Drug Extending Life of Breast Cancer Patients by Six Months Is “Unheard-Of”

(p. A16) The patients had metastatic breast cancer that had been progressing despite rounds of harsh chemotherapy. But a treatment with a drug that targeted cancer cells with laserlike precision was stunningly successful, slowing tumor growth and extending life to an extent rarely seen with advanced cancers.

The new study, presented at the annual meeting of the American Society of Clinical Oncology and published on Sunday [June 5, 2022] in the New England Journal of Medicine, would change how medicine was practiced, cancer specialists said.

. . .

The clinical trial, sponsored by the pharmaceutical companies Daiichi Sankyo and AstraZeneca and led by Dr. Shanu Modi of Memorial Sloan Kettering Cancer Center, involved 557 patients with metastatic breast cancer who were HER2-low. Two-thirds took the experimental drug, trastuzumab deruxtecan, sold as Enhertu; the rest underwent standard chemotherapy.

. . .

“It is unheard-of for chemotherapy trials in metastatic breast cancer to improve survival in patients by six months,” said Dr. Moore, who enrolled some patients in the study. Usually, she says, success in a clinical trial is an extra few weeks of life or no survival benefit at all but an improved quality of life.

The results were so impressive that the researchers received a standing ovation when they presented their data at the oncology conference in Chicago on Sunday.

. . .

“This strategy is the real breakthrough,” he said, explaining that it would enable researchers to zoom in on molecular targets on tumor cells that were only sparsely present.

“This is about more than just this drug or even breast cancer,” Dr. Winer said. “Its real advantage is that it enables us to take potent therapies directly to cancer cells.”

For the full story see:

Gina Kolata. “Trial of New Breast Cancer Drug Results in ‘Unheard-Of’ Survival Rates.” The New York Times (Wednesday, June 8, 2022): A16.

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

(Note: the online version of the story has the date June 7, 2022, and has the title “Breast Cancer Drug Trial Results in ‘Unheard-Of’ Survival.” Where there are minor differences in wording between the versions, the passages quoted above follow the online version.)

The academic NEJM article reporting the results summarized in the passages quoted above is:

Modi, Shanu, William Jacot, Toshinari Yamashita, Joohyuk Sohn, Maria Vidal, Eriko Tokunaga, Junji Tsurutani, Naoto T. Ueno, Aleix Prat, Yee Soo Chae, Keun Seok Lee, Naoki Niikura, Yeon Hee Park, Binghe Xu, Xiaojia Wang, Miguel Gil-Gil, Wei Li, Jean-Yves Pierga, Seock-Ah Im, Halle C.F. Moore, Hope S. Rugo, Rinat Yerushalmi, Flora Zagouri, Andrea Gombos, Sung-Bae Kim, Qiang Liu, Ting Luo, Cristina Saura, Peter Schmid, Tao Sun, Dhiraj Gambhire, Lotus Yung, Yibin Wang, Jasmeet Singh, Patrik Vitazka, Gerold Meinhardt, Nadia Harbeck, and David A. Cameron. “Trastuzumab Deruxtecan in Previously Treated Her2-Low Advanced Breast Cancer.” New England Journal of Medicine 387, no. 1 (July 7, 2022): 9-20.

Three Cups of Coffee a Day Lowers Risk of Death

(p. D6) That morning cup of coffee may be linked to a lower risk of dying, researchers from a study published Monday [June 6, 2022] in The Annals of Internal Medicine concluded. Those who drank 1.5 to 3.5 cups of coffee per day, even with a teaspoon of sugar, were up to 30 percent less likely to die during the study period than those who didn’t drink coffee. Those who drank unsweetened coffee were 16 to 21 percent less likely to die during the study period, with those drinking about three cups per day having the lowest risk of death when compared with noncoffee drinkers.

Researchers analyzed coffee consumption data collected from the U.K. Biobank, a large medical database with health information from people across Britain. They analyzed demographic, lifestyle and dietary information collected from more than 170,000 people between the ages of 37 and 73 over a median follow-up period of seven years. The mortality risk remained lower for people who drank both decaffeinated and caffeinated coffee. The data was inconclusive for those who drank coffee with artificial sweeteners.

“It’s huge. There are very few things that reduce your mortality by 30 percent,” said Dr. Christina Wee, an associate professor of medicine at Harvard Medical School and a deputy editor of the scientific journal where the study was published. Dr. Wee edited the study and published a corresponding editorial in the same journal.

. . .

The study showed that the benefits of coffee tapered off for people who drank more than 4.5 cups of coffee each day.

For the full story see:

Dani Blum. “Have a Cup of Coffee. It Could Extend Your Life.” The New York Times (Tuesday, June 7, 2022): D6.

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

(Note: the online version of the story has the date June 1, 2022, and has the title “Coffee Drinking Linked to Lower Mortality Risk, New Study Finds.” Where there are minor differences in wording between the versions, the passages quoted above follow the online version.)

The academic article summarized in the passages quoted above is:

Liu, Dan, Zhi-Hao Li, Dong Shen, Pei-Dong Zhang, Wei-Qi Song, Wen-Ting Zhang, Qing-Mei Huang, Pei-Liang Chen, Xi-Ru Zhang, and Chen Mao. “Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption with All-Cause and Cause-Specific Mortality.” Annals of Internal Medicine 175, no. 7 (July 2022): 909-17.

CDC’s “Rigid Checklist” Leads Doctors to Misdiagnose Atypical Cases

(p. A17) In his “memoir of illness and discovery,” Mr. Douthat tells us of his descent into a netherworld of consternation, paranoia and despair after contracting a chronic form of Lyme disease six years ago. Although he experienced physical pain that was often unbearable, he was stonewalled and scoffed at by skeptical doctors who refused to accept the existence of a long-lingering form of Lyme.

. . .

Lyme—a debilitating bacterial disease acquired from deer-tick bites—was ruled out because many of his symptoms didn’t match a rigid checklist drawn up for the ailment by the Centers for Disease Control and Prevention. This “diagnostic standardization,” Mr. Douthat writes, was “supposed to establish a consistent baseline for national case reporting, not rule out the possibility of atypical cases or constrain doctors from diagnosing them.” As a result of such inflexibility, he tells us, doctors miss “anywhere from a third to half of early Lyme cases.”

For the full review, see:

Tunku Varadarajan. “BOOKSHELF; Patient, Heal Thyself.” The Wall Street Journal (Saturday, Oct. 14, 2021): A17.

(Note: ellipsis added.)

(Note: the online version of the review has the date October 13, 2021, and has the title “BOOKSHELF; ‘The Deep Places’ Review: Patient, Heal Thyself.”)

The book under review is:

Douthat, Ross. The Deep Places: A Memoir of Illness and Discovery. New York: Convergent Books, 2021.

Brynjolfsson Made “Long Bet” with Gordon that A.I. Will Increase Productivity

(p. B1) For years, it has been an article of faith in corporate America that cloud computing and artificial intelligence will fuel a surge in wealth-generating productivity. That belief has inspired a flood of venture funding and company spending. And the payoff, proponents insist, will not be confined to a small group of tech giants but will spread across the economy.

It hasn’t happened yet.

Productivity, which is defined as the value of goods and services produced per hour of work, fell sharply in the first quarter this year, the government reported this month. The quarterly numbers are often volatile, but the report seemed to dash earlier hopes that a productivity revival was finally underway, helped by accelerated investment in digital technologies during the pandemic.

The growth in productivity since the pandemic hit now stands at about 1 percent annually, in line with the meager rate since 2010 — and far below the last stretch of robust improvement, from 1996 to 2004, when productivity grew more than 3 percent a year.

. . .

(p. B6) The current productivity puzzle is the subject of spirited debate among economists. Robert J. Gordon, an economist at Northwestern University, is the leading skeptic. Today’s artificial intelligence, he says, is mainly a technology of pattern recognition, poring through vast troves of words, images and numbers. Its feats, according to Mr. Gordon, are “impressive but not transformational” in the way that electricity and the internal combustion engine were.

Erik Brynjolfsson, director of Stanford University’s Digital Economy Lab, is the leader of the optimists’ camp. He confesses to being somewhat disappointed that the productivity pickup is not yet evident, but is convinced it is only a matter of time.

“Real change is happening — a tidal wave of transformation is underway,” Mr. Brynjolfsson said. “We’re seeing more and more facts on the ground.”

It will probably be years before there is a definitive answer to the productivity debate. Mr. Brynjolfsson and Mr. Gordon made a “long bet” last year, with the winner determined at the end of 2029.

For the full story see:

Steve Lohr. “Why Isn’t A.I. Increasing Productivity?” The New York Times (Wednesday, May 25, 2022): B1 & B6.

(Note: ellipsis added.)

(Note: the online version of the story was updated May 27, 2022, and has the title “Why Isn’t New Technology Making Us More Productive?”)

Young Despairing Chinese Adopt the “Run Philosophy”

(p. B1) “I can’t stand the thought that I will have to die in this place,” said Cheng Xinyu, a 19-year-old writer in the southwestern Chinese city of Chengdu, who is thinking of migrating to foreign countries before the government’s iron fist falls on her.

She can’t imagine having children in China, either.

“I like children, but I don’t dare to have them here because I won’t be able to protect them,” she said, citing concerns like pandemic control workers breaking into apartments to spray disinfectant, killing pets and requiring residents to leave the keys in their apartment door locks.

Ms. Cheng is part of a new trend known as the “run philosophy,” or “runxue,” that preaches running away from China to seek a safer and brighter future. She and millions of others also reposted a video in which a young man pushed back against police officers who warned that his family would be punished for three generations if he refused to go to a quarantine camp. “This will be our last generation,” he told the police.

His response became an online meme that was later censored. Many young people identified with the sentiment, saying they would be reluctant to have children under the increasingly authoritarian government.

. . .

(p. B3) The “run philosophy” and the “last generation” are the rallying cries for many Chinese in their 20s and 30s who despair about their country and their future. They are entering the labor force, getting married and deciding whether to have children in one of the country’s bleakest moments in decades. Censored and politically suppressed, some are considering voting with their feet while others want to protest by not having children.

. . .

Doris Wang, a young professional in Shanghai, said she had never planned to have children in China. Living through the harsh lockdown in the past two months reaffirmed her decision. Children should be playing in nature and with one another, she said, but they’re locked up in apartments, going through rounds of Covid testing, getting yelled at by pandemic control workers and listening to stern announcements from loudspeakers on the street.

“Even adults feel very depressed, desperate and unhealthy, not to mention children,” she said. “They’ll definitely have psychological issues to deal with when they grow up.” She said she planned to migrate to a Western country so she could have a normal life and dignity.

Compounding the frustrations, headlines are full of bad news about jobs. There will be more than 10 million college graduates in China this year, a record. But many businesses are laying off workers or freezing head counts as they try to survive the lockdowns and regulatory crackdowns.

. . .

“When you find that as an individual you have zero ability to fight back the state apparatus, your only way out is to run,” said Ms. Wang, the young professional in Shanghai.

For the full commentary see:

Li Yuan. “The New New World; Young Chinese Feel Suffocated.” The New York Times (Wednesday, May 25, 2022): B1 & B3.

(Note: ellipses added.)

(Note: the online version of the commentary has the date May 24, 2022, and has the title “The New New World;‘The Last Generation’: The Disillusionment of Young Chinese.”

Sri Lankan Ban on Synthetic Fertilizer Causes Soaring Food Prices and Hunger

(p. A17) The Green Revolution of Norman Borlaug, the American agronomist who did more to feed the world than any man before or since, set Sri Lanka on the path to agricultural abundance in 1970. It was built around chemical fertilizers and crops bred to be disease-resistant. Fifty-two years later, Sri Lanka has pulled off a revolution that is “antigreen” in the modern sense, toppling its president, Gotabaya Rajapaksa. In an uprising that has its roots in Mr. Rajapaksa’s imperious decision to impose organic farming on the entire country—which led to widespread hunger after the agricultural economy collapsed—Sri Lanka’s people have wrought the first contra-organic national uprising in history.

. . .

. . ., Mr. Rajapaksa was driven from office in part because he was an overzealous green warrior, who imposed on his countrymen a policy that the American environmental left holds sacred.

. . .

. . ., Mr. Rajapaksa took a step that poleaxed Sri Lanka. On April 27, 2021—with no warning, and with no attempt to teach farmers how to cope with the change—he announced a ban on all synthetic fertilizers and pesticides. Henceforth, he decreed, Sri Lankan agriculture would be 100% organic. Agronomists and other scientists warned loudly of the catastrophe that would ensue, but they were ignored. This Sri Lankan Nero listened to no one.

. . .

What happened next? Rice production fell by 20% in the first 180 days of the ban on synthetic fertilizer. Tea, Sri Lanka’s main cash crop, has been hit hard, with exports at their lowest level in nearly a quarter-century. Whether from indignation over the new laws or an inability to go organic, farmers left a third of all farmland fallow. Food prices soared as a result of scarcity and Sri Lanka’s people, their pockets already hit by the pandemic, began to go hungry. To add to the stench of failure, a shipload of manure from China had to be turned back after samples revealed dangerous levels of bacteria. The farmers had no synthetic fertilizer, and hardly any of the organic kind.

For the full commentary see:

Tunku Varadarajan. “Sri Lanka’s Green New Deal Was a Human Disaster.” The Wall Street Journal (Friday, July 15, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 14, 2022, and has the same title as the print version.

Despite Global Warming, “Largest Gathering of Fin Whales Ever Documented” in “Thrilling” Return to Ancestral Antarctic Waters

(p. A5) From a distance, it looked like thick fog across the horizon. But as the ship drew closer, the ocean bubbled as 150 fin whales, the planet’s second-largest creatures, dived and lunged against the water’s surface.

Six weeks into a nine-week expedition, near the coast of Elephant Island, northeast of the Antarctic Peninsula, researchers had stumbled upon the largest gathering of fin whales ever documented.

“It was one of the most spectacular observations I’ve had,” said Helena Herr, a marine mammal ecologist at the University of Hamburg. “The fin whales seemed to go crazy because of the food load they were confronted with. It was absolutely thrilling.”

Dr. Herr and her colleagues documented the return of large numbers of fin whales to the waters that once made up their historical feeding grounds in a paper published on Thursday [July 7, 2022] in the journal Scientific Reports.

. . .

In the oceans, recent modeling has estimated that global warming caused by continued greenhouse gas emissions could trigger a mass die-off of marine species by 2300.

The rebounding of the fin whales’ population, however, offers “a sign that if you enforce management and conservation, there are chances for species to recover,” Dr. Herr said.

. . .

Scientists are not sure why some of the gatherings were so large. Dr. Herr noted that the scenes they witnessed had at least some parallels to historical reports written before widespread commercial whaling. For instance, the naturalist William Speirs Bruce described seeing whales’ backs and blasts stretching “from horizon to horizon” on an Antarctic expedition in 1892.

Recent research has proposed that the rebound in whale populations is good not only for the whales but also for the entire ecosystem, through a concept known as the “whale pump.” Scientists posit that as whales feed on krill, they excrete iron, which was locked in the crustaceans, back into the water. That, in turn, can boost phytoplankton, microscopic organisms that use carbon dioxide in photosynthesis and serve as the base of the marine food chain.

As the fin whales bring the krill to the water’s surface, they can also facilitate the success of other predators, including seabirds, and seals, Dr. Santora said. “There’s much more cooperation and symbiosis than we usually give the ecosystem credit for.”

For the full story, see:

Winston Choi-Schagrin. “Conservation Success: 150 Fin Whales Gather For Feast in Antarctic.” The Wall Street Journal (Friday, July 8, 2022): A5.

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

(Note: the online version of the story was updated July 11, 2022, and has the title “A Whale Feeding Frenzy in Antarctica Signals a Conservation Success.”)

The academic article in Nature affiliated journal Scientific Reports, mentioned above, is:

Herr, Helena, Sacha Viquerat, Fredi Devas, Abigail Lees, Lucy Wells, Bertie Gregory, Ted Giffords, Dan Beecham, and Bettina Meyer. “Return of Large Fin Whale Feeding Aggregations to Historical Whaling Grounds in the Southern Ocean.” Scientific Reports 12, no. 1 (July 7, 2022): DOI: 10.1038/s41598-022-13798-7

Log4j Open Source Bug Created “Endemic” Risk for “a Decade or Longer”

Continuing worries about the Log4j software bug are consistent with my skepticism of open source software, Openness to Creative Destruction. You can find a brief discussion in the chapter defending patents.

(p. A6) WASHINGTON—A major cybersecurity bug detected last year in a widely used piece of software is an “endemic vulnerability” that could persist for more than a decade as an avenue for hackers to infiltrate computer networks, a U.S. government review has concluded.

. . .

“The Log4j event is not over,” the report said. “The board assesses that Log4j is an ‘endemic vulnerability’ and that vulnerable instances of Log4j will remain in systems for many years to come, perhaps a decade or longer. Significant risk remains.”

. . .

Security researchers uncovered last December a major flaw in Log4j, an open-source software logging tool. It is a widely used piece of free code that logs activity in computer networks and applications.

For the full story, see:

Dustin Volz. “‘Endemic’ Risk Seen In Log4j Cyber Bug.” The Wall Street Journal (Friday, July 15, 2022): A6.

(Note: ellipses added.)

(Note: the online version of the story has the date July 14, 2022, and has the title “Major Cyber Bug in Log4j to Persist as ‘Endemic’ Risk for Years to Come, U.S. Board Finds.”)

My book, mentioned above, is:

Diamond, Arthur M., Jr. Openness to Creative Destruction: Sustaining Innovative Dynamism. New York: Oxford University Press, 2019.

Insurers Claim Curing Obesity Is “Vanity”

(p. A17) Maya Cohen’s entree into the world of obesity medicine came as a shock.

In despair over her weight, she saw Dr. Caroline Apovian, an obesity specialist at Brigham and Women’s Hospital, who prescribed Saxenda, a recently approved weight-loss drug. Ms. Cohen, who is 55 and lives in Cape Elizabeth, Maine, hastened to get it filled.

Then she saw the price her pharmacy was charging: $1,500 a month. Her insurer classified it as a “vanity drug” and would not cover it.

“I’m being treated for obesity,” she complained to her insurer, but to no avail.

. . .

More than 40 percent of Americans have obesity, and most have tried repeatedly to lose weight and keep it off, only to fail. Many suffer from medical conditions that are linked to obesity, including diabetes, joint and back pain and heart disease, and those conditions often improve with weight loss.

“The evidence is now overwhelming that there are physical changes in weight regulating pathways that make it difficult for people to lose weight and maintain their weight loss,” said Dr. Louis Aronne, an obesity medicine specialist who directs the comprehensive weight control center at Weill Cornell Medicine. “It’s not that they don’t have willpower. Something physical is holding them back.”

. . .

“Access to medicines for the treatment of obesity is dismal in this country,” said Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School.

. . .

Douglas Langa, an executive vice president at Novo Nordisk, . . . said that diabetes and obesity were “separate categories, separate marketplaces” to explain the difference in price between the companies’ two drugs that were based on the same medicine, semaglutide. He said Wegovy’s price “reflects efficacy and clinical value in this area of unmet need.”

Dr. Stanford was appalled.

“It’s unbelievable,” she said, adding that it was a gross inequity to charge people more for the same drug because of their obesity. She finds herself in an untenable situation: getting excited when her patients with obesity also have diabetes because their insurers pay for the drug.

For the full story, see:

Gina Kolata. “Many Insurers Won’t Cover New Weight Loss Drugs.” The New York Times (Wednesday, June 1, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the story has the date May 31, 2022, and has the title “The Doctor Prescribed an Obesity Drug. Her Insurer Called It ‘Vanity.’.”)

Entrepreneur Turns Invasive Predator Crabs into Tasty Whiskey

(p. A12) CONCORD, N.H. — Care for a hint of crab in your whiskey?

A New Hampshire distillery has come up with its newest concoction called “Crab Trapper” – whiskey flavored with invasive green crabs.

Tamworth Distilling, a maker of craft spirits, is not afraid of pushing boundaries with unexpected flavors. In the past, the distillery produced a whiskey with the secretion from beavers’ castor sacs. Last year, it was turkey over the holidays and before that the notoriously pungent smell of durian.

The company said the body of this peculiar brew has hints of maple, vanilla oak, clove, cinnamon and allspice.

. . .

Searching for a fresh flavor, Tamworth Distilling cast its eye to the sea. Distiller Matt Power said the company heard about the problems caused by the invasive green crabs from the University of New Hampshire Extension’s Gabriela Bradt.

. . .

Bradt, a fisheries extension specialist, said the crabs are “so numerous that they have really impacted shellfish habitats and fisheries because they are also voracious predators.” A good example, she said, was the soft-shell clam fishery, which has suffered millions of dollars in losses.

. . .

The distillery’s sales manager, Jillian Anderson, said the whiskey, available on site, at Philadelphia’s Art in the Age and online, has grown in popularity.

For the full story see:

Michael Casey, The Associated Press. “Invasive Crabs Become Whiskey.” Omaha World-Herald (Sunday, June 30, 2022): A12.

(Note: ellipses added.)

Is Apple’s Lack of New Breakthroughs Due to Lack of Opportunity or Lack of Steve Jobs?

(p. 15) Steve Jobs, Apple’s co-founder and animating spirit, died in 2011, leaving the firm in the hands of Jony Ive, the British-born designer-savant, and Tim Cook, a child of Alabama who’d become a master of supply chains and production costs. “After Steve,” by the New York Times reporter Tripp Mickle, covers Ive’s and Cook’s careers, and how they and the company changed after they took over.

. . .

In the epilogue, Mickle drops his reporter’s detachment to apportion responsibility for the firm’s failure to launch another transformative product. Cook is blamed for being aloof and unknowable, a bad partner for Ive, “an artist who wanted to bring empathy to every product.” Ive is also dinged for taking on “responsibility for software design and the management burdens that he soon came to disdain.” By the end, the sense that the two missed a chance to create a worthy successor to the iPhone is palpable.

It’s also hooey, and the best evidence for that is the previous 400 pages. It’s true that after Jobs died, Apple didn’t produce another device as important as the iPhone, but Apple didn’t produce another device that important before he died either. It’s also true that Cook did not play the role of C.E.O. as Jobs had, but no one ever thought he could, including Jobs, who on his deathbed advised Cook never to ask what Steve would do: “Just do what’s right.”

Ive and Cook wanted another iPhone, but, as Mickle’s exhaustive reporting makes clear, there was not another such device to be made. Self-driving cars were too hard, health devices too regulated, television protected in ways music had not been, and even the earbuds and watch, devices they actually shipped, were peripheral, technically and conceptually, to Apple’s greatest product.

Epilogue aside, the book is an amazingly detailed portrait of the permanent tension between strategy and luck: Companies make their own history, but they do not make it as they please. What happened after Steve was that Cook’s greatest opportunities were in Apple’s future, Ive’s in its past.

For the full review, see:

Clay Shirky. “The Watchmen.” The New York Times Book Review (Sunday, May 29, 2022): 15.

(Note: ellipsis added; italics in original.)

(Note: the online version of the review was updated May 2, 2022, and has the title “Apple Inc., ‘After Steve’.”)

The book under review is:

Mickle, Tripp. After Steve: How Apple Became a Trillion-Dollar Company and Lost Its Soul. New York: William Morrow, 2022.