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

. . .

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

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

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

For the full commentary, see:

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

(Note: ellipses added.)

Reference to the Garrett article:

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

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

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

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

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

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

. . .

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

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

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

For the full story, see:

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

(Note: ellipsis added.)

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

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

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

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

. . .

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

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

For the full story, see:

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

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

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

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

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

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

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

. . .

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

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

For the full story, see:

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

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

(Note: ellipses added.)

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

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

For the full story, see:

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

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

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

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

For the full commentary, see:

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

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

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

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

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

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

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

For the full story, see:

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

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

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

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

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

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

For the full commentary, see:

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

(Note: ellipsis added.)

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

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

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

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

. . .

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

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

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

For the full commentary, see:

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

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

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

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

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

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

For the full review, see:

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

(Note: ellipsis added.)

Reference the book being reviewed:

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

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

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

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

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

For the full commentary, see:

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

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

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

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

. . .

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

. . .

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

. . .

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

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

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

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

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

. . .

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

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

For the full interview, see:

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

(Note: ellipses added.)

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

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

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

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

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

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

. . .

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

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

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

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

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

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

For the full story, see:

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

(Note: ellipsis added.)

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

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

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

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

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

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

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

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

For the full story, see:

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

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

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

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

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

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

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

Source:

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

(Note: ellipsis added.)

(Note: italics in original.)

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

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

Here is the core of Smith's analysis:

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

This structure defines an incentive nightmare.

. . .

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

For the full commentary, see:

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

(Note: ellipsis added.)

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

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

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

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

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

. . .

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

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

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

. . .

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

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

. . .

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

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

For the full story, see:

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

(Note: ellipses added.)

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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.)

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

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

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

Source:

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

(Note: ellipsis added.)

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

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

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

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

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

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

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

For the full story, see:

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

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

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

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

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

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

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

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

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

Source of book discussed above:

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

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

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

For a neat little paper on Oswald Avery, see:

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

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

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

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

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

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

. . .

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

. . .

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

. . .

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

For the full story, see:

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

(Note: ellipses added.)

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

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

For the full account, see:

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

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

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(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.

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(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.)

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(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.)

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

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

. . .

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

. . .

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

. . .

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

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

For the full commentary, see:

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

(Note: ellipses added.)

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

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

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

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

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

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

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

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

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

For the full story, see:

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

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

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

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

For the full commentary, see:

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

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

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

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

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

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

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

For the full story, see:

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

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

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(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.)

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

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

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

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

For the full story, see:

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

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

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

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

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

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

. . .

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

For the full story, see:

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

(Note: ellipsis added.)

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

. . .

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

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

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

For the full commentary, see:

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

(Note: ellipsis added.)

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

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

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

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

"Soon," she said. "Soon."

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

. . .

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

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

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

. . .

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

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

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

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

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

Appealing an F.D.A. Denial

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

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

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

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

. . .

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

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

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

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

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

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

(Note: ellipses added.)

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

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

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

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

For the full commentary, see:

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

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"Thomas Eakins's "The Gross Clinic" (1875)" Source of photo: online version of the WSJ review quoted and cited below. Source of caption: print version of the WSJ review quoted and cited below.

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

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

. . .

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

. . .

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

For the full review, see:

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

(Note: ellipses added.)

The reference to the reviewed book is:

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

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

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

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

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

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

For the full story, see:

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

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

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

For the full obituary, see:

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

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

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

. . .

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

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

For the full review, see:

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

(Note: ellipsis added.)

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

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

. . .

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

For the full story, see:

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

(Note: ellipsis added.)

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

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

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

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

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

. . .

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

For the full commentary, see:

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

(Note: ellipsis added.)

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

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

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

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

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

For the full interview, see:

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

(Note: ellipses added.)

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

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

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

Dear Mr. Anthony van Leeuwenhoek,

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

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

Source:

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

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

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

. . .

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

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

Source:

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

(Note: ellipses added.)

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

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

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

Source:

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

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

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

. . .

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

Source:

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

(Note: ellipses added.)

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

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

Source:

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

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

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

Source:

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

(Note: ellipsis added.)

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

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

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

Source:

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

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

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

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

Life is not always unfair:

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

Source:

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

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

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

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

. . .

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

Source:

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

(Note: ellipses added.)

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

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

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

Source:

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

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

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

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

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

Source:

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

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

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

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

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

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

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

. . .

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

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

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

Don't waste time on:

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

(Note: ellipses added.)

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

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

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

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

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

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

. . .

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

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

. . .

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

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

For the full story, see:

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

(Note: eillipses added.)

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

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

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

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

For the full story, see:

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

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

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

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

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

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

For the full story, see:

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

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

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

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

. . .

So what does it take to succeed?

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

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

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

. . .

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

For the full story, see:

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

(Note: ellipses added.)

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

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

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

. . .

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

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

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

. . .

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

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

For the full commentary, see:

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

(Note: ellipses added.)

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

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

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

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

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

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

. . .

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

. . .

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

. . .

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

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

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

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

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

For the full story, see:

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

(Note: ellipses added.)

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

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

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

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

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

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

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

For the full story, see:

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

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

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

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

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

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

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

For the full story, see:

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

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

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

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

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

For the full story, see:

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

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

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

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

For the full story, see:

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

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"Sam Houston." Source of caption and photo: online version of the WSJ commentary quoted and cited below.

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

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

Why? Two words: Tort reform.

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

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

For the full commentary, see:

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

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

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

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

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

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

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

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

. . .

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

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

For the full story, see:

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

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

(Note: ellipsis added.)

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

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

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

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

. . .

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

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

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

For the full story, see:

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

(Note: ellipsis added.)

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

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

For the full commentary, see:

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

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

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

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

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

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

. . .

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

. . .

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

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

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

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

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

For the full story, see:

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

(Note: ellipses added.)

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

Buy ScyFIX 600 and Accessories on-line!

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

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

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

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

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

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

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

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

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

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

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

. . .

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

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

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

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

For the full story, see:

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

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

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

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

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

. . .

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

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

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

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

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

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

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

. . .

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

For the full story, see:

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

(Note: ellipses added.)

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

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

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

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

For the full commentary, see:

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

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

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

For the full commentary, see:

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

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

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

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

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

For the rest of the commentary, see:

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

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

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

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

. . .

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

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

For the full commentary, see:

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

(Note: ellipsis added.)

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

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

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

. . .

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

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

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

. . .

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

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

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

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

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

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

For the full story, see:

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

(Note: ellipses added.)

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

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

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

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

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

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

. . .

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

For the full commentary, see:

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

(Note: ellipsis added.)

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

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

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

. . .

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

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

For the full summary, see:

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

(Note: ellipses added.)

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

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

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

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

For the full story, see:

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

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

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

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

. . .

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

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

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

For the full story, see: 

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

(Note:  ellipses added.)

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

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

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

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

. . .

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

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

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

For the full story, see: 

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

(Note:  ellipses added.)

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

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

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

. . .

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

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

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

. . .

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

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

 

For the full story, see:

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

(Note:  ellipses added.)

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

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

. . .

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

For the full story, see: 

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

(Note:  ellipsis added.)

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

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

. . .

(p. C8)  If the efforts of the two big 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.)

  Medical records.  Source of photo:  online version of the NYT article cited above.

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   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.

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   "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.  

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

   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.

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   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. 

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

   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.

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

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

   "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.)

    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.

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  "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.

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   "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. 

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     "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.

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   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.)

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  "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.)

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   "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.

  "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.

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    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.)

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   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.

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   "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.

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   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.)

   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.

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

  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.

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

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.)

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

  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.

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

   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.

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

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

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

(p. A1)  Stark evidence that high medical payments do not necessarily buy high-quality patient care is presented in a hospital study set for release today.

In a Pennsylvania government survey of the state’s 60 hospitals that perform heart bypass surgery, the best-paid hospital received nearly $100,000, on average, for the operation while the least-paid got less than $20,000. At both, patients had comparable lengths of stay and death rates.

And among the 20 hospitals serving metropolitan Philadelphia, two of the highest paid actually had higher-than-expected death rates, the survey found.

Hospitals say there are numerous reasons for some of the high payments, including the fact that a single very expensive case can push up the averages.

Still, the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine.

“For most consumers, the fact that there is no connection between quality and cost is one of the dirty secrets of medicine,” said Peter V. Lee, the chief executive of the Pacific Business Group on Health, a California group of employers that provide health care coverage for workers.

. . .

(p. C4)  And the survey found that good care can go unrewarded. One Philadelphia area hospital, Main Line Health’s Lankenau center, which performs a large number of bypass surgeries and has a high success rate, according to the survey, was paid an average of $33,549 by private insurers. That was less than half the nearly $80,000 in average payments received by the other hospitals, with poorer track records.

. . .

“The current reimbursement paradigm is fundamentally broken,” said Dr. Ronald Paulus, an executive with Geisinger, who says there is no current financial incentive for a hospital to provide the kind of care that leads to better outcomes and lower payments.

. . .

The problem, according to some health policy experts, is that the hospitals may, in fact, be rewarded for poor care:  keeping patients too long because they caught an infrection or had a complication.  That, they say, could be the main lesson of the Pennsylvania survey.

"What this highlights is the assumption that more money means better care is flat-out wrong," said Mr. Lee, the chief executive of the California employer group.  "It's easy to pay for bad quality, and we pay for it every day."

For the full story, see: 

REED ABELSON.  "In Health Care, Cost Isn’t Proof of High Quality." The New York Times  (Thurs., June 14, 2007):  A1 & C4. 

(Note:  The last three paragraphs, and the last sentence of the fourth from the last paragraph, of the print version of the article, are missing from the online version.)

(Note:  ellipses added.)

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

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

Why are so many lumbar fusions done, in spite of the absence of evidence for their efficacy?  Well, doctors find the procedure lucrative.  Patients do not pay for it themselves, so they have little incentive to look hard at the effectiveness.  And health care providers, through licensing and government regulations, have largely insulated themselves from competition from low cost providers.

(p. C1)  In Idaho Falls, Idaho, anyone suffering from the sort of lower back pain that may conceivably be helped by the fusing of two vertebrae is quite likely to have the surgery.  It’s known as lumbar fusion, and the rate at which it is performed in Idaho Falls is almost five times the national average.  The rate in Idaho Falls is 20 times that in Bangor, Me., where lumbar fusion is less common than anywhere else.

These numbers come from the wonderful Dartmouth Atlas of Health Care.  The Dartmouth researchers adjust the numbers to take into account age, race and sex, which is another way of saying that there is no good explanation for the huge variations they find.  Doctors in the Idaho Falls area are probably just being more aggressive than doctors elsewhere.

But it’s not clear that their patients are any better off.  The evidence for lumbar fusion is incredibly mixed.  It seems to help people with certain kinds of pain, but many others recover just as well without the surgery. Of course, doctors are almost always better off if the surgery is done:  The typical hospital bill for lumbar fusion is roughly $50,000.

This is about as good an example as you can find of the health care mess.  The number of lumbar fusions performed in this country has more than tripled since the early 1990s, and Medicare now spends more than $600 million a year on the procedure.  It’s one reason your health insurance bill has gone up.

For the full commentary, see: 

DAVID LEONHARDT.  "ECONOMIX; Health Care As if Costs Didn't Matter."  The New York Times  (Weds., June 6, 2007):  C1 & C8.

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

The FDA's major problem is not laxity, but zealotry.  Its current get-tough view on conflict of interest only aggravates the fundamental flaw in its institutional design. Transfixed on the harms drugs can cause, the FDA remains largely oblivious to the harms they can prevent. Any delay in the use of a successful drug is costly: The delay matters little to the FDA, but a great deal to the thousands who plea for compassionate exemptions to try a drug that has not met with FDA approval.  Nor is the FDA sensitive, as individual physicians surely are, to the simple fact that a drug which cannot be tolerated by one person works wonders in another.

. . .

Right now, we all have a simple expedient to protect ourselves against dangerous drugs that make it to the market: Don't take them. But we have no protection at all when the FDA denies us that choice in the first place. Right now the pace of drug approval is too slow.  We don't need the FDA to slow it up still further.

For the full commentary, see: 

Richard A. Epstein.  “Drug Crazy.”  The Wall Street Journal  (Mon., March 26, 2007):  A12.

(Note:  ellipsis added.)

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

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

The experiment described in the article excerpted below sounds promising. Such experiments would be easier, and more common, if health care were not so highly regulated, and if the government did not create such large barriers to entry in the practice of medicine.

(p. A1)  What if medical care came with a 90-day warranty? 

That is what a hospital group in central Pennsylvania is trying to learn in an experiment that some experts say is a radically new way to encourage hospitals and doctors to provide high-quality care that can avoid costly mistakes.

The group, Geisinger Health System, has overhauled its approach to surgery. And taking a cue from the makers of television sets, washing machines and consumer products, Geisinger essentially guarantees its workmanship, charging a flat fee that includes 90 days of follow-up treatment.

Even if a patient suffers complications or has to come back to the hospital, Geisinger promises not to send the insurer another bill.

Geisinger is by no means the only hospital system currently rethinking ways to better deliver care that might also reduce costs. But Geisinger’s effort is noteworthy as a distinct departure from the typical medical reimbursement system in this country, under which doctors and hospitals are paid mainly for delivering more care — not necessarily better care. 

. . .

Under the typical system, missing an antibiotic or giving poor instructions when a patient is released from the hospital results in a perverse reward: the chance to bill the patient again if more treatment is necessary. As a result, doctors and hospi-(p. C4)tals have little incentive to ensure they consistently provide the treatments that medical research has shown to produce the best results.

Researchers estimate that roughly half of American patients never get the most basic recommended treatments — like an aspirin after a heart attack, for example, or antibiotics before hip surgery.

The wide variation in treatments can translate to big differences in death rates and surgical complications. In Pennsylvania alone, the mortality rate during a hospital stay for heart surgery varies from zero in the best-performing hospitals to nearly 10 percent at the worst performer, according to the Pennsylvania Health Care Cost Containment Council, a state agency.

For the full story, see: 

REED ABELSON.  "In Bid for Better Care, Surgery With a Warranty."  The New York Times  (Thurs., May 17, 2007):  A1 & C4.

    Providing a warranty provides the hospital to provide higher quality care, as evidenced, for example, in this nurse counting sponges to make sure that none have been left behind in the patient.  Source of photo:  online version of the NYT article quoted and cited above.

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

The most welcome news a cancer patient can hear from their doctor is: "Your tumor is regressing." Sadly, the message that the Food and Drug Administration is now delivering to cancer patients is that the fight against tumors is regressing.

Current FDA policies are discouraging the development of groundbreaking treatments for cancer and other killer diseases, turning the clock back on hard-won regulations put in place in response to the AIDS crisis that allow patients faster access to new drugs. Case in point: This week, facing rejection by the Agency, GPC Biotech withdrew its New Drug Application (NDA) for Satraplatin, a drug to treat prostate cancer -- despite data from a large controlled clinical trial showing the drug delayed tumor growth in patients where the disease is widespread.

Most of the patients in this study had exhausted all known therapies; many required powerful medication to control bone pain. Time is running out for them, yet results from this statistically significant study were not sufficient for the FDA. Although GPC Biotech's application for Satraplatin was under consideration for accelerated approval, the Agency indicated it would need to wait for full survival data from this trial, which will delay approval at least one year.

Sadly, far from being an aberration, Satraplatin is the fifth promising cancer treatment set back by the FDA this year.

. . .

For patients with life-threatening diseases and their families, the implications of the FDA's recent regressive trend are devastating. It may be acceptable for regulators to be risk-averse when considering drugs for routine or nonserious diseases where alternative therapies exist. But this mindset is simply irrational when it comes to drugs intended to treat patients suffering from deadly diseases -- people who often have only weeks or months to live.

For the full commentary, see: 

RICHARD MILLER.  "Cancer Regression."  The Wall Street Journal  (Weds., August 1, 2007):  A15.

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    "THE DOCTOR MIGHT BE IN Cubans young and old at a Havana clinic in 2004."  Source of caption and photo:  online version of the NYT article cited below. 

CUBA works hard to jam American TV signals and keep out decadent Hollywood films. But it’s a good bet that Fidel Castro’s government will turn a blind eye to bootleg copies of “Sicko,” Michael Moore’s newest movie, if they show up on the streets of Havana.

“Sicko,” the talk of the Cannes Film Festival last week, savages the American health care system — and along the way extols Cuba’s system as the neatest thing since the white linen guayabera.

Mr. Moore transports a handful of sick Americans to Cuba for treatment in the course of the film, . . .

. . .

Universal health care has long given the Cuban regime bragging rights, though there is growing concern about the future. In the decades that Cuba drew financial and military support from the Soviet Union, Mr. Castro poured resources into medical education, creating the largest medical school in Latin America and turning out thousands of doctors to practice around the world.

But that changed after the collapse of the Soviets, according to Cuban defectors like Dr. Leonel Cordova. By the time Dr. Cordova started practicing in 1992, equipment and drugs were already becoming scarce. He said he was assigned to a four-block neighborhood in Havana Province where he was supposed to care for about 600 people.

“But even if I diagnosed something simple like bronchitis,” he said, “I couldn’t write a prescription for antibiotics, because there were none.”

He defected in 2000 while on a medical mission in Zimbabwe and made his way to the United States. He is now an urgent-care physician at Baptist Hospital in Miami.

Having practiced medicine in both Cuba and the United States, Dr. Cordova has an unusual perspective for comparison.

“Actually there are three systems,” Dr. Cordova said, because Cuba has two: one is for party officials and foreigners like those Mr. Moore brought to Havana. “It is as good as this one here, with all the resources, the best doctors, the best medicines, and nobody pays a cent,” he said.

But for the 11 million ordinary Cubans, hospitals are often ill equipped and patients “have to bring their own food, soap, sheets — they have to bring everything.”  . . .

. . .

Until he had to have emergency surgery last year, Fidel Castro — who turned 80 this year — was considered a model of vibrant long life in Cuba. But it was only last week that he acknowledged in an open letter that his initial surgery by Cuban doctors had been botched. He did not confirm, however, that a specialist had been flown in from Spain last December to help set things right. 

For the full commentary, see: 

ANTHONY DePALMA.  "‘Sicko,’ Castro and the ‘120 Years Club’."  The New York Times, Section 4  (Sun., May 27, 2007):   3. 

(Note:  ellipses added.)

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

   Former Senator Fred Thomspson.  Source:  online version of the WSJ article cited below.

Mr. Moore was back from Cuba, where he made a documentary on the superiority of Castro's health-care system. Mr. Thompson suggested Mr. Moore is just another lefty who loves dictators. Mr. Moore challenged Mr. Thompson to a health-care debate and accused him of smoking embargoed cigars. Within hours Mr. Thompson and his supposedly nonexistent staff had produced a spirited video response that flew through YouTube and the conservative blogosphere. Sitting at a desk and puffing on a fat cigar, Mr. Thompson announces to Mr. Moore he can't fit him into his schedule. Then: "The next time you're down in Cuba . . . you might ask them about another documentary maker. His name was Nicolás Guillén. He did something Castro didn't like, and they put him in a mental institution for several years, giving him devastating electroshock treatments. A mental institution, Michael. Might be something you ought to think about."

You couldn't quite tell if Mr. Thompson was telling Mr. Moore he ought to think more about Cuba, or might himself benefit from psychiatric treatment. It seemed almost . . . deliberately unclear.

PEGGY NOONAN.  "DECLARATIONS; The Man Who Wasn't There."  The Wall Street Journal  (Sat., May 19, 2007): P14.

(Note:  ellipsis in original.)

See Fred Thompson's response to Michael Moore on YouTube at:

http://www.youtube.com/watch?v=Ds_GhRxivOI  

    Source:  screen capture from Fred Thompson's response to Michael Moore at http://www.youtube.com/watch?v=Ds_GhRxivOI

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

    A CVS pharmacy MinuteClinic.  Source of photo:  online version of the WSJ article cited below. 

It's Friday evening and you suspect that your child might have strep throat or a worsening ear infection. Do you bundle him up and wait half the night in an emergency room? Or do you suffer through the weekend and hope that you can get an appointment with your pediatrician on Monday -- taking time off your job to drive across town for another wait in the doctor's office?

Every parent has faced this dilemma. But now there are new options, courtesy of the competitive marketplace. You might instead be able to take a quick trip on Friday night to a RediClinic in the nearby Wal-Mart or a MinuteClinic at CVS, where you will be seen by a nurse practitioner within 15 minutes, most likely getting a prescription that you can have filled right there. Cost of the visit? Generally between $40 and $60.

These new retail health clinics are opening in big box stores and local pharmacies around the country to treat common maladies at prices lower than a typical doctor's visit and much lower than the emergency room. No appointment necessary. Open daytime, evenings and weekends. Most take insurance.

Much like the response to Hurricane Katrina, private companies are far ahead of the government in answering Americans' needs, this time for more accessible and more affordable health care. Political leaders across the country seeking to expand government's role in health care should take note. 

For the full commentary, see:

GRACE-MARIE TURNER.  "Customer Health Care."  The Wall Street Journal  (Mon., May 14, 2007):   A17.

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

Consider the FDA's handling of Genasense, a new drug for melanoma and chronic lymphocytic leukemia (CLL), two often terminal forms of cancer. The drug is being developed by Genta, a small, innovative company with only one approved drug and limited financial resources. Despite compelling evidence that Genasense is making progress in fighting both diseases, the FDA appears determined to kill the drug.

In the case of the melanoma application, instead of reviewing the clinical-trial data in accordance with usual methods (which showed positive results), the FDA chose a nonstandard statistical approach aimed at discrediting the results. The agency used this analysis in its briefing to its advisory committee, claiming that the drug might not be effective. The committee then relied on that information to vote against approval.

. . .

The FDA's inane answer to the CLL experts was that the long-lasting disappearance of disease in patients taking Genasense was a "theoretical construct" and not grounds for approval.

The experts explained to the FDA that complete responses in advanced CLL patients are the medical equivalent of the Holy Grail. The FDA finally agreed, but was unimpressed with emerging data showing responders to Genasense living longer than responders in the control group.

The experts were unanimous in advising that Genasense should be approved, but the FDA was unmoved. The agency's Dr. Pazdur suggested that Genta could make the drug available as an unapproved treatment through an expanded access program -- this from a regulator fond of stating that the best way to get a drug to patients in need is through approval! In this case the agency was saying to Genta: We are not going to approve your drug, but any patient who needs it can have it so long as you give it away.

. . .

The FDA's handling of Genasense lays bare the all too common, aggressive incompetence of the FDA's cancer-drug division and should lead to an immediate examination of its policies and leadership, followed by swift corrective action.

As for the FDA's belief that their power to control us and even deny us the pursuit of life itself is unlimited under the Constitution, we can only hope the appeals court disagrees. An agency that blocks progress against deadly diseases -- while arguing that its power to do so is above challenge -- is in dire need of a court supervised review.

For the full commentary, see: 

STEVEN WALKER.  "Drug Czars."  The Wall Street Journal  (Fri., May 4, 2007):  A15.

(Note:  ellipses added.)

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

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

In the article excerpted below, the profit motive in medicine is painted as the villain of the piece.  But the problem is not the profit motive.  The problem is that government occupational licensing and regulation in medicine raises barriers to entry for low-cost competitors to enter, innovate, and compete. 

(p. A1)  Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.

Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers.

For the full story, see: 

ALEX BERENSON and ANDREW POLLACK.  "Doctors Reap Millions for Anemia Drugs."  The New York Times  (Weds., May 9, 2007):  A1 & C4. 

   Bernice Wilson's kidney dialysis treatment includes the anti-anemia drug Epogen.  Source of photo:  online version of the NYT article quoted and cited above.

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

On March 1, a federal appeals court will hear oral arguments in the case of the Abigail Alliance organization's lawsuit to change systems at the Food and Drug Administration to allow terminally ill patients access to promising drugs that have successfully completed initial stages of human safety testing. Because of my former role in the oncology division at the FDA, and in my eight-year experience as a cancer patient advocate on behalf of my son, I may be able to shed some light on the regulatory policy, medical drug development and patient rights issues surrounding this landmark case.

. . .  

Patients have valid arguments in demanding greater access to promising agents under development. Public servants should respect citizens who advocate that they be allowed to have a say in methods of their treatment when terminally ill, and government officials should have very compelling reasons for denying such access. New drug development will not suffer if a small minority of patients fighting for their lives, with no other options and in concert with their physician, gain access to a potentially beneficial agent with an established basic safety profile.

For the full commentary, see: 

MARK THORNTON.  "The Clinical Trial."  The Wall Street Journal  (Mon., February 12, 2007):  A14.

(Note:  ellipsis added.)

According to the online version of USA Today, the court did hear oral arguments on March 1st, and ". . .  isn't likely to rule for several months, . . . "

Source:  http://www.usatoday.com/news/nation/2007-04-02-unapproved-drugs_N.htm

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    A stent from Boston Scientific.  Source of photo:  online version of the NYT article cited below.

Dr. Boden would not have been so "incredulous" if he had read August 2006 and December 2006 entries on artdiamondblog.com.  My title for this entry could have read "Statins Beat Stents" if I had taken account of statin's being less invasive than stents, with lower risk of complications.

NEW ORLEANS, March 26 — Many heart patients routinely implanted with stents to open arteries gain no lasting benefit compared with those treated just with drugs, researchers reported Monday.

The researchers said patients with stents to prop open coronary blood vessels in addition to being treated with statins and other heart drugs in a five-year trial had better blood flow to the heart than patients treated only with drugs.

But they did not live longer or suffer fewer heart attacks, a finding that confirmed the results of smaller studies.

The researchers also found that the stents were highly successful at improving blood flow and relieving symptoms, including chest pain and shortness of breath, but that the advantage disappeared over time.

“When I saw the results, I was incredulous,” said Dr. William E. Boden, a cardiologist at the University at Buffalo School of Medicine and Biomedical Sciences, lead author of a report on the study published online on Monday by The New England Journal of Medicine.

For the full story, see: 

BARNABY J. FEDER.  "In Trial, Drugs Equal Benefits of Artery Stents."  The New York Times  (Tues., March 27, 2007):  A1 & A13.

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The author of the commentary excerpted below, won the Nobel Prize in economics in 2000. 

Last year, Medicare underwent a major expansion with the addition of Part D prescription drug coverage. A controversial feature of this new program was its organization as a market in which consumers could choose among various plans offered competitively by different insurers and HMOs, rather than the single-payer, single-product model used elsewhere in the Medicare system. Proponents of this design touted the choices it would offer consumers, and the benefits of competition for product quality and cost; opponents objected that consumers would be overwhelmed by the complexity of the market, and that it was unnecessarily generous to pharmaceutical and insurance companies.

Part D is a massive social experiment on the ability of a privatized market to deliver social services effectively. With the support of the National Institute on Aging, my research group has monitored consumer choices and outcomes from the new Part D market.  . . .

. . .

My overall conclusion is that, so far, the Part D program has succeeded in getting affordable prescription drugs to the senior population. Its privatized structure has not been a significant impediment to delivery of these services. Competition among insurers seems to have been effective in keeping a lid on costs, and assuring reasonable quality control. We do not have an experiment in which we can determine whether a single-product system could have done as well, or better, along these dimensions, but I think it is reasonable to say that the Part D market has performed as well as its partisans hoped, and far better than its detractors expected.

For the full commentary, see: 

DANIEL L. MCFADDEN.  "A Dog's Breakfast."  The Wall Street Journal  (Fri., February 16, 2007):  A15.

(Note:  ellipses added.)

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   The projected path of Venter's Sorcerer II ship in collecting sea organisms.  Source of map:  http://scrippsnews.ucsd.edu/Releases/?releaseID=706

Craig Venter's private gene-sequencing effort beat the government's effort.  His new research is being funded by a $24.5 million private grant from the Gordon and Betty Moore Foundation.  (For more information beyond the WSJ article excerpted below, see the Scripps Institution of Oceanography press release.)

(p. B1)  Marine microbes are among the most abundant life form on the planet and among the most mysterious. Now, results from the first phase of a global expedition are expected to provide a glimpse into this long-hidden world while potentially leading to new drugs and even fighting climate change.

Craig Venter, the brash biologist who helped crack the human genome seven years ago, says he and other scientists have used DNA-analysis techniques to discover millions of new genes and thousands of new proteins in ocean microbes. These microscopic life forms are mainly bacteria and organisms known as archaea.

"Everything we've seen is a surprise," Mr. Venter said in a phone interview from his marine research vessel, Sorcerer II, in the Sea of Cortez. The unexpected variety of microbial DNA he's found overturns earlier notions that the oceans are a homogenous soup of bacteria and other microscopic life. The details are being published today in the Public Library of Science Biology, an Internet-based scientific journal.

A diverse supply of microbial DNA from the oceans could be a rich lode for scientists. Drug companies are hunting for new compounds in sea creatures, especially to attack cancer and neurodegenerative diseases. The new data will also allow researchers to compare the DNA of oceanic bacteria to the genetic code of microorganisms that cause human disease.

"This is the largest DNA sequence ever obtained, and the magnitude of what's being done is entirely unparalleled," said Douglas Bartlett, professor of marine microbiology at the University of California, San Diego, who isn't involved in Dr. Venter's project. Marine microbes "have all kind of metabolic activity. It is expected that [Dr. Venter's team] will discover new pathways for making drugs and treating infectious disease."

For the full story, see: 

GAUTAM NAIK.  "Seafaring Scientist Sees Rich Promise In Tiny Organisms."  The Wall Street Journal  (Tues., March 13, 2007):  B1 & B5.

   Photo on left shows Venter (on left) on his Socerer II research ship.  Photo on right shows a slide of sea bacteria collected by Venter.  Source of photos:  http://scrippsnews.ucsd.edu/Releases/?releaseID=706

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(p. D8)  Most of us interpret “increased survival” to mean fewer deaths. But it does not, because survival is subject to two powerful distortions.

The first is called lead-time bias. Simply advancing the time of diagnosis (as with CT screening) will always increase survival.

Imagine two patients with lung cancer. Even if both die at age 70, a patient with cancer diagnosed by spiral CT screening at age 59 has a longer survival than one with cancer diagnosed because of symptoms (cough, weight loss and so on) at age 67. The first patient survives 11 years; the second 3 years. But both died at the same age. Survival is increased, but mortality is the same.

A second source of distortion results from overdiagnosis, when screening finds cancers that were never destined to progress and cause death. Overdiagnosis bias can also drastically inflate survival statistics, even if mortality is unchanged.

To understand why, you need to understand the definition of the two statistics. Both are fractions. Survival is calculated over a fixed period, for example 5 or 10 years.

Overdiagnosis inflates both the numerator of the survival statistic (number alive at a specified time) and the denominator (number of diagnoses). For the mortality statistic, overdiagnosis has no effect on the numerator (number of deaths) or the denominator (number studied). Perhaps the easiest way to understand this is to imagine if we told all the people in the country that they had lung cancer today: lung cancer mortality would be unchanged, but lung cancer survival would skyrocket.

The goal of lung cancer screening is to reduce mortality — to save lives. Because the New England Journal study examines only survival, it cannot tell us whether any lives are saved. Because the JAMA study examines mortality, it is the more valid study. It also corroborates the Mayo trial finding that a significantly increased survival rate can coexist with no difference in mortality.

For the full essay, see:

H. Gilbert Welch, Steven Woloshin and Lisa M. Schwartz.  "ESSAY; How Two Studies on Cancer Screening Led to Two Results."  The New York Times  (Tues., March 13, 2007):  D5 & D8.

The New England Journal of Medicine article was published on Oct. 26, 2006, and the lead author was Claudia Henschke.

The JAMA article was published in March 2007.

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   The open spaces in the weekend hospital parking lot on the left, compared to the crowded weekday lot on the right, is consistent with the findings of lower weekend staffing levels.  (These photos are from Toronto's Sunnybrook Hospital.)  Source of photos:  online version of the NYT article cited below. 

An extensive study of heart attack patients in New Jersey finds that those who arrived at hospitals on weekends were less likely to receive aggressive treatment and were slightly more likely to die than those who arrived on weekdays, researchers are reporting today.

The study, based on an analysis of 231,164 heart attack patients admitted to New Jersey hospitals from 1987 to 2002, found a gap of almost 1 percentage point in heart attack death rates over one three-year span, 12.9 percent for weekend patients and 12 percent for weekday patients.

The deaths occurred within a month of admission.

In that period, 1999 to 2002, 10 percent of weekday patients had angioplasty to open blocked arteries on the day they were admitted, compared with 6.7 percent of weekend patients. Angioplasty within a few hours of the start of heart attacks can interrupt the attacks and save lives.

The study, led by William J. Kostis, a fourth-year medical student at the Robert Wood Johnson Medical School in New Brunswick, N.J., who also has a Ph.D. in electrical engineering, is being published today in The New England Journal of Medicine.

Dr. Donald A. Redelmeier, a professor of medicine at the University of Toronto who wrote an accompanying editorial, said the higher death rate on weekends “has everything to do with staffing in hospitals.” It can mean, Dr. Redelmeier said, that not enough expert medical staff members are available on weekends for prompt and aggressive treatment.

“It’s not just that there are fewer people around, but those who are around are often spread thinner,” he added. “And there is a shift in seniority, as well. The most skilled and savvy people don’t work weekends.”

For the full story, see: 

GINA KOLATA.  "Death Rate Higher in Heart Attack Patients Hospitalized on Weekends, Study Finds."  The New York Times  (Thurs., March 15, 2007):  A19.

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   Charlton Heston as Robert Neville, the last scientist on earth.  Source of photo:  http://datacore.sciflicks.com/the_omega_man/images/the_omega_man_large_09.jpg

In the 1970s, one of my favorite films was "The Omega Man" (1971) starring Charlton Heston as the doctor/scientist who was the last healthy man on earth.  A plague had killed most of humanity, leaving a few in a demented "tertiary" condition.  Heston as "Robert Neville" had developed a vaccine, but only had been able to test it on himself, as the world collapsed.  

Those in the "tertiary" state had been organized by a former broadcast commentator named "Matthias" into the "family" whose goal it was to burn books, and destroy all remnants of science and technology. 

At one point near the end, the family captures Neville, and as the family destroys Neville's paintings, and laboratory, Matthias rants that Neville is the last scientist, the last remnant of the old world, and that all will be well when they have destroyed him.  Then comes one of my favorite exchanges.

Matthias: Now we must build.

Robert Neville: Build coffins, that's all you'll need.

When I saw the movie again today (3/16/07) for the first time in decades, I was worried that I had built it up in my memory, and that the reality would be way disappointing. 

I was relieved to see that the movie, though not perfect, was still plenty good enough.

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(p. 108)  It is worth pausing for a second to reflect on Snow's willingness to pursue his investigation this far.  Here we have a man who had reached the very pinnacle of Victorian medical practice---attending on the queen of England with a procedure that he himself had pioneered---who was nonetheless willing to spend every spare moment away from his practice knocking on hundreds of doors in some of London's most dangerous neighborhoods, seeking out specifically those houses that had been attacked by the most dread disease of the age.  But without that tenacity, without that fearlessness, without that readiness to leave behind the safety of professional success and royal patronage, and venture into the streets, his "grand experiment"---as Snow came to call it---would have gone nowhere.   The miasma theory would have remained unchallenged,

Source: 

Johnson, Steven. The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed Science, Cities, and the Modern World. New York: Riverhead Books, 2006.

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In the passage below, Johnson begins by noting the reality captured in a phrase of Charles Dickens in the following pasage from Bleak House:  "Jo lives---that is to say, Jo has not yet died---in a ruinous place . . ." 

(p. 85)  The phrasing captures the dark reality of urban poverty; to live in such a world was to live with the shadow of death hovering over your shoulder at every moment.  To live was to be not dead yet. 

From our vantage point, more than a century later, it is hard to tell how heavily that fear weighed upon the minds of individual Victorians.  As a matter of practical reality, the threat of sudden devastation---your entire extended family wiped out in a matter of days---was far more immediate than the terror threats of today.  At the height of a nineteenth-century cholera outbreak, a thousand Londoners would often die of the disease in a matter of weeks---out of a population that was a quarter the size of modern New York.  Imagine the terror and panic of a biological attack killed four thousand otherwise healthy New Yorkers over a twenty-day period.  Living amid cholera in 1854 was like living in a world where urban tragedies on that scale happened week after week, year after year.  A world where it was not at all out of the ordinary for an entire family to die in the space of forty-eight hours, children suffering alone in the arsenic-lit dark next to the corpses of their parents.

Source:

Johnson, Steven. The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed Science, Cities, and the Modern World. New York: Riverhead Books, 2006.

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

(p. A1)  Four years ago, Paluxy Valley Physicians of Glen Rose, Texas, was struggling to recoup more than $500,000 in denied or unpaid claims from insurers. Two of its eight doctors left the practice, while three others had to borrow $100,000 to keep it afloat.

To turn things around, the medical practice turned to Boston-based athenahealth Inc., one of the biggest of hundreds of companies in a lucrative niche: helping doctors wring payments from health plans. Athenahealth's software flagged and corrected the complex coding for thousands of claims, preventing them from getting hung up in insurers' Byzantine rules. Today, Paluxy Valley has whittled its claims outstanding to $179,000 and repaid the bank loan. No longer in a revenue crunch, its doctors have stopped moonlighting in the emergency room to make money.

"The insurers outcode us, they outsmart us and they have more manpower," says Shari Reynolds, the administrator at Paluxy Valley, which pays athenahealth a little over 3% of the $2.5 million it collects annually from insurers. "Now at least we have a fighting chance." 

Doctors increasingly complain that the insurance industry uses complex, opaque claims systems to confound their efforts to get paid fairly for their work. Insurers say their systems are designed to counter unnecessary charges and help keep down soaring health-care costs. Like many tug-of-wars over the health-care money pot, the tension has spawned a booming industry of intermediaries.

It's called "denial management." Doctors, clinics and hospitals are investing in software systems costing them each hundreds of thousands of dollars to help them navigate insurers' systems and head off denials. They're also hiring legions of firms that dig through past claims in search of shortchanged payments and tussle with insurers over rejected charges. "Turn denials into dollars," promises one consultant's online advertisement.

The imbroglio is costing medical providers and insurers around $20 billion -- about $10 billion for each side -- in unnecessary administrative expenses, according to a 2004 report by the Center for Information Technology Leader-(p. A18)ship, a nonprofit health-technology research group based in Boston.

For the full story, see: 

VANESSA FUHRMANS.  "BILLING BATTLE; Fights Over Health Claims Spawn a New Arms Race; Insurers and Doctors Try for Upper Hand; Firms Help Both Sides."  The Wall Street Journal  (Weds., February 14, 2007):  A1 & A18.

(Note:  I noticed some minor differences between the titles and texts of the print and online versions.  My excerpt gives the online version.) 

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

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

When it comes to managing its citizens' health, the U.S. is a model of inefficiency.

Recently released figures from the U.S. Centers for Medicare and Medicaid Services show that in 2005, the U.S. health-care tab came to 16% of gross domestic product, more than any other country. France spends 10.5% of its GDP on health care, according to the Organization for Economic Cooperation and Development, while Japan spends 8%.

Americans don't seem to be getting much for the money. In both France and Japan, the average life expectancy is higher than in the U.S., and the infant mortality rate is lower. This is true in most other OECD countries, so green tea and red wine don't explain it all.

This is a drag on U.S. companies, raising their costs, pulling money out of consumer pockets and giving overseas firms a competitive edge.

For the full commentary, see: 

JUSTIN LAHART.  "AHEAD OF THE TAPE; Rethinking Health Care And the GDP." The Wall Street Journal (Thurs., January 25, 2007):  C1.

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EXPERTS have long been puzzled by the existence of large regional disparities in medical care in the United States. Even for diseases for which the appropriate treatment is widely accepted, doctors across the country take vastly different approaches, often leading to enormous expense without making any appreciable improvement in their patients’ health.

Consider heart attacks. Prescribing beta blockers immediately after a heart attack is a well-established, cheap and efficient treatment. In Iowa, nearly 80 percent of victims in 2000 received the drugs within 24 hours of a heart attack. In Alabama or Georgia, by contrast, fewer than 6 out of 10 patients received the drugs.

“What makes the lag in beta-blocker adoption puzzling is that the clinical benefits have been understood for years,” wrote Jonathan S. Skinner and Douglas O. Staiger, economists at Dartmouth, in a recent study about these regional patterns.

Congress has decided that some treatment decisions may be best taken out of doctors’ hands. In one of their last acts this year before adjourning, lawmakers passed a bill entitling doctors to a bonus from Medicare if they report data on the quality of their care, using criteria like whether they prescribe aspirin or beta blockers to heart attack victims. In the future, this data would permit Medicare to reward doctors who followed government guidelines.

. . .

. . . , much spending on health care provides enormous benefits. A study published this year by Mr. Skinner, Mr. Staiger and Dr. Elliott S. Fisher of Dartmouth Medical School found that Medicare spending on hospital care for heart attack victims surged two-thirds from 1986 to 1996, after accounting for inflation. But the percentage of victims who were alive a year after their attacks also increased, though by just 10 percentage points, to roughly 68 percent.

The relationship — rising costs bringing increased benefits — has broken down recently. From 1996 to 2002, Medicare spending on treatments for heart attack victims increased about 14 percent, after inflation. But there was virtually no improvement in survival rates.

There is mounting evidence that the zeal to treat and spend may actually hurt patients. The study by Mr. Skinner, Mr. Staiger and Dr. Fisher found that hospitals in regions where spending grew fastest from 1986 to 2002 had some of the worst practices, in terms of providing tried-and-true therapies, and recorded the smallest gains in survival rates.

Treatment of heart disease underscores the deeply idiosyncratic nature of many choices made by America’s doctors and hospitals. Coupled with a fee-for-service system that encourages aggressive treatment, these choices stimulate health spending that provides little benefit to patients. “A lot of the innovation and spending growth are going into gray areas that are not helping people that much,” Mr. Skinner said.

For the full commentary, see: 

EDUARDO PORTER.  "ECONOMIC VIEW; The More You Pay, the Better the Care? Think Twice."  The New York Times  (Sun., December 17, 2006):  5.

(Note:  ellipses are added.)

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Another lesson from an intriguing book by Steven Johnson, is that Edwin Chadwick's good intentions were not enough to beat the cholera epidemic in London.  Johnson tells of Chadwick's two catastrophic illusions:

The first was his belief that, since the mephitic odors of private cesspools posed such a clear and present danger to health, sewage ought instead to be discharged down public drains into the Thames, from which most Londoners took their drinking water. As the great builder Thomas Cubitt remarked: "The Thames is now made a great cesspool instead of each person having one of his own."

The consequences of this well-intentioned blunder were worse even than those of the decision of the Lord Mayor during the Great Plague of 1665-66 to exterminate all the city's dogs and cats because of the false rumor that they were spreading the plague, thus allowing an exponential increase in the population of the rats who were the real transmitters.

Having contaminated a large part of the population he was trying to protect, Chadwick committed his second mistake, sternly setting his face against the simple explanation that would bring about a cure. To his dying day -- which did not come until 1890 -- Chadwick remained an unrepentant miasmatist, as proponents of the airborne explanation for cholera were known. So was Florence Nightingale. The Lancet, the leading medical journal, venomously denounced the waterborne theory and its dogged proponent, John Snow.

For the full review, see: 

FERDINAND MOUNT.  "BOOKS; Lost in a Time of Cholera; How a doctor's search solved the mystery of an epidemic in Victorian London."  The Wall Street Journal   (Sat., October 21, 2006):  P8.

The reference to the book is:

Johnson, Steven. The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed Science, Cities, and the Modern World. New York: Riverhead Books, 2006.  299 pages, $26.95

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   Source of book image:  http://images.barnesandnoble.com/images/11460000/11468284.jpg

I have not yet read The Ghost Map, but from the review excerpted below, it sounds like a wonderful book.  One lesson from the book appears to be that much good can come from a careful collection of evidence, and that much harm can come from sticking to a theory in spite of the evidence.  It is also interesting that in this tale, the villain turns out to be the advocate of public works, whose good intentions resulted in much death and suffering. 

 

(p. P8) The sociology of error is a wonderful subject. Some university ought to endow a chair in it -- and then make Steven Johnson the first professor. Mr. Johnson last provoked the public with his counterintuitive polemic "Everything Bad Is Good For You," in which he argued that TV and videogames actually improve our cognitive skills. In "The Ghost Map" he tells the story of how for 30 years and more the medical establishment in Victorian London refused to accept what was staring them in the face, namely that cholera was a waterborne disease.

Thousands of Londoners died while doctors and public-health officials stubbornly clung to the view that the plague was an airborne miasma that hung in the foul atmosphere of the slums and was inhaled by the wretched creatures who lived there. Every kind of cure was proposed: opium, linseed oil and hot compresses, smoke, castor oil, brandy -- everything but the simple, obvious remedy of rehydration, which reduces the otherwise fatal disease to a bad case of diarrhea.

The fact that the cholera toxin tricks the cells in the lining of the colon into expelling water at a terrifying rate (victims have been known to lose 30% of their body weight in a matter of hours) should surely have alerted someone to the possibility that putting this Niagara back into the body might be worth trying. Only one doctor, Thomas Latta, hit upon the answer, in 1832, just a few months after the first outbreak ever in Britain. His mistake was not to inject enough salty water, and his lone initiative was soon overwhelmed by the brainless babble of the quacks.

Chief among the villains of Mr. Johnson's unputdownable tale was the man whom we were brought up to revere as the father of public sanitation, Edwin Chadwick. This dour, tactless, unpopular reformer laid the foundations for all the government interventions in public health that we now take for granted. Yet in this story he labored under not one but two illusions that proved catastrophic.

. . .

With the austere teetotaller and vegetarian Dr. Snow and his devoted helper in the Soho slums, the Rev. Henry Whitehead, "The Ghost Map" gains not one but two heroes. Patiently they mapped the patterns of victims and survivors and narrowed down the most likely source of the cholera plague to the Broad Street pump. But even after the pump handle was removed so that Londoners could no longer fill their buckets there and the illness subsided, the miasmatists were not convinced. Snow then tramped the streets of Battersea and Vauxhall to demonstrate that those who had their water from higher up the Thames, above the reach of the tide, remained unharmed, while those who took it from the foul tidewater perished in the hundreds. This was no easy task, since the pattern of water pipes under London's houses was as tangled as the pattern of Internet service providers are today.

Why did it take so long? Because mapping epidemics was only in its infancy, though Snow's famous map was not quite the first. Because the questions that Chadwick's public-health board researched were self-fulfilling, all having to do with the smells and personal habits of the poor and not with the water they drank. The researchers mistook correlation for causation: Nobody died on the high ground of Hampstead, where the air was purer, therefore higher was safer -- or so it seemed until a Mrs. Eley, who had retired thither, arranged to receive a jugful of water from her beloved Broad Street pump and got cholera.

But above all Chadwick and his crew were certain of themselves because the stench of the slums was so utterly disgusting and because smell acts so powerfully on our imaginations. Only the most careful and dispassionate investigators were free of the obsession with stench. Henry Mayhew, for example, noted in his "London Labour and the London Poor" (1851) that sewer-hunters, who scavenged deep underground knee-deep in muck, lived to a ripe old age. The Great Stink of 1858, which finally persuaded the government to commission Sir Joseph Bazalgette to lay down the magnificent network of sewers that have lasted to this day, did not kill a single Londoner -- yet still Chadwick did not believe.

For the full review, see: 

FERDINAND MOUNT.  "BOOKS; Lost in a Time of Cholera; How a doctor's search solved the mystery of an epidemic in Victorian London."  The Wall Street Journal   (Sat., October 21, 2006):  P8.

(Note: ellipsis added.)

The reference to the book is:

Johnson, Steven. The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed Science, Cities, and the Modern World. New York: Riverhead Books, 2006.  299 pages, $26.95

   Dr. John Snow.  Source of photo:  online version of the WSJ article cited above.

   Edwin Chadwick.  Source of photo:  online version of the WSJ article cited above.

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

   Source of graph:  online version of NYT article cited below.

WASHINGTON, Jan. 8 — Spending on health care in the United States increased in 2005 at the slowest pace in six years, mostly because of much slower growth in spending on prescription drugs, the government reported Monday.

It was the third consecutive year of slower growth in the nation’s medical bills. Total health spending reached nearly $2 trillion in 2005, growing only a bit faster than the economy as a whole, officials said.

But with new medical technology becoming available every month and with a generation of baby boomers approaching old age, federal officials made no bold claims about having tamed health costs.

“It is unclear whether this phenomenon is temporary or indicative of a longer-term trend,” said Aaron C. Catlin, the principal author of the government’s annual report on health spending, published in the journal Health Affairs.

For the full story, see: 

ROBERT PEAR. "In '05, Medical Bills Grew At Slowest Pace in 6 Years."  The New York Times  (Tues., January 9, 2007):  A13.

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   CEO of drug company Eli Lilly.  Source of image:  online version of WSJ artcle cited below.

NEW YORK -- Is the future of your health riding on what happens in Washington?  Sidney Taurel thinks it might be.  The Eli Lilly CEO ticks off a list of former "death sentences" being cured or turned into chronic conditions -- "AIDS, leukemia, Hodgkins, hopefully solid tumors within the next few years.  The potential for medical research is unlimited.  We just need to make sure we don't interdict it by the wrong policies."

And what might those "wrong policies" be?  Anything, it would appear, that reduces the financial incentives for drug companies to invest in research and development.  Mr. Taurel points without hesitation to the mere threat of HillaryCare in the early 1990s as an episode that reduced investment in R&D, as drug makers, including his own, redirected money toward the purchase of pharmacy benefit management companies.  As another example, he offers the anti-drug industry crusade of Sen. Estes Kefauver in the late 1950s and early '60s:

"At that point companies started to diversify.  We bought Elizabeth Arden, we went into animal health and agricultural chemical products, later on in medical instruments and so forth.  All other companies did similar things.  And for a while after that we saw fewer new products.  When this threat subsided the companies focused again on R&D and we saw a golden era in the '80s and '90s with a lot of new products and breakthroughs."

For the full interview, see:

ROBERT L. POLLOCK.  "THE WEEKEND INTERVIEW with Sidney Taurel; Of Politics and Pills."  The Wall Street Journal  (Sat., December 2, 2006):  A8. 

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   Source of book image:  http://www.encounterbooks.com/books/cure/

Milton Friedman is gone now, but the new book reviewed below, includes a forward written by him.  Friedman can be praised for many reasons; a minor one is that he was tireless and generous in offering praise and support for others who were seeking to better understand free markets. 

About 10 years ago, I broke my leg playing basketball.  After I came out of surgery, with a cast stretching from my ankle to the top of my leg, an orderly asked me whether I had ever used crutches before.  I hadn't, so he showed me what to do, swinging through them from one end of the room to the other.  The whole lesson lasted about 90 seconds.  When I got my hospital bill, I saw that I had been charged $150 for "gait training on crutches."  I did what all insured Americans do:  I forwarded the bill to my insurance company.  Why should I care?  I wasn't paying for it.

One of the problems with American health care, as David Gratzer notes in "The Cure," is precisely a payment system that takes the patient out of the equation.  In the early 1960s, the average American paid out of pocket one of every two dollars that he spent on health care; today the figure is one dollar in seven.  The inevitable effect is hugely wasteful spending (and inflated hospital bills like mine).  In fact, per-patient costs have gone up almost exactly in inverse proportion to the share of spending borne by the consumer.

Dr. Gratzer cites a remarkable Rand Corp. study that tracked health-care spending by 2,000 families over eight years.  The families who got free health care spent 40% more than the families with cost-sharing arrangements.  And yet the health outcomes for the two groups were the same.  The lesson:  Market-based health insurance systems, such as health savings accounts, cut out inefficiencies and lower costs without compromising quality.

. . .

. . . :   America is clearly at a crossroads in medical care.  Within the next decade we will get either some version of Hillary-care or more free-market medicine, starting with universally available health savings accounts.  Let's hope that our nation's policy makers read "The Cure" before they decide.  They will learn that the government route flattens costs only by holding back the pace of technology, artificially controlling its price and rationing its use.  That is not a prescription for better health.

For the full review, see: 

STEPHEN MOORE.  "BOOKS; The Market and Its Medicine."  The Wall Street Journal  (Tues.,  By  December 5, 2006; Page D6. 

The reference to the book under review, is: 

Dr. David Gratzer.  The Cure: How Capitalism Can Save American Health Care.  Encounter Books, 2006.  (233 pages, $25.94)

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

Most people have of a clear image of how atherosclerosis, popularly known as hardening of the arteries, causes a heart attack -- fatty deposits called plaque build up in a coronary artery until the day the blood flow that sustains the heart is blocked.

If only they were right.  In reality, severe coronary artery blockages almost always cause chest pain known as angina and other symptoms as they form.  But among those who suffer heart attacks, half of the men and two-thirds of the women report never experiencing a warning symptom.  And autopsies of such victims frequently show blood clots jammed into arteries that have been only modestly narrowed.

Standard atherosclerosis therapies include bypass surgery to route blood around blockages, angioplasty and stenting to clear blockages from inside the artery, and drugs like statins that reduce cholesterol levels to slow the formation of plaque.  But they have not been enough to prevent 200,000 to 500,000 American deaths annually from what doctors refer to as coronary artery disease.

As a result, many researchers have turned their attention from atherosclerosis in general to the tendency of some patients to develop a form of plaque prone to inflammation and rupture, which can spill a stew of cells into the bloodstream that can incite rapid clotting.  Such plaques have been called ''vulnerable'' plaque. 

For the full story, see:

BARNABY J. FEDER.  "In Quest to Improve Heart Therapies, Plaque Gets a Fresh Look."  The New York Times  (Mon., November 27, 2006):  C1 & C3.

Posted by Art Diamond at 1:01 AM | Permalink