On Strokes, Doctors Decide for Patients, Even When Patient’s Family Knows More

(p. D1) It was one of those findings that would change medicine, Dr. Christopher Lewandowski thought.
For years, doctors had tried — and failed — to find a treatment that would preserve the brains of stroke patients. The task was beginning to seem hopeless: Once a clot blocked a blood vessel supplying the brain, its cells quickly began to die. Patients and their families could only pray that the damage would not be too extensive.
But then a large federal clinical trial proved that a so-called clot-buster drug, tissue plasminogen activator (T.P.A.), could prevent brain injury after a stroke by opening up the blocked vessel. Dr. Lewandowski, an emergency medicine physician at Henry Ford Health System in Detroit and the trial’s principal investigator, was ecstatic.
“We felt the data was so strong we didn’t have to explain it” in the published report, he said.
He was wrong. That groundbreaking clinical trial concluded 22 years ago, yet Dr. Lewandowski and others are still trying to explain the data to a powerful contingent of doubters.
The skeptics teach medical students that T.P.A.is dangerous, causing brain hemorrhages, and that the studies that found a benefit were deeply flawed. Better to just let a stroke run its course, they say.
It’s a perspective with real-world consequences. Close to 700,000 patients have strokes caused by blood clots each year and could be helped by T.P.A. Yet up to 30 percent of stroke victims who arrive at hospitals on time and are perfect candidates for the clot-buster do not receive it.
The result: paralysis and muscle weakness; impaired cognition, speech or vision; emotional and behavioral dysfunction; and many other permanent neurological injuries.
Stroke treatment guidelines issued by the American Heart Association and the American Stroke Association strongly endorse T.P.A. for patients after they’ve been properly evaluated. But treatment must start within three hours (in some cases, four(p. D4)-and-a-half hours) of the stroke’s onset, and the sooner, the better.
A number of medical societies also endorse the treatment as highly effective in reducing disability. The drug can cause or exacerbate cerebral hemorrhage, or bleeding in the brain — a real risk. But in most stroke patients it prevents brain injury, and in any event, rates of cerebral hemorrhage have declined as doctors have gained experience over the years.
. . .
About a decade ago, Dr. Lewandowski was at work when he got a call that his father had had a stroke — his right side was paralyzed. But his father had gotten to the hospital within 45 minutes, well inside the window to receive T.P.A.
Dr. Lewandowski told his mother to make the family’s wishes very clear. They wanted the emergency room doctor to give the clot-buster to his dad. The doctor refused.
“He told my mom that he doesn’t believe in the drug and he is not giving it. He doesn’t care who I am,” Dr. Lewandowski said.
“I got in my car and drove 400 miles to the hospital,” he recalled. But by the time he got there, it was too late. The treatment window had closed.
His father had a facial droop and slurred speech. His right arm and right leg flopped about uselessly. His stroke scale was 7, moderately disabling, but he survived for a few more years.
“It was very difficult for me personally,” Dr. Lewandowski recalled. “I had spent so much of my professional life working on this treatment. It actually worked.”
“I felt like I had let my dad down.”

For the full story, see:

GINA KOLATA. “A Stroke Treatment Mired in Controversy.” The New York Times (Tuesday, March 27, 2018): D1 & D4.

(Note: ellipsis added.)
(Note: the online version of the story has the date MARCH 26, 2018, and has the title “For Many Strokes, There’s an Effective Treatment. Why Aren’t Some Doctors Offering It?”)

Dockless Scooter Startups Follow Uber in Asking Regulators for Forgiveness Instead of Permission

(p. B1) Electric scooters have arrived en masse in cities like Los Angeles, San Francisco and Washington, with companies competing to offer the dockless and rechargeable vehicles. Leading the pack is Mr. VanderZanden’s Bird, with rivals including Spin and LimeBike. The start-ups are buoyed with more than $250 million in venture capital and a firm belief that electric scooters are the future of transportation, at least for a few speedy blocks.
The premise of the start-ups is simple: People can rent the electric scooters for about a $1, plus 10 cents to 15 cents a minute to use, for so-called last-mile transportation. To recharge the scooters, (p. B5) the companies have “chargers,” or people who roam the streets looking to plug in the scooters at night, for which they get paid $5 to $20 per scooter.
The problem is that cities have been shocked to discover that thousands of electric scooters have been dropped onto their sidewalks seemingly overnight. Often, the companies ignored all the usual avenues of getting city approval to set up shop. And since the scooters are dockless, riders can just grab one, go a few blocks and leave it wherever they want, causing a commotion on sidewalks and scenes of scooters strewn across wheelchair ramps and in doorways.
So officials in cities like San Francisco and Santa Monica, Calif., have been sending cease-and-desist notices and holding emergency meetings. Some even filed charges against the scooter companies.
“They just appeared,” said Mohammed Nuru, director of the San Francisco Public Works, which has been confiscating the scooters. “I don’t know who comes up with these ideas or where these people come from.”
Dennis Herrera, the San Francisco city attorney who sent cease-and-desist letters to Bird and others, described the chaos as “a free for all.”
Mr. VanderZanden said given how enormous a social shift he believes his scooters are, he was not surprised it ruffled some feathers. But people would eventually adjust, he said.
“Go back to the early 1900s, and people would have a similar reaction to cars because they were used to horses,” he said. “They had to figure out where to park all the dockless cars.”
If there is something familiar about these scooter companies’ strategy of just showing up in cities without permission, that’s because that has now become a tried-and-true playbook for many start-ups. In its early days, Uber, the ride-hailing giant, also barreled into towns overnight to launch its service and only asked for forgiveness later.
“Cities don’t know what it is,” Caen Contee, the head of marketing for LimeBike, said of the arrival of electric scooters. “They don’t know how to permit it until they’ve seen it.”
. . .
“My brother and sister legislators from Santa Monica warned me that that phenomenon has hit their cities,” said Aaron Peskin, who is on San Francisco’s board of supervisors, the city’s legislative branch. Referring to the scooter start-ups, he added, “These people are out of their minds.”

For the full story, see:
Nellie Bowles and David Streitfeld. “Charged Up Over Scooters Despite Uproar.” The New York Times (Sat., April 21, 2018): B1 & B5.
(Note: ellipsis added.)
(Note: the online version of the story has the date April 20, 2018, and has the title “Electric Scooters Are Causing Havoc. This Man Is Shrugging It Off.”)

The Role of Progressives in the Forced Sterilization of Thousands

(p. 22) Progressivism was always more than a single cause, however. Attracting reformers of all stripes, it aimed to fix the ills of society through increased government action — the “administrative state.” Progressives pushed measures ranging from immigration restriction to eugenics in a grotesque attempt to protect the nation’s gene pool by keeping the “lesser classes” from reproducing. If one part of progressivism emphasized fairness and compassion, the other reeked of bigotry and coercion.
“Imbeciles,” by Adam Cohen, the author of “Nothing to Fear: FDR’s Inner Circle and the Hundred Days That Created Modern America,” examines one of the darkest chapters of progressive reform: the case of Buck v. Bell. It’s the story of an assault upon thousands of defenseless people seen through the lens of a young woman, Carrie Buck, locked away in a Virginia state asylum. In meticulously tracing her ordeal, Cohen provides a superb history of eugenics in America, from its beginnings as an offshoot of social Darwinism — ¬≠human survival of the fittest — to its rise as a popular movement, advocating the state-sponsored sterilization of “feeble¬≠minded, insane, epileptic, inebriate, criminalistic and other degenerate persons.”

For the full review, see:
DAVID OSHINSKY. “No Justice for the Weak.” The New York Times Book Review (Sunday, March 20, 2018): 1 & 22-23.
(Note: the online version of the review has the date March 14, 2018, and has the title “‘Imbeciles’ and ‘Illiberal Reformers’.”)

The book under review, is:
Cohen, Adam. Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck. New York: Penguin Press, 2016.

Dockless Bikes Flood Dallas as Officials Scramble to Regulate

(p. B4) . . . in recent months, Dallas has become ground zero for a nascent national bike-share war, as five startups armed with hundreds of millions of venture capital dollars have blanketed the city with at least 18,000 bikes.   . . .    . . . , the bikes flooding Dallas are “dockless.” In other words, these bikes–popular in many Chinese cities–can be left almost anywhere when the rider is done.
. . .
City officials are scrambling to write regulations. “You drive down a street, you see bikes everywhere, all scattered out,” said Dallas City Council member Tennell Atkins. “We’ve got to think it through. It’s a mess.”
Other U.S. cities are having a similar experience, if on a smaller scale. The startups, which include China’s two leading bike-share companies, are in the early stages of a plan to blanket U.S. cities with hundreds of thousands of dockless bikes in the coming year.
Typically acting with cooperation and encouragement from city governments, companies seed a city with bikes placed on sidewalks, by bus stops and throughout downtowns. Users pay $1 per half-hour or hour for a bike they locate and unlock with an app on their smartphones, eliminating the need for a bike rack.

For the full story, see:
Eliot Brown. “It’s the Wild West for Bike Sharing.” The Wall Street Journal (Tuesday, March 27, 2018): B4.
(Note: ellipses added.)
(Note: the online version of the story has the date March 26, 2018, and has the title “Dockless Bike Share Floods into U.S. Cities, With Rides and Clutter.”)

Environmentalists Raising a Stink

(p. A11) The deodorants, perfumes and soaps that keep us smelling good are fouling the air with a harmful type of pollution — at levels as high as emissions from today’s cars and trucks.
That’s the surprising finding of a study published Thursday [Feb. 15, 2018] in the journal Science. Researchers found that petroleum-based chemicals used in perfumes, paints and other consumer products can, taken together, emit as much air pollution in the form of volatile organic compounds, or V.O.C.s, as motor vehicles do.
The V.O.C.s interact with other particles in the air to create the building blocks of smog, namely ozone, which can trigger asthma and permanently scar the lungs, and another type of pollution known as PM2.5, fine particles that are linked to heart attacks, strokes and lung cancer.
. . .
Concerned consumers may be tempted to turn to “natural” products, though the researchers say that isn’t a cure-all. For example, one class of compounds called terpenes gives many cleaning products a pine or citrus smell. These terpenes can be produced synthetically, or naturally from oranges.
“But whether it’s synthetic or natural, once it gets into the atmosphere it’s incredibly reactive,” Dr. Gilman said. Similar natural compounds give the Blue Ridge Mountains in Appalachia their name, from the blue haze formed by terpenes emitted from the trees there, Dr. Gilman added.
Galina Churkina, a research fellow at the Yale School of Forestry and Environmental Studies who was not involved in the study, noted that the study did not consider emissions related to biological sources like trees and animals. But the authors said their study was not the end of this line of research.
. . .
For consumers looking for a greener solution, Dr. McDonald offered some advice. “Use as little of the product as you can to get the job done,” he said.

For the full story, see:

Kendra Pierre-Louis and Hiroko Tabuchi. “Want to Save the Planet? Try Using Less Deodorant.” The New York Times (Saturday, February 17, 2018): A11.

(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date February 16, 2018, and has the title “Want Cleaner Air? Try Using Less Deodorant.”)

The Science study summarized above, is:
McDonald, Brian C., Joost A. de Gouw, Jessica B. Gilman, Shantanu H. Jathar, Ali Akherati, Christopher D. Cappa, Jose L. Jimenez, Julia Lee-Taylor, Patrick L. Hayes, Stuart A. McKeen, Yu Yan Cui, Si-Wan Kim, Drew R. Gentner, Gabriel Isaacman-VanWertz, Allen H. Goldstein, Robert A. Harley, Gregory J. Frost, James M. Roberts, Thomas B. Ryerson, and Michael Trainer. “Volatile Chemical Products Emerging as Largest Petrochemical Source of Urban Organic Emissions.” Science 359, no. 6377 (Feb. 16, 2018): 760-64.

Workers Rejecting Big-Rig Trucking Jobs

(p. B1) Trucking companies eager to hire more drivers but facing a slim pipeline of new recruits aren’t finding much to encourage them at the James Rumsey Technical Institute in Martinsburg, W.Va.
Enrollment in commercial-driving courses at the school dropped to its lowest point in about 15 years this winter, a signal that the industry’s efforts to sell workers on truck driving haven’t gained much traction. “Recruiters said all the schools were down this winter,” said instructor Michael Timmer, although he added that more students are trickling in as the weather warms.
Freight volumes in the U.S. are surging on the back of strong economic growth, as retailers and manufacturers hire more trucks to haul imports from seaports to distribution centers and raw materials to factories. But the flow of new truck drivers is lagging far behind the roaring freight market.
With unemployment at a nearly two-decade low, the downsides of life behind the wheel are making recruitment tough. Many workers are opting for construction or energy jobs that offer more time at home or better pay.

For the full story, see:
Jennifer Smith. “Trucking’s Big-Rig Life Stays a Tough Sell.” The Wall Street Journal (Wednesday, April 4, 2018): B1-B2.
(Note: the online version of the story has the date April 3, 2018, and has the title “Trucking Companies Are Struggling to Attract Drivers to the Big-Rig Life.”)

“Searing Portrait” of Uber Entrepreneur Travis Kalanick

(p. B3) Mr. Lashinsky’s book gives readers an inside view of the ride-hailing giant’s creation and what created the broken corporate culture that yielded so many negative news stories this year.
“Wild Ride” offers a searing portrait of Uber’s former chief executive, Travis Kalanick, whom Mr. Lashinsky shows to be both a genius and wildly headstrong (and not in a good way). Because of when it was published, the book does not include many of the episodes that consumed Uber in 2017, including Susan Fowler’s viral blog post about the company’s misogynistic culture and the ouster of Mr. Kalanick. But until that book is written — and it surely will be — “Wild Ride” is a good primer.

For the full commentary, see:
Sorkin, Andrew Ross. “DEALBOOK For a Year Filled With News, A List of Books Worth a Look.” The New York Times (Tuesday, DEC. 26, 2017): B1 & B3.
(Note: the online version of the commentary has the date DEC. 25, 2017, and has the title “DEALBOOK; In a Year of Nonstop News, a Batch of Business Books Worth Reading.”)

The Lashinsky book mentioned above, is:
Lashinsky, Adam. Wild Ride: Inside Uber’s Quest for World Domination. New York: Portfolio, 2017.

Debt-Free, Focused Year of Tech Ed Yields Good Jobs for High School Grads

(p. A3) As a high-school senior in Hampton, Va., Aidan Cary applied last year to prestigious universities like Dartmouth, Vanderbilt and the University of Virginia.
Then he clicked on the website for a one-year-old school called MissionU and quickly decided that’s where he wanted to go.
Mr. Cary, 19 years old, is enrolled in a one-year, data-science program. He studies between 40 and 50 hours a week, visits high-tech, Bay Area companies as part of his education, and will pay the San Francisco-based school a percentage of his income for three years after he graduates.
This new type of postsecondary education is proving a hit: The school says it has received more than 10,000 applications for 50 spots.
“I think people feel backed into a corner by the cost of college,” Mr. Cary said. “They’ve been waiting for something like this so when it finally came around they could instantly see the value proposition.”
MissionU, which enrolled its first class in September [2017], is part of new breed of institutions that bill themselves as college alternatives for the digital age. The schools–whose admission rates hover in the single digits–comparable to the Ivy League, according to the schools–offer a debt-free way to attain skills in hot areas and guaranteed apprenticeships with high-tech companies. Together those create a pipeline to well-paying high-tech jobs.

For the full story, see:
Douglas Belkin. “One-Year Alternatives to College Pop Up.” The Wall Street Journal (Tuesday, April 10, 2018): A3.
(Note: bracketed year added.)
(Note: the online version of the story has the date April 9, 2018, and has the title “One Year of ‘College’ With No Degree, But No Debt And a Job at the End.” In the penultimate paragraph quoted above, the print version has “value” where the online version has “value proposition.” I use the online version.)

Individualistic Cultures Foster Innovation

IndividualismProductivityGraph2018-04-20.pngSource of graph: online version of the WSJ commentary quoted and cited below.

(p. B1) Luther matters to investors not because of the religion he founded, but because of the cultural impact of challenging the Catholic Church’s grip on society. By ushering in what Edmund Phelps, the Nobel-winning director of Columbia University’s Center on Capitalism and Society, calls the “the age of the individual,” Luther laid the groundwork for capitalism.
. . .
(p. B10) Mr. Phelps and collaborators Saifedean Ammous, Raicho Bojilov and Gylfi Zoega show that even in recent years, countries with more individualistic cultures have more innovative economies. They demonstrate a strong link between countries that surveys show to be more individualistic, and total factor productivity, a proxy for innovation that measures growth due to more efficient use of labor and capital. Less individualistic cultures, such as France, Spain and Japan, showed little innovation while the individualistic U.S. led.
As Mr. Bojilov points out, correlation doesn’t prove causation, so they looked at the effects of country of origin on the success of second, third and fourth-generation Americans as entrepreneurs. The effects turn out to be significant but leave room for debate about how important individualistic attitudes are to financial and economic success.

For the full commentary, see:
James Mackintosh. “STREETWISE; What Martin Luther Says About Capitalism.” The Wall Street Journal (Friday, Nov. 3, 2017): B1 & B10.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Nov. 2, 2017, and has the title “STREETWISE; What 500 Years of Protestantism Teaches Us About Capitalism’s Future.” Where there are minor differences in wording in the two versions, the passages quoted above follow the online version.)