Category: Health

“An Inalienable Right to Sit In AC”

(p. C4) “Let’s sit in AC.” An American friend of mine, recently living in Mumbai, was wildly amused to hear this said in that steamy megalopolis, as if retreating to the tantalizing cool of an air-conditioned room were an activity in itself.

It took me a moment to see what he found so funny. I had grown up with the deprivations of socialist India in the 1980s. I was hardwired to fetishize air-conditioning. It was not an adjunct to life, sewn seamlessly into our daily routines, as it is in the U.S., where 82.7 million homes have central AC. It was, as the philosopher Immanuel Kant would say, the “thing-in-itself,” and to sit “in” AC was something of a national pastime.

. . .

Our first AC was an unbranded gimcrack contraption, jerry-built by a local electrician, but—my god!—how we loved it.

. . .

India loves to assert the demands of belonging through pacts of mutual suffering, and to be in AC was almost to be a little less Indian, as if you had decamped for the West. Even now that the country is the world’s fastest growing market for air-conditioners—projected by the International Energy Agency to be the biggest by 2050—the first line of attack from your average troll is: “What do you know of the realities of India, sitting in AC?”

. . .

. . . this summer, as newspapers report the hottest temperatures ever recorded on Earth and Amazon blasts me with discounts on their best-selling ACs, I cannot help feeling that our turn has come at a bad time. If nothing is done to make air-conditioning more energy-efficient, India alone is projected to use 30 times more electricity in 2030 than it did in 2010. Globally, air conditioning is projected to account for 40% of the growth in energy consumption in buildings by 2050—the equivalent of all the electricity used today in the U.S. and Germany combined. It’s enough to send a chill down the spine of the most ardent of AC evangelists.

The irony of a world made hotter by our need to be cool strikes some as proof of our rapacity. To me, having grown up in the place where so much of the new demand is coming from, I see it as part of a necessary realignment. As the global south gets richer, it will act as a frontier and laboratory. My hope is that it will achieve a miraculous breakthrough in energy efficiency, even as it asserts an inalienable right to sit in AC.

For the full commentary, see:

Aatish Taseer. “My Love Affair With Air- Conditioning.” The Wall Street Journal (Saturday, July 15, 2023): C4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 14, 2023, and has the same title as the print version.)

Blue Cross of California Seeks to End Drug Rebates and Hidden Fees

(p. A3) A major health insurer says it will jettison the complicated system that Americans use to pay for drugs, and create something that aims to be better, with partners including Amazon.com and the entrepreneur Mark Cuban.

Blue Shield of California said it is dropping CVS Health’s Caremark, the pharmacy-benefit manager it currently uses, which negotiates drug prices and wraps in other services such as a mail-order pharmacy.

. . .

Blue Shield said that, working with its partners, it aims to negotiate prices with pharmaceutical makers in a way that is different from the typical approach—with a simple net price structure that is supposed to eliminate rebates and hidden fees.

Blue Shield executives said that with one company handling many aspects of how drugs are procured through the system, it is often hard to track the flow of payments accurately.

“The current pharmacy supply chain is a forest of opacity and profit,” said Paul Markovich, Blue Shield’s chief executive officer, in an interview with The Wall Street Journal. “It is overwhelmingly complex, it is designed to maximize the earnings of the participants.” His company’s new setup, he said, will be “flipping that on its head.”

For the full story, see:

Anna Wilde Mathews. “Health Insurer Revamps Drug Pricing Model.” The Wall Street Journal (Friday, Aug. 18, 2023): A3.

(Note: ellipsis added.)

(Note: the online version of the story was updated Aug. 17, 2023, and has the title “A Big Health Insurer Is Ripping Up the Playbook on Drug Pricing.”)

Socialist Alexandria Ocasio-Cortez (AOC) Buys Foreign Sunscreens Not Approved by U.S. Government F.D.A.

(p. 2) After months of prompting, I have finally managed to help my husband form a daily sunscreen habit. Whenever I see traces of paper white cream in his dark beard, I think, We’re halfway there.

Hoping to avoid the white cast, heaviness and greasiness common in many sunscreen products available in U.S. drugstores, some Americans, including Representative Alexandria Ocasio-Cortez of New York, have taken matters into their own hands, opting for sunscreens manufactured abroad. In a recent interview, the congresswoman said she toggled between Bioré in the summer and Beauty of Joseon in the winter — two Asian brands that employ active ingredients not approved for use in the United States.

“The technology is very sophisticated,” Ms. Ocasio-Cortez said. “You don’t feel like you have a layer of sunscreen on, and it kind of just feels like you’re putting on a moisturizer in that sense, which makes it easier to use.”

While sunscreen is regulated as a cosmetic in major skin-care hubs like South Korea, Japan and the European Union, in the United States, it falls under the purview of the Food and Drug Administration. Any drug product marketed to American consumers must be approved by the F.D.A., and because sunscreen “makes a drug claim” — namely, that it can prevent sunburn, decrease the risk of skin cancer and mitigate early skin aging — the agency regulates it as an over-the-counter drug.

The last time the Food and Drug Administration approved new active ingredients for use in sunscreens was more than two decades ago, and at times it can feel as if the rest of the world has surpassed the United States in the development of new sunscreen formulations and protocols. Skin-care influencers on TikTok and Instagram are in a near-constant state of frenzy over exciting new products and innovations that are nowhere to be found on American shelves. Currently there are 14 sunscreen filters approved for use by the F.D.A. The European Union employs more than 30.

Frustrated by what seems to be a wealth of more exciting options for sun protection overseas, skin-care-conscious Americans have been quick to point the finger at the F.D.A. for the delay in approving new active ingredients.

For the full story, see:

Sandra E. Garcia. “U.S. Sunscreen Is Stuck in the ’90s.” The New York Times, SundayStyles Section (Sunday, August 13, 2023): 2.

(Note: the online version of the story has the date Aug. 12, 2023, and has the title “U.S. Sunscreen Is Stuck in the ’90s. Is This a Job for Congress?”)

“Best-Funded Startup” in History Seeks Longevity by Rejuvenating Cells

(p. B1) Arch is the largest institutional investor in Altos, which already has $3 billion of committed investments, likely making it the biotech indus-(p. B2)try’s best-funded startup on record.

Nelsen is characteristically unrestrained when discussing Altos’s prospects.

“Epigenetic reprogramming is the biggest thing in healthcare in 100 years. Or ever,” he says. “We will clearly live much healthier and longer lives if this works.”

. . .

A native of Walla Walla, Wa., Nelsen studied biology and economics at the University of Puget Sound before getting an M.B.A. at the University of Chicago.

. . .

His manic energy can lead to confrontations. Nelsen drives his GMC Yukon so aggressively that some friends avoid riding with him. He’s started fights with supermarket customers who resisted using plastic bags.

“I hate plastic bag bans, because the assumption that they are better for the environment than paper is flawed and I am grown up enough to not have government choose my bag for me,” Nelsen says.

. . .

Taking cells back to their youthful, healthier state long captured the imagination of scientists, but seemed unlikely. Then a breakthrough paper published in 2006 by Japanese scientist Shinya Yamanaka and a colleague showed mature skin cells of mice could be reprogrammed into primordial, immature stem cells—called induced pluripotent stem cells—in effect resetting their molecular clocks. Yamanaka, who later shared a Nobel Prize for work in this area, is an adviser to Altos. In 2016, Spanish biochemist Juan Carlos Izpisua Belmonte, Altos’s founding scientist, showed how the age of cells could be reverted without changing their genome and identity. His work demonstrated the potential for toggling between the ‘old’ and ‘young’ states of cells—the basis for Altos’s effort to rejuvenate cells.

For the full story, see:

Gregory Zuckerman. “Fear of Death Drives A Venture Capitalist.” The Wall Street Journal (Monday, Aug. 21, 2023): B1-B2.

(Note: the online version of the story has the date August 20, 2023, and has the title “For This Venture Capitalist, Research on Aging Is Personal; ‘Bob Has a Big Fear of Death’.”)

Well-Intentioned Antislavery Colonists Accidentally Spread Yellow Fever Plague

(p. C9) Hardly anyone noticed the first to die in the sultry August of 1793—a few foreigners, a sailor, an oyster seller. Most Philadelphians brushed off the deaths as the result of air fouled by rotting coffee or fish near the docks. Then the healthy and affluent began to die: public officials, ministers. The plague that was sweeping the young nation’s temporary capital was yellow fever, a contagion little understood at the time. Writes Robert Watson in “America’s First Plague,” the outbreak was “one of the worst epidemics in American history.”

In the course of three horrendous months, between 6,000 and 9,500 people would die, constituting 15% to 20% of Philadelphia’s population.

. . .

The source of the plague is a story in its own right. It apparently derived from infected mosquitoes that had bred on a ship named the Hankey. Earlier in the year, the Hankey had transported an expedition of antislavery Londoners to an island off the coast of present-day Guinea-Bissau, where they hoped to found a model biracial colony. They were instead beset by hostile natives and rampant yellow fever, which the few desperate survivors carried with them across the Atlantic to ports in the Caribbean and eventually to Philadelphia. Mr. Watson, a professor of history at Lynn University in Boca Raton, Fla., notes that “the ship inadvertently unleashed death at every port where it docked.” (A riveting account of this hapless colonial experiment may be found in Billy G. Smith’s “Ship of Death,” published in 2013.)

Fortunately for those who remained in the city, Philadelphia’s capable mayor, a businessman named Matthew Clarkson, aided by a beleaguered committee of brave volunteers, did his best to organize public-health measures and burials.

. . .

Among the doctors who struggled to cope with a disease they couldn’t cure, Mr. Watson rightly emphasizes the polymath Benjamin Rush. A signer of the Declaration of Independence, Rush incarnated both the humanistic best and medical worst of the early republic. Although his treatments were widely accepted, they were disastrous. He believed dogmatically in violent purges, forced heat to blister the limbs and above all bloodletting. He bled his patients of as much as 10 ounces a day, probably killing more of them than he saved. When he himself fell ill, he subjected himself to the same brutal regimen but survived to persist in his malpractice.

For the full review see:

Fergus M. Bordewich. “When Yellow Jack Attacked.” The Wall Street Journal (Saturday, June 10, 2023): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date June 9, 2023, and has the title “‘America’s First Plague’ Review: Attack of the Yellow Jack.”)

The book under review is:

Watson, Robert P. America’s First Plague: The Deadly 1793 Epidemic That Crippled a Young Nation. Lanham, Maryland: Rowman & Littlefield Publishers, 2023.

The “riveting” book mentioned above is:

Smith, Billy G. Ship of Death: A Voyage That Changed the Atlantic World. New Haven, CT: Yale University Press, 2013.

With Repetitions Surgeons Gain Informal Knowledge, Such as “Muscle Memory”

(p. C6) Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?

In a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems.

. . .

. . ., the results suggested if the over-60 doctors took care of 1,000 patients, 13 patients who died in their care would have survived had they been cared for by the under-40 doctors. We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers.

. . .

Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers.

. . .

. . ., a separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age.

. . .

The results showed that unlike hospitalists, surgeons got better with age. Their patient mortality rates had modest but significant declines as they got older: mortality was 6.6% for surgeons under 40, 6.5% for surgeons age 40-49, 6.4% for surgeons age 50-59, and 6.3% for surgeons over age 60.

Clearly something different was happening here. It may be that for hospitalists, the benefit of steadily increasing experience starts to be outweighed by their waning knowledge of the most up-to-date care. It’s different for surgeons, though, who hone many of their skills in the OR. Surgeons build muscle memory through repetition, working in confined spaces with complex anatomy. They learn to anticipate technical problems before they happen and plan around them based on prior experience. Over time, they build greater technical skills across a wider variety of scenarios, learn how to best avoid complications, and choose better surgical strategies.

What does this mean for all of us as patients when we meet a new doctor? Taking studies of hospitalists and surgeons together, it’s clear that a doctor’s age isn’t something that can be dismissed out of hand—age does matter—but nor can it be considered in isolation. If we’re concerned about the quality of care we’re receiving, the questions worth asking aren’t “How old are you?” or even “How many years of experience do you have?” but rather “Do you have a lot of experience caring for patients in my situation?” or “What do you do to stay current with the research?”

For the full essay, see:

Anupam B. Jena and Christopher Worsham. “Do Younger or Older Doctors Get Better Results?” The Wall Street Journal (Saturday, July 8, 2023): C6.

(Note: ellipses added.)

(Note: the online version of the essay was updated July 8, 2023, and has the same title as the print version.)

The essay quoted above is adapted from the book:

Jena, Anupam B., and Christopher M. Worsham. Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health. New York: Doubleday, 2023.

The “Deliciously Guilty Pleasure” and “Disorienting Joy” of California Skiing in August

(p. A20) This weekend, . . . hordes of Californians are smearing pink and yellow zinc oxide on noses, shoving feet into hard plastic ski boots and gliding over to the lifts at Mammoth Mountain for yet another day on the slopes. A reminder: It’s August.

. . .

Unpredictable change is the new status quo.  . . . it can also, in a rare instance like the chance to ski in the dog days of summer, bring a disorienting joy.

. . .

In mid-July [2023], well after all the hot dogs and fireworks, I headed up to the Sierra and ran into so much lingering snow that the road through Yosemite National Park hadn’t yet opened for the season. I took an alternate route, 108 over Sonora Pass, and saw people parking in turnouts, carrying skis up dirt trails through trees, stepping onto sunny snow slopes and linking turns back down to ice chests full of cold drinks before, you know, maybe going for a swim. When I finally got to Kelly’s place, the creek on her high desert property frothed in a fabulous white and clear torrent through sage lands sparkling with superblooming yellow mule’s ear, red paintbrush and white phlox. The big peaks, meanwhile — in the dead heat of a California summer — remained so heavily blanketed in snow that I felt I was seeing them the way Indigenous people must have during the Little Ice Age, 500 years ago.

The premise of California’s secular faith in nature is that water plus sunshine equals enlightenment. In high school I was transfixed by a description on the jacket of Bank Wright’s classic “Surfing California” of “skiing Mount Baldy in the morning and surfing Hermosa Beach in the afternoon.” That struck the teenage me as the absolute perfect way of snatching healthy peace and giddy fun from the predictable maw of adult misery.

. . .

. . . when I drove to Mammoth, put on my favorite cowboy hat against the sun and sipped iced coffee while watching tiny black figures ski down blinding white slopes, the experience was perhaps best likened to the queasy adrenalized thrill of an oncoming manic episode after a long and dark depression — worrisome, yes, bound for nowhere good but, as long as we’re just talking here and now, a deliciously guilty pleasure.

For the full commentary, see:

Daniel Duane. “The Upside of Climate Chaos? Skiing in August.” The New York Times (Monday, August 7, 2023): A20.

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

(Note: the online version of the commentary has the date Aug. 6, 2023, and has the title “It’s August. Californians Are Still Skiing. Don’t Ask.”)

“Proud Symbol of Britain’s Welfare State” in “Deepest Crisis of Its History”

(p. A1) As it turns 75 this month, the N.H.S., a proud symbol of Britain’s welfare state, is in the deepest crisis of its history: flooded by aging, enfeebled patients; starved of investment in equipment and facilities; and understaffed by doctors and nurses, many of whom are so burned out that they are either (p. A6) joining strikes or leaving for jobs abroad.

Interviews over three months with doctors, nurses, patients, hospital administrators and medical analysts depict a system so profoundly troubled that some experts warn that the health service is at risk of collapse.

. . .

(p. A6) More than 7.4 million people in England are waiting for medical procedures, everything from hip replacements to cancer surgery. That is up from 4.1 million before the coronavirus pandemic began in 2020.

Mortality data, exacerbated by long wait times, paints a bleak picture. In 2022, the number of excess deaths rose to one of the highest levels in the last 50 years, and those numbers have kept rising, even as the pandemic has ebbed.

In the first quarter of 2023, more than half of excess deaths — that is, deaths above the five-year average mortality rate, before the pandemic — were caused by something other than Covid-19. Cardiovascular-related fatalities, which can be linked to delays in treatment, were up particularly sharply, according to Stuart McDonald, an expert on mortality data at LCP, a London-based pension and investment advisory firm.

For the full story, see:

Mark Landler. “After 75 Years, Health Service In U.K. Teeters.” The New York Times (Monday, July 17, 2023): A1 & A6-A7.

(Note: ellipsis added.)

(Note: the online version of the story has the date July 16, 2023, and has the title “A National Treasure, Tarnished: Can Britain Fix Its Health Service?”)

Perverse Medicare Pricing Incentives Drive Hospital Consolidation Inefficiency

(p. A17) Currently, Medicare pays hospital-owned facilities two to three times as much as independent physician offices for the same service, according to the Alliance for Site Neutral Payment Reform. This creates an enormous incentive for large hospital chains to acquire outpatient practices. Consolidation creates a vicious circle in which larger hospital systems can demand ever higher rates from insurers and also have the capital to buy up physician practices. Removing this perverse incentive will ensure that patients have access to trusted doctors and appropriate care at the same price regardless of treatment location and remove artificial pressure to consolidate.

These bipartisan reforms would deliver hundreds of billions in savings for families. Site-neutral payments would save taxpayers more than $153 billion in Medicare spending over the next decade and also substantially reduce premiums and cost-sharing for Medicare beneficiaries by $94 billion, according to CRFB. In total, these changes could save patients and taxpayers between $346 billion and $672 billion over the next decade.

Large hospital systems have exploited our nation’s outdated billing systems to foist gigantic bills on Americans. Bringing much-needed transparency in hospital billing will deliver more affordable care and put patients back in control.

For the full commentary, see:

Bobby Jindal and Charlie Katebi. “Doctor’s Office Care at Hospital Prices.” The Wall Street Journal (Thursday, July 27, 2023): A17.

(Note: the online version of the commentary has the date July 26, 2023, and has the same title as the print version.)

Scientists Had Political Motives for Dismissing Wuhan Lab-Based Covid Origin

(p. A17) On March 17, 2020, the journal Nature Medicine published a paper by five scientists, “The Proximal Origin of SARS-CoV-2,” that dismissed “any type of laboratory based scenario” for the origin of the pandemic. It was cited by thousands of news outlets to claim that the virus emerged naturally. But Slack messages and emails subpoenaed and released by the House Oversight Select Subcommittee on the Coronavirus Pandemic suggest that some of the authors didn’t believe their own conclusions. Before, during and even after the publication of their paper, they worried privately that Covid-19 was caused by a laboratory escape, perhaps even of a genetically engineered virus.

. . .

On April 16, a month after publication, Mr. Andersen wrote that “I’m still not fully convinced that no culture was involved” and “we also can’t fully rule out engineering”—i.e., that the virus not only was released from the lab but had been genetically manipulated there. He worried about the Wuhan lab’s research on live SARS-like viruses from bats at low biosafety levels: “it’s definitely concerning work, no question about it.”

So why did they publish a paper denying that laboratory origin was plausible? The answer may lie in their messages. In early February 2020, Mr. Rambaut wrote: “Given the s— show that would happen if anyone serious accused the Chinese of even accidental release, my feeling is we should say that given there is no evidence of a specifically engineered virus, we cannot possibly distinguish between natural evolution and escape so we are content to ascribing it to natural processes.”

Mr. Andersen replied: “I totally agree that that’s a very reasonable conclusion. Although I hate when politics is injected into science—but it’s impossible not to.”

. . .

To adjust the conclusions in a scientific paper for political reasons isn’t part of the scientific process. The world was misled with serious consequences.

For the full commentary, see:

Matt Ridley and Alina Chan. “The Covid Lab-Leak Deception.” The Wall Street Journal (Thursday, July 27, 2023): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 26, 2023, and has the same title as the print version.)

Elderly Benefit Most from Air-Conditioning

(p. A18) The aging process makes older bodies generally less capable of withstanding extreme heat, doctors say.

“They’re at extremely high risk of heat stroke and death,” James H. Diaz, a professor of environmental and occupational health sciences at Louisiana State University’s School of Public Health, said of older people. “When we look at what happens with these heat waves, most of the deaths occur in the homebound elderly.”

In many communities, including in New Orleans and Houston, officials have opened cooling centers and shelters in recent weeks, with air-conditioned shuttle buses meandering through neighborhoods, picking people up. Programs are also in place to provide or repair air-conditioners or help people struggling to afford their electricity bills.

. . .

In . . . Orlando, Veronica King, 67, said she keeps her air-conditioner running even if she can’t afford to. “I have to figure out how to cover that bill,” she said, adding that she relies on machines that help her breathe. “When it’s hot, I can’t breathe.”

In Houston, where the heat index could reach 107 degrees on Sunday, Ms. Lowry and her husband, Jasper, 72, have come up with a compromise. They have two cars, neither with working air-conditioning. But they figured they could at least spare the money to repair it in one of them.

For the full story, see:

Shannon Sims and Rick Rojas. “Rising Temperatures Could Bring More Than Misery for Seniors.” The New York Times, First Section (Sunday, July 9, 2023): 18.

(note: ellipses added.)

(Note: the online version of the story was updated July 12, 2023, and has the title “Rising Temperatures Threaten More Than Misery for Oldest Americans.”)