Category: Government

Biden’s Cancer “Moonshot Is 100 Percent Hype”

(p. A17) WASHINGTON — President Biden unveiled a plan on Wednesday to reduce the death rate from cancer by at least 50 percent over the next 25 years — an ambitious new goal, he said, to “supercharge” the cancer “moonshot” program he initiated and presided over five years ago as vice president.

Mr. Biden, joined by his wife, Jill Biden, and Vice President Kamala Harris, also announced a campaign to urge Americans to undergo screenings that were missed during the coronavirus pandemic.

. . .

More screenings are not the answer — the only cancers for which screening has indisputably lowered the death rate are colon and cervical. Death rates for other cancers, like breast, have fallen, but a large part of the drop, if not all of it, is because of improved treatment, said Donald A. Berry, a biostatistician at the University of Texas M.D. Anderson Cancer Center who has spent decades studying these issues.

“Everybody loves early detection, but it comes with harms,” he said — principally, the harm of finding and treating tumors that do not need to be treated because they are innocuous. “The harms we know, but the benefits of screening are very uncertain,” he said.

If the age-adjusted cancer death rate were to plunge by 50 percent, it would have to be because cancers were being cured. Some treatments, like a drug that treats chronic myelogenous leukemia, have slashed death rates for that disease, but such marked effects in cancer are few and far between.

. . .

The White House billed the event as a fresh push by the president to “reignite” the moonshot program and “end cancer as we know it.”

. . .

Yet one Wall Street analyst who specializes in biotechnology and pharmaceuticals said that the time, money and effort might be better spent on initiatives to prevent cancer, like reducing smoking and rates of obesity. The Centers for Disease Control and Prevention says being obese increases a person’s risk of cancer. And reducing smoking is a proven way to cut the cancer death rate.

“This moonshot is 100 percent hype; this is the absolute wrong way to do this,” said the analyst, Stephen Brozak, the president of WBB Securities.

Presidents since Richard M. Nixon have sought to tackle cancer, of which there are more than 100 types of disease that can vary in how they grow, spread and respond to treatment. The cancer institute estimates that nearly 40 percent of men and women will be diagnosed with some type of cancer at some point during their lifetimes. The American Cancer Society estimates there will be 1.9 million new cases of cancer in the United States this year, and more than 609,000 cancer deaths.

For the full story, see:

Sheryl Gay Stolberg and Gina Kolata. “President Aims to Cut The Cancer Death Rate In Half Over 25 Years.” The New York Times (Thursday, February 3, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the story has the date Feb. 2, 2022, and has the title “Biden Presents Ambitious Plan to Cut Cancer Death Rate in Half.”)

Expert Medical Advice Often Flip-Flops

(p. D6) A History of Medical Flip-Flops

Shifting medical advice is surprisingly common, and it tends to fall into three categories: emerging guidance, replacement advice and reversals.

Emerging guidance comes during times of crisis — like pandemics — and is destined to change quickly. In the past several months, guidance about the best way to treat Covid patients, masks to prevent transmission and the limits of vaccine protection have all shifted as knowledge of the coronavirus and its variants has evolved.

Sometimes it’s hard to tell the difference between replacement advice, which is issued when research improves on advice that came before it, and a full reversal, which comes about because a common medical practice got ahead of the science and never actually worked or even caused harm. Here are some examples of true medical flip-flops in recent years.

MENOPAUSE HORMONES TO PROTECT THE HEART: In 2002, decades of advice about the heart benefits of menopause hormones seemed to change overnight when a major study called the Women’s Health Initiative was halted after researchers detected more heart attacks in the women taking hormones. In hindsight, doctors had misinterpreted data from observational research. The current advice: Hormones can relieve menopause symptoms but shouldn’t be used for chronic disease prevention.

VIOXX AS A LOWER-RISK ARTHRITIS TREATMENT: In 1999, the Food and Drug Administration approved Vioxx as a breakthrough pain reliever because it lowered the risk of gastrointestinal problems. But by 2004, Merck had withdrawn the drug because studies showed it significantly raised the risk of heart attack.

ARTHROSCOPIC SURGERY ON AGING KNEES: For years, the partial removal of torn meniscus tissue was the most common orthopedic procedure in the United States, with about 700,000 performed a year. In 2013, a researcher in Finland compared the operation to a “sham” procedure and found there was no benefit. Most doctors now recommend physical therapy instead.

VITAMIN MEGADOSES TO LOWER CANCER AND HEART RISK: For years, doctors believed various vitamins could lower risk for cancer and heart disease, but a number of studies showed just the opposite. A study of beta carotene and vitamin A found that the supplements actually increased the risk of lung cancer in male smokers. A study of vitamin E and selenium, thought to protect against prostate cancer, increased risk for the disease.

STENTS FOR STABLE HEART DISEASE: Doctors used to insert stents — tiny wire mesh tubes that prop open arteries — in millions of otherwise stable patients with heart disease. A study found that the surgical procedure was no better than drug therapy for preventing heart attacks.

Dr. Vinay Prasad, associate professor at the University of California San Francisco, and Dr. Adam S. Cifu, a professor of medicine at the University of Chicago Department of Medicine, coined the term “medical reversal” and concluded that about 40 percent of common medical practices that they reviewed turned out to be useless or harmful. In their book, “Ending Medical Reversal: Improving Outcomes, Saving Lives,” they noted that most of these failed treatments were initially embraced because they were based on logical reasoning.

“The thing that’s often behind reversal: All of these things have a good story, they have good pathophysiological rationale,” Dr. Cifu said. “They should work. But things only work if they’ve been shown in people to work, and people are so complicated.”

For the full story, see:

Tara Parker-Pope. “Shifting Medical Advice Is a Feature, Not a Bug.” The New York Times (Tuesday, November 2, 2021): D6.

(Note: the online version of the story was updated Oct. 24, 2021, and has the title “Is the New Aspirin Advice a Medical Flip-Flop, or Just Science?” The paragraphs on menopause hormones to protect the heart and on vitamin megadoses to lower cancer and heart risk appear in the online version, but not in the print version.)

The book co-authored by Prasad and mentioned above is:

Prasad, Vinayak K., and Adam S. Cifu. Ending Medical Reversal: Improving Outcomes, Saving Lives. Baltimore: Johns Hopkins University Press, 2015.

Calcutta Commuters Avoid Slow Unreliable Trams Because “People Want to Move Fast”

(p. A4) “You get all the flavors of Calcutta here, so it’s the best way to travel,” said a medical student, Megha Roy, riding the tram with two friends. She used the Anglicized version of Kolkata, which residents deploy interchangeably with its current spelling and pronunciation.

The three friends had jumped onboard spontaneously, with no clear idea of where the tram was going, or when it was scheduled to get there. But it didn’t really matter. The ride itself was an unexpected treat.

“It’s like a fairy tale,” Ms. Roy said.

. . .

. . . the authorities say that while trams should remain a part of the transit mix, buses and the city’s metro system better serve 21st-century riders in the city of some 15 million people.

. . .

“Scientifically, economically, environmentally, there is no reason to convert the tramways for buses,” said Debasish Bhattacharyya, president of the Calcutta Tram Users’ Association.

But the scene at one tram stop suggested commuters may feel differently. Fewer than half a dozen people were waiting for the tram, while nearby, hundreds were piling onto buses that sagged under the weight of so many passengers, belching black plumes of diesel exhaust as they careened over the tram’s tracks and onto the street.

Admittedly, neither speed nor punctuality are hallmarks of the trams, which must contend with a mélange of traffic on their routes: trucks, buses, cars, vintage yellow Ambassador taxis, rickshaws manual and electric, pedestrians, herds of goats and the occasional cow.

“Nobody knows when the next car will come,” Mr. Bhattacharyya said. “They say this is the control room, but nothing is controlled, everything is scattered,” he said, gesturing to a hub of the tram system in central Kolkata.

. . .

Aboard a tram crawling along Lenin Sarani, one of central Kolkata’s main thoroughfares and named in honor of the Russian revolutionary, Sumit Chandra Banerjee, a ticket taker, said he looked forward to mandatory retirement when he turned 60 in October [2021].

. . .

Many of Kolkata’s urban landmarks — from cinemas and bookstores to museums and hospitals — were built near the tracks. One of those institutions was Das Gupta Books, founded in 1886.

Aranda Das Gupta, the shop’s fourth-generation managing director, called the tram a “beautiful journey,” while acknowledging that it takes “maximum time.”

“Nowadays,” he said, “people want to move fast.”

For the full story, see:

Emily Schmall. “INDIA DISPATCH; Kolkata Is Letting Its ‘Fairy Tale’ Trams Waste Away.” The New York Times (Friday, September 3, 2021): A4.

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

(Note: the online version of the story has the date Sept. 2, 2021, and has the title “INDIA DISPATCH; Kolkata’s ‘Fairy Tale’ Trams, Once Essential, Are Now a Neglected Relic.”)

Feds Impede Consumer Choice by Going Back to Incandescent Ban

(p. A16) In 2019, the Trump administration blocked a rule designed to phase out older incandescent bulbs, calling it unnecessary and an impediment to consumer choice.

With the move, the administration heeded to both industry demands as well as free market proponents who have long railed against tougher efficiency regulations for consumer appliances and goods, like energy-saving bulbs or water-saving dishwashers, as governmental overreach.

“The new bulb is many times more expensive, and I hate to say it, it doesn’t make you look as good,” Donald J. Trump, the former president, quipped at a White House meeting in 2019, referring to an early common complaint that LEDs emit a harsher light, though recent LED lights come in warmer hues. “We’re bringing back the old light bulb,” he later told a rally in Michigan.

The Biden administration has moved to reinstate the standards. But in a letter to the Department of Energy last year, NEMA, the industry group, urged federal rules to allow companies to manufacture and import inefficient bulbs for at least another year, followed by another year or more to sell out stockpiled inventory.

For the full story, see:

Hiroko Tabuchi. “Obsolete Bulbs Fill the Shelves At Dollar Stores.” The New York Times (Monday, January 24, 2022): A1 & A16.

(Note: the online version of the story has the date January 23, 2022, and has the title “Old-Fashioned, Inefficient Light Bulbs Live On at the Nation’s Dollar Stores.”)

Instead of Centralizing With C.D.C., the Need for Speed Requires “Clinical and Commercial Labs to Create and Deploy Tests”

(p. A22) The faulty coronavirus testing kits developed by the Centers for Disease Control and Prevention in the early weeks of the pandemic were not only contaminated but had a basic design flaw, according to an internal review by the agency.

Health officials had already acknowledged that the test kits were contaminated, but the internal report, whose findings were published in PLOS ONE on Wednesday, also documented a design error that caused false positives.

. . .

The C.D.C.’s test was designed to detect three distinct regions, or target sequences, of the virus’s genetic material. The test kits contain a set of what are known as primers, which bind to and make copies of the target sequences, and probes, which produce a fluorescent signal when these copies are made, indicating that genetic material from the virus is present.

The primers and probes need to be carefully designed so that they bind to the target sequences and not to each other. In this case, that did not happen. One of the probes in the kit sometimes bound to one of the primers, producing the fluorescent signal and generating a false positive.

“It’s something that should have been caught in the design phase,” said Susan Butler-Wu, a clinical microbiologist at the Keck School of Medicine of the University of Southern California. “That’s one thing that you check for.”

. . .

The bigger lesson, Dr. Butler-Wu said, is that the responsibility for developing diagnostic tests should be distributed more widely during a public health emergency. Rather than relying on the C.D.C. to be the sole test developer, officials could also enlist clinical and commercial labs to create and deploy tests.

“It’s great that there’s all these additional checks in place, but what are you going to do when there’s a new emerging pathogen and we need to respond quickly?” she said. “I don’t think that’s a viable model for responding to a pandemic.”

For the full story, see:

Emily Anthes. “C.D.C. Finds Design Error In Testing Kits It Distributed.” The New York Times Thursday, December 16, 2021): A22.

(Note: ellipses added.)

(Note: the online version of the story has the date Dec. 15, 2021, and has the title “C.D.C. Virus Tests Were Contaminated and Poorly Designed, Agency Says.”)

The PLOS ONE article mentioned above is:

Lee, Justin S., Jason M. Goldstein, Jonathan L. Moon, Owen Herzegh, Dennis A. Bagarozzi, Jr., M. Steven Oberste, Heather Hughes, Kanwar Bedi, Dorothie Gerard, Brenique Cameron, Christopher Benton, Asiya Chida, Ausaf Ahmad, David J. Petway, Jr., Xiaoling Tang, Nicky Sulaiman, Dawit Teklu, Dhwani Batra, Dakota Howard, Mili Sheth, Wendi Kuhnert, Stephanie R. Bialek, Christina L. Hutson, Jan Pohl, and Darin S. Carroll. “Analysis of the Initial Lot of the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel.” PLOS ONE 16, no. 12 (Dec. 15, 2021). DOI: 10.1371/journal.pone.0260487.

Majority of Economists Say Price Controls Would Fail to “Successfully” Reduce Inflation

(p. B1) America’s recent inflation spike has prompted renewed interest in an idea that many economists and policy experts thought they had long ago left behind for good: price controls.

The federal government last imposed broad-based limits on how much private companies could charge for their goods and services in the 1970s, when President Richard M. Nixon ushered in wage and price freezes over the course of a few years. That experiment was widely regarded as a failure, and ever since, the phrase “price controls” has, at least for many people, called to mind images of product shortages and bureaucratic overreach. In recent decades, few economists have bothered to study the idea at all.

. . .

(p. B2) Artificially holding down prices leads to shortages, inefficiencies or other unintended consequences, like an increase in black-market activity. And while some economists say price controls on specific products can make sense in specific situations — to prevent price-gouging after a natural disaster, for example — most argue that they are a poor tool for fighting inflation, which is a broad increase in prices.

In a recent survey of 41 academic economists conducted by the University of Chicago’s Booth School of Business, 61 percent said that price controls similar to those imposed in the 1970s would fail to “successfully reduce U.S. inflation over the next 12 months.” Others said the policy might bring down inflation in the short-term but would lead to shortages or other problems.

“Price controls can of course control prices — but they’re a terrible idea!” David Autor, an economist at the Massachusetts Institute of Technology, wrote in response to the survey.

. . .

“It sounds good: Your wages are going to be higher, and your prices are going to be the same,” said Lawrence H. Summers, a Harvard University economist. “Unless there is a mechanism for producing more stuff, it’s just going to result in longer queues.”

For the full story, see:

Ben Casselman and Jeanna Smialek. “A Throwback Idea Returns As Inflation Rears Its Head.” The New York Times (Monday, January 17, 2022): B1-B2.

(Note: ellipses added.)

(Note: the online version of the story was updated Jan. 13, 2022, and has the title “Price Controls Set Off Heated Debate as History Gets a Second Look.”)

“Fission Is in Fashion” and Is Over-Regulated

(p. A15) Fission is in fashion as drawbacks of intermittent wind and solar power emerge.

. . .

Regulatory limits on annual exposure around nuclear plants are less than a year’s background radiation from rocks and cosmic rays. Radiation scientists now know that people can safely absorb that much radiation every day because DNA is repaired and cells are replaced constantly in living beings. Yet regulators’ mandated limits, at a thousandth of what’s really harmful, create fright of all radiation. No one needed to be evacuated at Fukushima or around Chernobyl, places where thousands died from unwarranted fear and relocation stress.

For the full commentary, see:

Robert Hargraves. “If You Want Clean Power, Go Fission.” The Wall Street Journal (Thursday, January 27, 2022): A15.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Jan. 26, 2022, and has the same title as the print version.)

DeSantis Upgrades Infrastructure to Mitigate Flooding

(p. A5) The Republican governor, unlike many of his Democratic counterparts, didn’t use the term “climate change” or endorse specific policies aimed at combating factors that most climate scientists say are driving warming, such as greenhouse-gas emissions. He focused on responding to the effects of a warming climate.

“What I’ve found is people, when they start talking about things like global warming, they typically use that as a pretext to do a bunch of left-wing things,” said Mr. DeSantis at the event. “We’re not doing any left-wing stuff.”

Governors and lawmakers in several Republican-led states, including Idaho, South Carolina and Texas, are taking a similar approach as concern about climate change increases. After natural disasters that research suggests are becoming more frequent and intense, they are taking measures such as infrastructure upgrades to mitigate flooding, wildfires and severe storms. Such moves are vital to their states’ economic livelihood, they say.

. . .

At the Oldsmar event, Mr. DeSantis outlined a proposal to dedicate more than $270 million to 76 projects aimed at bolstering defenses against rising sea levels and flooding. “We’re a low-lying state, we’re a storm-prone state, and we’re a flood-prone state,” he said.

For the full story, see:

Arian Campo-Flores. “Republicans Adjust Climate Message.” The Wall Street Journal (Monday, January 24, 2022): A5.

(Note: ellipsis added.)

(Note: the online version of the story has the date Jan. 23, 2022, and has the title “Millions Have Lost a Step Into the Middle Class, Researchers Say.”)

Machiavelli Described the Methods of Tyrants

(p. C12) But anyone who observes politics, business or even the loftiest social institutions will know that the world is rife with backstabbers, hypocrites and ethical ne’er-do-wells all thriving at the highest levels—beyond the reach of law or hashtag.

. . .

Machiavelli’s gift, Mr. Boucheron argues, was “naming with precision that which was happening.” He explains the behavior of tyrants not to excuse them, but to show the rest of us what to look out for, in the clearest terms possible. Machiavelli’s “lucidity,” says Mr. Boucheron, was the “weapon of the despairing.”

Other political thinkers have read Machiavelli this way. Jean-Jacques Rousseau wrote in “The Social Contract” that Machiavelli was not advising tyrants but “instructing the people on what they have to fear.” John Adams credited Machiavelli for helping him think through the likely threats to a young American republic.

For the full review, see:

Philip Delves Broughton. “A Poetics for Tyrants.” The Wall Street Journal (Saturday, January 25, 2020): C12.

(Note: ellipsis added.)

(Note: the online version of the review has the date January 24, 2020, and has the title “‘Machiavelli’ Review: A Poetics for Tyrants.”)

The book under review is:

Boucheron, Patrick. Machiavelli: The Art of Teaching People What to Fear. Translated by Willard Wood. New York: Other Press, 2020.

Socialist Mayor’s Environmental Bicycles Turn Paris Streets into Risky Chaos

(p. 4) PARIS — On a recent afternoon, the Rue de Rivoli looked like this: Cyclists blowing through red lights in two directions. Delivery bike riders fixating on their cellphones. Electric scooters careening across lanes. Jaywalkers and nervous pedestrians scrambling as if in a video game.

Sarah Famery, a 20-year resident of the Marais neighborhood, braced for the tumult. She looked left, then right, then left and right again before venturing into a crosswalk, only to break into a rant-laden sprint as two cyclists came within inches of grazing her.

“It’s chaos!” exclaimed Ms. Famery, shaking a fist at the swarm of bikes that have displaced cars on the Rue de Rivoli ever since it was remade into a multilane highway for cyclists last year. “Politicians want to make Paris a cycling city, but no one is following any rules,” she said. “It’s becoming risky just to cross the street!”

The mayhem on Rue de Rivoli — a major traffic artery stretching from the Bastille past the Louvre to the Place de la Concorde — is playing out on streets across Paris as the authorities pursue an ambitious goal of making the city a European cycling capital by 2024.

Mayor Anne Hidalgo, who is campaigning for the French presidency, has been burnishing her credentials as an ecologically minded Socialist candidate. She has earned admirers and enemies alike with a bold program to transform greater Paris into the world’s leading environmentally sustainable metropolis, reclaiming vast swaths of the city from cars for parks, pedestrians and a Copenhagen-style cycling revolution.

For the full story, see:

Liz Alderman. “PARIS DISPATCH; Europe’s New Cycling Capital, or a Pedestrian’s Nightmare?” The New York Times, First Section (Sunday, Oct. 3, 2021): 4.

(Note: the online version of the story was updated Oct. 4, 2021, and has the title “PARIS DISPATCH; As Bikers Throng the Streets, ‘It’s Like Paris Is in Anarchy’.”)

FDA Takes “Several Months” to Approve Manufacturers’ “Rapid” Test Applications

(p. A1) As rising Covid-19 infections stoked demand for tests across the U.S. in December, California-based LumiQuick Diagnostics Inc. shipped 100,000 rapid tests to a hospital customer—in Germany.

LumiQuick didn’t receive authorization from the Food and Drug Administration to sell Covid-19 tests domestically after waiting several months for a decision.

Some public-health experts said the relatively strict review process is part of a broader failure by U.S. officials and manufacturers to make and distribute enough rapid tests to track the pandemic adequately. Nearly two years into the pandemic, people have struggled to find tests during the holiday season as infections surge again, fueled by the highly infectious Omicron variant.

. . .

(p. A4) “We’ve never gotten the testing situation well instituted in our country,” said Ezekiel Emanuel, co-director of the Healthcare Transformation Institute at the University of Pennsylvania, and a former member of the Biden administration’s disbanded coronavirus advisory board.

. . .

Some U.S. manufacturers said the FDA’s slow review of new rapid tests discouraged them from making products that they weren’t sure they would be able to sell in the U.S. “Without approval we cannot commit,” said Frank Wang, chief executive officer of BioMedomics Inc., a North Carolina manufacturer that applied for authorization in March. The company has sold some tests outside the U.S.

Another test maker, Kaya17 Inc., said it has been waiting on FDA approval for months. “The FDA has to up their game and move faster,” said Sulatha Dwarakanath, the company’s CEO.

For the full story, see:

Austen Hufford and Brianna Abbott. “Slow Test Approvals Blamed for Shortage.” The Wall Street Journal (Friday, Dec. 31, 2021): A1 & A4.

(Note: ellipses added.)

(Note: the online version of the story has the date December 30, 2021, and has the title “Covid-19 Rapid Test Shortages Tied to Slow Federal Action.” The online version says that the title of the print version is “Tests in Short Supply as Approvals Lag.” But my print version (probably the Central Edition) has the title “Slow Test Approvals Blamed for Shortage.”)