Health – Page 100 – artdiamondblog.com

The Danger of “Misconceived Pessimism”

In the full version of the commentary quoted below, the authors mention four lines of research that they believe hold promise for the future: vaccines, epigenetics, targeted therapies, and cancer “stem cells.”

(p. A17) This week, the National Cancer Institute, in conjunction with other organizations that track cancers, reported that the death rate from cancer declined from 2002-2004 by an average of 2.1% per year. This is an improvement over the 1.1% annual declines from 1993-2002 and is very good news indeed. Each 1% decline represents 5,000 people living rather than dying, and, of course, this figure is compounded each year.
While some part of the declining death rate from cancer is the consequence of screening, much is the result of greatly improved treatments. And we believe that the successes achieved to date are only the modest beginning of a revolution in the research into and treatment of cancer.
During the last half of the 20th century, almost all treatments of cancers involved forms of chemotherapy in which cancerous and normal tissues were bombarded with nonselective cytoxic drugs. These drugs killed all cells, healthy as well as malignant. Worse, they did not kill all cancer cells, so the cancer progressed — leading to the pessimism dominant in people’s minds today, a reflection of years of articles and opinion pieces in the popular press expressing the view that “the war on cancer” has been waged incorrectly, if not lost.
Now, however, new therapeutic modes are in play, based on better understandings of cancers and great advances in technologies.
. . .
The danger is that misconceived pessimism might result in a loss of popular moral support for the revolutionary new approaches to cancer research and treatment.

For the full commentary, see:
Samuel Waxman and Richard Gambino. “The New Ways We Fight Cancer.” Wall Street Journal (Oct 18, 2007): A17.
(Note: ellipsis added.)

Less Inflammation, Longer Life

The passage below is from a WSJ summary of an article that appeared in the December 2007 issue of Discover:

(p. B12) Scientists are increasingly hopeful that controlling inflammation will allow them to turn back the clock on aging, writes Kathleen McGowan in Discover magazine.
Inflammation is already a well-established predictor of many chronic illnesses, such as diabetes, atherosclerosis and Alzheimer’s disease. . . .
. . .
Many prominent gerontologists reason that if these chronic diseases are the product of an overactive immune system, then they can be countered with the right anti-inflammatory drug. . . .
“The research is really to prevent the chronic debilitating diseases of aging,” says Nir Barzilai, a molecular geneticist and director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. “But if I develop a drug, it will have a side effect, which is that you will live longer.”

For the full summary, see:
“The Informed Reader; Health; How Scientists Hope to Shrink Aging Effects.” Wall Street Journal (Weds., Nov. 14, 2007): B12.
(Note: ellipses added.)

Columbus Absolved of Bringing Lice-Borne Disease to Indians

“Braided hair is intact on a Peruvian mummy like those used in a study. Scientists say lice in the Americas predated Columbus.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A10) When two pre-Columbian individuals died 1,000 years ago, arid conditions in the region of what is now Peru naturally mummified their bodies, as well as the lice in their long, braided hair.

That was all scientists needed, they reported Wednesday, to extract well-preserved louse DNA and establish that lice had accompanied their human hosts in the original peopling of the Americas, probably as early as 15,000 years ago. The DNA matched that of the most common type of louse known to exist worldwide now and also before Europeans colonized the New World.

The findings absolve Columbus of responsibility for at least one wrong unintentionally wrought on the people he found in the Americas and called Indians. The Europeans who followed Columbus to America may have introduced diseases, namely smallpox and measles, but not the most common of lice, as had been suspected.

For the full story, see:
JOHN NOBLE WILFORD. “Scientists Say Mummies’ Lice Show Pre-Columbian Origins.” The New York Times (Thurs., February 7, 2008): A10.

“The No. 1 Need that Poor People Have is a Way to Make More Cash”

Moving water is easier with the 20-gallon rolling drum. Source of photo: online version of the NYT article quoted and cited below.

(p. D3) . . . , the Cooper-Hewitt National Design Museum, . . . , is honoring inventors dedicated to “the other 90 percent,” particularly the billions of people living on less than $2 a day.

Their creations, on display in the museum garden until Sept. 23, have a sort of forehead-thumping “Why didn’t someone think of that before?” quality.

. . .

Interestingly, most of the designers who spoke at the opening of the exhibition spurned the idea of charity.

“The No. 1 need that poor people have is a way to make more cash,” said Martin Fisher, an engineer who founded KickStart, an organization that says it has helped 230,000 people escape poverty. It sells human-powered pumps costing $35 to $95.

Pumping water can help a farmer grow grain in the dry season, when it fetches triple the normal price. Dr. Fisher described customers who had skipped meals for weeks to buy a pump and then earned $1,000 the next year selling vegetables.

For the full story, see:

DONALD G. McNEIL Jr. "Design That Solves Problems for the World’s Poor." The New York Times (Tues., May 29, 2007): D3.

(Note: ellipses added.)

The photo on the left shows a woman safely drinking bacteria-laden water through a filter. The photo on the right shows a "pot-in-pot cooler" that evaporates water from wet sand between the pots, in order to cool what is in the inner pot. Source of photos: online version of the NYT article quoted and cited above.

“Sometimes It Pays to Read the Old Literature”

(p. A1) Researchers in New York believe they have solved one of the great mysteries of the flu: Why does the infection spread primarily in the winter months?

The answer, they say, has to do with the virus itself. It is more stable and stays in the air longer when air is cold and dry, the exact conditions for much of the flu season.

. . .

(p. A22) To his surprise, Dr. Palese stumbled upon a solution that appeared to be a good second best.

Reading a paper published in 1919 in the Journal of the American Medical Association on the flu epidemic at Camp Cody in New Mexico, he came upon a key passage: “It is interesting to note that very soon after the epidemic of influenza reached this camp, our laboratory guinea pigs began to die.” At first, the study’s authors wrote, they thought the animals had died from food poisoning. But, they continued, “a necropsy on a dead pig revealed unmistakable signs of pneumonia.”

Dr. Palese bought some guinea pigs and exposed them to the flu virus. Just as the paper suggested, they got the flu and spread it among themselves. So Dr. Palese and his colleagues began their experiments.

. . .

As for Dr. Palese, he was glad he spotted the journal article that mentioned guinea pigs.

“Sometimes it pays to read the old literature,” he said.

For the full story, see:

GINA KOLATA. “Study Shows Why the Flu Likes Winter.” The New York Times (Weds., December 5, 2007): A1 & A22.

(Note: ellipses added.)

Government Pushing Fluorescent Bulbs with Hazardous Mercury

Source of image: online version of the WSJ article quoted and cited below.

(p. D1) As part of the government’s focus on energy and the environment, Americans are urged to buy compact fluorescent light bulbs, which use only about 25% of the energy and last up to 10 times as long as traditional incandescent bulbs. Nearly 300 million such bulbs were sold in U.S. in 2007, compared with 100 million two years earlier, according to the Department of Energy.

. . .

Yet unlike traditional incandescent bulbs, these bulbs contain mercury, a metal hazardous to human health and the environment. Consumers are urged not to toss them in the trash. In some states, such as California, it’s illegal to throw them away; they must be recycled. Still, many cities and towns don’t have recycling programs for the bulbs, and consumers aren’t sure what to do with them.

For the full story, see:

SARA SCHAEFER MUÑOZ. “The Dark Side Of ‘Green’ Bulbs Disposing of Fluorescents, Electronics Releases Toxins; Companies Tout Recycling.” The Wall Street Journal (Thurs., January 24, 2008): D1.

(Note: ellipsis added.)

Google and Microsoft Seek to Shift Health Care Power to Consumers

Source of graph: online version of the NYT article cited below.

(p. C1) In politics, every serious candidate for the White House has a health care plan. So too in business, where the two leading candidates for Web supremacy, Google and Microsoft, are working up their plans to improve the nation’s health care.

. . .

(p. C8) If the efforts of the two big companies gain momentum over time, that promises to accelerate a shift in power to consumers in health care, just as Internet technology has done in other industries.

Today, about 20 percent of the nation’s patient population have computerized records — rather than paper ones — and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

Microsoft and Google are hoping this will lead people to seek more control over their own health records, using tools the companies will provide.

For the full story, see:

STEVE LOHR. "Dr. Google and Dr. Microsoft." The New York Times (Tues., August 14, 2007): C1 & C8.

(Note: ellipsis added.)

Health Care Costs Are High and Rising

Source of graph: online version of the Omaha World-Herald article quoted and cited below.

The article quoted below summarizes a seminar by Dr. John Abramson. He was right to highlight the high costs of health care in the U.S., though he didn’t show any special insight in suggesting solutions.

(p. 1D) Costs are out of control, he said, and yet the United States, out of 22 developed nations, pays the most per person for health care and ranks last in having citizens lead long, healthy lives.

For the full story, see:

STEVE JORDON. “Employers urged to cure health system.” Omaha World-Herald (Weds., August 22, 2007): 1D & 2D.

Source of cartoon: online version of the Omaha World-Herald article quoted and cited above.

Free Market Can Provide Better, Cheaper Health Care

"Eve Linney, 5, who had an infected finger, went with her family last week to a walk-in clinic at a Duane Reade drugstore on Broadway in Manhattan. Her father, John, is at the counter." Source of caption and photo: online version of the NYT article quoted and cited below.

Clayton Christensen and co-authors in Seeing What’s Next, make a plausible case for the improvement of health care through disruptive innovation. A key aspect of their vision is the increasing role of nurse-practitioners in taking on increasingly routinized tasks, a development they see as generally both effective, and cost-efficient.

The article excerpted below suggests that this trend is promising, if it does not get killed by the government, and by organized medical doctors protecting their turf from competition.

(p. A1) The concept has been called urgent care “lite”: Patients who are tired of waiting days to see a doctor for bronchitis, pinkeye or a sprained ankle can instead walk into a nearby drugstore and, at lower cost, with brief waits, see a doctor or a nurse and then fill a prescription on the spot.

With demand for primary care doctors surpassing the supply in many parts of the country, the number of these retail clinics in drugstores has exploded over the past two years, and several companies operating them are now aggressively seeking to open clinics in New York City.

. . .

More than 700 clinics are operating across the country at chain stores including Wal-Mart, CVS, Walgreens and Duane Reade.

New York State regulators are investigating the business relationships between drugstore companies and medical providers to determine whether the clinics are being used improperly to increase business or steer patients to the pharmacies in which the clinics are located.

And doctors’ groups, whose members stand to lose business from the clinics, are citing concerns about standards of care, safety and hygiene, and they have urged the federal and state governments to step in to more rigorously regulate the new businesses.

. . .

(p. A16) Patients, however, have flocked to the clinics, according to a new industry group, the Convenient Care Association.

“I think it’s great you don’t have to make an appointment. That could take weeks,” said Ezequiel Strachan, 33, who lives in Manhattan and walked into the clinic at the Duane Reade store at 50th Street and Broadway on a recent morning for treatment of a sore throat. “People here value their time a lot.”

The average waiting time for an exam at such clinics nationwide is 15 to 25 minutes, according to the Convenient Care Association.

The association estimated that 70 percent of clinic patients have health insurance and are using the clinics because of convenience. For them, costs may not be much different from those at doctors’ offices, because the same insurance co-payments apply. But uninsured patients could reap substantial savings.

In New York City, one in five residents lacks a regular doctor and one in six is uninsured, according to a recent survey by the city’s Department of Health and Mental Hygiene, and overcrowded emergency rooms are often their first resort for routine care.

. . .

MinuteClinic officials insisted that there was nothing improper in the relationships between providers and the drugstores and that medical care is not being compromised.

“We are transparent with regulators,” said Michael C. Howe, the chief executive of MinuteClinic, which is based in Minneapolis and operates more than 200 clinics nationwide. using the motto “You’re Sick, We’re Quick.”

Mr. Howe said the concerns of doctors’ groups and other critics “are being raised by voices of people who have not really studied the model.”

Preliminary data from a two-year study of claims from MinuteClinic by a Minnesota health maintenance organization, HealthPartners, which was released to The Minneapolis Star Tribune in July, showed that each visit to the retail clinic cost an average of $18 less than a visit to other primary-care clinics, but that pharmacy costs were $4 higher per patient.

Duane Reade, New York City’s largest drugstore chain, which opened four clinics in Manhattan in May, plans to open as many as 60 more across the city in the next 18 months. A key difference at the Duane Reade clinics is that they use doctors, while nurse practitioners and physician assistants typically provide the care at most retail clinics.

For the full story, see:

SARAH KERSHAW. "Tired of Waiting for a Doctor? Try the Drugstore." The New York Times (Thurs., . August 23, 2007): A1 & A16.

(Note: the title of the online version is "Drugstore Clinics Spread, and Scrutiny Grows." Ellipses added.)

"Dr. Maggie Bertisch saw Eve while her mother, Claire, waited." Source of caption and photo: online version of the NYT article quoted and cited above.

Feds Force Us to Fluoresce, Causing Migraines and Epileptic Seizures

Source: screen capture from the CNN report cited below.

The new energy bill signed into law on Weds., Dec. 19, 2007, included a provision to force us all to fluoresce starting in 2012. In the CNN report cited below, Dr. Sanjay Gupta summarizes recent research suggesting that fluorescent bulbs cause a significant increase in the number of migraine headaches and epileptic seizures.

For the full story, see:

Dr. Sanjay Gupta. "Eco-bulbs and migraines." CNN Report. Posted online on January 4, 2008.

Source: screen capture from the CNN report cited above.

Huge Health Gains from Vaccines

Source of graphic: online version of the WSJ article quoted and cited below.

I hypothesize that most of the health gains from modern medicine come from a few advances, with vaccines being a very prominent example. (My hypothesis implies that many health care procedures do relatively little to increase health and longevity.)

(p. A18) Death rates for 13 diseases that can be prevented by childhood vaccinations are at all-time lows in the United States, according to a study released yesterday.

The study, by the Centers for Disease Control and Prevention in Atlanta, and published in The Journal of the American Medical Association, is the first time that the agency has searched historical records going back to 1900 to compile estimates of cases, hospitalizations and deaths for all the diseases children are routinely vaccinated against.

In nine of the diseases, rates of death or hospitalization declined more than 90 percent since vaccines against them were approved, and in the cases of smallpox, diphtheria and polio, by 100 percent.

In only four diseases — hepatitis A and B, invasive pneumococcal diseases and varicella (the cause of chickenpox and shingles) — did deaths and hospitalizations fall less than 90 percent. Those vaccines are all relatively new — the one for chickenpox, for example, was adopted nationally only in 1995. Also, some diseases like hepatitis typically strike adults, who are less likely to be immunized.

The results “are a testament to the fact that vaccines can drive diseases down to near nil,” said Dr. Gregory A. Poland, chief of the vaccine research group at the Mayo Clinic.

For the full story, see:

DONALD G. McNEIL Jr. "Sharp Drop Seen in Deaths From Ills Fought by Vaccine." The New York Times (Thurs., November 14, 2007): A23.