Month: June 2024

High and Growing Financial Burden of Cancer

The story quoted below would lead many to support socialized medicine, euphemistically called a “single-payer system” where the single payer is the taxpayer. But socialized medicine is inefficient and slows innovation. The main reason that cancer therapy has grown so costly is that the new therapies are very expensive to achieve approval. That expense could be slashed if we followed Milton Friedman’s suggestion to stop mandating hyper-expensive Phase 3 randomized clinical trials. (These are the large trials mainly intended to prove efficacy, while the much smaller and cheaper Phase 1 and Phase 2 trials are mainly intended to prove safety.) I am researching Friedman’s suggestion and hope to write more on it soon.

(p. A1) The economic burden of a cancer diagnosis is getting strikingly worse in the U.S., as drug and medical costs soar and more patients live longer with the disease. About 55% of cancer drugs introduced between 2019 and 2023 cost at least $200,000 a year, according to Iqvia’s Institute for Human Data Science. And an increasing number of patients are working-age, a group more likely to report financial hardship after diagnosis compared with older adults.

Nearly 60% of working-age cancer survivors report facing some financial difficulty. Many patients struggle to afford care and end up taking on debt, with some getting payday loans or running up credit cards. Cancer alone accounts for some 40% of medical campaigns seeking financial help on GoFundMe, research shows.

. . .

(p. A2) Among common diseases, cancer creates a uniquely difficult financial strain known as financial toxicity. Treatments with expensive medicines start immediately and come with a string of nonmedical costs. Chemotherapy and other treatments can leave patients too weak to work for weeks or months. This can result in a twofold blow, with patients losing income and their employer-sponsored health insurance.

. . .

The problem starts with costs for medical care and cancer drugs that have either risen above the rate of inflation or have high starting prices. Common cancer drugs have list prices that go well into the six figures: Imbruvica, which treats leukemia, has a list price of more than $213,000 for a full year. The average Medicare patient taking it paid $5,247 out-of-pocket in 2022, federal data show. AbbVie, one of the drug’s co-marketers, declined to comment.

. . .

Many insurers have shifted rising healthcare costs to patients. Some employer-backed plans require patients to pay a percentage of a drug’s cost, which can add up to thousands of dollars. One report found a 15% increase in out-of-pocket costs for privately insured, working-age cancer patients from 2009 to 2016. Patients also foot the bill for transportation, lodging, child care and parking.

. . .

People with cancer are at higher risk of ending up late on credit-card payments, mortgage payments, and experiencing other financial challenges than noncancer patients, according to research co-written by Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Center in Seattle.

Other research shows that patients with more out-of-pocket costs are more likely to delay starting their medications or stop taking them. Ramsey and his co-authors also found that cancer patients who file for bankruptcy had an 80% higher risk of dying than cancer patients who didn’t file.

“There actually was a pretty big detriment for survival,” he said.

For the full story, see:

Brianna Abbott and Peter Loftus. “Cancer Costs Destroy Finances: ‘It Broke Me’.” The Wall Street Journal (Wednesday, May 29, 2024): A1-A2.

(Note: ellipses added.)

(Note: the online version of the story has the date May 28, 2024, and has the title “Cancer Is Capsizing Americans’ Finances. ‘I Was Losing Everything.’.”)

One of the relevant papers co-authored by Ramsey and mentioned above is:

Ramsey, Scott D., Aasthaa Bansal, Catherine R. Fedorenko, David K. Blough, Karen A. Overstreet, Veena Shankaran, and Polly Newcomb. “Financial Insolvency as a Risk Factor for Early Mortality among Patients with Cancer.” Journal of Clinical Oncology 34, no. 9 (March 2016): 980-86.

Bdelloids Frozen for 24,000 Years Return to Life and Reproduce

(p. D2) Bdelloids can . . . come back to life after tens of thousands of years in deep freeze, according to a study published Monday [June 7, 2021] in the journal Current Biology. Bdelloids are one of a handful of teensy creatures, including tardigrades, that are known to survive incredibly inhospitable conditions.

. . .

For the study, scientists collected samples by drilling about 11 feet below the surface of permafrost in northeastern Siberia. They discovered living bdelloid rotifers locked in the ancient permafrost, whose average temperature hovers around 14 degrees Fahrenheit.

. . .

Radiocarbon-dating revealed the bdelloids were 24,000 years old. They then bounced back and were still capable of reproducing once thawed.

For the full story see:

Marion Renault. “The Deepest Sleeper: It Makes Rip Van Winkle Look Like an Amateur.” The New York Times (Tuesday, June 15, 2021 [sic]): D2.

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

(Note: the online version of the story has the date June 7, 2021 [sic], and has the title “This Tiny Creature Survived 24,000 Years Frozen in Siberian Permafrost.” Where the versions differ, in the passages quoted above I follow the online version.)

The study mentioned above is:

Shmakova, Lyubov, Stas Malavin, Nataliia Iakovenko, Tatiana Vishnivetskaya, Daniel Shain, Michael Plewka, and Elizaveta Rivkina. “A Living Bdelloid Rotifer from 24,000-Year-Old Arctic Permafrost.” Current Biology 31, no. 11 (June 7, 2021): R712-R713.

Physicians Are Neither Trained Nor Paid to Express the “Medical Heresy” that Good Health Depends on Good Nutrition

(p. A17) Amazingly, medical schools in the United States focus very little on nutrition. The topic, according to one study, gets less than 1% of the classroom time that aspiring physicians are required to sit through over four years—even though the foods and beverages people ingest are far and away, in America, the biggest drivers of disease.

Because of the knowledge gap, doctors routinely miss opportunities to counsel their patients on the connection between nutrition and health—thus allowing bad eating habits to keep doing major damage. This failure is one of many indictments that Robert Lustig, a physician, brings against America’s medical-nutritional establishment in “Metabolical,” a wide-ranging polemic that covers the misdeeds of food and beverage companies and the misinformation that, in his view, contributes to the undermining of health.

. . .

Dr. Lustig’s real complaint is with “ultra-processed” products, which account for 58% of Americans’ calorie intake. Such products—candy, crackers, deli meat, frozen pizzas, fruit juices—are increasingly found not just in supermarkets and restaurants but virtually everywhere: movie theaters, hardware stores, gas stations, even health clubs. They’re typically mass produced, have a long shelf life and offer low nutritional quality.

How low? Dr. Lustig characterizes these products as “poison” more than two dozen times. To validate the claim, he describes in detail how the dominant features of such foods—high in sugar but also teeming with nitrates and refined carbohydrates—lead to cancer and other chronic diseases like diabetes and heart disease. Roughly 60% of Americans are afflicted with such diseases today (up from 30% in 1980). Relatedly, unhealthy eating has contributed to the decline in U.S. life expectancy in recent years.

That doctors don’t do more to steer their patients away from such hazards is only part of Dr. Lustig’s attack on the medical profession. He believes that, on the whole, doctors are “parochial,” taking their cues mostly from other doctors and thus succumbing to herd thinking. He worries that too many elements in their professional world—research, clinical meetings, webinars—are underwritten by Big Pharma and that the little nutrition science they know is compromised by studies that are sponsored by food companies. He says that doctors “don’t listen” to their patients and prefer to reach for the “quickest and easiest form of treatment,” whether it works or not, in part because insurance companies have limited the length of patient visits. “Talking about lifestyle changes takes time that we don’t have—because that’s how we’ve been trained and how we get paid.”

. . .

Dr. Lustig says that his book is “both my act of contrition to you, the public, and my act of medical disobedience to the medical establishment.” He hints that he could write such a book only after retiring from clinical practice—at the University of California, San Francisco (where he is an emeritus professor)—because “no ivory tower academic bastion would want to take credit for the ‘medical heresy’ that you’ll find sandwiched within these pages.”

For the full review, see:

Matthew Rees. “BOOKSHELF; Is It Something I Ate?” The Wall Street Journal (Monday, May 10, 2021 [sic]): A17.

(Note: ellipses added.)

(Note: the online version of the review has the date May 9, 2021 [sic], and has the title “BOOKSHELF; ‘Metabolical’ Review: Is It Something I Ate?”)

The book under review is:

Lustig, Robert H. Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine. New York: Harper, 2021.

After This Virus Infects This Fungus, It Transforms the Fungus from Killer to Probiotic

(p. D2) Some 400 species of plants are thought to be susceptible to the pathogen, including soybeans, which fell in droves to the fungus in 2009, costing farmers $560 million. The fungus also goes dormant in soil for years, seeding new infections that can raze entire fields of crops.

Dr. Jiang has spent 10 years hot on Sclerotinia’s trail in the hopes of bringing the blight to heel. He and his colleagues now think they’ve found an answer: a treatment that doesn’t just stop the fungus from killing, but transforms it into a probiotic that can boost plant growth and enhance resilience to future disease. They reported their findings Tuesday in the journal Molecular Plant.

For the full story see:

Katherine J. Wu. “If it Goes Viral: Turning a Scourge Into a Farmer’s Friend.” The New York Times (Tuesday, October 6, 2020 [sic]): D2.

(Note: the online version of the story has the date Sept. 29, 2020 [sic], and has the title “Infected by a Virus, a Killer Fungus Turns Into a Friend.” Where the versions differ, the passages quoted above follow the more detailed online version.)

The article in Molecular Plant mentioned above is:

Zhang, Hongxiang, Jiatao Xie, Yanping Fu, Jiasen Cheng, Zheng Qu, Zhenzhen Zhao, Shufen Cheng, Tao Chen, Bo Li, Qianqian Wang, Xinqiang Liu, Binnian Tian, David B. Collinge, and Daohong Jiang. “A 2-Kb Mycovirus Converts a Pathogenic Fungus into a Beneficial Endophyte for Brassica Protection and Yield Enhancement.” Molecular Plant 13, no. 10 (2020): 1420-33.

Species Shifting Their Range Due to Climate Change May Have Enabled the “Playing Around With Resources” That Invented Farming

(p. D6) In the 1990s, archaeologists largely concluded that farming in the Fertile Crescent began in Jordan and Israel, a region known as the southern Levant. “The model was that everything started there, and then everything spread out from there, including maybe the people,” said Melinda A. Zeder, a senior research scientist at the Smithsonian National Museum of Natural History.

But in recent years, Dr. Zeder and other archaeologists have overturned that consensus. Their research suggests that people were inventing farming at several sites in the Fertile Crescent at roughly the same time. In the Zagros Mountains of Iran, for example, Dr. Zeder and her colleagues have found evidence of the gradual domestication of wild goats over many centuries around 10,000 years ago.

People may have been cultivating plants earlier than believed, too.

In the 1980s, Dani Nadel, then at Hebrew University, and his colleagues excavated a 23,000-year-old site on the shores of the Sea of Galilee known as Ohalo II. It consisted of half a dozen brush huts. Last year, Dr. Nadel co-authored a study showing that one of the huts contained 150,000 charred seeds and fruits, including many types, such as almonds, grapes and olives, that would later become crops. A stone blade found at Ohalo II seemed to have been used as a sickle to harvest cereals. A stone slab was used to grind the seeds. It seems clear the inhabitants were cultivating wild plants long before farming was thought to have begun.

“We got fixated on the very few things we just happened to see preserved in the archaeological record, and we got this false impression that this was an abrupt change,” Dr. Zeder said. “Now we really understand there was this long period where they’re playing around with resources.”

Many scientists have suggested that humans turned to agriculture under duress. Perhaps the climate of the Near East grew harsh, or perhaps the hunter-gatherer population outstripped the supply of wild foods.

But “playing around with resources” is not the sort of thing people do in times of desperation. Instead, Dr. Zeder argues, agriculture came about as climatic changes shifted the ranges of some wild species of plants and animals into the Near East.

Many different groups began experimenting with ways of producing extra food, which eventually enabled them to start a new way of life: settling down in more stable social groups.

For the full story see:

Carl Zimmer. “The First Farmers.” The New York Times (Tuesday, October 18, 2016 [sic]): D1 & D6.

(Note: the online version of the story has the date Oct. 17, 2016 [sic], and has the title “How the First Farmers Changed History.”)

The 2015 study co-authored by Dani Nadel and mentioned above is:

Snir, Ainit, Dani Nadel, Iris Groman-Yaroslavski, Yoel Melamed, Marcelo Sternberg, Ofer Bar-Yosef, and Ehud Weiss. “The Origin of Cultivation and Proto-Weeds, Long before Neolithic Farming.” PLOS ONE 10, no. 7 (July 22, 2015): e0131422.

Common Ritualistic Human Sacrifice Detract from the Myth of the Past as Golden Age

(p. D2) One thing that’s definitely gotten better over time: not as much ritualistic human sacrifice.

. . .

The authors list some run-of-the-mill techniques for human sacrifice, but others they mention are more, let’s say, specific: being crushed under a newly built canoe, or being rolled off the roof of a house and then decapitated.

For the full story see:

Tatiana Schlossberg. “Hierarchies: A Grisly Social Order.” The New York Times (Tuesday, April 5, 2016 [sic]): D2.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 4, 2016 [sic], and has the title “Why Some Societies Practiced Ritual Human Sacrifice.” Where the versions differ, in the passages quoted above I follow the more detailed account in the online version.)

The article quoted above references the following academic article:

Watts, Joseph, Oliver Sheehan, Quentin D. Atkinson, Joseph Bulbulia, and Russell D. Gray. “Ritual Human Sacrifice Promoted and Sustained the Evolution of Stratified Societies.” Nature 532, no. 7598 (April 4, 2016): 228-31.