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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:

Blastland, Michael, and David Spiegelhalter. The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books, 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 New York Times (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.


. . .

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



For the full commentary, see:

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

(Note: ellipsis added.)


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

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





October 25, 2009

Harvard Medical School Conference on the Quest for Eternal Life



SinclairWestphalStiris2009-10-04.jpg"AGE WELL. David Sinclair, left, and Christoph Westphal, co-founders of Sitris Pharmaceuticals, in Dr. Sinclair's laboratory in Cambrdge, Mass. The company develops drugs that mimic resveratrol, a chemical found in some red wines." Source of caption and photo: online version of the NYT article quoted and cited below.


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

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


. . .

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 Gallagher said that unpublished tests in mice showed that another chemical mimic, SRT-1720, increased both health and lifespan; after two years, twice as many mice taking the drug were alive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

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

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


. . .

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

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


. . .

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

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



For the full story, see:

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

(Note: ellipses added.)





October 24, 2009

Rapid Mutation of RNA-Based Flu Virus Allows Rapid Adaptation to Immune System Response



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

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


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

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

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

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

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

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

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

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




Source:

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

(Note: italics in original.)





October 16, 2009

How Wilson and the Feds Turned "Only Influenza" into "The Great Influenza"



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


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

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



Source:

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

(Note: ellipsis added.)





October 15, 2009

How Government Universal Health Care Works in India



JahanAmirIndianWeaver2009-09-26.jpg "Amir Jahan found her health insurance wouldn't pay for all of her $200 stomach surgery; she continues to work with an untreated tumor." Source of caption: print version of the WSJ article quoted and cited below. Source of photo: online version of the WSJ article quoted and cited below.


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

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

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

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

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

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



For the full story, see:

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





October 13, 2009

Government Actions Helped Spread 1918 Influenza



GreatInfluenzaBK.jpg















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



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

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

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

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

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

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

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



Source of book discussed above:

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



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

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



For a neat little paper on Oswald Avery, see:

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





October 9, 2009

Doctors Seek to Regulate Retail Health Clinic Competitors



NursePractitioner2009-09-26.jpg"A nurse practitioner with a patient at a retail clinic in Wilmington, Del." Source of caption and photo: online version of the WSJ article quoted and cited below.


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

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


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

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


. . .


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


. . .


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


. . .


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



For the full story, see:

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

(Note: ellipses added.)


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

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



For the full account, see:

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


RetailHealthClinicGraph2009-09-26.gif












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






September 26, 2009

Increase Health Insurance Competition by Ending Cross-State Ban



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

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



For the full commentary, see:

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






September 22, 2009

In Economic Policy, as in Medicine: "First, Do No Harm"



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


. . .


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



For the full commentary, see:

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

(Note: italics in original; ellipsis added.)





September 16, 2009

Four Month Wait for Blood Test in Brits' Government Health Care



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

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


. . .


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

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

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

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

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



For the full commentary, see:

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

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

(Note: ellipsis added.)






August 30, 2009

Native Americans Suffer from Government Health Care



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

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


. . .


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


. . .


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


. . .


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

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



For the full commentary, see:

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

(Note: ellipses added.)

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





August 28, 2009

Small Business Sceptical of Big Government Health Plan



BriguglioPatty2009-08-14.jpg"No, I mean it," said Ms. Brigugulio, "I expect you to keep your word on this." Source of the photo and caption: http://boss.blogs.nytimes.com/2009/07/30/mr-prez-meets-ms-biz-the-story-behind-the-photo/



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

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

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

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

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

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

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



For the full story, see:

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

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





August 21, 2009

"The Voluntary Slaves of a 'Compassionate' Government"



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


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


For the full commentary, see:

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





August 8, 2009

Experiments Suggest We Can Live Longer



RhesusMonkeysLongevity2009_07_11.jpg"Rhesus monkeys, 27-year-old Canto, left, and Owen, 29, are among the oldest surviving subjects in a study of the links between diet and aging." Source of photo and caption: online version of the WSJ article quoted and cited below.


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

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

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

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

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



For the full story, see:

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



LongerLivesBarChart2009_07_11.gif

















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





July 26, 2009

Free-Range Pork Carries More Disease



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

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


. . .


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



For the full commentary, see:

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

(Note: ellipsis added.)





July 11, 2009

Drug Innovation Funding Slashed in Economic Crisis



BiotechIPOgraph.gif














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




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

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

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



For the full story, see:


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






July 9, 2009

Government Regulators Again Suppress Entrepreneurial Innovation



FeetNibblingFish2009-06-20.jpgSource of photo: http://images.quickblogcast.com/82086-71861/pedicurex_large.jpg


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

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

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

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


. . .


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




For the full story, see:

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

(Note: ellipsis added.)





July 6, 2009

Our "Patently Absurd" Patent System



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


. . .

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

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

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



For the full commentary, see:

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

(Note: ellipsis added.)





June 29, 2009

To Cure Fatal Diseases We Need More Financial Incentives and Fewer F.D.A. Restrictions



ThompsonJoshuaAndSons.jpg








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












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

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

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

"Soon," she said. "Soon."

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


. . .


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

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

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


. . .


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

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

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

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

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

Appealing an F.D.A. Denial

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

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

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

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


. . .


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

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

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

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



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

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

(Note: ellipses added.)




ThompsonJoshuaIplexInjection2009-06-10.jpg"IN MARCH, Joshua Thompson received his first Iplex injection, from Dr. David L. Werwath. Thereafter Joshua's wife, Joy, left, and mother, Kathy, took over the daily duties." Source of the photo and caption: online version of the NYT article quoted and cited above.





June 28, 2009

"Don't Kill the Goose"



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

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

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



For the full commentary, see:

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






June 3, 2009

Medical Care is Much Advanced Since Victorian Era of Mid-1800s



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


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


. . .


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


. . .


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



For the full review, see:

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

(Note: ellipses added.)


The reference to the reviewed book is:

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

MakingOfMrGraysAnatomyBK.jpg















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





May 18, 2009

Greenmarket Rules Are "Cumbersome, Confusing and Contradictory"



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


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

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

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



For the full story, see:

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





April 30, 2009

Charles Wolf's Main Cancer Regret: "I'm Not There for the Market Open"



WolfCharles2009-2-15.jpg "Charles Wolf with laptop and Archie, in his house near Denver last spring." Source of the caption and the photo: online version of the WSJ article quoted and cited below.


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


For the full obituary, see:

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





April 16, 2009

Unintended Consequences in Medicine



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


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

. . .

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

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



For the full review, see:

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

(Note: ellipsis added.)





April 6, 2009

Experiments on Animal Genes Enthuses Longevity Researchers


YogiCharles.jpg










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


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

. . .

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



For the full story, see:

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

(Note: ellipsis added.)




February 27, 2009

Patients "Stuck on Waiting Lists" in Canadian Universal Healthcare


UniversalHealthcareCartoon.jpg









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


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

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

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

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

. . .

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



For the full commentary, see:

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

(Note: ellipsis added.)




February 17, 2009

Christensen Book Re-Thinks Basic Assumptions About Health Care Innovation



Innovators PrescriptionBK.jpg







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


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

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

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

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



For the full interview, see:

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

(Note: ellipses added.)




February 10, 2009

Leeuwenhoek's Great Discovery Was at First Rejected by the "Experts"


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

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

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

Dear Mr. Anthony van Leeuwenhoek,

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



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



Source:

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





January 25, 2009

A Salute to the Sudanese Medicine Men


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

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

. . .

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

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



Source:

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

(Note: ellipses added.)




January 13, 2009

Inability to Patent Sulfa, Delayed Its Marketing


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

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


Source:

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




January 9, 2009

French Entrepreneur Fourneau Was Against Law, But Used It


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

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

. . .

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



Source:

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

(Note: ellipses added.)




January 5, 2009

Christian Care "Replaced Roman Hygiene with Frequent Prayers and Infrequent Baths"


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

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


Source:

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




January 1, 2009

Industrialist Duisberg Made Domagk's Sulfa Discovery Possible



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

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



Source:

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

(Note: ellipsis added.)





December 28, 2008

"Four G's Needed for Success: Geduld, Geschick, Glück, Geld"


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

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

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



Source:

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

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




December 25, 2008

A True Christmas Story of Hope and Justice


DomagkGerhard.jpg









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


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

Life is not always unfair:

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


Source:

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




December 20, 2008

Why You Want Your Surgeon to Be a Disciple of Lister


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

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

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

. . .

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



Source:

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

(Note: ellipses added.)




December 16, 2008

Doctors Rejected Pasteur's Work


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

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

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


Source:

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




December 4, 2008

The Benefits from the Discovery of Sulfa, the First Antibiotic


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

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

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

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


Source:

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




November 18, 2008

Kronman Thinks It's Good that We Die (and Charles Murray Applauds)


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

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

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

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


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

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

. . .

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



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

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

Don't waste time on:

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

(Note: ellipses added.)




November 10, 2008

Emergency Room Waiting Time Continues to Increase


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

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

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

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

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

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

. . .

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

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

. . .

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

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



For the full story, see:

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

(Note: eillipses added.)




November 9, 2008

Urgent Care Clinics Are Replacing Emergency Rooms


SolanticUrgentCare.jpg







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


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

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

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



For the full story, see:

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




October 30, 2008

Fewer Jobs Under Obama's High-Cost Health Plan


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

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

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

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

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



For the full story, see:

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





September 20, 2008

Hospitals Lack Hospitality


SettingTheTableBK.jpg










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

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

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

. . .

So what does it take to succeed?

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

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

News Corp.'s HarperCollins Publishers first published 30,000 copies in October 2006. (News Corp. also publishes The Wall Street Journal.) Mr. Meyer's work, chatty personal anecdotes wrapped around a core message that emphasizes hospitality as the key to creating satisfied customers, proved a hit.

. . .

"The most surprising thing was the interest from the hospital community," Mr. Meyer says. "That's an industry in turmoil based on the absence of hospitality. They over-focus on the metrics of stays and cure rates rather than how they make people feel."



For the full story, see:


JEFFREY A. TRACHTENBERG. "Running the Show; Me, Me, Me; So many entrepreneurs are writing books about how they made it. Their books, though, aren't nearly as successful." The Wall Street Journal (Mon., June 16, 2008): R7.

(Note: ellipses added.)




September 18, 2008

Medicare Pays $110 for Walker that Wal-Mart Sells for $60


MedicareSavingsFromEquipmentBids.jpg Source of table: online version of the NYT article quoted and cited below.

(p. C1) On Wal-Mart's Web site, you can buy a walker for $59.92. It is called the Carex Explorer, and it's a typical walker: a few feet high, with four metal poles extending to the ground. The Explorer is one of the walkers covered by Medicare.

But Medicare and its beneficiaries aren't paying $59.92 for the Explorer or any similar walker. In fact, they're not paying anything close to it. They are paying about $110.

. . .

(p. C5) In the abstract, fixing the health care system sounds perfectly unobjectionable: it's about reducing costs (and then being able to cover the uninsured) by getting rid of inefficiency and waste. In reality, though, almost every bit of waste benefits someone.

Doctors who perform spinal fusion surgeries, despite decidedly mixed evidence that they're effective, are making a nice living. Hospitals that order $1,000 diagnostic tests, even when a cheaper one would work just as well, are helping their bottom line. Medical equipment makers selling walkers for $110, while Wal-Mart sells them for $60, are fattening their profits.

The current fight to protect those profits is a microcosm of what you can expect to see if a larger effort to rein in health costs ever gets going. The defenders of the status quo won't say that they are protecting themselves. Instead, they'll use the same arguments that the medical equipment makers are using -- that a change will destroy jobs, bankrupt small businesses and, above all, harm patients.

. . .

But this is a case in which the market can clearly do a better job than a government-mandated fee schedule. Just look at Wal-Mart's Web site or, for that matter, the bids that Medicare has already received.

By standing in the way of this competition, Congress is really standing up for higher health care costs.



For the full commentary, see:

DAVID LEONHARDT. "ECONOMIC SCENE; High Medicare Costs, Courtesy of Congress." The New York Times (Weds., June 25, 2008): C1 & C5.

(Note: ellipses added.)




August 27, 2008

A.D.A. Tries to Stop Dental Therapists from Competing with Dentists


JohnsonAuroraDentalTherapist.jpg "Aurora Johnson, left, a dental therapist, filled cavities for Paul Towarak, 10, in the village of Unalakleet, Alaska. For more involved procedures, Ms. Johnson refers patients to a dentist." Source of caption and photo: online version of the NYT article quoted and cited below.

Clayton Christensen (and co-authors) have suggested that disruptive technologies could reduce the cost and improve the quality of health care. One pathway for this to occur is new technologies that permit effective treatment to be carried out by para-professionals with less education than MD's.

The article below illustrates Christensen's idea, and also highlights the main obstacle to its implementation: professional organizations asking the government to regulate and restrict competition from the lower-cost para-professionals.

(p. A1) UNALAKLEET, Alaska -- The dental clinic in this village on the edge of the Bering Sea looks like any other, with four chairs, a well-scrubbed floor and a waiting area filled with magazines.

But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.

Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. John-(p. A15)son's. And while such arrangements are common outside the United States, only one American dental school, in Anchorage, offers such a program.

. . .

(p. A15) In Alaska, the A.D.A. and the state's dental society had filed a lawsuit to block the program that trained people like Ms. Johnson, who are called dental therapists. The groups dropped the suit last summer after a state court judge issued a ruling critical of the dentists. But the A.D.A. continues to oppose allowing therapists to operate anywhere in the lower 49 states. Currently, therapists are allowed to practice only in Alaska, and only on Alaska Natives.

. . .

Therapists are a low-cost way to provide care to people who might not otherwise have access to it, according to Dr. Ron Nagel, a dentist and consultant for the Alaska Native Tribal Health Consortium, a nonprofit group financed mostly by federal money that provides medical and dental care to tribal communities. "There's a huge need for these basic services," Dr. Nagel said.

. . .

Since 1990, the number of private dentists has remained roughly flat, at 150,000, even as the United States population has increased 22 percent. As a result, dentists can easily fill their appointment books without seeing people who cannot meet their fees, and patients who have decayed teeth are suffering needlessly, said Tammy Guido, 50, who is one of seven students now training in Anchorage to become a therapist.

"We're meeting a need that is not being met," Ms. Guido said.

Alaskan tribal organizations sponsor Ms. Guido and the other students in Anchorage for the program. To be accepted, students must have a high school diploma or equivalency degree; for the newest class, 7 of 18 candidates were accepted.

In interviews, the students in this year's class all said they were enthusiastic about the chance to serve communities that have little access to care. All seven had quit full-time jobs and must now get by on a $750 monthly stipend during the two years of training.

"Anybody who's ever had a toothache can tell you it hurts," said Ben Steward, 24, the only man in this year's class. "But talk to someone who's had a toothache for a year."



For the full story, see:

ALEX BERENSON. "Dental Clinics, Meeting a Need With No Dentist." The New York Times (Mon., April 28, 2008): A1 & A15.

(Note: ellipses added.)

One source of Christensen's views on health care can be found in a chapter in:

Christensen, Clayton M., Scott D. Anthony, and Erik A. Roth. Seeing What's Next: Using Theories of Innovation to Predict Industry Change. Boston, MA: Harvard Business School Press, 2004.




August 23, 2008

Health Care Spending Takes a Large and Growing Share of Income


HealthCareShareGraph.jpg







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


The most interesting part of the article quoted below, was the above graph, that dramatically shows health care's large and growing share of disposable personal income.

(p. 28) Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

Health costs are "burying small business," said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by Ron Wyden, Democrat of Oregon.

Last year, Mr. Roach paid about $27,000 in health premiums for his eight employees. "It's a huge chunk of change," he said, noting that he was forced to raise his employees' yearly deductible by 50 percent, to $750.



For the full story, see:

REED ABELSON and MILT FREUDENHEIM. "Even the Insured Feel Strain of Health Costs." The New York Times, Section 1 (Sun., May 4, 2008): 1 & 28.





August 22, 2008

Brain-Controlled Prosthetics Within Reach


MonkeyArtificialArm.jpg "A grid in the monkey's brain carried signals from 100 neurons for the mechanical arm to grab and carry snacks to the mouth." Source of caption and photos: online version of the NYT article quoted and cited below.

(p. A1) Two monkeys with tiny sensors in their brains have learned to control a mechanical arm with just their thoughts, using it to reach for and grab food and even to adjust for the size and stickiness of morsels when necessary, scientists reported on Wednesday.

The report, released online by the journal Nature, is the most striking demonstration to date of brain-machine interface technology. Scientists expect that technology will eventually allow people with spinal cord injuries and other paralyzing conditions to gain more control over their lives.

The findings suggest that brain-controlled prosthetics, while not practical, are at least technically within reach.

In previous studies, researchers showed that humans who had been paralyzed for years could learn to control a cursor on a computer screen with their brain waves and that nonhuman primates could use their thoughts to move a mechanical arm, a robotic hand or a robot on a treadmill.

The new experiment goes a step further. In it, the monkeys' brains seem to have adopted the mechanical appendage as their own, refining its movement as it interacted with real objects in real time. The monkeys had their own arms gently restrained while they learned to use the added one.



For the full story, see:

BENEDICT CAREY. "Monkeys Think, Moving Artificial Arm as Own." The New York Times (Thurs., May 29, 2008): A1 & A18.




August 3, 2008

Sprouted "Methuselah" Seed Is 2,000 Years Old


MethuselahDatePalmSeedsAndPlant.jpg


"One of a handful of 2,000-year-old seeds (top) from the fortress of Masada in present-day Israel grew into a date palm plant (bottom) called Methuselah in 2005." Source of caption and photos: online article quoted and cited below.

The oldest-sprouted seed in the world is a 2,000-year-old plant from Jerusalem, a new study confirms.

"Methuselah," a 4-foot-tall (1.2-meter-tall) ancestor of the modern date palm, is being grown at a protected laboratory in the Israeli capital.

In 2005 the young plant was coaxed out of a seed recovered in 1963 from Masada, a fortress in present-day Israel where Jewish zealots killed themselves to avoid capture by the Romans in A.D. 70.



For the full story, see:


Anne Minard. ""Methuselah" Tree Grew From 2,000-Year-Old Seed." National Geographic News online (June 12, 2008), downloaded on 6/19/08 from: http://news.nationalgeographic.com/news/2008/06/080612-oldest-tree.html





August 2, 2008

Paternalistic Doctors With Way Too Much Time on Their Hands


(p. C6) The American Medical Association is hulking mad at Marvel Studios.

Last week, the advocacy arm of the powerful physicians' group unleashed a tsk-tsk campaign against "The Incredible Hulk," a Marvel film that opened on Friday and is distributed by Universal Pictures. The complaint was of "gratuitous depictions of smoking."

In the movie, which drew a PG-13 rating from the Motion Picture Association of America, Gen. Thunderbolt Ross, a bad guy played by William Hurt, is rarely seen without a smoke-spewing cigar. (Presumably, the physicians' association worries that children who identify with the authoritarian general -- who wants to annihilate the Hulk, played by Edward Norton -- may be tempted to pick up the habit.)



For the full story, see:

BROOKS BARNES. "Physicians' Group Furious at Cigars in 'Hulk' Movie." The New York Times (Mon., June 16, 2008): C6.




July 30, 2008

After Tort Reform, 7,000 M.D.s Have Gone to Texas



(p. A9) When Sam Houston was still hanging his hat in Tennessee in the 1830s, it wasn't uncommon for fellow Tennesseans who were packing up and moving south and west to hang a sign on their cabins that read "GTT" - Gone to Texas.

Today obstetricians, surgeons and other doctors might consider reviving the practice. Over the past three years, some 7,000 M.D.s have flooded into Texas, many from Tennessee.

Why? Two words: Tort reform.

In 2003 and in 2005, Texas enacted a series of reforms to the state's civil justice system. They are stunning in their success. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35%, saving doctors some $217 million over four years. There is also a competitive malpractice insurance industry in Texas, with over 30 companies competing for business. This is driving rates down.

The result is an influx of doctors so great that recently the State Board of Medical Examiners couldn't process all the new medical-license applications quickly enough. The board faced a backlog of 3,000 applications. To handle the extra workload, the legislature rushed through an emergency appropriation last year.



For the full commentary, see:


JOSEPH NIXON. "CROSS COUNTRY; Why Doctors Are Heading for Texas." The Wall Street Journal (Sat., May 17, 2008): A9.






July 8, 2008

"Creaky Regulations . . . Act as a Brake on Innovation"






"Paul Metzger, holding the Handler, an anti-microbial device that helps users avoid touching surfaces that might carry germs." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. C5) With so many people worried about getting sick -- whether from the common cold and flu or exotic new strains of antibiotic-resistant bacteria -- Paul and Jeffrey Metzger had every reason to hope that the germ-fighting key fob they invented would be a runaway hit.

Their device, known as the Handler, began selling last year online and in stores like Duane Reade pharmacies for about $11. It features a pop-out hook so germophobes can avoid touching A.T.M. keypads, door handles and other public surfaces where undesirable microbes may lurk. As added protection, the Handler's rubber and plastic surfaces are impregnated with tiny particles of silver to kill germs that land on the device itself.

But those little silver particles have run Maker Enterprises, the Metzger brothers' partnership in Los Angeles, into a big regulatory thicket. The Metzgers belatedly realized that the Environmental Protection Agency might decide that a 1947-era law that regulates pesticides would apply to antimicrobial products like theirs.

The agency ruled last fall that the law covered Samsung's Silvercare washing machine. Samsung was told it would have to register the machine as a pesticide, a potentially costly and time-consuming process, because the company claims the silver ions generated by the washer kill bacteria in the laundry.

The Metzgers halted production of their key fob while they sought legal guidance on how to avoid a similar fate.

Their quandary highlights a challenge facing the growing number of entrepreneurs who have ventured into nanotechnology, a field that gets its name from its reliance on materials so small their dimensions are measured in nanometers, or billionths of a meter.

. . .

"They don't really know how they want to register these particles," said Tracy Heinzman, a lawyer in Washington who deals frequently with the E.P.A. "There's no clear path forward."

More broadly, the limbo into which the Handler has tumbled shows how the limited resources of agencies like the E.P.A. can combine with creaky regulations to act as a brake on innovation. "The marketplace is always ahead of the E.P.A.," Ms. Heinzman said.


For the full story, see:

BARNABY J. FEDER. "Small Business; Fighting Germs and Regulators; Pesticide Rules May Apply to Tiny Particles That Kill Microbes." The New York Times (Thurs., March 6, 2008): C5.

(Note: the title of the online version was "Small Business; New Device for Germophobes Runs Into Old Law.")

(Note: ellipsis added.)


Handler.jpg





"Production of the Handler has ceased for the time being." Source of caption and photo: online version of the NYT article quoted and cited above.




June 23, 2008

Resveratrol May Extend Life, Even at Lower Doses


(p. A1) Red wine may be much more potent than was thought in extending human lifespan, researchers say in a new report that is likely to give impetus to the rapidly growing search for longevity drugs.

The study is based on dosing mice with resveratrol, an ingredient of some red wines. Some scientists are already taking resveratrol in capsule form, but others believe it is far too early to take the drug, especially using wine as its source, until there is better data on its safety and effectiveness.

The report is part of a new wave of interest in drugs that may enhance longevity. On Monday, Sirtris, a startup founded in 2004 to develop drugs with the same effects as resveratrol, completed its sale to GlaxoSmithKline for $720 million.

. . .

(p. A16) Separately from Sirtris's investigations, a research team led by Tomas A. Prolla and Richard Weindruch, of the University of Wisconsin, reports in the journal PLoS One on Wednesday that resveratrol may be effective in mice and people in much lower doses than previously thought necessary. In earlier studies, like Dr. Auwerx's of mice on treadmills, the animals were fed such large amounts of resveratrol that to gain equivalent dosages people would have to drink more than 100 bottles of red wine a day.

The Wisconsin scientists used a dose on mice equivalent to just 35 bottles a day. But red wine contains many other resveratrol-like compounds that may also be beneficial. Taking these into account, as well as mice's higher metabolic rate, a mere four, five-ounce glasses of wine "starts getting close" to the amount of resveratrol they found effective, Dr. Weindruch said.

Resveratrol can also be obtained in the form of capsules marketed by several companies. Those made by one company, Longevinex, include extracts of red wine and of a Chinese plant called giant knotweed. The Wisconsin researchers conclude that resveratrol can mimic many of the effects of a caloric-restricted diet "at doses that can readily be achieved in humans."



For the full story, see:

NICHOLAS WADE. "New Hints Seen That Red Wine May Slow Aging." The New York Times (Weds., June 4, 2008): A1 & A16.

(Note: ellipsis added.)




May 23, 2008

Prices of Education and Medical Care Increase Dramatically Over Decade


InflationGraphic.jpg











Source of the graphic: online version of the NYT article cited below.

The most interesting part of a recent David Leonhardt column, was not what he wrote, but the graphs that were included with the article, especially the one at the top of this entry. Notice that the price of education and medical care have increased much more dramatically than other categories of consumer spending. (And remember how heavily government is involved in those two sectors, both directly through government run institutions, and indirectly through regulations and subsidies.)

For the full commentary, see:

DAVID LEONHARDT. "ECONOMIC SCENE; Seeing Inflation Only in the Prices That Go Up." The New York Times (Weds., May 7, 2008): C1 and C11.


ConsumerSpendingGraphic.jpgSource of the graphic: online version of the NYT article cited above.




May 7, 2008

Freeing Medical Entrepreneurship Could Speed Cures


HaroldTomScyFIX.jpg










Medical entrepreneur Tom Harold.    Source of photo:   http://www.scyfix.org/management.php

(p. 1D) ScyFix, a Chanhassen, Minn., startup, has developed a device it claims treats diseases such as glaucoma and macular degeneration by shooting electric currents into the eye. The company, which is conducting clinical trials in India and the United States, hopes to sell the first device approved by the Food and Drug Administration designed to restore eyesight.

"To me, this is the pacemaker for the eye," said Dr. Darrell DeMello, ScyFix president and a former executive at Boston Scientific Corp.

ScyFix hopes to eventually raise $60 million to $70 million to finish its clinical trials.

. . .

(p. 2D) Thomas Harold first came up with the idea for ScyFix in 2002. An Internet entrepreneur and a former executive at General Mills, Harold became interested in studies that showed electricity could restore sight. Drugs, however, could only slow the effects of some diseases.

. . .

Specifically, the studies showed electricity could stimulate the production of neurotrophins, a family of proteins that can instruct optic nerve, retinal neurons and photoreceptor cells not to die. In addition, neuromodulation can also repair cell membranes, allowing cells to absorb nutrients, release wastes, improve blood flow to the eye and rewire faulty nerve connections.

Working with doctors and engineers, Harold, who has no medical background, developed a device that releases low-intensity electric currents into the eyelids through electrodes. A complex mathematical equation programmed into the device controls the amount and frequency of the electricity. Patients can administer the treatment at home twice a day for 20 minutes.

Harold says he is encouraged by the results so far: Since 2002, the device has halted progression of diseases in 95 percent of the 1,000 patients tested in 29 countries, according to ScyFix.

"Everything stopped getting worse," Harold said. "That was a win in itself."

In addition, 80 percent of the patients reported vision improvement. There were no side effects, the company said.


For the full story, see:

Lee, Thomas (The Star Tribune). "'Pacemaker' for eyes shows initial promise." Omaha World-Herald (Sunday, March 9, 2008): 1D & 2D.

(Note: ellipses added.)


Below I have pasted a couple of paragraphs from the ScyFIX web site. Note that Europeans are free to try the therapy, if they so desire. But citizens of the United States are not free to try the therapy, due to the regulations of the Food and Drug Admininstration (FDA) of the U.S. government.


Buy ScyFIX 600 and Accessories on-line!

Welcome to ScyFIX international web shop where you can order products, choose payment method, including a secure on-line credit card payment service (SSL), and check your delivery status on-line. Buying on-line is safe and easy and you will be guided all the way. All prices are in € (Euro). Place your order and your credit card company will convert the amount in € to your own currency. We accept Visa, Master Card, EuroCard and most bank cards connected to VISA or Master Card. Follow the instructions to take you through the pages, and then onto a secure site in which you will input your credit card and shipping details. When bank authorization has been attained, you will get a confirmation on-line, as well as a confirming e-mail. If at any stage you wish to change your order, just click the "Remove"-button.

Please note that ScyFIX can not ship devices to US addresses, until the ongoing FDA trials have resulted in an approval to market the product in the USA. US customers who mistakenly order and pay for a therapy kit over the web, will be contacted and refunded. However, ScyFIX will deduct 100€ (Euros) covering banking fees and handling costs. If you are a US resident and want to know more about our therapy, please send an inquiry by e-mail to our European office support@scyfix.org, or fill in your personal information in our Clinical Trial & Purchase Interest Form by clicking here www.scyfix.org/clinical_trial_form.htm.


The paragraphs were accessed on 3/9/08 from:

http://www.scyfix.org/shop/




April 29, 2008

Seniors Want Independence and to Live in Familiar Surroundings


StairsGeorgeAllen.jpg "Climbing stairs is a challenge for George Allen." Source of caption and photo: online version of the NYT article quoted and cited below.


(p. A1) WASHINGTON -- On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.

Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and he expects to lose his driver's license when it comes up for renewal. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.

So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide -- a dozen of them planned here in Washington and its suburbs -- their group is part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help and for baby boomers anticipating the future.

"We are totally dependent on ourselves," Mr. Allen said. "But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that's what we want."

Their group has registered as a nonprofit corporation, is setting membership dues, and is lining up providers of transportation, home repair, companionship, security and other services to meet their needs at home for as long as possible.

Urban planners and senior housing experts say this movement, organized by residents rather than government agencies or social service providers, could make "aging in place" safe and affordable for a majority of elderly people. Almost 9 in 10 Americans over the age of 60, according to AARP polls, share the Allens' wish to live out their lives in familiar surroundings.

. . .

(p. A18) The first village in the Washington area is expected to be on Capitol Hill. When it opens for business on Oct. 1, annual memberships will be $750 for a couple and $500 for an individual.

Among those eager to join are Marie Spiro, 74, and Georgine Reed, 78, who share a rambling house that they insist they will only leave "feet first." Between them, Ms. Spiro, an emeritus professor of art history and archaeology, and Ms. Reed, a retired designer of museum exhibits, have already endured three knee replacements and an array of other ailments.

Ms. Spiro describes huffing and puffing while grocery shopping; Ms. Reed is increasingly reluctant to visit friends across town. Both women, who are childless, would already welcome help with meals, transportation and paperwork. If they need home care, Capitol Hill Village will be able to organize that.

"I've never had to rely on other people, and I never wanted to," Ms. Spiro said. "But I'd rather pay a fee than have to ask favors."


For the full story, see:

JANE GROSS "A Grass-Roots Effort to Grow Old at Home The New York Times (Tues., August 14, 2007): A1 & A18.

(Note: ellipses added; caption for the George Allen photo is the online caption, not the different one in the print version of the article.)


SpiroMarie.jpg "Georgine Reed, 78, right, and Marie Spiro, 74, share a Capitol Hill home and are joining a group that will help them stay there. "I'd rather pay a fee," Ms. Spiro said, "than have to ask favors."" Source of caption and photo: online version of the NYT article quoted and cited above.




April 28, 2008

Wal-Mart Designs Health Care Around the Needs of Consumers


LedlieAliciaWalMartHealth.jpg "Alicia Ledlie, senior director of health business development for Wal-Mart, said walk-in medical clinics would look like the mockup behind her, in a warehouse in Bentonville, Ark." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. C4) Moving to upgrade its walk-in medical clinic business, Wal-Mart is set to announce on Thursday plans for several hundred new clinics at its stores, using a standardized format and jointly branded with hospitals and medical groups.

. . .

Walk-in medical clinics are a growing industry, with numerous competitors that include big-box retailers, drugstores and even grocery chains around the country. Industry executives say 1,500 to 1,800 clinics will be open by the end of the year.

Propelled by the drugstore chains CVS and Walgreens, by far the biggest sponsors of the clinics to date, more than 700 clinics have opened in the last 15 months. But the business model is unproven so far.

Few, if any, clinics are profitable, according to industry analysts, and only a handful have broken even on daily operations. Most have been open a year or less, and executives say it takes up to three years for a clinic to become profitable enough to recover start-up costs.

Medical societies are inclined to be skeptical of the clinics. The American Academy of Pediatrics opposes them, saying they add to fragmentation in the health care system.

Dr. Edward Zissman, a pediatrician in central Florida, said he had qualms about hospitals that hook up with the clinics. "Putting their name on a product that I don't think has the highest quality," he said, "is going to cost them dearly with physicians."

The American Academy of Family Physicians and the American Medical Association have set forth principles for clinics to observe, including sending patients' medical record to their doctors and finding doctors for patients who do not already have them. Most states require varying degrees of physician supervision of the clinic nurses. Clinic operators say they are complying.

Many patients have said they like the convenience of the walk-in clinics' weekend and evening hours, the short waiting times to see a nurse practitioner, and the posted price lists for a limited menu of care like tests and prescriptions for sore throats and ear infections and seasonal flu shots.

. . .

"The clinics are the latest big example of how you could think about consumers and what their needs are, rather than a health care system exclusively designed around the needs of providers," said Margaret Laws, director of an innovations program at the California Health Care Foundation, an independent group that finances health policy research.


For the full story, see:

MILT FREUDENHEIM. "Wal-Mart Will Expand In-Store Medical Clinics." The New York Times (Thurs., February 7, 2008): C4.

(Note: ellipses added.)


WalMartMedicalClinicDesign.jpg "The design of the Wal-Mart medical clinic is intended to look like a doctor's office, complete with the usual medical hardware." Source of caption and photo: online version of the NYT article quoted and cited above.




April 26, 2008

"Isn't This a Teeny-Weeny Bit of Socialism?"


(p. 12) FROM the very beginning of the nation's modern social welfare system -- even before Michael Moore began to explore the issue -- there was a tension in it: What should the government be expected to provide? What should be left to the individual? How much government is too much?

The questions were asked even in 1935, not exactly a time to instill confidence in the resilient power of private markets. Senator Thomas Pryor Gore, Democrat of Oklahoma, put it bluntly when Frances Perkins, the secretary of labor, testified on Capitol Hill that year about President Franklin D. Roosevelt's plan for a new program called Social Security.

''Isn't this socialism?'' Senator Gore demanded. When Ms. Perkins denied it, he asked again: ''Isn't this a teeny-weeny bit of socialism?'' In recent days, on Capitol Hill and on the campaign trail, a new version of that debate has been flaring, this time around an issue that the New Dealers decided (perhaps wisely) to put off for a later date: health care.


For the full commentary, see:

Robin Toner. "IDEAS & TRENDS; Less, Less, Less! More, More, Moore!" The New York Times, Week in Review section (Sun., August 5, 2007): 12.




April 18, 2008

Ban on DDT is a Lethal Vestige of Colonialism


(p. A16) Environmental leaders must join the 21st century, acknowledge the mistakes Carson made, and balance the hypothetical risks of DDT with the real and devastating consequences of malaria. Uganda has demonstrated that, with the proper support, we can conduct model indoor spraying programs and ensure that money is spent wisely, chemicals are handled properly, our program responds promptly to changing conditions, and malaria is brought under control.

Africa is determined to rise above the contemporary colonialism that keeps us impoverished. We expect strong leadership in G-8 countries to stop paying lip service to African self-determination and start supporting solutions that are already working.


For the full commentary, see:

Sam Zaramba. "Give Us DDT." Wall Street Journal (Tues., Jun 12, 2007): A16.




April 11, 2008

Much Health Spending "Does Nothing to Improve Our Health"


BrownleeShannon.jpg


Shannon Brownlee is the author of "Overtreated" which "diagnoses the big flaw in medical spending." Source of caption and photo: online version of the NYT commentary quoted and cited below.


(p. C5) Fortunately -- if that's the right word -- there is an obvious candidate for cost-cutting: all that care that brings no health benefit. It's not hard to find examples. Scientific studies have shown that many treatments, including spinal fusion, routine episiotomies and neonatal intensive care, are overdone. These procedures often help specific subsets of patients. But for a lot of people, and "Overtreated" is full of stories, the treatments are a modern-day version of bloodletting.

"We spend between one fifth and one third of our health care dollars," writes Ms. Brownlee, a senior fellow at the New America Foundation and former writer for U.S. News & World Report, "on care that does nothing to improve our health."

Worst of all, overtreatment often causes harm, because even the safest procedures bring some risk. One study found that a group of Medicare patients admitted to high-spending hospitals were 2 to 6 percent more likely to die than a group admitted to more conservative hospitals.


For the rest of the commentary, see:

DAVID LEONHARDT. "ECONOMIC SCENE; No. 1 Book, And It Offers Solutions." The New York Times (Weds., December 19, 2007): C1 & C5.




April 10, 2008

Non-Market Health Care Pricing Results in Health Care Shortages


(p. A22) When my Labrador retriever became acutely lame, we were able to locate a veterinary orthopedic expert in Atlanta within 48 hours who was able to repair a ruptured tendon within one week. But my prospects of identifying an endocrinologist who can care for my daughter's diabetes when she turns 18 are much less promising.

The limited number of endocrine specialists is a not a consequence of limited demand -- everyone is aware of the epidemic of diabetes we are facing. There are also shortages of generalists and other specialists, and the reason is the absence of market signals -- i.e., market-based prices -- for influencing the supply of physicians in various specialties.

The roots of this problem lay in the use of administrative pricing structures in medicine. The way prices are set in health care already distorts the appropriate allocation of efforts and resources in health care today. Unfortunately, many of the suggested reforms of our health care system -- including the various plans for universal care, or universal insurance, or a single-payer system, that various policy makers and Democratic presidential candidates espouse -- rest on the same unsound foundations, and will produce more of the same.

. . .

One important lesson of the 20th century is that, while markets are far from perfect, more choices are available when people are able to use free markets to interact with each other. Markets may not get the prices exactly correct all the time, but they are capable of self- correction, a capacity that has yet to be demonstrated by administrative pricing.

It tells you something when the supply of and demand for specialist veterinary care is so easily matched when the prices of these services are established on the market -- while shortages and oversupplies are common for human medical care when the prices of these services are set by administrators in the public sector. Will health-care reformers -- and American citizens -- get the message?


For the full commentary, see:

Robert A. Swerlick. "Our Soviet Health System." Wall Street Journal (Tues., Jun 5, 2007): A22.

(Note: ellipsis added.)




April 9, 2008

Entrepreneurial Medicine Hunter Seeks Cures in Ethnobotany


MacaDried.jpg Source of photo: screen capture from slide show on online version of the NYT article quoted and cited below.


(p. C1) Part David Attenborough, part Indiana Jones, Mr. Kilham, an ethnobotanist from Massachusetts who calls himself the Medicine Hunter, has scoured remote jungles and highlands for three decades for plants, oils and extracts that can heal. He has eaten bees and scorpions in China, fired blow guns with Amazonian natives, and learned traditional war dances from Pacific Islanders.

But behind the colorful tales lies the prospect of money, lots of money -- for Western pharmaceutical companies, impoverished indigenous tribes and Mr. Kilham.

. . .

(p. C5) In Peru, Mr. Kilham is betting on maca, a small root vegetable that grows here in the central highlands -- "a turnip that packs a punch," he says, adding "it imparts energy, sex drive and stamina like nothing else."

That view is supported by studies carried out at the International Potato Center, a Lima-based research center that is internationally financed and staffed. Studies there show maca improves stamina, reduces the risk of prostate cancer and increases the motility, volume and quality of sperm.

Some peer reviewed studies published in the journal Reproductive Biology and Endocrinology backed up those findings.

. . .

One product, Maca Stimulant, is sold in Wal-Mart under Mr. Kilham's Medicine Hunter brand. Mr. Kilham earns a retainer from both Naturex and Enzymatic Therapy, in addition to royalties from another Medicine Hunter-branded product at Wal-Mart.

Mr. Kilham says he earns around $200,000 each year in retainers, and sales are so buoyant he expects to make "in the mid-six figures" in royalties next year.

Mr. Kilham insists he is not in the business simply for financial gain. His motivation comes from promoting herbal medicines and helping traditional communities, he said.

"I have financial security and don't need to make money from this," he said. "I believe trade is the best way to get good medicines to the public, to help the environment and to help indigenous people."

He and Mr. Cam pay growers here in Ninacaca a premium of 6 soles (about $2) for a kilo of maca, almost twice the going rate of 3 to 3.40 soles a kilo. They have set up a computer room at the Chakarunas warehouse and a free dental clinic, the town's first.

Mr. Kilham is clearly adored by the locals in these desolate, wind-swept villages. On a recent visit here, shamans, maca growers and their families flocked to him. Since only maca and potatoes grow at this altitude, they are thankful Mr. Kilham is helping them sell their produce.


For the full story, see:

ANDREW DOWNIE. "On a Remote Path to Cures." The New York Times (Tues., January 1, 2008): C1 & C5.

(Note: ellipses added.)


MacaFlour.jpg Source of photo: screen capture from slide show on online version of the NYT article quoted and cited above.





April 2, 2008

The Danger of "Misconceived Pessimism"


In the full version of the commentary quoted below, the authors mention four lines of research that they believe hold promise for the future: vaccines, epigenetics, targeted therapies, and cancer "stem cells."

(p. A17) This week, the National Cancer Institute, in conjunction with other organizations that track cancers, reported that the death rate from cancer declined from 2002-2004 by an average of 2.1% per year. This is an improvement over the 1.1% annual declines from 1993-2002 and is very good news indeed. Each 1% decline represents 5,000 people living rather than dying, and, of course, this figure is compounded each year.

While some part of the declining death rate from cancer is the consequence of screening, much is the result of greatly improved treatments. And we believe that the successes achieved to date are only the modest beginning of a revolution in the research into and treatment of cancer.

During the last half of the 20th century, almost all treatments of cancers involved forms of chemotherapy in which cancerous and normal tissues were bombarded with nonselective cytoxic drugs. These drugs killed all cells, healthy as well as malignant. Worse, they did not kill all cancer cells, so the cancer progressed -- leading to the pessimism dominant in people's minds today, a reflection of years of articles and opinion pieces in the popular press expressing the view that "the war on cancer" has been waged incorrectly, if not lost.

Now, however, new therapeutic modes are in play, based on better understandings of cancers and great advances in technologies.

. . .

The danger is that misconceived pessimism might result in a loss of popular moral support for the revolutionary new approaches to cancer research and treatment.


For the full commentary, see:

Samuel Waxman and Richard Gambino. "The New Ways We Fight Cancer." Wall Street Journal (Oct 18, 2007): A17.

(Note: ellipsis added.)




March 19, 2008

Less Inflammation, Longer Life


The passage below is from a WSJ summary of an article that appeared in the December 2007 issue of Discover:

(p. B12) Scientists are increasingly hopeful that controlling inflammation will allow them to turn back the clock on aging, writes Kathleen McGowan in Discover magazine.

Inflammation is already a well-established predictor of many chronic illnesses, such as diabetes, atherosclerosis and Alzheimer's disease.  . . .

. . .

Many prominent gerontologists reason that if these chronic diseases are the product of an overactive immune system, then they can be countered with the right anti-inflammatory drug.    . . .

"The research is really to prevent the chronic debilitating diseases of aging," says Nir Barzilai, a molecular geneticist and director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. "But if I develop a drug, it will have a side effect, which is that you will live longer."


For the full summary, see:

"The Informed Reader; Health; How Scientists Hope to Shrink Aging Effects." Wall Street Journal (Weds., Nov. 14, 2007): B12.

(Note: ellipses added.)




March 13, 2008

Columbus Absolved of Bringing Lice-Borne Disease to Indians


MummyPeruLice.jpg




"Braided hair is intact on a Peruvian mummy like those used in a study. Scientists say lice in the Americas predated Columbus." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A10) When two pre-Columbian individuals died 1,000 years ago, arid conditions in the region of what is now Peru naturally mummified their bodies, as well as the lice in their long, braided hair.

That was all scientists needed, they reported Wednesday, to extract well-preserved louse DNA and establish that lice had accompanied their human hosts in the original peopling of the Americas, probably as early as 15,000 years ago. The DNA matched that of the most common type of louse known to exist worldwide now and also before Europeans colonized the New World.

The findings absolve Columbus of responsibility for at least one wrong unintentionally wrought on the people he found in the Americas and called Indians. The Europeans who followed Columbus to America may have introduced diseases, namely smallpox and measles, but not the most common of lice, as had been suspected.

For the full story, see:

JOHN NOBLE WILFORD. "Scientists Say Mummies' Lice Show Pre-Columbian Origins." The New York Times (Thurs., February 7, 2008): A10.




February 29, 2008

"The No. 1 Need that Poor People Have is a Way to Make More Cash"

 

  Moving water is easier with the 20-gallon rolling drum.  Source of photo:  online version of the NYT article quoted and cited below.

 

(p. D3)  . . . , the Cooper-Hewitt National Design Museum, . . . , is honoring inventors dedicated to “the other 90 percent,” particularly the billions of people living on less than $2 a day.

Their creations, on display in the museum garden until Sept. 23, have a sort of forehead-thumping “Why didn’t someone think of that before?” quality.

. . .

Interestingly, most of the designers who spoke at the opening of the exhibition spurned the idea of charity.

“The No. 1 need that poor people have is a way to make more cash,” said Martin Fisher, an engineer who founded KickStart, an organization that says it has helped 230,000 people escape poverty.  It sells human-powered pumps costing $35 to $95.

Pumping water can help a farmer grow grain in the dry season, when it fetches triple the normal price.  Dr. Fisher described customers who had skipped meals for weeks to buy a pump and then earned $1,000 the next year selling vegetables.

 

For the full story, see: 

DONALD G. McNEIL Jr.  "Design That Solves Problems for the World's Poor."  The New York Times  (Tues., May 29, 2007):  D3.

(Note:  ellipses added.)

 

FilterForDrinkingWater.jpg TechnologiesForPoor.jpg   The photo on the left shows a woman safely drinking bacteria-laden water through a filter.  The photo on the right shows a "pot-in-pot cooler" that evaporates water from wet sand between the pots, in order to cool what is in the inner pot.  Source of photos:  online version of the NYT article quoted and cited above.

 




"The No. 1 Need that Poor People Have is a Way to Make More Cash"

 

  Moving water is easier with the 20-gallon rolling drum.  Source of photo:  online version of the NYT article quoted and cited below.

 

(p. D3)  . . . , the Cooper-Hewitt National Design Museum, . . . , is honoring inventors dedicated to “the other 90 percent,” particularly the billions of people living on less than $2 a day.

Their creations, on display in the museum garden until Sept. 23, have a sort of forehead-thumping “Why didn’t someone think of that before?” quality.

. . .

Interestingly, most of the designers who spoke at the opening of the exhibition spurned the idea of charity.

“The No. 1 need that poor people have is a way to make more cash,” said Martin Fisher, an engineer who founded KickStart, an organization that says it has helped 230,000 people escape poverty.  It sells human-powered pumps costing $35 to $95.

Pumping water can help a farmer grow grain in the dry season, when it fetches triple the normal price.  Dr. Fisher described customers who had skipped meals for weeks to buy a pump and then earned $1,000 the next year selling vegetables.

 

For the full story, see: 

DONALD G. McNEIL Jr.  "Design That Solves Problems for the World's Poor."  The New York Times  (Tues., May 29, 2007):  D3.

(Note:  ellipses added.)

 

FilterForDrinkingWater.jpg TechnologiesForPoor.jpg   The photo on the left shows a woman safely drinking bacteria-laden water through a filter.  The photo on the right shows a "pot-in-pot cooler" that evaporates water from wet sand between the pots, in order to cool what is in the inner pot.  Source of photos:  online version of the NYT article quoted and cited above.

 




February 22, 2008

"Sometimes It Pays to Read the Old Literature"


(p. A1) Researchers in New York believe they have solved one of the great mysteries of the flu: Why does the infection spread primarily in the winter months?

The answer, they say, has to do with the virus itself. It is more stable and stays in the air longer when air is cold and dry, the exact conditions for much of the flu season.

. . .

(p. A22) To his surprise, Dr. Palese stumbled upon a solution that appeared to be a good second best.

Reading a paper published in 1919 in the Journal of the American Medical Association on the flu epidemic at Camp Cody in New Mexico, he came upon a key passage: "It is interesting to note that very soon after the epidemic of influenza reached this camp, our laboratory guinea pigs began to die." At first, the study's authors wrote, they thought the animals had died from food poisoning. But, they continued, "a necropsy on a dead pig revealed unmistakable signs of pneumonia."

Dr. Palese bought some guinea pigs and exposed them to the flu virus. Just as the paper suggested, they got the flu and spread it among themselves. So Dr. Palese and his colleagues began their experiments.

. . .

As for Dr. Palese, he was glad he spotted the journal article that mentioned guinea pigs.

"Sometimes it pays to read the old literature," he said.

 

For the full story, see:

GINA KOLATA. "Study Shows Why the Flu Likes Winter." The New York Times (Weds., December 5, 2007): A1 & A22.

(Note:  ellipses added.)

 




February 4, 2008

Government Pushing Fluorescent Bulbs with Hazardous Mercury

 

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

 

(p. D1)  As part of the government's focus on energy and the environment, Americans are urged to buy compact fluorescent light bulbs, which use only about 25% of the energy and last up to 10 times as long as traditional incandescent bulbs. Nearly 300 million such bulbs were sold in U.S. in 2007, compared with 100 million two years earlier, according to the Department of Energy.

. . .

Yet unlike traditional incandescent bulbs, these bulbs contain mercury, a metal hazardous to human health and the environment. Consumers are urged not to toss them in the trash. In some states, such as California, it's illegal to throw them away; they must be recycled. Still, many cities and towns don't have recycling programs for the bulbs, and consumers aren't sure what to do with them.

 

For the full story, see: 

SARA SCHAEFER MUÑOZ.  "The Dark Side Of 'Green' Bulbs Disposing of Fluorescents, Electronics Releases Toxins; Companies Tout Recycling." The Wall Street Journal  (Thurs., January 24, 2008):  D1.  

(Note:  ellipsis added.)

 




February 3, 2008

Google and Microsoft Seek to Shift Health Care Power to Consumers

 

InternetHealthGraph.jpg    Source of graph:  online version of the NYT article cited below. 

 

(p. C1)  In politics, every serious candidate for the White House has a health care plan. So too in business, where the two leading candidates for Web supremacy, Google and Microsoft, are working up their plans to improve the nation’s health care.

. . .

(p. C8)  If the efforts of the two big companies gain momentum over time, that promises to accelerate a shift in power to consumers in health care, just as Internet technology has done in other industries.

Today, about 20 percent of the nation’s patient population have computerized records — rather than paper ones — and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

Microsoft and Google are hoping this will lead people to seek more control over their own health records, using tools the companies will provide.

 

For the full story, see: 

STEVE LOHR.  "Dr. Google and Dr. Microsoft."  The New York Times  (Tues., August 14, 2007):  C1 & C8.

(Note:  ellipsis added.)

 




February 1, 2008

Health Care Costs Are High and Rising

 

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

 

The article quoted below summarizes a seminar by Dr. John Abramson.  He was right to highlight the high costs of health care in the U.S., though he didn't show any special insight in suggesting solutions.

 

(p. 1D)  Costs are out of control, he said, and yet the United States, out of 22 developed nations, pays the most per person for health care and ranks last in having citizens lead long, healthy lives.

 

 

For the full story, see: 

STEVE JORDON.  "Employers urged to cure health system."  Omaha World-Herald  (Weds., August 22, 2007):  1D & 2D.  

 

  Source of cartoon:  online version of the Omaha World-Herald article quoted and cited above.

 




January 26, 2008

Free Market Can Provide Better, Cheaper Health Care

 

   "Eve Linney, 5, who had an infected finger, went with her family last week to a walk-in clinic at a Duane Reade drugstore on Broadway in Manhattan. Her father, John, is at the counter."  Source of caption and photo:  online version of the NYT article quoted and cited below.  

 

Clayton Christensen and co-authors in Seeing What's Next, make a plausible case for the improvement of health care through disruptive innovation.  A key aspect of their vision is the increasing role of nurse-practitioners in taking on increasingly routinized tasks, a development they see as generally both effective, and cost-efficient.

The article excerpted below suggests that this trend is promising, if it does not get killed by the government, and by organized medical doctors protecting their turf from competition.

 

(p. A1)  The concept has been called urgent care “lite”:  Patients who are tired of waiting days to see a doctor for bronchitis, pinkeye or a sprained ankle can instead walk into a nearby drugstore and, at lower cost, with brief waits, see a doctor or a nurse and then fill a prescription on the spot.

With demand for primary care doctors surpassing the supply in many parts of the country, the number of these retail clinics in drugstores has exploded over the past two years, and several companies operating them are now aggressively seeking to open clinics in New York City. 

. . .

More than 700 clinics are operating across the country at chain stores including Wal-Mart, CVS, Walgreens and Duane Reade.

New York State regulators are investigating the business relationships between drugstore companies and medical providers to determine whether the clinics are being used improperly to increase business or steer patients to the pharmacies in which the clinics are located.

And doctors’ groups, whose members stand to lose business from the clinics, are citing concerns about standards of care, safety and hygiene, and they have urged the federal and state governments to step in to more rigorously regulate the new businesses.

. . .

(p. A16)  Patients, however, have flocked to the clinics, according to a new industry group, the Convenient Care Association.

“I think it’s great you don’t have to make an appointment. That could take weeks,” said Ezequiel Strachan, 33, who lives in Manhattan and walked into the clinic at the Duane Reade store at 50th Street and Broadway on a recent morning for treatment of a sore throat. “People here value their time a lot.”

The average waiting time for an exam at such clinics nationwide is 15 to 25 minutes, according to the Convenient Care Association.

The association estimated that 70 percent of clinic patients have health insurance and are using the clinics because of convenience. For them, costs may not be much different from those at doctors’ offices, because the same insurance co-payments apply. But uninsured patients could reap substantial savings.

In New York City, one in five residents lacks a regular doctor and one in six is uninsured, according to a recent survey by the city’s Department of Health and Mental Hygiene, and overcrowded emergency rooms are often their first resort for routine care.

. . .

MinuteClinic officials insisted that there was nothing improper in the relationships between providers and the drugstores and that medical care is not being compromised.

“We are transparent with regulators,” said Michael C. Howe, the chief executive of MinuteClinic, which is based in Minneapolis and operates more than 200 clinics nationwide. using the motto “You’re Sick, We’re Quick.”

Mr. Howe said the concerns of doctors’ groups and other critics “are being raised by voices of people who have not really studied the model.”

Preliminary data from a two-year study of claims from MinuteClinic by a Minnesota health maintenance organization, HealthPartners, which was released to The Minneapolis Star Tribune in July, showed that each visit to the retail clinic cost an average of $18 less than a visit to other primary-care clinics, but that pharmacy costs were $4 higher per patient.

Duane Reade, New York City’s largest drugstore chain, which opened four clinics in Manhattan in May, plans to open as many as 60 more across the city in the next 18 months. A key difference at the Duane Reade clinics is that they use doctors, while nurse practitioners and physician assistants typically provide the care at most retail clinics.

 

For the full story, see:

SARAH KERSHAW.  "Tired of Waiting for a Doctor?  Try the Drugstore."  The New York Times  (Thurs., . August 23, 2007):  A1 & A16.

(Note:  the title of the online version is "Drugstore Clinics Spread, and Scrutiny Grows."  Ellipses added.)

 

   "Dr. Maggie Bertisch saw Eve while her mother, Claire, waited."  Source of caption and photo:  online version of the NYT article quoted and cited above.  

 




January 11, 2008

Feds Force Us to Fluoresce, Causing Migraines and Epileptic Seizures

 

   Source:  screen capture from the CNN report cited below.

 

The new energy bill signed into law on Weds., Dec. 19, 2007, included a provision to force us all to fluoresce starting in 2012.  In the CNN report cited below, Dr. Sanjay Gupta summarizes recent research suggesting that fluorescent bulbs cause a significant increase in the number of migraine headaches and epileptic seizures.

 

For the full story, see:

Dr. Sanjay Gupta. "Eco-bulbs and migraines." CNN Report. Posted online on January 4, 2008.

 

   Source:  screen capture from the CNN report cited above.

 




January 3, 2008

Huge Health Gains from Vaccines

 

VaccineReducesDeaths90PercentGraph.jpg   Source of graphic:  online version of the WSJ article quoted and cited below.

 

I hypothesize that most of the health gains from modern medicine come from a few advances, with vaccines being a very prominent example.  (My hypothesis implies that many health care procedures do relatively little to increase health and longevity.) 

 

(p. A18)  Death rates for 13 diseases that can be prevented by childhood vaccinations are at all-time lows in the United States, according to a study released yesterday.

The study, by the Centers for Disease Control and Prevention in Atlanta, and published in The Journal of the American Medical Association, is the first time that the agency has searched historical records going back to 1900 to compile estimates of cases, hospitalizations and deaths for all the diseases children are routinely vaccinated against.

In nine of the diseases, rates of death or hospitalization declined more than 90 percent since vaccines against them were approved, and in the cases of smallpox, diphtheria and polio, by 100 percent.

In only four diseases — hepatitis A and B, invasive pneumococcal diseases and varicella (the cause of chickenpox and shingles) — did deaths and hospitalizations fall less than 90 percent. Those vaccines are all relatively new — the one for chickenpox, for example, was adopted nationally only in 1995. Also, some diseases like hepatitis typically strike adults, who are less likely to be immunized.

The results “are a testament to the fact that vaccines can drive diseases down to near nil,” said Dr. Gregory A. Poland, chief of the vaccine research group at the Mayo Clinic.

 

For the full story, see:

DONALD G. McNEIL Jr.  "Sharp Drop Seen in Deaths From Ills Fought by Vaccine."  The New York Times  (Thurs., November 14, 2007):  A23. 

 




January 1, 2008

Prominent Transplant Surgeon Endorses Market for Kidneys

 

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

 

(p. A1)  Amid a severe kidney-donor shortage, an idea long considered anathema in the medical community is gaining new currency: payments for people willing to give up a kidney. 

One of the most outspoken voices on the topic isn't a free-market libertarian, but a prominent transplant surgeon named Arthur Matas.

Dr. Matas, 59 years old, is a Canadian-born physician best known for his research at the University of Minnesota. Lately, he's been traveling the country trying to make the case that barring kidney sales is tantamount to sentencing some patients to death.

"There's one clear argument for sales," Dr. Matas told a gathering of surgeons earlier this year. The practice, currently illegal in the U.S., "would increase the supply of kidneys, save lives and improve the quality of life for those with end-stage renal disease."

The doctor supports a regulated market only for kidneys, since live donors can give one up and survive without excessive health risks. (Transplants of other organs, such as livers and lungs, pose greater complications to a living donor.) And Dr. Matas doesn't rule out financial incentives for the families of deceased donors.

 

For the full story, see:

LAURA MECKLER.  "Kidney Shortage Inspires A Radical Idea: Organ Sales As Waiting List Grows, Some Seek to Lift Ban; Exploiting the Poor?"  The Wall Street Journal  (Tues., November 13, 2007):  A1 & A22.

 

MatasArthurTransplantSurgeon.jpg  Source of image:  online version of the WSJ article quoted and cited above.

 




December 23, 2007

Unwashed Hospital Worker Hands Often Spread Disease

 

   "A special light reveals deadly bacteria."  Source of caption and photo:  online version of the NYT article quoted and cited below.

 

If health care in the U.S. were a free market, with unregulated entry, and real consumer choice, it is hard to believe that some Wal-Mart-of-health-care wouldn't come along that would gain huge market share and profits by providing its employees incentives to wash their hands.

 

(p. A1)  PITTSBURGH — At a veterans’ hospital here, nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves.

Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.

The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say.

But in the past two years, a few hospitals have demonstrated that simple screening and isolation of patients, along with a relentless focus on hygiene, can reduce the number of dangerous infections. By doing so, they have fueled a national debate about whether hospitals are doing all they can to protect patients from infections, which are now linked to more deaths than diabetes or Alzheimer’s disease.

. . .

(p. A16)  Dr. Richard P. Shannon, who championed a program to reduce catheter infections at Allegheny General Hospital in Pittsburgh, was able to show administrators that the average infection cost the hospital $27,000. He demonstrated that reimbursement payments for weeks of extended treatment were not keeping pace with actual costs. “I think it was assumed that hospitals didn’t mind treating these infections because they were getting paid for it,” Dr. Shannon said.

A major emphasis at the Pittsburgh hospitals has been hand hygiene. Studies have consistently shown that busy hospital workers disregard basic standards more than half the time. At the veterans hospital, where nurses have taken to pushing elevator buttons with their knuckles, annual spending on hand cleaner has doubled.

 

For the full story, see:

KEVIN SACK.  "Swabs in Hand, Hospital Cuts Deadly Infections."  The New York Times   (Fri., July 27, 2007):   A1 & A16.

(Note:  ellipsis added.)

 

 InfectionsDropGraph.jpg CunninghamBillNurse.jpg  In the photo on the right, Pittsburgh nurse Bill Cunningham, "puts on a gown and gloves before approaching patients with infections."  Source of graph, caption, and photo:  online version of the NYT article quoted and cited above.

 




December 20, 2007

Entrepreneur Bets His Wealth on a Risky, Important Project

 

  "Alfred E. Mann, at his home in Beverly Hills, Calif., has put nearly $1 billion of his own money into developing an insulin that can be inhaled."  Source of caption and photo:  online version of the NYT article quoted and cited below.

 

(p. C1)  LOS ANGELES, Nov. 15 — Pfizer, the world’s biggest drug company, flopped miserably with a seemingly can’t-miss idea. But Alfred E. Mann is so certain he can succeed that he is betting nearly $1 billion of his own money on the effort.

Pfizer’s failure was a form of insulin that people with diabetes could inhale rather than inject. But last month, after selling only $12 million worth of inhaled insulin in the first nine months of the year, Pfizer said it would take a $2.8 billion charge and abandon the product.

Mr. Mann, the 82-year-old chief executive and controlling shareholder of the MannKind Corporation, is not deterred. He says his company’s inhalable insulin is not just a way to avoid needles but is medically superior to Pfizer’s product and to injected insulin.

If he is right, he could help change the way diabetes is treated.

“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 said at his 23,000-square-foot mansion overlooking the San Fernando Valley. The interview took place on a Saturday evening, which Mr. Mann said was the only opening in his seven-day work schedule.

Despite Mr. Mann’s remarkable entrepreneurial career — he has founded more than a dozen aerospace and medical device companies — there are people who wonder whether he has so much invested in this latest effort, both financially and emotionally, that he cannot see any odds against him.

“I don’t know of an individual who has spent as much of a personal fortune on a long shot,” said Andrew Forman, an analyst with WR Hambrecht & Company. Mr. Forman said MannKind faced numerous regulatory and patent challenges, as well as possible competition from the leaders in injected insulin, Eli Lilly and Novo Nordisk, which are also developing inhalable products.

 

For the full story, see:

ANDREW POLLACK. "Betting an Estate on Inhaled Insulin." The New York Times  (Fri., November 16, 2007):  C1 & C5.

 

  "The inhaled insulin device, about the size of a cellphone."  Source of caption and photo:  online version of the NYT article quoted and cited above.

 




December 4, 2007

Cuba's Best Doctors Not Blind to Incentives Offered by "Communist" Government

 

   "Patients at the Ramón Pando Ferrer eye hospital in Havana."  Source of caption and photo:  online version of the NYT article quoted and cited below.

 

(p. A4)  Cuban doctors abroad receive much better pay than in Cuba, along with other benefits from the state, like the right to buy a car and get a relatively luxurious house when they return. As a result, many of the finest physicians have taken posts abroad.

The doctors and nurses left in Cuba are stretched thin and overworked, resulting in a decline in the quality of care for Cubans, some doctors and patients said.

 

For the full story, see:   

JAMES C. McKINLEY Jr.  "Havana Journal;  A Health System’s ‘Miracles’ Come With Hidden Costs."  The New York Times   (Tues., November 20, 2007):  A4. 

 




December 1, 2007

Von Hippel Promotes User-Driven Innovation

 

     "Eric von Hippel of M.I.T., left, and Dr. Nathaniel Sims, with hospital devices Dr. Sims has modified. Mr. von Hippel says users can improve on products."  Source of caption and photo:  online version of the NYT article cited below.

 

Some innovation is done by the devoted for free.  But in his books, and in the article excerpted below, I think von Hippel puts too little emphasis on the entrepreneur and the entrepreneur's profit motive, as drivers of innovation. 

One example is the Moveable Type free program that underlies this, and many other blogs.  It is often described as one of the best blog platforms, but it is hard to use for a non-techie, kludgey, and very limited in some obvious ways.  For example, there apparently is no way that I can make comments to the most recent 10 entries visible on the main blog page.  And there is only limited backup capabilities.  And the spell-checker does not have "blog" in its dictionary, and asks me if I really meant to type "bog."

You can bet that if Moveable Type was produced for profit, they would have provided users these obvious capabilities.  And I would rather pay for a more capable program, rather than get a less capable program for free.

 

(p. 5) DR. NATHANIEL SIMS, an anesthesiologist at Massachusetts General Hospital, has figured out a few ways to help save patients’ lives. 

In doing so, he also represents a significant untapped vein of innovation for companies.

Dr. Sims has picked up more than 10 patents for medical devices over his career. He ginned up a way to more easily shuttle around the dozen or more monitors and drug-delivery devices attached to any cardiac patient after surgery, with a device known around the hospital as the “Nat Rack.”

. . .

What Dr. Sims did is called user-driven innovation by Eric von Hippel, a professor at the Massachusetts Institute of Technology’s Sloan School of Management. Mr. von Hippel is the leading advocate of the value of letting users of products modify them or improve them, because they may come up with changes that manufacturers never considered. He thinks that this could help companies develop products more quickly and inexpensively than with their internal design teams.

“It could drive manufacturers out of the design space,” Mr. von Hippel says.

It is a difficult idea for research and development departments to accept, but one of his studies found that 82 percent of new capabilities for scientific instruments like electron microscopes were developed by users.

. . .

One problem with the user-innovation model is that it can run into intellectual property rights protections.  . . .

. . .

. . . , Mr. von Hippel’s ideas are up against more conventional forms of user-aided design, such as sending anthropologists to study how people use products in their daily lives. Companies then translate their research into new designs.

Even some of Mr. von Hippel’s acolytes remain cautious. “A lot of this is still in the category of, ‘You could imagine this working out really well,’ ” says Saul T. Griffith, who as an M.I.T. engineering student was part of a group of kite-surfers who developed products for their sport that have since become commercialized. Mr. von Hippel wrote about Mr. Griffith in his 2005 book, “Democratizing Innovation.

 

For the full story, see:

MICHAEL FITZGERALD.  "Prototype How to Improve It? Ask Those Who Use It."  The New York Times, Section 3  (Sun., March 25, 2007):  5.

(Note:  ellipses added.) 

 

von Hippel has two main books in which he defends his user-driven innovation ideas:

von Hippel, Eric. The Sources of Innovation. New York:  Oxford University Press, 1988.

von Hippel, Eric. Democratizing Innovation. Cambridge, MA:  MIT Press, 2005.

 




November 27, 2007

Accepting an 80% Pay Cut for a Chance to Defy Death

 

   David Sinclair (left) and Christoph Westphal (right).  Source of photo:  online version of the NYT article cited below.

 

Humans are often risk-averse, but are also often willing to accept greater risk, in the pursuit of a really important goal. 

 

SIRTRIS PHARMACEUTICALS wants to sell you the elixir of youth. Yet the company’s founders are neither cranks nor quacks, but include a well-regarded Harvard scientist and a serial entrepreneur. 

Imagine a pill, derived from a compound found in something as benign as red wine, that treated the most feared and debilitating diseases of aging: illnesses like diabetes, neurodegenerative conditions like Alzheimer’s and Parkinson’s, and many forms of cancer. Imagine, furthermore, that this pill had no injurious side effects. Imagine, finally, that the pill’s only side effect conferred what human beings have always wanted: an increase in life span. That’s what Sirtris wants to create.

. . .

Mr. Sinclair, who at the relatively youthful age of 37 is already renowned for his investigations into how we grow old, discovered in 2003 that a molecular compound called resveratrol, found in red wine and other plant products, extends the life span of mice by as much as 24 percent and the life span of other animals, such as flies and fish, by as much as 59 percent.

Dr. Westphal, a self-described “geek” who relaxes by reading papers in academic journals like Nature and Science, was stunned by Mr. Sinclair’s discovery, and visited him in his lab to discuss the implications for drug development. The two soon decided to start a company.

“I figured if there’s going to be one chance that I’d take an 80 percent pay cut to be the C.E.O. of a company rather than general partner in a venture firm, then this was it,” Dr. Westphal, 39, told me when I visited Sirtris’s offices in Cambridge, Mass. “If we’re right on this one, everyone’s going to want to take these drugs and they’re going to treat many of the major diseases of Western society.”

. . .

“Nobody knows why we age,” Mr. Sinclair explained to me. “We’re working on genes that increase fitness and defenses against diseases. The body mounts those defenses when it’s under adversity. Caloric restriction is one of those triggers and the molecules we’re developing are also one of those triggers.”

Dr. Westphal and Mr. Sinclair stress that they are not working to “cure” aging, a condition that, so far at least, is common to all humanity and that most physicians do not consider a disease. “Curing aging is not an endpoint the federal drug agency would recognize,” Dr. Westphal says dryly. Instead, both men say, they are working to ameliorate the diseases of aging.

While Mr. Sinclair has bragged that resveratrol is as “close to a miraculous molecule as you get,” much uncertainty surrounds his research and the commercialization of his discovery faces many challenges.

. . .

Sirtris hopes to have its first drugs in commercial production by 2012 or 2013. While that may seem far off, it’s wonderfully fast for the biopharmaceutical industry, where development is onerously slow, difficult and uncertain.

This speed of research and development owes much to Dr. Westphal’s energy and Mr. Sinclair’s ambition.

“For as long as I can remember, I’ve wanted to develop drugs that combat diseases of aging,” Mr. Sinclair says. “As soon as I realized I was mortal, I started to worry. I set a goal to see if we could make drugs that would target the diseases of aging in my lifetime. I didn’t know it would be possible at all — and I didn’t know it would happen so quickly.”

 

For the full story, see: 

JASON PONTIN.  "SLIPSTREAM; An Age-Defying Quest (Red Wine Included)."  The New York Times, Section 3  (Sun., July 8, 2007):  3.

(Note:  ellipses added.)

 




November 26, 2007

FDA Hurts Consumers with New Burdens on Small Firms Making Proven Drugs

 

  "Larry Blansett, chief executive of the Blansett Pharmacal Company, sells a wide range of what he calls legacy drugs."  Source of caption and photo:  online version of the NYT article cited below.

 

(p. C1)  In the 1970s, Larry Blansett was producing a wide array of prescription cough syrups, antihistamine tablets and pain killers at the company he co-founded, UAD Laboratories. But the Food and Drug Administration was not keeping a close watch.

Mr. Blansett continues to sell the same range of products at his latest venture, the Blansett Pharmacal Company, which employs about 90 people in North Little Rock, Ark. “We grew gradually at first, but are now a national company,” he said.

Now, however, the F.D.A. has begun to crack down on the thousands of drugs that have never had to go through the agency’s stringent approval process, many of them made by small companies like Blansett Pharmacal. And those companies are crying foul.

. . .

Perry Cole, executive director of the Branded Pharmaceutical Association, . . .  said these drugs — the makers call them legacy drugs and define them as (p. C5) drugs that have been prescribed for at least 25 years and have gained a history for safety and efficacy — were far safer than many prescription drugs of recent vintage, like Viagra, which he said had been associated with hundreds of premature deaths.

. . .

The agency began its campaign against the makers of unapproved drugs in June 2006, and immediately began ordering companies that made products that it deemed potentially hazardous to file new drug applications or take them off the market.

In December, for example, it told firms to stop making unapproved products containing quinine, which has been used since the 1600s to treat malaria. The one company that made an approved quinine product, Qualaquin, was the Mutual Pharmaceutical Company of Philadelphia, and the F.D.A’s action, in effect, granted Mutual a temporary monopoly.

 

For the full story, see:

BRENT BOWERS. "Small Business; A Headache for Small Drug Makers."  The New York Times (Thurs., October 18, 2007): C1 & C5.

(Note:  ellipses added.)

 




November 20, 2007

Doctors Seek New Business Models to Avoid Paperwork and Insurance Regulation

 

   "Dr. Steven Meed works for Sickday Medical House Calls, a service in Manhattan."  Source of caption and photo:  online version of the NYT article quoted and cited below.

 

“We have that perfect storm. The current system doesn’t work well for patients or physicians,” said Dr. Rick Kellerman, a doctor who works in Wichita, Kan., and is president of the American Academy of Family Physicians. "More doctors are coming up with new home business practice models. They’re exasperated with paperwork and insurance regulation.”

The demand for primary care physicians outweighs the supply in many cities, so patients can wait weeks, and even months, for appointments, and hospital emergency rooms are becoming overloaded with nonemergency cases. Health insurance premiums, meanwhile, have continued to rise.

Some doctors are doing things like taking only house-call appointments or operating “micropractices” in which they work without front-office staff and nurses and see their patients in a smaller one-room office, Dr. Kellerman said.

When making house calls, “you get paid,” said Dr. Steven Meed, one of eight New York physicians working for Sickday Medical House Calls, which started last year and serves patients in Manhattan. “The paperwork overhead is kept at a minimum, the fee is fixed and it’s not going to be reduced.”

 

For the full story, see:

JENNIFER ALSEVER. "SPENDING; Retro Medicine: Doctors Making House Calls (for a Price)."  The New York Times, SundayBusiness Section  (Sun., September 23, 2007):  6.

 

MeedStevenHouseCalls2.jpg  "He took the subway, top, to travel to the apartment of a patient, Kayla McDermott, who had a sore throat."  Source of caption and photos:  online version of the NYT article cited above.

 




November 19, 2007

Incentives for Organ Donations Would Save Lives

 

SatelSally.jpg    Sally Satel is a medical doctor and a resident scholar at the Amerrican Enterprise Institute.  Source of photo:  http://www.aei.org/publications/filter.all,pubID.25785/pub_detail.asp

 

(p. A12)  At the annual meeting of The American Society of Transplant Surgeons this winter a straw poll revealed that 80 to 85% were in favor of studying incentives for living donors, according to society president Arthur Matas. In 2003, the American Medical Association testified on behalf of legislation that would have permitted pilot studies of incentives for deceased organs.

The public seems receptive as well, according to a new Gallup poll on attitudes toward donation of organs after death. The most striking results were among 18 to 34 year olds wherein an impressive 34% said that incentives would make them "more likely" to donate while 6% said less likely.  . . .

. . .

The idea of combining organ donation with material gain can make people queasy. Yet the mix of financial and humanitarian motives is commonplace. No one objects, for example, to a tax credit for charitable contributions--a financial incentive to complement the "pure" motive of giving to others. The great teachers who enlighten us and the doctors who heal us inspire no less gratitude because they are paid. An increase in the supply of kidneys will ameliorate suffering and prevent needless death. This is more important than whether an organ has been given freely or for material gain.  . . .

 

For the full commentary, see: 

Satel, Sally.  "Doing Well By Doing Good."  The Wall Street Journal  (Fri, March 16 2007):  A12.

(Note:  ellipses added.)

 




November 11, 2007

Unintended Consequences of Health Privacy Law

 

HealthPrivacyLawGraphic.gif   Source of graphic:  online version of the NYT article cited below.

 

(p. A1)  An emergency room nurse in Palos Heights, Ill., told Gerard Nussbaum he could not stay with his father-in-law while the elderly man was being treated after a stroke. Another nurse threatened Mr. Nussbaum with arrest for scanning his relative’s medical chart to prove to her that she was about to administer a dangerous second round of sedatives.

The nurses who threatened him with eviction and arrest both made the same claim, Mr. Nussbaum said: that access to his father-in-law and his medical information were prohibited under the Health Insurance Portability and Accountability Act, or Hipaa, as the federal law is known.

Mr. Nussbaum, a health care and Hipaa consultant, knew better and stood his ground. Nothing in the law prevented his involvement. But the confrontation drove home the way Hipaa is misunderstood by medical professionals, as well as the frustration — and even peril — that comes in its wake.

Government studies released in the last few months show the frustration is widespread, an unintended consequence of the 1996 law.

. . .

(p. A12)   

Most common are seat-of-the-pants decisions made by employees who feel safer saying “no” than “yes” in the face of ambiguity.

. . .

Ms. McAndrew said there was no way to know how often information was withheld. Of the 27,778 privacy complaints filed since 2003, the only cases investigated, she said, were complaints filed by patients who were denied access to their own information, the one unambiguous violation of the law.

Complaints not investigated include the plights of adult children looking after their parents from afar. Experts say family members frequently hear, “I can’t tell you that because of Hipaa,” when they call to check on the patient’s condition.

That is what happened to Nancy Banks, who drove from Bartlesville, Okla., to her mother’s bedside at Town and Country Hospital in Tampa, Fla., last week because Ms. Banks could not find out what she needed to know over the telephone.

Her 82-year-old mother had had a stroke. When Ms. Banks called her room she heard her mother “screaming and yelling and crying,” but conversation was impossible. So Ms. Banks tried the nursing station.

Whoever answered the phone was not helpful, so Ms. Banks hit the road. Twenty-two hours later, she arrived at the hospital.

But more of the same awaited her. She said her mother’s nurse told her that “because of the Hipaa laws I can get in trouble if I tell you anything.”

In the morning, she could speak to the doctor, she was told.

The next day, Ms. Banks was finally informed that her mother had had heart failure and that her kidneys were shutting down.

“I understand privacy laws, but this has gone too far,” Ms. Banks said. “I’m her daughter. This isn’t right.”

A hospital spokeswoman, Elena Mesa, was asked if nurses were following Hipaa protocol when they denied adult children information about their parents.

She could not answer the question, Ms. Mesa said, because Hipaa prevented her from such discussions with the press.

 

For the full story, see: 

JANE GROSS.  "Keeping Patients’ Details Private, Even From Kin."  The New York Times  (Tues., July 3, 2007):  A1 & A12.

(Note:  ellipses added.)

 

   After nurses refused to tell her what was wrong over the phone, Nancy Banks (left) drove 22 hours to find out that her mother Lourene Trusler (right) had had a stroke.  Source of photo:  online version of the NYT article cited above.

 




November 10, 2007

Texas Shows Tort Reform Works

 

   "Dr. Donald W. Patrick, executive director of the Texas Medical Board, with applications for medical licenses sent to it."  Source of caption and photo:  online version of the NYT article quoted, and cited, below. 

 

HOUSTON, Oct. 4 — In Texas, it can be a long wait for a doctor: up to six months.

That is not for an appointment. That is the time it can take the Texas Medical Board to process applications to practice.

Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.

The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count.

“It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.

“Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.

 

For the full story, see: 

RALPH BLUMENTHAL.  "After Texas Caps Malpractice Awards, Doctors Rush to Practice There."  The New York Times  (Fri., October 5, 2007):  A21.

 




October 27, 2007

Academic Entrepreneurs in a Toxic Wasteland

 

   The Berkeley Pit was once a copper mine, and now holds a lake of toxic waste.  Source of photo:  online version of the NYT article quoted and cited below.

 

Here are a few paragraphs from a fascinating story about a couple of people who seem to be practicing what Taleb is preaching in The Black Swan:

 

BUTTE, Mont. — Death sits on the east side of this city, a 40-billion-gallon pit filled with corrosive water the color of a scab. On the opposite side sits the small laboratory of Don and Andrea Stierle, whose stacks of plastic Petri dishes are smeared with organisms pulled from the pit. Early tests indicate that some of those organisms may help produce the next generation of cancer drugs.

From death’s soup, the Stierles hope to coax life.

“I love the idea of looking at toxic waste and finding something of value,” said Ms. Stierle, 52, a chemistry researcher at Montana Tech of the University of Montana.

For decades, scientists assumed that nothing could live in the Berkeley Pit, a hole 1,780 feet deep and a mile and a half wide that was one of the world’s largest copper mines until 1982, when the Atlantic Richfield Company suspended work there. The pit filled with water that turned as acidic as vinegar, laced with high concentrations of arsenic, aluminum, cadmium and zinc.

. . .

Mr. Stierle is a tenured professor at Montana Tech, but his wife gets paid only for teaching an occasional class or if there is a grant to finance her research. From 1996 to 2001 they applied for dozens of grants, but received only rejection letters. So they financed their own research, using personal savings and $12,000 in annual patent royalty payments. In 2001, they won a six-year, $800,000 grant from the United States Geological Survey.

“Their work is considered a very high-risk approach,” said Matthew D. Kane, a program director at the National Science Foundation. “It takes a long time to get funding, and some luck to find active compounds.”

Unlike scientists at large research universities, who commonly teach only one class a year and employ graduate students to run their laboratories, Mr. Stierle teaches four classes each semester at a college with 2,000 undergraduates and no major research presence.

. . .

The couple said they were negotiating privately with a pharmaceutical company to test some of the compounds they have discovered and possibly turn them into drugs. As they wait, they open another Mason jar filled with murky pit water, draw a sample and return to work.

“The pit very easily could have been a complete waste of time,” Mr. Stierle said. “We just had luck and worked our butts off. We take that first walk into the dark.”

 

For the full story, see:

CHRISTOPHER MAAG.  "In the Battle Against Cancer, Researchers Find Hope in a Toxic Wasteland."   The New York Times  (Tues., October 9, 2007):  A21.

(Note:  ellipses added.)

 

BerkeleyPitMap.gif   In the photo immediately above, Don and Andrea Steirle work in their lab.  The map to the left shows the location of the Berkeley Pit.  Source of the photo and map:  online version of the NYT article quoted and cited above.

 




October 20, 2007

Incentives, and Unintended Consequences, in Medicine

 

  A clever image, but is it apt, since the article claims doctors are extracting money, rather than injecting it?  Source of image:  online version of the NYT article quoted and cited below.

 

If patients paid for their own care, doctors would have a greater incentive to improve overall care that is valued by patients.  The perverse incentives of the current government Medicare reimbursement rules would be gone.

One main lesson from the article below is to show how fundamentally hard it is for the government to get the incentives right:  they tried to re-jigger the reimbursement rules, but the law of unintended consequences once again bit them in their collective ass (or more accurately, alas, it bit us). 

 

(p. C1)  When Medicare cracked down two years ago on profits that doctors made on drugs they administered to patients in their offices, it ended a windfall worth hundreds of thousands of dollars a year for each physician.

The change, which mainly affected drugs to treat cancer and its side effects, had an immediate effect. In all, cancer doctors billed about $4.4 billion for chemotherapy and anemia medications in 2005, down from $5.6 billion in 2004, with Medicare covering 80 percent of the bills in each year. The difference mostly represented profit that doctors had made on the drugs.

But the change did not reduce overall federal spending on cancer care, which increased slightly. And cancer doctors say the change did nothing to reduce a larger problem in cancer treatment.

Some physicians say that cancer doctors responded to Medicare’s change by performing additional treatments that got them the best reimbursements, whether or not the treatments benefited patients. Those doctors also say that Medicare’s reimbursement policies are responsible.

“The system doesn’t value the time we spend with patients,” said Dr. Peter Eisenberg, a cancer doctor in Greenbrae, Calif., and a former director of the American Society of Clinical Oncology. “The system values procedures.”

The ballooning cost of cancer treatment, one of Medicare’s most expensive categories, offers a vivid example of how difficult it may be to rein in the nation’s runaway health care spending without fundamentally changing the way doctors are paid.

. . .

(p. C6)   Now, oncologists are lobbying Medicare officials and members of Congress to reverse some of the changes and again raise the prices the government pays for drugs.

But Dr. Robert Geller, who worked as an oncologist in private practice from 1996 to 2005 before leaving to become senior medical director at Alexion, a biotechnology company, said that increasing drug reimbursement might raise oncologists’ profits but would not relieve the system’s deeper flaws.

As long as oncologists continue to be paid by the procedure instead of for spending time with patients, they will find ways to game the system, however much money they make or lose on prescribing drugs, he said.

“People go where the money is, and you’d like to believe it’s different in medicine, but it’s really no different in medicine,” Dr. Geller said. “When you start thinking of oncology as a business, then all these decisions make sense.”

 

For the full story, see: 

ALEX BERENSON.  "A Stubborn Case Of Spending On Cancer Care."  The New York Times (Tues., June 12, 2007):  C1 & C6.

(Note:  ellipsis added.)

 

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

 




October 1, 2007

Mugabe Driven by Quest for Power, More than from Paranoia, or Marxism: More on Why Africa is Poor

 

No one outside of Mr. Mugabe’s inner circle, of course, can say with certainty why he has pursued policies since 2000 that have produced economic and social bedlam. For his part, Mr. Mugabe says Zimbabwe’s chaos is the product of a Western plot to reassert colonial rule, while he is simply taking steps to fight that off.

Among many outside that circle, however, the growing conviction is that Zimbabwe’s descent is neither the result of paranoia nor the product of Mr. Mugabe’s longstanding belief in Marxist economic theory. Instead, they say, Zimbabwe is fast becoming a kleptocracy, and the government’s seemingly inexplicable policies are in fact preserving and expanding it.

. . .

Mr. Mugabe’s government declares currency trading illegal, but regularly dumps vast stacks of new bills on the black market, still wrapped in plastic, to raise foreign exchange for its own needs, business leaders and economists say.

The nation’s extraordinary hyperinflation, last pegged by analysts at 10,000 percent a year, is an economic disaster that, by all accounts, the government needs to address. Yet after it ordered merchants in July to slash their prices, cadres of policemen and soldiers moved into shops to enforce the new controls, scoop up bargains and give friends and political heavyweights preferential access to cheap goods.

. . .

Mr. Mugabe’s 25-bedroom mansion in Borrowdale, the gated high-end suburb of Harare, the capital, is the locus of a boomlet that has spawned luxury homes for government and party officials. (Mr. Mugabe said his mansion was built with goods and labor donated by foreign governments.)

Mr. Mugabe arrived to open Zimbabwe’s Parliament this month in a Rolls-Royce. Equally telling, the legislature’s parking lot was crammed with luxury cars.

Such riches have been accompanied by a steep decline in living standards for just about everyone else. The death rate for Zimbabweans under the age of 5 grew by 65 percent from 1990 to 2005, even as the rate for the world’s poorest nations dropped. Average life expectancy here is among the world’s lowest, according to the United Nations.

 

For the full commentary, see: 

MICHAEL WINES.  "News Analysis; Zimbabwe’s Chaos: The Powerful Thrive."  The New York Times (Fri., August 3, 2007):  A8. 

(Note:  ellipses added.)

 




September 30, 2007

"A Payment System that Rewards Everybody for Staying Busy"

 

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

 

(p. H6) WHY does health care for the average Medicare patient cost nearly twice as much a year in New Jersey, at $8,076, as it does in Hawaii, at $4,529?

The differences are one example of perplexing geographic variations in medical expenses and quality. And in a study that has important implications for the nation’s $2 trillion health care tab, researchers have found that more intensive and expensive care does not necessarily mean better outcomes. In fact, the opposite may be true.

The Dartmouth Atlas of Health Care, a research group that studies variations and costs in medical care, sums it up like this: Geography is destiny. It means that your chances of undergoing certain surgical procedures, visiting the doctor often or even dying in a hospital or at home are related to where you live.

For example, Medicare patients living in Rhode Island undergo knee replacements at a rate of 5 in 1,000 people. In Nebraska, the number rises to 10 in 1,000. Female Medicare enrollees who receive a diagnosis of breast cancer have nearly seven times the chance of having a mastectomy in South Dakota, where the rate is 2 in 1,000, as they do in Vermont, where the rate is .3 in 1,000.

. . .

In communities with surplus hospital beds, research shows, patients do not necessarily get more elective surgery, but they have more hospital stays, more frequent doctor’s visits and are more likely to be referred to specialists.

Dr. Elliott S. Fisher, who studies health care economics and is a member of the Dartmouth research group, said that part of the problem was the way doctors and hospitals were paid.

“In a payment system that rewards everybody for staying busy, every bit of capacity you have, whether it’s the number of specialists or the number of intensive care beds or the M.R.I. scanner, has to stay fully occupied because they bought them already and they have to keep paying for them,” Dr. Fisher said in a telephone interview.

. . .

Paradoxically, the Dartmouth research, which confirms some similar studies, shows that patients in high-cost areas are not necessarily getting better care. Dr. Fisher said that he and his colleagues found higher mortality rates in higher-spending regions.

. . .

Extra care without better outcomes translates into waste in the health care system. Some experts say that waste accounts for as much as if not more than 30 percent of the national spending on health care. Such spending now totals 16 percent of the gross domestic product.  

 

For full story, see: 

STEPHANIE SAUL.  "TREATMENTS; Need a Knee Replaced? Check Your ZIP Code."  The New York Times  (Mon., June 11, 2007):  H6.

(Note:  ellipses added.)

 

     Source of map:  online version of the NYT article cited above.

 




September 28, 2007

"We're Not Looking to Achieve Incremental Advances"

 

LevinsonArthurGenentechCEO.jpg   Genentech CEO Dr. Arthur D. Levinson.  Source of image:  online version of the WSJ article cited below.

 

(p. B1)  WSJ: You have multiple blockbuster biotech drugs on the market and more on the way. In such an uncertain business, how do you manage scientists to achieve that kind of success?

Dr. Levinson: We are first and foremost committed to doing great science. If a drug can't be the first in class or the best in class, we're just not interested. We're not looking to achieve incremental advances or extend patents or do X, Y, Z unless it is going to really matter for patients. That allows us to bring in phenomenal scientists and encourage them to do the basic and translational research.

We decided 15 years ago that we would be committing (p. B2) to oncology, which at the time for us was new. We are now the leading producer of anticancer drugs in the United States. We took a lot of risks. In many cases, those risks paid off. We are now also in immunology. Again, the role of management here is to set the broad direction and then hire absolutely the best scientists and bring them in and say, 'Do your stuff.'

 

For the full interview, see:

MARILYN CHASE. The Wall Street Journal "How Genentech Wins At Blockbuster Drugs CEO to Critics of Prices: 'Give Me a Break'."   The Wall Street Journal  (Tues., June 5, 2007):  B1 & B2.

 

 GenentechStockPrices.gif   Source of graph:  online version of the WSJ article cited above.

 



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