Author: Art Diamond

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.”)

“The Spontaneous, Uncoordinated Effort of Businesses, Entrepreneurs and Innovators”

(p. A1) True Value Co. heard from its more than 4,500 affiliated hardware stores last month that hand sanitizer was flying off the shelves, leaving store staff with none for themselves.

At the company’s factory in Cary, Ill., which makes cleaning products and paint, John Vanderpool, the company’s divisional vice president of paint, recalled asking, “What can we do to help here?” After a tip from his wife, a pharmacist, he consulted with the Food and Drug Administration, then huddled with his maintenance team and engineers over two weekends to retool two paint-filling lines to produce jugs of FDA-approved hand sanitizer.

Starting this week they are being shipped free to stores for their own use. The product will go on sale to the public eventually.

The changeover at True Value’s factory from paint to hand sanitizer is one of countless private-sector initiatives that represent an underappreciated asset in Americans’ fight against the coronavirus. It is a 21st-century version of the “Arsenal of Democracy,” the mobilization of industrial might that helped win World War II, only this time to make personal protective equipment, ventilators, tests and vaccines instead of uniforms, ammunition, tanks and bombers.

And where that arsenal was orchestrated by the federal government, this one has been largely the spontaneous, uncoordinated effort of businesses, entrepreneurs and innovators driven as much by the urge to contribute as by future profit.

. . .

(p. A9) Joel Mokyr, an economic historian at Northwestern University, said national crises such as wars and pandemics historically generate a hive of entrepreneurial innovation, from the late 18th-century search in England for a treatment for smallpox to a German drive in the run-up to World War I to use atmospheric nitrogen for explosives.

“We have this huge reservoir of creative energy spread around the economy. When you have an event like this all of a sudden, everyone says, ‘Oh wow let’s look at this problem—let’s see what I can do to solve it.’ ”

This time, innovators are exploiting tools and methods that didn’t exist in previous crises. In mid-March, Lennon Rodgers, director of the Grainger Engineering Design Innovation Lab at the University of Wisconsin in Madison, fielded a plea from the university’s hospital to make 1,000 face shields.

He often gets requests from around the campus to manufacture random items and “initially, I didn’t take it too seriously,” he recalled. But after his wife, an anesthesiologist, told him the shields were indispensable for dealing with highly infectious patients, he scoured hardware and craft stores for parts.

He teamed up with Delve, a local design firm, and Midwest Prototyping, a contract manufacturer, to design their own “Badger Shield,” named after the University of Wisconsin mascot. They expected to use 3-D printers, then concluded that wouldn’t achieve the necessary scale. They uploaded the design to their website along with the necessary parts for anyone to download. A few days later Ford Motor Co. did, and, with tweaks of its own, began turning out face shields for Detroit-area hospitals.

For the full story, see:

Greg Ip. “Health Crisis Awakens Spirit Of Private-Sector Innovation.” The Wall Street Journal (Friday, April 17, 2020): A1 & A9.

(Note: ellipsis added.)

(Note: the online version of the story was updated April 16, 2020, and has the title “Shoes to Masks: Corporate Innovation Flourishes in Coronavirus Fight.”)

“Real World Evidence” on Effectiveness of Experimental Drugs Can Be Extracted From Electronic Health Records

(p. A7) . . . analysis of compassionate-use data, about the experimental drug remdesivir from Gilead Sciences Inc. published in the New England Journal of Medicine, came under criticism. Scientists pointed out that the Covid-19 patients received the drug in centers around the world where care may have differed, data on some patients was incomplete and there was no comparison group.

That study’s first author, Jonathan Grein, of Cedars-Sinai Medical Center in Los Angeles, said given how little is known about the coronavirus and how to treat it, “I think at this point any information is potentially helpful.” He said the study, funded by Gilead Sciences, noted the findings were limited and preliminary. “It is a starting point, an opportunity to aggregate our initial experiences,” he said.

. . .

The FDA . . . has worked closely with companies trying to extract “real world evidence” about patients’ experiences with new or experimental drugs from sources such as electronic health records.

For the full story, see:

Amy Dockser Marcus. “Hundreds Get Plasma in National Study.” The Wall Street Journal (Wednesday, April 22, 2020): A7.

(Note: ellipses added.)

(Note: the online version of the story has the date April 21, 2020, and has the title “Hundreds Receive Plasma From Recovered Coronavirus Patients in National Study.”)

Blacks Deficient in Vitamin D Are at Greater Risk of Cytokine Storm from Covid-19

(p. A15) Black Americans are dying of Covid-19 at a higher rate than whites. Socioeconomic factors such as gaps in access to health care no doubt play a role. But another possible factor has been largely overlooked: vitamin D deficiency that weakens the immune system.

Researchers last month released the first data supporting this link. Based on a link between levels of the inflammatory marker C-reactive protein and severe cases of Covid-19, they estimate that tens of thousands of lives could be saved world-wide by normalizing vitamin D levels, through its modulation of the inflammatory cascade.

Vitamin D is produced by a reaction in the skin to the ultraviolet rays in sunlight. Many Americans are low in vitamin D, but those with darker skin are at a particular disadvantage because melanin inhibits the vitamin’s production.

For the full commentary, see:

Vatsal G. Thakkar. “Vitamin D and Coronavirus Disparities.” The Wall Street Journal (Friday, April 17, 2020): A15.

(Note: the online version of the commentary has the date April 16, 2020, and has the same title as the print version. Where the wording of the online and print versions differs, the passages quoted above follow the online version.)

The research working paper mentioned above, is:

Daneshkhah, Ali, Vasundhara Agrawal, Adam Eshein, Hariharan Subramanian, Hemant Kumar Roy, and Vadim Backman. “The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in Covid-19 Patients.” (April 30, 2020).