Month: October 2023

Nursing Slots Filled Via Gig Apps Give More Control to Nurses and More Uncertainty to Hospitals

(p. A3) Hospitals are joining the gig economy.

Some of the nation’s largest hospital systems including Providence and Advocate Health are using apps similar to ride-hailing technology to attract scarce nurses. An app from ShiftKey lets workers bid for shifts. Another, CareRev, helps hospitals adjust pay to match supply, lowering rates for popular shifts and raising them to entice nurses to work overnight or holidays.

The embrace of gig work puts hospitals in more direct competition with the temporary-staffing agencies that siphoned away nurses during the pandemic. The apps help extend hospitals’ labor pool beyond their employees to other local nurses who value the highly flexible schedules of gig work.

. . .

Gig apps give nurses even more control than other common temporary-employment options that lock in workers for multiweek contracts, at least. It opens shifts to a broader labor pool, too, but also a more fluid one, hospital executives said.

That means less certainty for employers.

For the full story, see:

Melanie Evans. “Gig Work Helps Hospitals Fill Nursing Shifts.” The Wall Street Journal (Wednesday, April 19, 2023): A3.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 18, 2023, and has the title “Nurse Shortage Pushes Hospitals Into the Gig Economy.”)

Organisms Differ Based on How DNA’s Fluid Instructions Are Implemented by Different Cells

(p. 13) Martinez Arias, a developmental biologist, has lived and breathed the cell’s struggle to be heard over a career spanning 40-odd years. His story is one of DNA elites against hardworking, blue-collar cells. Cells, not DNA, Martinez Arias points out, determine the ripples of our fingerprints and the texture of our irises.

Martinez Arias builds his argument against the supremacy of DNA around Frankenstein-like experiments that involve borrowing a gene from one organism and dropping it into another. Take, for instance, the fruit fly PAX6 gene. When this gene is mutated, flies develop without eyes. Yet when a human version of PAX6 is swapped in for the fly gene, it makes a fly with fly eyes, not a fly with human eyes.

This is because fly cells are doing the work. Living things are much more fluid, Martinez Arias argues, than the concept of a DNA instruction manual would have us believe. An organism is less like a car, built according to a precise blueprint, he suggests, than a hobbyist’s renovation project, where the cells who live there build a deck or replace a light fixture based on the tools that happen to be lying around in the garage and whatever lumber is on sale at the store. Many of the differences between you and me are the result of accidents in time, enacted by our cells.

For the full review, see:

Alex Johnson. “Going Viral.” The New York Times Book Review (Sunday, September 17, 2023): 13.

(Note: the online version of the review has the date Aug. 15, 2023, and has the title “A Reason to Cheer for Cells and the Viruses That Feed on Them.”)

The book under review is:

Arias, Alfonso Martinez. The Master Builder: How the New Science of the Cell Is Rewriting the Story of Life. New York: Basic Books, 2023.

FDA Commissioner Said FDA Was “Too Slow” to Allow Foreign Firms to Supply Baby Formula to Fill Empty Shelves in U.S. Stores

(p. A3) Federal health regulators outlined plans Friday [Sept. 30, 2022] that will allow overseas baby-formula makers to continue selling their products in the U.S. long term following a baby-formula shortage that led to empty shelves at some stores.

. . .

The guidance is expected to help bolster the supply chain for baby formula and could be a financial gain for global manufacturers that have long sought to enter the concentrated U.S. market, where Abbott Laboratories and Reckitt Benckiser Group account for most infant- and toddler-formula sales.

. . .

The FDA responded by temporarily letting foreign manufacturers ship their products to the U.S. FDA Commissioner Robert Califf commissioned an external review of the agency’s food division, saying in congressional testimony that the agency’s response to the shortage was too slow.

For the full story, see:

Stephanie Armour. “FDA Sets New Plan On Baby Formula.” The Wall Street Journal (Saturday, Oct. 1, 2022): A3.

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

(Note: the online version of the story has the date September 30, 2022, and has the title “Overseas Baby-Formula Makers Given Path to Keep Selling in U.S.”)

European Farmers Want Climate Protected by More Innovation, Not by Less Agriculture

(p. 4) To meet climate goals, some European countries are asking farmers to reduce livestock, relocate or shut down — and an angry backlash has begun reshaping the political landscape before national elections in the fall.

. . .

Those like Helma Breunissen, who runs a dairy farm in the Netherlands with her husband, say that too much of the burden is falling on them, threatening both their livelihoods and their way of life.

For almost 20 years, Ms. Breunissen has provided the Dutch with a staple product, cow’s milk, and she felt that her work was valued by society, she said. The dairy sector in the Netherlands, which also produces cheeses like Gouda and Edam, is celebrated as a cornerstone of national pride.

But the sector also produces almost half the Netherlands’ emissions of nitrogen, a surplus of which is bad for biodiversity. Ms. Breunissen and thousands of other farmers bridle that they are now labeled peak emitters.

“I was confused, sad and angry,” said Ms. Breunissen, who manages a farm of 100 cows in the middle of the country. “We are doing our best. We try to follow the rules. And suddenly, it’s like you are a criminal.”

. . .

In the Netherlands, the government has asked thousands of farmers to scale back, move or close. The authorities set aside about 24 billion euros, about $26 billion, to help farmers put in place more sustainable solutions — or to buy them out.

. . .

For Ms. Breunissen, who is 48 and works as a veterinarian in addition to her duties on the farm, none of the government-proposed options seem feasible. She is too young to quit and too old to uproot her life, she said, and the authorities have not provided enough support and information on how to change what she now does.

“There are so many questions,” she said. “The trust in the government is completely gone.”

. . .

A host of new groups are vying to displace traditional parties. They include the Farmer Citizen Movement, known by its Dutch acronym BBB, which was established four years ago.

. . .

Caroline van der Plas, the party’s co-founder, used to be a journalist in The Hague covering the meat industry, and she has never worked in farming. But she grew up in a small city in a rural area, and she said in an interview that she wanted to be “the voice of the people in rural regions who are not seen or heard” by policymakers.

She and her party have talked down the need for drastic steps to cut emissions, saying the reductions can be achieved through technological innovation. Policies should be based on “common sense,” she said, while offering no concrete solutions.

“It’s not like science says this or that,” Ms. van der Plas said, referring to how theories can change. “Science is always asking questions.”

For the full story, see:

Monika Pronczuk and Claire Moses. “New Climate Standards Have Farmers in Europe Bristling.” The New York Times, First Section (Sunday, Aug. 27, 2023): 4.

(Note: ellipses added.)

(Note: the online version of the story was updated Aug. 28, 2023, and has the title “Labeled Climate Culprits, European Farmers Rebel Over New Standards.”)

Increasing Patient Administrative Burdens Reduce Health Care Benefits and Efficiency

If we want a health system that is effective, efficient, and innovative, we need to have prices that transparently and accurately reflect the real costs of providing care. This would include all costs, including what the physician Chavi Karkowsky (quoted below) calls “administrative costs.” If we do not take account of the patient’s administrative costs, we will have a system that is ineffective, inefficient, and stagnant. And we will have set up perverse incentives that block entrepreneurs from improving the system. A true accounting will reveal higher costs, and that will raise concerns about too limited access to health care. But true prices also will provide information and incentives for medical entrepreneurs to find lower-cost ways to make health care more effective and more efficient. In the short-term, concerns about access could be addressed by a health care voucher system, analogous to what Milton Friedman proposed for education, or by a health insurance system like that proposed by Susan Feigenbaum.

Several years ago, I was called urgently to our small obstetric triage unit because a pregnant patient was very sick.

. . .

Within minutes, a team was swarming the triage bay — providing oxygen, applying the fetal heart rate and contraction monitor, placing IVs. I called the neonatal intensive care unit, in case labor progressed, to prepare for a very preterm baby. In under an hour, we had over a dozen people, part of a powerful medical system, working to get her everything she might need.

Breathing quickly behind her oxygen mask, my patient explained that she had noticed symptoms of a urinary tract infection about four days ago; she had gone to her doctor the next day and had gotten an antibiotics prescription. But the pharmacy wouldn’t fill it — something about her insurance, or a mistake with her record. She tried calling her doctor’s office, but it was the weekend, and she couldn’t get through. She read on the internet to drink water and cranberry juice, so she kept trying that. She called 9-1-1 in the middle of the night when she woke up and felt as if she couldn’t breathe.

This is the story of our medical system — quick, massive, powerful, able to assemble a team in under an hour and willing to spend thousands of dollars when a patient is sick.

This is also the story of a medical system that didn’t think my patient was worth a $12 medication to prevent any of this from happening.

This patient’s story is a result of the space between the care that providers want to give and the care that the patient actually receives. That space is full of barriers — tasks, paperwork, bureaucracy. Each is a point where someone can say no. This can be called the administrative burden of health care. It’s composed of work that is almost always boring but sometimes causes tremendous and unnecessary human suffering.

The administrative burden includes many of the chores we all hate: calling doctor’s offices, lining up referrals, waiting in the emergency room, sorting out bills from a recent surgery, checking on prescription refills.

. . .

There’s a general sense that all that unpaid labor required to get medical care is increasing.

. . .

At the same time, creating administrative burden is a time-honored tactic for insurance companies. “When you’re trying to incentivize things, and you don’t want to push up the dollar cost, you can push up the time cost,” said Andrew Friedson, the director of health economics at the Milken Institute.

Administrative burden can work as a technique to keep costs down. However, part of the problem, Dr. Friedson said, is that we don’t count the burden to patients, and so it doesn’t factor into policy decisions. There’s nobody measuring the time spent on the phone plus lost wages plus complications from delayed care for every single patient in the United States. A recent study co-written by Michael Anne Kyle, a research fellow at Harvard Medical School, found that about a quarter of insured adults reported their care was delayed or missed entirely because of administrative tasks.

. . .

One of the first steps to any comprehensive solution would be a true accounting of the costs of administrative burden. Maybe we in the medical system do have to start counting up the hours patients and providers spend on the phone, in waiting rooms and filling out forms. That would be difficult: It’s not a metric the health care industry is used to evaluating. But it’s not harder than doing the work itself, as patients do.

For the full commentary, see:

Karkowsky, Chavi. “The Overlooked Reason Our Health Care System Crushes Patients.” nytimes.com, Posted July 20, 2023 [Accessed Sept. 26, 2023]. Available from https://www.nytimes.com/2023/07/20/opinion/healthcare-bureaucracy-medical-delays.html.

(Note: ellipses, and italics, added.)

(Note: published in the online version, but not the print version, of The New York Times.)

The recent study co-authored by Michael Anne Kyle and mentioned above is:

Kyle, Michael Anne, and Austin B. Frakt. “Patient Administrative Burden in the US Health Care System.” Health Services Research 56, no. 5 (Oct. 2021): 755-65.

Susan Feigenbaum discusses her proposed health insurance system in:

Feigenbaum, Susan. “Body Shop’ Economics: What’s Good for Our Cars May Be Good for Our Health.” Regulation 15, no. 4 (Fall 1992): 25-31.

Medical Research Focuses More on Antibiotics Than on Phages Partly Because Antibiotics Are Easier to Patent

(p. 13) While recent events have provided a painful reminder of the very bad viruses that prey on us, Tom Ireland’s “The Good Virus” is a colorful redemption story for the oft-neglected yet incredibly abundant phage, and its potential for quelling the existential threat of antibiotic resistance, which scientists estimate might cause up to 10 million deaths per year by 2050. Ireland, an award-winning science journalist, approaches the subject of his first book with curiosity and passion, delivering a deft narrative that is rich and approachable.

In the hands of d’Herelle and others, the phage became a potent tool in the fight against cholera. But, in the 1940s, when the discovery of the methods to produce penicillin at an industrial scale led to the “antibiotic era,” phage therapy came to be seen as quackery in Europe and America, in part, Ireland suggests, because antibiotics, unlike phages, fit the mold of capitalist society.

Capitalists love patents. A funny quirk of the patent system is that you cannot patent entire natural things, but you can sometimes patent the way you extract their byproducts. The first antibiotics, being the secretions of fungi, were easier to patent in the United States than phages, which were whole viruses.

For the full review, see:

Alex Johnson. “Going Viral.” The New York Times Book Review (Sunday, September 17, 2023): 13.

(Note: the online version of the review has the date Aug. 15, 2023, and has the title “A Reason to Cheer for Cells and the Viruses That Feed on Them.”)

The book under review is:

Ireland, Tom. The Good Virus: The Amazing Story and Forgotten Promise of the Phage. New York: W. W. Norton & Company, 2023.

Musk’s $48 Billion Pay Deal Showed that the Entrepreneurs Is Not Obsolete

(p. B3) WILMINGTON, Del.—The scale of concern among Tesla Inc. board members about how to keep Elon Musk‘s attention trained on the electric-vehicle maker loomed large during a weeklong trial over the chief executive’s pay package.

A desire to motivate Mr. Musk to focus on Tesla triggered a monthslong pay negotiation that culminated in the shareholders’ approval of a 2018 CEO equity grant valued at roughly $48 billion at recent stock prices.

That deal—and the process under which it was put together—have been the subject of the trial in Delaware’s business-law court, where testimony has underscored that current and former Tesla board members have long viewed Mr. Musk as irreplaceable.

For the full story, see:

Rebecca Elliott and Meghan Bobrowsky. “Pay Trial Shines Light on Tesla’s View of Musk as Irreplaceable.” The Wall Street Journal (Monday, November 21, 2022): B3.

(Note: the online version of the story was updated November 19, 2022, and has the title “Tesla Board View That Elon Musk Is Irreplaceable Emerged in Pay Trial.”)

Octopus Eggs Thrive in Hot Ocean Water of “Octopus Garden”

(p. 14) In 2018, Amanda Kahn, an invertebrate biologist at San Jose State University, joined an ocean expedition to scout the base of Davidson Seamount, an inactive underwater volcano off the coast of central California. She came for the sponges and corals.

But she and her colleagues stumbled across something much more astounding. As their remotely operated vehicle, which was probing the seafloor and streaming video back to their ship, rose from behind a rock, the crew gasped. In shimmering waters, they saw scores of upside-down octopuses nestled in rocky crevices with their arms clutched around their frames. A closer look revealed that they were protecting eggs, similar to the way that birds brood in a nest.

“Sometimes you recognize immediately the magnitude of something special that you’ve found,” Dr. Kahn said. “And I think that was one of those really special moments.”

When James Barry, a marine ecologist at the Monterey Bay Aquarium Research Institute, got a glimpse on a later expedition, he instantly wondered why so many octopuses were here. “And so we set about to figure out,” he said.

. . .

The team’s findings, detailed in a new paper published Wednesday in Science Advances, suggest that this hot spot makes the octopuses’ eggs hatch faster, which improves reproductive success.

. . .

“That’s a big deal for these eggs, because in the deep sea, one of the really big challenges is that it’s cold,” Dr. Barry said. Chilly temperatures slow down the metabolism of coldblooded animals, including rates of embryonic growth. For this species of octopus, it could have taken anywhere from five to 10 years for the eggs to fully develop in ambient waters — but in this nursery, the scientists found that they were hatching in less than two years on average.

The earlier the better, the team reasoned, when it comes to reproductive success. Less time spent as an embryo reduces the risks of being eaten by predators, or suffering infections or injuries that lead to death. Because octopuses don’t eat while brooding — and die after reproducing — they also suspect that quicker egg hatchings might make for a higher chance of survival, since the mother is less likely to lose the energy needed to sustain them.

It’s the mothers’ last hurrah, Dr. Kahn said: “They go all out in protecting those eggs.” She added that brooding near a hot spring helps ensure the mothers’ final acts are a success.

The findings make sense to Michael Vecchione, a deep-sea cephalopod biologist at the National Oceanic and Atmospheric Administration who was not involved in the study. Dr. Vecchione, who had seen the discovery of the garden back in 2018, had also speculated that the octopuses were using the heat to speed up embryo growth. “I’m not surprised that the warm temperature was beneficial to them,” he said. “And apparently, it’s starting to look like it’s a pretty widespread phenomenon, even though nobody had ever seen it until just a few years ago.”

For the full story, see:

Katrina Miller. “Under the Sea, an ‘Octopus Garden’ Thrives in the Shade of a Hot Spring.” The New York Times, First Section (Sunday, Aug. 27, 2023): 14.

(Note: ellipses added.)

(Note: the online version of the story has the date Aug. 23, 2023, and has the title “Atop an Underwater Hot Spring, an ‘Octopus Garden’ Thrives.” The online version says that the print version appears on p. 12. My national edition of the print version had the article on p. 14.)

Bankrupt Yellow Trucking Firm Got $700 Million Covid “Rescue Loan” from Taxpayers

(p. B2) Trucking company Yellow is preparing to file for bankruptcy, according to people familiar with the matter, heightening the threat that one of the nation’s largest freight carriers will shut down as customers abandon it amid a cash crunch and union negotiations.

. . .

A bankruptcy filing would again spotlight the $700 million Covid-19 rescue loan that Yellow received from U.S. taxpayers in 2020. A congressional probe later concluded that the Treasury Department erred in giving the loan on national-security grounds when Yellow didn’t meet the standards for that designation.

For the full story, see:

Soma Biswas, Paul Page and Alexander Gladstone. “Trucker Yellow Prepares To File for Bankruptcy.” The Wall Street Journal (Thursday, July 27, 2023): B2.

(Note: ellipsis added.)

(Note: the online version of the story has the date July 26, 2023, and has the title “Trucker Yellow Prepares to File for Bankruptcy as Customers Flee.”)