Trump Walks the Walk on Hydroxychloroquine

(p. A6) WASHINGTON—President Trump said he is taking hydroxychloroquine, an antimalarial drug that he has cited as a possible defense against the novel coronavirus but that some scientists have cautioned needs further study and could be dangerous.

“I happen to be taking it, hydroxychloroquine,” he told reporters at the White House on Monday. He said he had consulted with the White House doctor and suggested he is taking the drug as a preventive measure. Mr. Trump said he has been checked regularly for Covid-19, has tested negative and has no symptoms. He said he has been taking hydroxychloroquine for about a week and a half.

. . .

On Monday [May 18, 2020], Mr. Trump continued to stress anecdotal evidence in favor of the drug and told reporters, “I was just waiting to see your eyes light up when I said this.” He also expressed confidence in the drug’s safety. “I’m not going to get hurt by it. It’s been around for 40 years for malaria, for lupus, for other things.”

For the full story, see:

Catherine Lucey, Jared S. Hopkins. “President Trump Says He Is Taking Hydroxychloroquine as Preventive.” The Wall Street Journal (Tuesday, May 19, 2020): A6.

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

(Note: the online version of the story has the date May 18, 2020, and has the title “Trump Says He Takes Contested Drug for Prevention.”)

The key reference on advocates of a drug who take it first themselves, without confirmation from randomized double-blind clinical trials, is:

Altman, Lawrence K. Who Goes First?: The Story of Self-Experimentation in Medicine. Berkeley, CA: University of California Press, 1998.

China Sent Fewer Masks to World Than Claimed

(p. A6) This spring, Beijing energetically promoted its exports and overseas donations of medical supplies and asked foreign politicians to thank China publicly for the shipments. But a study released on Tuesday [May 6, 2020] found that the shipments were slow to get started.

. . .

The tonnage of China’s net exports of respirators and surgical masks was down 5 percent in March from the same month a year earlier, according to an analysis by Chad Bown, a trade specialist at the Peterson Institute for International Economics in Washington.

The analysis, based on Beijing’s own customs data, also found that China cut way back on exports of medical supplies in January and February and stepped up imports in those months.

For the full story, see:

“Top British Doctor Quits After Violating Lockdown.” The New York Times (Wednesday, May 6, 2020): A6.

(Note: ellipsis added.)

(Note: the online version of the story was updated May 21 [sic], 2020 and has the title “Top U.K. Scientist Resigns Over Coronavirus Distancing Violation.” The print and online articles are a series of brief articles that are only related by being on some aspect of the Covid-19 pandemic. In the online version, all of the brief articles must be searched-for under the name of the top brief article.)

Global Warming Allows Study of Transhumance to Flourish

(p. D3) OSLO — Ice patches that melted from the slopes of a remote mountain pass in Norway have revealed artifacts that provide new insight into the livelihood of hunters, traders and travelers along a route thousands of years old, archaeologists said this month.

. . .

The discoveries, outlined in the scientific journal Antiquity, were made on the central mountain range in Norway’s Innlandet County by the Glacier Archaeology Program, one of many programs worldwide studying what glaciers and ice patches are laying bare as they shift and melt because of climate change.

. . .

These discoveries have illuminated scientists’ understanding of transhumance, which describes how, where and why people moved from one place to another for trade, food, marriage or customs — sometimes over icy mountain passes rather than through the easier terrain, but longer distances, of valleys.

In 1991, hikers accidentally discovered the remains of a man, later nicknamed Ötzi the Tyrolean Iceman, preserved in 5,300 years’ worth of ice and snow in the Italian Alps. This marked the start of a promising period of archaeology that has gained pace as climate warming has revealed more artifacts, said Dr. Stephanie Rogers, a research assistant professor at Auburn University’s department of geosciences.

. . .

Dr. Rogers, who has done research on glacier archaeology in the Alps, said the discovery of the Iceman “really flipped a switch.”

“What was that person doing up there?” she asked, adding that researchers realized that “if we found something in this place, we are going to find something in other places.”

The field of transhumance has gained momentum in the past 10 to 20 years as artifacts have been laid bare because of the warming climate melting ice patches and moving glaciers, Dr. Rogers said.

For the full story, see:

Henrik Pryser Libell and Christine Hauser. “Warming Climate Reveals an Ancient Trade Route.” The New York Times (Tuesday, April 28, 2020): D3.

(Note: ellipses added.)

(Note: the online version of the story has the date April 16 [sic], 2020, and has the title “Warming Climate in Norway Reveals Relics of Ancient Viking Trade Route.”)

Cancer Mortality Declines Mainly Due to Less Smoking and Better Lung Cancer Treatment

(p. A12) . . . the American Cancer Society reported that the United States had experienced the sharpest one-year drop in cancer death rate ever recorded, . . . .

. . .

The society’s latest annual report on cancer statistics, released on Wednesday, noted that the death rate had dropped steadily over 26 years, from 1991 to 2017. The largest single-year decline ever reported, when the rate fell 2.2 percent, occurred from 2016 to 2017.

. . .

Experts attributed the decline in mortality to reduced smoking rates and to advances in lung cancer treatment. New therapies for melanoma of the skin have also helped extend life for many people with metastatic disease, or cancer that has spread to other parts of the body.

For the full story, see:

Michael Levenson. “Cancer Death Fell Sharply, And Trump Took Credit.” The New York Times (Monday, January 13, 2020): A12.

(Note: ellipses added.)

(Note: the online version of the story has the date Jan. 12, 2020 and has the title “Trump Took Credit for Lower Cancer Death Rates. Advocates Say Not So Fast.” Where there was a minor wording difference between the print and online versions, the quotation above follows the online version. )

The report from the American Cancer Society, mentioned above, is:

Siegel, Rebecca L., Kimberly D. Miller, and Ahmedin Jemal. “Cancer Statistics, 2020.” CA: A Cancer Journal for Clinicians 70, no. 1 (2020): 7-30.

Coffee Gives Us “More Ideas, More Talk, More Energy, More Time, More Life”

(p. C4) After five centuries, we still have questions about coffee, but we agree on what we need it to do. Most of us drink coffee not because we have a finely calibrated understanding of its role in blocking the adenosine that makes us feel tired and increasing the dopamine that makes us feel good. Instead, we drink coffee because . . . of our bottomless desire for more ideas, more talk, more energy, more time, more life.

For the full commentary, see:

Augustine Sedgewick. “How Coffee Became a Modern Necessity.” The Wall Street Journal (Saturday, April 4, 2020): C4.

(Note: ellipsis added.)

(Note: the online version of the commentary has the same date and title as the print version.)

Sedgewick’s commentary is related to her book:

Sedgewick, Augustine. Coffeeland: One Man’s Dark Empire and the Making of Our Favorite Drug. New York: Penguin Press, 2020.

Sarilumab Showed “Hint” of Promise for Critically Ill Covid-19 Patients

(p. A10) . . . , preliminary results on treatments with . . . sarilumab, marketed as Kevzara and made by Regeneron and Sanofi, indicate that it does not help patients who are hospitalized but not using ventilators.

. . .

The patients fell into two groups — “severe,” meaning they required oxygen but did not need a ventilator or so-called high flow oxygen, and “critical,” those who needed a ventilator, high flow oxygen or were in intensive care.

. . .

The results for the critically ill patients are not conclusive but there is a hint that such patients may be helped, so the study will continue with only critically ill patients. More than 600 have been enrolled. Results are expected in early June [2020].

For the full story, see:

Gina Kolata. “Drug Shows Slim Promise For Critical Covid Cases.” The New York Times (Tuesday, April 28, 2020): A10.

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

(Note: the online version of the story has the date April 27, 2020, and has the title “Arthritis Drug Did Not Help Seriously Ill Covid Patients, Early Data Shows.”)

“The Better the Person, the Crumbier the House Is Going to Look”

I smiled at Jerry Seinfeld’s comment below that good people are too busy doing good to spend enough time for their house to look fabulous. (Admission: I have never been known for having a neat office.)

(p. C4) I like wearing the suit and having the crowd and the energy and the crackle — I like the magic. I don’t want to know who you really are. I don’t want to see how you really live. We’re all just sick of people’s houses. They’re all so depressingly normal. And the better the person, the crumbier the house is going to look. Because they’re too busy to do anything. The only people that have fabulous, fabulous places, stink. They’re horrible at what they do. They’re spending their money on the house instead of focusing on their art.

For the full interview, see:

Dave Itzkoff, interviewer. “He’s Now ‘Post-Show-Business’.” The New York Times (Tuesday, May 5, 2020): C1 & C4.

(Note: the online version of the interview has the date May 4, 2020, and has the title “Jerry Seinfeld Is Making Peace With Nothing: He’s ‘Post-Show Business’.”)

Early Tool by Extinct Human Ancestors

(p. D2) What’s so special about a 300,000-year-old stick stuck in the muck?

“It’s a stick, sure,” said Jordi Serangeli, an archaeologist from the University of Tübingen in Germany.

. . .

. . . the short, pointed piece of wood his team found in Schöningen, Germany, in 2016 may be the newest addition to the hunting arsenal used by extinct human ancestors during the Middle Pleistocene.

For the full story, see:

Nicholas St. Fleur. “Haywire Immune Reaction Linked to Most Severe Cases.” The New York Times (Tuesday, April 28, 2020): D2.

(Note: ellipses added.)

(Note: the online version of the story has the date April 22, 2020, and has the title “A Short, Pointy, 300,000-Year-Old Clue to Our Ancestors’ Hunting Prowess.”)

Paul Marks Purged Old Guard in Order to Recruit New Talent for His Vision of Cancer Research

One important question, not addressed in the obituary quoted below, is the extent to which Marks’s vision for cancer research was farsighted and the extent to which it was misguided. Another important related issue is Marks’s role in support of Nixon’s centrally planned war on cancer.

(p. B11) Paul A. Marks, who transformed Memorial Sloan Kettering Cancer Center into one of the world’s leading institutions for research and treatment of cancer, died on April 28 at his home in Manhattan. He was 93.

. . .

Memorial Sloan Kettering today is very different from the institution Dr. Marks joined in 1980 as president and chief executive. It was still reeling from a scientific scandal in the 1970s involving crudely falsified data. It was also behind the times, focused more on surgical interventions than on the developing frontiers of biological science.

“Frankly, it was an institution that really needed surgery from top to bottom, and Marks was the right guy,” James Rothman, chairman of the Yale School of Medicine’s department of cell biology, said in a phone interview.

. . .

The timing was ideal, said Richard Axel, a neuroscientist and molecular biologist in the department of neuroscience at Columbia University Medical Center. Dr. Marks, he said, energized the institution to pursue the alterations in DNA that cause tumors, doing so at the very moment that it was becoming possible “to truly study DNA, to pet it, to clone it, to determine its sequence.”

What followed was a purge of much of the institution’s old guard, with attendant turmoil and alienation for many of those involved. Dr. Marks instituted a tenure system with a tough review process, and dozens of scientists left between 1982 and 1986. A 1987 article about Dr. Marks in The New York Times Magazine noted that “there are researchers who call Marks ‘Caligula,’ ‘Attila the Hun’ or simply ‘the monster.’”

The article described a scene in his laboratory during his Columbia days when Dr. Marks “grabbed a man by the throat and dragged him across a table.” His wife, Joan Marks, then head of graduate programs at Sarah Lawrence College in Bronxville, N.Y., said in the article, “He can be brutal,” adding, “He really doesn’t understand why people don’t work 97 hours a day, and why they don’t care as much as he cares.”

In his memoir, “On the Cancer Frontier: One Man, One Disease, and a Medical Revolution” (2014, with the former Times reporter James Sterngold), Dr. Marks said he had been embarrassed to see the incident recounted in the article. While he didn’t deny that it had happened, he said that he had actually grabbed the man by both arms, not the throat, and shaken him.

For all of the sharpness of his elbows, Dr. Rothman of Yale said, there was also charm. Dr. Marks, he said, “projected at once a kind of a deep warmth and, at the same time, a formidable aspect.”

Dr. Marks was known for a sharp eye in recruiting talent. “He had an uncanny ability to attract these great scientists from all over the nation,” said Joan Massagué, the director of the Sloan Kettering Institute, the institution’s experimental research arm.

For the full obituary, see:

John Schwartz. “Paul Marks, 93, Administrator Who Pushed Memorial Sloan Kettering to Top-Tier Status.” The Wall Street Journal (Thursday, May 7, 2020): B11.

(Note: ellipses added.)

(Note: the online version of the obituary was updated May 6, 2019 and has the title “Paul Marks, Who Pushed Sloan Kettering to Greatness, Dies at 93.”)

Marks’s memoir, mentioned above, is:

Marks, Paul, and James Sterngold. On the Cancer Frontier: One Man, One Disease, and a Medical Revolution. New York, NY: PublicAffairs, 2014.

Physicians Fighting Covid-19 Use Social Media “to Share Improvised Solutions”

(p. A9) In mid-March [2020], as U.S. hospitals scrambled for ventilators to treat a surge of coronavirus cases, a Vermont pulmonologist proposed a different treatment on a blog popular with emergency-medicine doctors.

Joshua Farkas observed in the post on the EMCrit blog that many Covid-19 patients seemed to benefit from less-invasive alternatives to help their breathing, including pressure therapy used to treat sleep apnea—sometimes referred to as CPAP, for continuous positive airway pressure.

. . .

The post helped galvanize an emerging theory about the treatment of Covid-19 patients, which in recent weeks has taken hold in U.S. hospitals. In New York City, where ventilators are in perilously short supply, doctors say they have since embraced CPAP and other treatments to improve breathing in Covid-19 patients.

The shift is one example of how health-care workers are writing the playbook for treating coronavirus patients on the fly, knowing they can’t wait for peer-reviewed articles or studies in established medical journals. Instead they are tapping into social media, podcasts, inside-baseball medical blogs and text-message groups to share improvised solutions to supply shortages and patient care, forcing hospitals to quickly re-evaluate their practices.

“This has been a rapidly evolving process,” said Dr. Farkas, who has treated Covid-19 patients in the intensive-care unit at the University of Vermont in Burlington. “As we struggle with how to treat a disease that so recently was totally unknown, this rapid exchange and updating of information is crucial.”

. . .

Last week, Michelle Romeo, a chief emergency-medicine resident at NYU Langone and Bellevue hospital in Manhattan, tweeted photos of a jury-rigged breathing device involving a mask used for BiPAP—an airway pressure therapy similar to CPAP.

At Mount Sinai Hospital in Manhattan, pulmonologists worked with the hospital’s sleep lab to figure out a way to use BiPAP machines like a ventilator. The result was posted on Reddit, and got “all kinds of different responses,” said Valerie Burgos-Kneeland, a registered nurse in the hospital’s Medical Intensive Care Unit. “It’s kind of been an opportunity for people to get creative.”

For the full story, see:

Rebecca Davis O’Brien. “Doctors Improvise, Share Treatments.” The Wall Street Journal (Friday, April 10, 2020): A9.

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

(Note: the online version of the story has the date April 9, 2020, and has the title “Doctors Are Improvising Coronavirus Treatments, Then Quickly Sharing Them.”)

Drugs Targeting Cytokines Tried Against Covid-19

(p. A9) Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.

As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients, doctors say. Genetics may be a factor.

. . .

Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.

Drugs targeting specific cytokines rather than the entire immune system may be more effective, doctors say.

Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.

For the full story, see:

Jared S. Hopkins, Joseph Walker. “Haywire Immune Reaction Linked to Most Severe Cases.” The Wall Street Journal (Friday, April 10, 2020): A1 & A9.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 9, 2020, and has the title “Haywire Immune Response Eyed in Coronavirus Deaths, Treatment.”)