Category: Health

Is Ignorance Bliss, When Knowledge Is Not Actionable?

(p. C1) . . . even in today’s pandemic world, cancer holds a special place in the anxious imagination. Its advance is often stealthy, its prognosis potentially frightening and its treatments damaging and life-altering. Once its shadow falls on us, we fear it will never go away—that there will always be another relapse and a return to harsh therapies that subsume our lives.

. . .

(p. C2) The borders of “Cancerland”—a term the oncologist David Scadden coined with the title of his 2018 memoir—begin to feel all-encompassing. In the past, entry was reserved for those with a diagnosis of cancer. Today everyone, in one way or another, slowly becomes a citizen.

. . .

The promise of detecting cancer in its earliest stages, together with that of identifying those at genetic risk for future cancer, is powerfully alluring. And yet the prospect of farther-reaching surveillance for this elusive long-term illness also warrants caution. In the 1950s, the sociologist Erving Goffman coined the term “total institution” for a community in which “a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life.”

Total institutions, such as mental hospitals, prisons and even boarding schools, have rituals of entry and exit. They inculcate belonging. They invent their own vocabulary and codes of behavior; they have an internal logic, impenetrable to others. They encourage surveillance and create anxiety: Members are united by a common sense of purpose, by the feeling of being chosen or marked. Those who are expelled may feel a sense of betrayal, while those who remain can be consumed by the guilt of survivorship.

In this new era of cancer treatment, I wonder whether we unwittingly, but insidiously, intensify the totality of the “cancer institution” for patients. When I once asked a woman with a rare sarcoma about her life outside the hospital, she observed, “I am in the hospital even when I am outside the hospital.”

For the full commentary, see:

Siddhartha Mukherjee. “Will We All Soon Live in Cancerland?” The Wall Street Journal (Saturday, Dec. 18, 2021): C1-C2.

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

(Note: the online version of the commentary was updated Dec. 17, 2021, and has the same title as the print version.)

Muckherjee’s commentary is adapted from his chapter in The New Deal for Cancer book:

Mukherjee, Siddhartha. “The New Borders of Cancerland.” In A New Deal for Cancer: Lessons from a 50 Year War, edited by Abbe R. Gluck and Charles S. Fuchs. New York: PublicAffairs, 2021, pp. 27-42.

Applying Coase Theorem to Refute the Externality Argument Used to Defend Covid-19 Mandates and Lockdowns

(p. A17) The online Merriam-Webster dictionary defines “anti-vaxxer” as “a person who opposes the use of vaccines or regulations mandating vaccination.” Where does that leave us? We both strongly favor vaccination against Covid-19; one of us (Mr. Hooper) has spent years working and consulting for vaccine manufacturers. But we strongly oppose government vaccine mandates. If you’re crazy about Hondas but don’t think the government should force everyone to buy a Honda, are you “anti-Honda”?

. . .

. . ., early in the pandemic the Food and Drug Administration used its coercive power to discourage the development of diagnostic tests for Covid-19. The FDA required private labs wanting to develop tests to submit special paperwork to get approval that it had never required for other diagnostic tests. That, in combination with the CDC’s claims that it had enough testing capacity, meant that testing necessitated the use of a CDC test later determined to be so defective that it found the coronavirus in laboratory-grade water.

With voluntary approaches, we get the benefit of millions of people around the world actively trying to solve problems and make our lives better. We get high-quality vaccines from BioNTech/ Pfizer, Johnson & Johnson and Moderna, instead of the suspect vaccines from the governments of Cuba and Russia. We get good diagnostic tests from Thermo Fisher Scientific instead of the defective CDC one. We get promising therapeutics such as Pfizer’s Paxlovid and Merck’s molnupiravir.

. . .

The supposed trump card of those who favor coercion is externalities: One person’s behavior can put another at risk. But that’s only half the story. The other half is that we choose how much risk we accept. If some customers at a store exhibit risky behavior, then we can vaccinate, wear masks, keep our distance, shop at quieter times, or avoid the store.

Economists understand how one person can impose a cost on another. But it takes two to tango, and it’s generally more efficient if the person who can change his behavior with the lower cost changes how he behaves. In other words, to perform a proper evaluation of policies to deal with externalities, we must consider the responses available to both parties. Many people, including economists, ignore this insight.

For the full commentary, see:

David R. Henderson and Charles L. Hooper. “Coercion Made the Pandemic Worse.” The Wall Street Journal (Tuesday, December 28, 2021): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date December 27, 2021, and has the same title as the print version.)

Mars Can Be Terraformed to Reduce Costs of Colonization

(p. D5) Since joining NASA in 1980, Jim Green has seen it all. He has helped the space agency understand Earth’s magnetic field, explore the outer solar system and search for life on Mars. As the new year arrived on Saturday, he bade farewell to the agency.

Over the past four decades, which includes 12 years as the director of NASA’s planetary science division and the last three years as its chief scientist, he has shaped much of NASA’s scientific inquiry, overseeing missions across the solar system and contributing to more than 100 scientific papers across a range of topics. While specializing in Earth’s magnetic field and plasma waves early in his career, he went on to diversify his research portfolio.

. . .

Ahead of a December [2021] meeting of the American Geophysical Union in New Orleans, Dr. Green spoke about some of this wide-ranging work and the search for life in the solar system. Below are edited and condensed excerpts from our interview.

. . .

    You’ve previously suggested it might be possible to terraform Mars by placing a giant magnetic shield between the planet and the sun, which would stop the sun from stripping its atmosphere, allowing the planet to trap more heat and warm its climate to make it habitable. Is that really doable?

Yeah, it’s doable. Stop the stripping, and the pressure is going to increase. Mars is going to start terraforming itself. That’s what we want: the planet to participate in this any way it can. When the pressure goes up, the temperature goes up.

The first level of terraforming is at 60 millibars, a factor of 10 from where we are now. That’s called the Armstrong limit, where your blood doesn’t boil if you walked out on the surface. If you didn’t need a spacesuit, you could have much more flexibility and mobility. The higher temperature and pressure enable you to begin the process of growing plants in the soils.

There are several scenarios on how to do the magnetic shield. I’m trying to get a paper out I’ve been working on for about two years. It’s not going to be well received. The planetary community does not like the idea of terraforming anything. But you know. I think we can change Venus, too, with a physical shield that reflects light. We create a shield, and the whole temperature starts going down.

For the full story, see:

Jonathan O’Callaghan, interviewer. “Inhabiting Mars? He Calls It ‘Doable.’” The New York Times (Tuesday, January 4, 2022): D5.

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

(Note: the online version of the story has the date Jan. 2, 2021, and has the title “NASA’s Retiring Top Scientist Says We Can Terraform Mars and Maybe Venus, Too.” The first three paragraphs, and the block-indented sentence and question, are by the interviewer Jonathan O’Callaghan. The answer after the question is by Jim Green.)

“Endless” Trial-and-Error Experiments Led to Creation of Islet Cells to Cure Type 1 Diabetes

(p. 1) Brian Shelton’s life was ruled by Type 1 diabetes.

. . .

His ex-wife, Cindy Shelton, took him into her home in Elyria, Ohio. “I was afraid to leave him alone all day,” she said.

Early this year, she spotted a call for people with Type 1 diabetes to participate in a clinical trial by Vertex Pharmaceuticals. The company was testing a treatment developed over decades by a scientist who vowed to find a cure after his baby son and then his teenage daughter got the devastating disease.

Mr. Shelton was the first patient. On June 29, [2021] he got an infusion of cells, grown from stem cells but just like the insulin-producing pancreas cells his body lacked.

Now his body automatically controls its insulin and blood sugar levels.

Mr. Shelton, now 64, may be the first person cured of the disease with a new treatment that has experts daring to hope that help may (p. 18) be coming for many of the 1.5 million Americans suffering from Type 1 diabetes.

“It’s a whole new life,” Mr. Shelton said. “It’s like a miracle.”

. . .

One problem was the source of the cells — they came from unused fertilized eggs from a fertility clinic. But in August 2001, President George W. Bush barred using federal money for research with human embryos. Dr. Melton had to sever his stem cell lab from everything else at Harvard. He got private funding from the Howard Hughes Medical Institute, Harvard and philanthropists to set up a completely separate lab with an accountant who kept all its expenses separate, down to the light bulbs.

Over the 20 years it took the lab of 15 or so people to successfully convert stem cells into islet cells, Dr. Melton estimates the project cost about $50 million.

The challenge was to figure out what sequence of chemical messages would turn stem cells into insulin-secreting islet cells. The work involved unraveling normal pancreatic development, figuring out how islets are made in the pancreas and conducting endless experiments to steer embryonic stem cells to becoming islets. It was slow going.

. . .

The next step for Dr. Melton, knowing he’d need more resources to make a drug that could get to market, was starting a company.

. . .

His company Semma was founded in 2014, a mix of Sam and Emma’s names.

One challenge was to figure out how to grow islet cells in large quantities with a method others could repeat. That took five years.

The company, led by Bastiano Sanna, a cell and gene therapy expert, tested its cells in mice and rats, showing they functioned well and cured diabetes in rodents.

At that point, the next step — a clinical trial in patients — needed a large, well financed and experienced company with hundreds of employees. Everything had to be done to the exacting standards of the Food and Drug Administration — thousands of pages of documents prepared, and clinical trials planned.

Chance intervened. In April 2019, at a meeting at Massachusetts General Hospital, Dr. Melton ran into a former colleague, Dr. David Altshuler, who had been a professor of genetics and medicine at Harvard and the deputy director of the Broad Institute. Over lunch, Dr. Altshuler, who had become the chief scientific officer at Vertex Pharmaceuticals, asked Dr. Melton what was new.

Dr. Melton took out a small glass vial with a bright purple pellet at the bottom.

“These are islet cells that we made at Semma,” he told Dr. Altshuler.

Vertex focuses on human diseases whose biology is understood. “I think there might be an opportunity,” Dr. Altshuler told him.

Meetings followed and eight weeks later, Vertex acquired Semma for $950 million. With the acquisition, Dr. Sanna became an executive vice president at Vertex.

. . .

Less than two years after Semma was acquired, the F.D.A. allowed Vertex to begin a clinical trial with Mr. Shelton as its initial patient.

For the full story, see:

Gina Kolata. “A Cure for Severe Diabetes? For an Ohio Patient, It Worked.” The New York Times, First Section (Sunday, November 28, 2021): 1 & 18.

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

(Note: the online version of the story has the date Nov. 27, 2021, and has the title “A Cure for Type 1 Diabetes? For One Man, It Seems to Have Worked.”)

Wisconsin Hospitals Increasingly Sue Patients

(p. A8) Hospitals in Wisconsin have sued patients over medical debt at a rate that amounts to one out of every 1,000 residents a year, especially people in low-income areas and who are Black, a new study found.

The study, published Monday [Dec. 6, 2021] in the health-policy journal Health Affairs, found some hospitals were more likely than others to take patients to court and low-income and Black patients were disproportionately sued.

The findings highlight how the financial and legal jeopardy that patients face depends on which hospital they go to. The findings also add to mounting research on the consequences of medical debt, a problem that research shows is more acute among people who are uninsured.

Medical-bill lawsuits “are not a fait accompli,” said Zack Cooper, an economist with the Yale University School of Public Health and an author of the new lawsuit analysis. “This is very much a choice that these hospitals are making.”

. . .

Hospitals were suing people more for unpaid bills, the study also found. The rate increased to 1.53 lawsuits for every 1,000 residents in 2018, up from 1.12 lawsuits per 1,000 residents in 2001.

. . .

Dr. Cooper called for more data to better understand potential factors driving the disproportionate number of lawsuits among Black patients.

“First, Black patients could have a higher burden of unpaid medical bills, which leads them to get sued more on a per-capita basis,” he said. “Second, Black patients could have a similar amount of debt, but were more likely targeted by hospitals.”

For the full story, see:

Melanie Evans and Tom McGinty. “Hospital Debt-Collection Practices Vary.” The Wall Street Journal (Tuesday, Dec. 07, 2021): A8.

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

(Note: the online version of the story was updated December 6, 2021, and has the title “Hospitals in Wisconsin Pursued Medical Debt Collection Widely but Unevenly, Study Finds.” The online version says that the title of the New York print version is “Hospitals Faulted on Medical-Debt Suits.” The title of my National edition of the print version is “Hospital Debt-Collection Practices Vary.”)

The article co-authored by Cooper, and discussed above, is:

Cooper, Zack, James Han, and Neale Mahoney. “Hospital Lawsuits over Unpaid Bills Increased by 37 Percent in Wisconsin from 2001 to 2018.” Health Affairs 40, no. 12 (Dec. 2021): 1830-35.

Immuno-Suppressed Patients Take Longer to Clear Covid-19, Allowing Time for More Mutations and New Variants

(p. 14) When people with H.I.V. are prescribed an effective antiretroviral and take it consistently, their bodies almost completely suppress the virus. But if people with H.I.V. aren’t diagnosed, haven’t been prescribed treatment, or don’t, or can’t, take their medicines consistently each day, H.I.V. weakens their immune systems. And then, if they catch the coronavirus, it can take weeks or months before the new virus is cleared from their bodies.

When the coronavirus lives that long in their systems, it has the chance to mutate and mutate and mutate again. And, if they pass the mutated virus on, a new variant is in circulation.

“We have reasons to believe that some of the variants that are emerging in South Africa could potentially be associated directly with H.I.V.,” said Tulio de Oliveira, the principal investigator of the national genetic monitoring network.

In the first days of the pandemic, South Africa’s health authorities were braced for soaring death rates of people with H.I.V. “We were basically creating horror scenarios that Africa was going to be decimated,” said Salim Abdool Karim, an epidemiologist who heads the AIDS institute where KRISP is housed. “But none of that played out.” The main reason is that H.I.V. is most common among young people, while the coronavirus has hit older people hardest.

An H.I.V. infection makes a person about 1.7 times as likely to die of Covid — an elevated risk, but one that pales in comparison with the risk for people with diabetes, who are 30 times more likely to die. “Once we realized that this was the situation, we then began to understand that our real problems with H.I.V. in the midst of Covid was the prospect that severely immunocompromised people would lead to new variants,” Dr. Abdool Karim said.

. . .

. . . a single variant can rattle the world, as Omicron has.

The origin of this variant is still unknown. People with H.I.V. are not the only ones whose systems can inadvertently give the coronavirus the chance to mutate: It can happen in anyone who is immunosuppressed, such as transplant patients and those undergoing cancer treatments.

By the time the KRISP team identified the second case of a person with H.I.V. producing coronavirus variants, there were more than a dozen reports of the same phenomenon in medical literature from other parts of the world.

Viruses mutate in people with healthy immune systems, too. The difference for people with H.I.V., or another immunosuppressing condition, is that because the virus stays in their systems so much longer, the natural selection process has more time to favor mutations that evade immunity. The typical replication period in a healthy person would be just a couple of weeks, instead of many months; fewer replications mean less opportunities for new mutations.

. . .

. . ., South Africa’s efforts to tackle the variant issue, and be transparent about it, have come at a steep price, in the form of flight bans and global isolation.

“As scientists, especially in the kind of forefront, we debate playing down the H.I.V. problem,” Dr. de Oliveira mused in his lab last week. “If we are very vocal, we also risk, again, big discrimination and closing borders and economic measures. But, if you are not very vocal, we have unnecessary deaths.”

For the full story, see:

Stephanie Nolen. “A Variant Hunt on Dirt Roads and in the Lab.” The New York Times, First Section (Sunday, December 5, 2021): 1 & 14.

(Note: ellipses added.)

(Note: the online version of the story was updated Dec. 6, 2021, and has the title “The Variant Hunters: Inside South Africa’s Effort to Stanch Dangerous Mutations.” The online version says that the New York edition of the print version had the title “A Variant Hunt From the Labs To Dirt Roads.” The title of my National edition of the print version was “A Variant Hunt on Dirt Roads and in the Lab.”)

Ross Douthat’s Self-Doctoring Was “Intensely Empirical”

(p. 12) The early chapters of “The Deep Places” unfold like the first act of a horror movie. Feeling the pull of home and burned out by life on Capitol Hill, Ross Douthat (a New York Times columnist) and his wife buy a 1790s farmhouse on three acres of Connecticut pasture.

. . .

Something is lurking in those woods. Back in D.C., Douthat has a swollen lymph node, a stiff neck and strange vibrations in his head and mouth. The urgent care doctor he sees first diagnoses him with a harmless boil. A few weeks later, he is in an emergency room at dawn with an alarming full-body shutdown, “as if someone had twisted dials randomly in all my systems.” The E.R. doctor suggests stress as the culprit — as do, in subsequent visits, an internist, neurologist, rheumatologist and gastroenterologist. A psychiatrist, his 11th doctor in 10 weeks, disagrees.

Only after Douthat completes his move north to Connecticut, namesake of Lyme disease, does it seem obvious to local doctors that he is suffering from something tick-borne.

. . .

He makes his case that tick-borne disease needs more research and its sufferers deserve more respect.

The trouble is that Douthat also wants to present his reckless journey as a road map. His revelation: “Given a stockpile of antibiotics, the array of over-the-counter medications available on Amazon and crowdsourced data from hundreds and thousands of Lyme sufferers sharing their experiences online, I could effectively become my own doctor, mixing and matching to gauge my body’s reaction to different combinations, like a Lyme researcher working on a study with a sample size, an ‘N,’ of only 1.”

This self-doctoring, he adds, “was in its own way intensely empirical and materially grounded — the most empirical work, in fact, that I have ever attempted in my life.” (Comparing this approach to Khakpour’s introspective memoir, I kept thinking of the couples-therapy trope that women prefer to talk through their problems while men leap to solve them.)

. . .

A subsequent bout of undiagnosed Covid-19, and scientists’ stumbles as they’ve worked to understand the new virus, have only hardened Douthat’s distrust of institutions like the Centers for Disease Control and Prevention and the Food and Drug Administration. “From the beginning of the pandemic to its still unfinished end,” he writes, “there were weirdos on the internet who were more reliable guides to what was happening, what was possible, and what should actually be done than Anthony Fauci or any other official information source.”

For the full review, see:

Sara Austin. “Darkness Invisible.” The New York Times Book Review (Sunday, November 28, 2021): 12.

(Note: ellipses, added; italics, in original.)

(Note: the online version of the review has the Updated Oct. 30, 2021, and has the title “A Transporting and Cozy Biography of a Pottery Pioneer.”)

The book under review is:

Douthat, Ross. The Deep Places: A Memoir of Illness and Discovery. New York: Convergent Books, 2021.

When Sri Lanka Government Banned Chemical Fertilizers, Yields Tanked and Prices “Shot Up”

(p. A4) RATNAPURA, Sri Lanka — This year’s crop worries M.D. Somadasa. For four decades, he has sold carrots, beans and tomatoes grown by local farmers using foreign-made chemical fertilizers and pesticides, which helped them reap bigger and richer crops from the verdant hills that ring his hometown.

Then came Sri Lanka’s sudden, and disastrous, turn toward organic farming. The government campaign, ostensibly driven by health concerns, lasted only seven months. But farmers and agriculture experts blame the policy for a sharp drop in crop yields and spiraling prices that are worsening the country’s growing economic woes and leading to fears of food shortages.

Prices for some foodstuffs, like rice, have risen by nearly one-third compared with a year ago, according to Sri Lanka’s central bank. The prices of vegetables like tomatoes and carrots have risen to five times their year-ago levels.

“I haven’t seen times that were as bad as these,” said Mr. Somadasa, a 63-year-old father of two who sells vegetables in the small town of Horana, just outside the island nation’s capital, Colombo. “We can’t find enough vegetables. And with the price hikes, people find it hard to buy the vegetables.”

. . .

President Gotabaya Rajapaksa cited health concerns when his government banned the importation of chemical fertilizers in April [2021], a pledge he had initially made during his 2019 election campaign.

. . .

The push for organic farming didn’t start with Mr. Rajapaksa’s current government, nor when another brother, Mahinda Rajapaksa, currently the prime minister, was president from 2005 to 2015. Some farmers and agriculture industry officials say they are warming to the idea of reducing dependence on chemicals in farming. But the shift was too sudden for farmers who didn’t know how to work organically, said Nishan de Mel, director of Verité Research, a Colombo-based analysis firm.

Verité found in a July [2021] survey that three-quarters of Sri Lanka’s farmers relied heavily on chemical fertilizers, while just about 10 percent cultivated without them. Almost all major crops grown in the country depend on the chemicals. For crops crucial to the economy like rice, rubber and tea, the dependence reaches 90 percent or more.

The April ban went into effect just before what is known as the Yala planting season, which lasts from May to August, and was felt almost immediately. The Verité survey showed that 85 percent of farmers expected a reduction in their harvest because of the fertilizer ban. Half of them feared that their crop yield could fall by as much as 40 percent.

Food prices shot up in September [2021], . . .

For the full story, see:

Aanya Wipulasena and Mujib Mashal. “A Plunge Into Organic Farming Brings Disaster to Sri Lanka.” The New York Times (Wednesday, December 8, 2021): A4.

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

(Note: the online version of the story has the date Dec. 7, 2021, and has the title “Sri Lanka’s Plunge Into Organic Farming Brings Disaster.”)

“Unanticipated Tragedies Are Unpreventable, No Matter How Many Regulations”

(p. A15) Dr. Offit acknowledges the limits of regulatory fixes, noting that, while regulatory guidelines are important, “unanticipated tragedies are unpreventable, no matter how many regulations, training programs, fines, and penalties are put in place.” He contrasts the tragic death in 1999 of 18-year-old Jesse Gelsinger in an early gene-therapy study—aimed at remediating a rare enzyme deficiency—with the triumphant experience of Emily Whitehead, a girl with leukemia treated 11 years later at the same university with genetically manipulated T-cells. Gelsinger’s death has been ascribed to protocol deficiencies, conflicts of interest and inadequate regulation, but “a closer look,” Dr. Offit writes, “shows that the only difference between the outcomes of Emily Whitehead and Jesse Gelsinger were luck and timing.” The specific supportive approach used by Whitehead’s doctors to address a life-threatening complication of her T-cell infusion stemmed directly from the lessons learned during Gelsinger’s ordeal. We recognize successes, Dr. Offit laments, but “never the failures that made those successes possible.”

One anxiety suffusing every page of “You Bet Your Life” is what to make of the Covid-19 vaccines. Dr. Offit, a member of the FDA’s vaccine advisory committee, has been described in The Wall Street Journal as “an outspoken advocate of the science and value of vaccinations,” including the Covid-19 vaccine. He has described its clinical-trial data as “enormously reassuring” and has seen little evidence of “a very rare, serious side effect that would be something that would cause a long term problem.” Yet his review of the history of vaccination and of its complexities evokes surprising empathy for the vaccine-hesitant. He recounts the early days of the Salk polio vaccine, which saved lives yet also tragically transmitted the disease to some patients when the product was inadequately prepared by one of its manufacturers. He notes that “the first vaccines aren’t always the best, safest, and last” and regrets the “disturbing show of hubris” by the Covid vaccine developers.

Ultimately, Dr. Offit emphasizes, we need to come to terms with the fact that all medical technologies carry risk—as does the decision not to avail oneself of them. “A choice not to get a vaccine is not a risk-free choice,” Dr. Offit notes. Either way, he says, “you’re gambling”—so “choose the lesser risk.”

For the full review, see:

David A. Shaywitz. “BOOKSHELF; The Dangers Of Finding a Cure.” The Wall Street Journal (Tuesday, Nov. 09, 2021): A15.

(Note: the online version of the review has the date November 8, 2021, and has the title “BOOKSHELF; ‘You Bet Your Life’ Review: The Dangers of Finding a Cure.”)

The book under review is:

Offit, Paul A. You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation. New York: Basic Books, 2021.

Covid-19 Raised Our Blood Pressure

(p. A12) On Monday [Dec. 6, 2021], scientists reported that blood pressure measurements of nearly a half-million adults showed a significant rise last year, compared with the previous year.

These measurements describe the pressure of blood against the walls of the arteries. Over time, increased pressure can damage the heart, the brain, blood vessels, kidneys and eyes. Sexual function can also be affected.

“These are very important data that are not surprising, but are shocking,” said Dr. Donald M. Lloyd-Jones, president of the American Heart Association, who was not involved in the study.

“Even small changes in average blood pressure in the population,” he added, “can have a huge impact on the number of strokes, heart failure events and heart attacks that we’re likely to be seeing in the coming months.”

The study, published as a research letter in the journal Circulation, is a stark reminder that even in the midst of a pandemic that has claimed more than 785,000 American lives and disrupted access to health care, chronic health conditions must still be managed.

. . .

“We observed that people weren’t exercising as much during the pandemic, weren’t getting regular care, were drinking more and sleeping less,” said Dr. Luke Laffin, the lead author, a preventive cardiologist who is co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic. “We wanted to know, was their blood pressure changing during the pandemic?”

The researchers found that blood pressure readings changed little from 2019 to the first three months of 2020, but increased significantly from April 2020 through December 2020, compared with the same period in 2019.

. . .

The new study found that the average monthly change from April 2020 to December 2020, compared with the previous year, was 1.10 mm Hg to 2.50 mm Hg for systolic blood pressure, and 0.14 to 0.53 for diastolic blood pressure.

The increases held true for both men and women, and in all age groups. Larger increases in both systolic and diastolic blood pressure were seen in women.

The average age of the study participants was just over 45, and slightly more than half were women.

. . .

The causes of an overall increase in blood pressure are not clear, Dr. Laffin and his colleagues said. The reasons may include an increase in alcohol consumption, a decline in exercise, rising stress, a drop in doctors’ visits and less adherence to a medication regimen.

The researchers dismissed a possible effect of weight gain, known to raise blood pressure, saying that the men in the study had lost weight and that the women had not gained more weight than usual.

For the full story, see:

Roni Caryn Rabin. “Does the Pandemic Have Your Blood Pressure Rising? You’re Not Alone.” The New York Times (Tuesday, December 7, 2021): A12.

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

(Note: the online version of the story has the date Dec. 6, 2021, and has the title “The Pandemic Has Your Blood Pressure Rising? You’re Not Alone.”)

The study summarized above is:

Laffin, Luke J., Harvey W. Kaufman, Zhen Chen, Justin K. Niles, Andre R. Arellano, Lance A. Bare, and Stanley L. Hazen. “Rise in Blood Pressure Observed among Us Adults During the Covid-19 Pandemic.” Circulation (2021) Published online: https://doi.org/10.1161/CIRCULATIONAHA.121.057075.

New Nuclear Designs Are “Cheap, Efficient, Extremely Reliable”, “Nearly Carbon-Free” and Much Safer

(p. A17) Jacopo Buongiorno, a nuclear-engineering professor at the Massachusetts Institute of Technology, has calculated that over the life cycle of power plants, which includes construction, mining, transport, operation, decommissioning and disposal of waste, the greenhouse-gas emissions for nuclear power are 1/700th those of coal, 1/400th of gas, and one-fourth of solar. Nuclear also requires 1/2,000th as much land as wind and around 1/400th as much as solar. For any given power output, the amount of raw material used to build a nuclear plant is a small fraction of an equivalent solar or wind farm. Although nuclear waste is obviously more difficult to dispose of, its volume is 1/10,000th that of solar and 1/500th of wind. This includes abandoned infrastructure and all the toxic substances that end up in landfills. One person’s lifetime use of nuclear power would produce about a half-ounce of waste. Even including the Chernobyl disaster, human mortality from coal is 2,000 to 3,000 times that of nuclear, while oil claims 400 times as many lives.

Although the federal government tends to resist nuclear power, many nuclear technologies are being investigated and funded by private capital including molten-salt reactors, liquid-metal reactors, advanced small modular reactors, microreactors and much more. More than 70 development projects are under way in the U.S., with many designs intended to create assembly-line construction facilities to simplify and standardize testing, licensing and installations. One appealing approach is to replace large-scale facilities with many smaller but safer, cheaper and more-manageable ones. The $10 billion 10-year planning and implementation cycle for a large nuclear plant can be cut in half with a small modular reactor and another half with a microreactor.

. . .

Nuclear power is cheap, efficient, extremely reliable and nearly carbon-free. New designs, including smaller reactors, drastically reduce the risk of large-scale radioactive contamination.

. . .

Sacrifice isn’t always the path to progress.

For the full commentary, see:

Andrew I. Fillat and Henry I. Miller. “Nuclear Power Is the Best Climate-Change Solution by Far.” The Wall Street Journal (Friday, Nov. 5, 2021): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 4, 2021, and has the same title as the print version.)