's credible and thought-provoking comments on the over-use of stents appeared in entries in this blog in August 2006 and in December 2006.



(p. A15) "The U.S. government has been preoccupied with health care 'reform,' but this refers to improving access and insurance coverage and has little or nothing to do with innovation," even though, as Dr. Topol notes, adopting new approaches would improve care and lower costs. . . .


. . .


"The Creative Destruction of Medicine"--an allusion to economist Joseph Schumpeter's description of "creative destruction" as an engine of business innovation--is a venture capitalist's delight, describing dozens of medical technologies that show great promise. The book also provides colorful anecdotes about Dr. Topol's own sampling of these products, as both a doctor and stand-in patient.


. . .


. . . , full adoption of the new tools will require the Food and Drug Administration to alter the way it evaluates products. The FDA, he says, should allow the testing of drugs on patients who are selected for their prospect of deriving a benefit. Right now, the FDA usually requires drugs to be tested in a scattershot fashion on large populations. With drugs being tested on cancer patients, he notes, the "FDA insists on a body count to be able to quantify how much and how long the new drug improves survival"--even though diagnostic markers can sometimes reveal in advance which patients are unlikely to gain a benefit.

Dr. Topol worries that doctors will resist technologies that empower patients because the tools will also diminish the doctors' gatekeeper role. The American Medical Association, for example, battled firms that provide genetic information directly to patients. "This arrangement ultimately appears untenable," the author writes, "and eventually there will need to be full democratization of DNA for medicine to be transformed."



For the full review, see:

SCOTT GOTTLIEB. "BOOKSHELF; Digital Doctoring; It's hard to fake sleep to avoid your spouse's bedtime chatter when a 'Zeo clock' is displaying your real-time brain waves." The Wall Street Journal (Fri., February 3, 2012): A15.

(Note: ellipses added.)

(Note: the online version of the review has the title "BOOKSHELF; Digital Doctoring; The digital revolution can spur unprecedented advances in the medical sciences, argues Eric Topol in "The Creative Destruction of Medicine".")



The book under review is:

Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.






February 8, 2012

Stem Cell Therapy for Dry Macular Degeneration



SchwartzStevenRetinaSpecialist2012-01-30.jpg

"Dr. Steven Schwartz, a retina specialist at the University of California, Los Angeles, conducted the trial with two patients." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. B7) LOS ANGELES -- A treatment for eye diseases that is derived from human embryonic stem cells might have improved the vision of two patients, bolstering the beleaguered field, researchers reported Monday.

The report, published online in the medical journal The Lancet, is the first to describe the effect on patients of a therapy involving human embryonic stem cells.


. . ..


Both patients, who were legally blind, said in interviews that they had gains in eyesight that were meaningful for them. One said she could see colors better and was able to thread a needle and sew on a button for the first time in years. The other said she was able to navigate a shopping mall by herself.


. . .


. . . , researchers at Advanced Cell Technology turned embryonic stem cells into retinal pigment epithelial cells. Deterioration of these retinal cells can lead to damage to the macula, the central part of the retina, and to loss of the straight-ahead vision necessary to recognize faces, watch television or read.

Some 50,000 of the cells were implanted last July under the retinas in one eye of each woman in operations that took about 30 minutes.

One woman, Sue Freeman, who is in her 70s, suffered from the dry form of age-related macular degeneration, a leading cause of severe vision loss in the elderly.




For the full story, see:

ANDREW POLLACK. "Stem Cell Treatment for Eye Diseases Shows Promise." The New York Times (Thurs., January 26, 2012): B7.

(Note: ellipses added.)

(Note: the online version of the article was dated January 25, 2012.)



FreemanSueVisionImproved2012-01-30.jpg

"Sue Freeman said her vision improved in a meaningful way after the treatment, which used embryonic stem cells." Source of caption and photo: online version of the NYT article quoted and cited above.








January 23, 2012

California Vegan Defends Freedom to Choose McDonald's



WarehamEllsworthVegan2012-01-21.jpg "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.)






December 29, 2011

The Case Against Fluoridating Public Water Supplies



(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.)






December 26, 2011

Bright Prospects for Longer Life



100BK.jpg












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.






December 18, 2011

When Christopher Hitchens Will Visit Nebraska



HitchensChristopherAfterTreatment2011-11-10.jpg











"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.)






December 7, 2011

Some Traits (Including Some Diseases) Depend on Many Genes Rather than a Single Gene



(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.)






November 29, 2011

Global Warming Reduces Bubonic Plague in U.S.



(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.)





November 25, 2011

Chocolate Reduces Risk of Cardiovascular Disorder by 37%



(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.)





November 24, 2011

"What Happens in America Is Defined by Tort Lawyers"



JungleGymRelic2011-11-09.jpg "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?.")





November 23, 2011

No Evidence that Parents Were Ever Indifferent to the Well-Being of Their Children



(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.)





November 21, 2011

Increase in Cholera Not Caused by Global Warming



(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.)





November 19, 2011

"The World Before the Modern Era Was Overwhelmingly a Place of Tiny Coffins"



(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.





November 18, 2011

Black Death Microbe Same as in Middle Ages But Now Does Much Less Harm



LondonMedievalMap2011-11-07.jpg







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.)





November 6, 2011

Of Mice and Men and Health and Longevity



MiceSenescentCells2011-11-04.jpg"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.





October 28, 2011

"A Landmark Achievement for Regenerative Medicine"



TracheaMadeInLab2011-08-09.jpg "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.





October 22, 2011

Easter Island Was Ravaged by Rats, Peruvian Slaving Parties and Nonnative Diseases, Not by Ecocide



Statues-That-WalkedBK.jpg















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.





October 18, 2011

"It's Our Right to Choose What We Want to Put in Our Bodies"



FoodSovereigntySign2011-08-06.jpg "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.)





October 17, 2011

The Lancet Accused Snow of Being "in the Pocket of Business Interests"




(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.)





October 13, 2011

Only John Snow Saw Flaw in Miasma Theory




(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.





October 5, 2011

In Middle Ages "Nearly Everyone Itched Nearly All the Time"




(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.)





September 29, 2011

McKinsey Finds 30% of Employers Will Drop Health Coverage in Response to Obamacare



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.






September 21, 2011

Coralville Police Close 4-Year-Old Abigail's Lemonade Stand



(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.")






September 19, 2011

John Crandon Proved Scurvy Caused by Lack of Vitamin C




(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.)





September 17, 2011

Study Finds No Link Between Cellphones and Cancer



(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.






September 15, 2011

Obstacles to Curing Scurvy: A Deadly Experiment and Putting Theory Before Evidence




(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.





August 31, 2011

The Victimless Crime of Selling Rice Wine



IllegalRiceWine2011-08-07.jpg "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.)






August 25, 2011

Drug from David Sinclair's Sirtris Start-Up Lengthens Life of Obese Mice



MiceLiveLonger2011-08-19.jpg"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.)







August 11, 2011

"The Government Wants to Decide What We Eat"



PuddingBannedDenmark2011-07-19.jpg "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.)






August 7, 2011

Theft of Elderly Woman's Air Conditioner Called "Murder"







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.






August 2, 2011

Refuting Claims of Bread Adulteration




(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.)





July 31, 2011

Findings "Strongly Suggest" Cholera in Haiti Due to United Nations



(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.





July 29, 2011

Resistance to New Technology




(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.)





July 21, 2011

"People Condemned to Short Lives and Chronic Hardship Are Perhaps Unlikely to Worry Overmuch about Decor"




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.





July 17, 2011

Medieval Halls of the Rich Incubated Plague in a Nest of "Filth Unmentionable"




(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.





July 12, 2011

In Medicine, as Elsewhere, What Pays Is Usually What Gets Done



LevinDonaldPsychiatrist2011-06-05.jpg ""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.)





July 11, 2011

Warm Yourself Over a "Dung Fire, and You Will Know What Pollution Really Is"



(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.)






June 30, 2011

Laron Syndrome Villagers Free of Cancer and Diabetes, Suggesting Longevity Breakthrough



LoranSyndromeCancerDiabetesGraphic2011-06-05.jpg











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.")



LoranSyndromeManAndChildren2011-06-05.jpg









"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.






June 16, 2011

The Secret to a Long Life Is Conscientiousness



LongevityProjectBK.jpg











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.






May 21, 2011

Feds Finally Admit Some Children Harmed by High Fluoridated Water Mandates



FluorisisChart2011-05-19.jpg
















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 Wall Street Journal (Sat., JANUARY 8, 2011): A3.

(Note: ellipses added.)






May 17, 2011

Patients Face Higher Costs and Less Innovation Due to FDA



CongerMartiDiskImplant2011-05-16.jpg"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.)





ArtificialDisk2011-05-16.jpg







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





May 10, 2011

Mexican Universal Health Care: "There Are No Doctors, No Medicine, No Hospital Beds"



(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.)





May 7, 2011

Nanotechnology Zaps Dangerous Superbug



MRSAcellBeforeNanoZap2011-04-25.jpg "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.)



MRSAcellAfterNanoZap2011-04-25.jpg"What's left of the cell after getting zapped." Source of caption and photo: online version of the WSJ article quoted and cited above.







April 27, 2011

45% of Mummies Had Heart Disease



MummyCTscan2011-04-25.jpg
"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.





April 26, 2011

The Elite Feel More Important, and Receive More Funding, During Crises



(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.








April 16, 2011

To Paul Ryan, More Market Incentives in Health Care Would Reduce Costs and Improve Care



(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.")






April 4, 2011

Father of Cornhusker Kickback Is Named "2010 Porker of the Year"



(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.)





March 12, 2011

The Dangers from Disease Are Much Greater than the Dangers from Vaccines



Offit-Deadly-ChoicesBK.jpg














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.






February 12, 2011

"Powerful Pressure for Scientists to Conform"



HypingHealthRisksBK2011-02-05.jpg













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.





January 31, 2011

Feds Protect Us from Freshly Baked Cookies



MastersElementaryBakeSale2011-01-30.jpg
"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.






January 25, 2011

Cuban Government Gets Billions by "Exporting" Doctors; Some Defect



RamirezFelixCubanDoctor2011-01-21.jpg "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.


CubanDefectingDoctorsGraph2011-01-21.jpg















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







January 15, 2011

Higher Cancer Rates Due More to Longer Life Spans than to Modern Life Styles



PrehistoricSkullCancer2011-01-12.jpg"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.)





December 30, 2010

Modern Lifestyles May Not Be Cause of Heart Disease



MummyCTscan2010-12-21.jpg"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.)






December 27, 2010

Government Mandates Insurers Pay for $4,300 Tests on Potential Donors Recruited by $60,000 a Week "Flirtatious Models"



(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.)





December 22, 2010

Under Health Care 'Reform' the Total Cost of Health Care Will "Go through the Roof!"



BushJonathanAthenahealth2010-12-20.jpg










"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.)





November 25, 2010

Neurosurgeons Treating Dogs is Mutually Beneficial to Dogs and Humans



(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.)





November 10, 2010

Feds Chastise Us for Being Fat AND Urge Us to Eat More Cheese Pizzas



PizzaCheeseFat2010-11-08.jpg "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.)



PizzaGraphic2010-11-08.jpgSource of graphic: online version of the NYT article quoted and cited above.





November 8, 2010

Being Bilingual Increases "Cognitive Reserve"



BilingualDementia2010-10-23.gif













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.





November 3, 2010

Paleolithic Humans Ate Carbohydrates



(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.)





October 24, 2010

Wilderness Act Makes Wilderness Inaccessible and Dangerous



(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.)






October 11, 2010

Obamacare Is Increasing Health Costs



HealthOutlays2010-10-01.gif





































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.)





August 28, 2010

Cuban Health Care Checkup



(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.





August 21, 2010

Feds' Sugar Quotas Lead to More Demand for Obesity-Causing Corn Syrup



CornSyrupGraph2010-08-05.jpgSource 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.)





May 26, 2010

Reid on Ben Nelson's Cornhusker Kickback: "He Got This for Him­self; He Wanted It"



(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.)





May 22, 2010

After Health Care Plan, Are There Any Limits to What the Government Can Mandate?



(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.)





February 14, 2010

Senile Mice Benefit from Cellphone Radiation



MouseCellphone2010-01-24.jpg












"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.





January 12, 2010

World's Poor Care More About Food and Illness than Global Warming



(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.





January 5, 2010

Heart Disease Is Not Just a Malady of Modern Societies, But "Is Part of the Human Condition"



MummyScanHeartDisease2009-12-21.jpg"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.")





December 5, 2009

Malaria "Weakly Related to Temperature"; "Strongly Related to Poverty"



(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.)





November 18, 2009

Government to Decide Who Lives and Who Dies



ReaperCuveGraph2009-10-28.jpg











"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.





November 12, 2009

Videos of Routines Are Better than Focus Groups and Surveys



ChangeByDesignBK.jpg














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.





November 11, 2009

"A Foolish Faith in Authority Is the Worst Enemy of Truth"



(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.)





November 10, 2009

John Mackey: "I Believe in the Dynamic Creativity of Capitalism"



MackeyJohn2009-10-28.jpg 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.)





November 8, 2009

New Scientific Optimism on Life Extension



HandsOldAndYoung2009-10-26.jpg 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.)





November 6, 2009

How "Free" Government Health Care Works



OmahaFluVaccineLine2009-11-05.jpg"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.")





October 28, 2009

"A Man of Science Past Sixty Does More Harm than Good" (Unless His Name is "Avery")



(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.)





October 26, 2009

Health Care Incentives and Information Improve When Patients Are Payers



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.