Category: Health

Lives Lost to Covid-19 Due to Slow Regulatory Recommendations

(p. B1) In the early days of the COVID-19 pandemic, the Nebraska Medical Center was at the forefront of an international clinical trial of the drug remdesivir, . . .

. . .

By April 2020, the early trial showed that remdesivir shortened the time it took for all patients hospitalized for COVID-19 to recover by five days overall, compared with those who received a placebo.

. . .

A study published last week in the British medical journal The Lancet Respiratory Medicine confirmed findings of the initial NIH trial.

Dr. Andre Kalil, who led the Omaha-based arm of the trial, said it’s always important to see studies replicated by other (p. B2) researchers.

But Kalil, in an invited commentary on the Lancet study, noted that a number of public health and medical bodies delayed acting on the early beneficial results and recommending the drug in guidelines for clinicians.

The National Institutes of Health and the Infectious Diseases Society of America guidelines for nearly two years recommended remdesivir only for hospitalized patients who received supplemental oxygen. Only after that time did the groups recommend it for patients who were hospitalized but did not need supplemental oxygen.

The World Health Organization didn’t recommend remdesivir for patients hospitalized with COVID-19 until late 2022.

“Regrettably, the delays in recommendation of remdesivir for patients — even after the initial remdesivir shortage was resolved — adversely shaped antimicrobial policy in hospitals around the world, preventing patients from receiving timely remdesivir,” wrote Kalil, a University of Nebraska Medical Center professor and an infectious diseases physician with Nebraska Medicine, the health system that includes the Nebraska Medical Center.

In an interview, Kalil said he believes more lives could have been saved if the guideline panels had been more timely in making their recommendations. All three now recommend remdesivir for hospitalized patients.

For the full story, see:

Julie Anderson. “Delays on Remdesivir May Have Cost Lives.” Omaha World-Herald (Sunday, March 5, 2023): B1-B2.

(Note: ellipses added.)

(Note: the online version of the story has the same date as the print version, and has the title “Could earlier adoption of remdesivir have saved lives during the COVID pandemic?”)

Janega Claims That Europeans in Middle Ages Washed Themselves Daily

If the claims in the book quoted below turn out to be well-documented, then I may need to modify a few sentences in my Openness book, if a new edition ever appears.

(p. A15) A longstanding myth holds that people in medieval Christian Europe didn’t bathe. In fact, the Middle Ages subscribed heartily to the adage “cleanliness is next to godliness.” Thinkers of the period considered physical beauty to represent spiritual purity, and they looked at hygiene in the same way: If one’s body was impure, it would by definition be unattractive and out of harmony. If it had any imperfections, one would best address them through cleansing. For women, in particular, cleanliness was one of the very highest virtues.

The daily wash usually involved collecting water in a ewer, heating it, then pouring it into a large basin to be used for scrubbing. Baths in a wooden tub would happen less often, given it was a world without plumbing. Water is heavy, and collecting it, heating it, and then getting it from the kettle into the bathtub was difficult. Baths also required space, which was at a premium in most households.

Luckily, there were a few ways to bathe outside the home. In warmer months, you could simply find a pond or a lake, and you were good to go. But in January this could be a problem, and that was where bathhouses came in. Bathhouses took the laborious and difficult work of drawing and heating water and monetized it. Most towns boasted at least one professional bathhouse, while cities played host to a number of competing establishments.

For the full essay, see:

Eleanor Janega. “The Middle Ages Were Cleaner Than We Think.” The Wall Street Journal (Saturday, Jan. 14, 2023): A15.

(Note: the online version of the essay has the date January 12, 2023, and has the same title as the print version.)

The essay quoted above is based on the author’s book:

Janega, Eleanor. The Once and Future Sex: Going Medieval on Women’s Roles in Society. New York: W.W. Norton, 2023.

610,000 Cancer Deaths Predicted in U.S. in 2023

(p. A3) The cancer mortality rate in the U.S. has dropped by a third in the past three decades, a report showed, but an increase in advanced prostate cancer diagnoses threatens to reverse some hard-won gains.

The American Cancer Society said Thursday [Jan. 12, 2023] that changes in preventive measures and screening in the past decade drove important trends in U.S. cancer incidence and outcomes.

. . .

The report was published in the journal CA: A Cancer Journal for Clinicians. The authors at ACS analyzed federal and state cancer registries for data on cancer rates through 2019 and federal mortality data through 2020, the report said.

Cancer is the second-leading cause of death in the U.S., behind heart disease, with nearly 2 million cases and some 610,000 deaths estimated to occur in 2023, the ACS said. The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991, the report said, averting an estimated 3.8 million cancer deaths in that time.

. . .

For prostate cancer, the second leading cause of cancer death among men after lung cancer, rates of advanced diagnoses have risen about 4.5% annually since 2011, the report found. The proportion of men diagnosed with later-stage disease has doubled. Declines in mortality rates have leveled off.

For the full story, see:

Brianna Abbott. “Cancer Death Rate Has Dropped By a Third.” The Wall Street Journal (Friday, Jan. 13, 2023): A3.

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

(Note: the online version of the story has the date January 12, 2023, and has the title “U.S. Cancer Death Rate Has Dropped by a Third Since 1991.”)

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Cancer-Ridden Chef Fights Cancer by Teaching Us to Cook Anti-Cancer Curry

While fighting terminal cancer, Raghavan is publishing a cookbook on how to more easily cook curry dishes. Curry contains turmeric, which some believe is helpful in fighting cancer.

(p. D1) Mr. Iyer arrived in Marshall, Minn., in 1982, unprepared for a hard culinary truth: There was almost nothing there for a vegetarian raised on South Indian cooking to eat. To make matters worse, Mr. Iyer couldn’t cook. He found a can of something called curry powder at a local grocery store and made potato curry. It was so bad he wept.

But Mr. Iyer, a man with six languages at his command and the astrological stubbornness of a Taurus, would not be defeated. He had his mother and older sister send recipes from India. He picked up a few cooking tips from new friends and put his chemistry degree to work.

“Everything became an experiment,” he said. “Blooming the spices was the big lesson.”

Mr. Iyer, 61, has by some estimations taught more Americans how to cook Indian food than anyone else. His formula is simple: Pare down techniques, use ingredients people can buy at the supermarket and deliver it all with the kindness of a kindergarten teacher.

. . .

(p. D7) Next Tuesday [Feb. 28, 2023], Mr. Iyer will publish “On the Curry Trail: Chasing the Flavor That Seduced the World in 50 Recipes.”

. . .

Mr. Iyer says it will be his last. Colorectal cancer has invaded his brain and lungs. He’s been fighting it for five years, which is years longer than people with that type of cancer usually survive. He has endured thousands of hours of radiation and chemotherapy, endless scans and four surgeries with multiple complications.

. . .

“I’m not worried about dying,” Mr. Iyer said. “Seriously, when you’re dead you don’t know what the hell is happening, so this book is not an homage to my death. This is really celebrating life, family, friends and food.”

That he eats a vegetarian diet, practices yoga and was an avid swimmer have helped him make it this long, he said. So did idli, the spongy, beloved South Indian breakfast staple made by fermenting and steaming rice.

After his first surgery, he lost 30 pounds — a lot for a man who had never topped 155. Before he went into the hospital, he made dozens of idli and froze them so Mr. Erickson could easily warm them up when Mr. Iyer returned home to recuperate.

“Idli nourished me from the inside out,” Mr. Iyer said.

His experience gave him the idea for the Revival Project, which he hopes to get up and running before he dies. He is building a searchable database of comfort-food recipes, organized by cuisine and medical condition, that hospital and other health care workers could use.

“I still don’t understand why the great wisdom of the world’s home cooks and healers has not yet found its way into hospitals and dietary training,” he said. If it weren’t for idli and sambar, yogurt and bowls of brothy rasam, Mr. Iyer might have not regained enough strength to finish “On the Curry Trail.”

. . .

The novelist Amy Tan met Mr. Iyer at the wedding of the writer Scott Turow. Both authors wrote endorsements for the book jacket.

“I jokingly said to Raghavan that this book is a recipe for world peace,” Ms. Tan said in a phone interview. “The way he embraces commonality as a form of love is truly special.”

She’s a vegan but not skilled in the kitchen, which is why she appreciates the way Mr. Iyer writes a recipe.

For the full story, see:

Kim Severson. “A Teacher Of Indian Cooking Takes On A New Cause.” The New York Times (Wednesday, February 22, 2023): D1 & D7-D8.

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

(Note: the online version of the story was updated Feb. 23, 2023, and has the title “He Taught Americans to Cook Indian Food. Now He’s on His Final Chapter.” The version quoted above omits a sentence that appears in the online, but not the print, version of the article.)

The latest curry cookbook by Raghavan is:

Iyer, Raghavan. On the Curry Trail: Chasing the Flavor That Seduced the World. New York: Workman Publishing Company, 2023.

Over 100,000 “Non-Covid Excess Deaths” Per Year in 2020 and 2021

(p. A15) Covid-19 is deadly, but so were the draconian steps taken to mitigate it. During the first two years of the pandemic, “excess deaths”—the death toll above the historical trend—markedly exceeded the number of deaths attributed to Covid. In a paper we just published in Inquiry, based on data from the Centers for Disease Control and Prevention, we found that “non-Covid excess deaths” totaled nearly 100,000 a year in 2020 and 2021.

Even these numbers likely overestimate deaths from Covid and underestimate those from other causes. Covid testing has become ubiquitous in hospitals, and the official count of “Covid deaths” includes people who tested positive but died of other causes.

For the full commentary, see:

Rob Arnott and Casey B. Mulligan. “How Deadly Were the Covid Lockdowns?” The Wall Street Journal (Thursday, Jan. 12, 2023): A15.

(Note: the online version of the commentary has the date January 11, 2023, and has the same title as the print version.)

The Mulligan and Arnott commentary is based on their academic article:

Mulligan, Casey B., and Robert D. Arnott. “The Young Were Not Spared: What Death Certificates Reveal About Non-Covid Excess Deaths.” INQUIRY: The Journal of Health Care Organization, Provision, and Financing 59 (Jan.-Dec. 2022): 00469580221139016.

“Nonprofit” Hospitals “Enjoy Lucrative Tax Exemptions” but Often Pressure Poor to Pay More

(p. 1) More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.

But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.

To understand the shift, The Times reviewed thousands of pages of court records, internal hospital financial records and memos, tax filings, and complaints filed with regulators, and interviewed dozens of patients, lawyers, current and former hospital executives, doctors, nurses and consultants.

The Times found that the consequences have been stark. Many nonprofit hospitals were ill equipped for a flood of critically sick Covid-19 patients because they had been operating with skeleton staffs in an effort to cut costs and boost profits. Others lacked intensive care units and other resources to weather a pandemic because the nonprofit chains that owned them had focused on investments in rich communities at the expense of poorer ones.

And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in (p. 22) the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.

Founded by nuns in the 1850s, Providence says its mission is to be “steadfast in serving all, especially those who are poor and vulnerable.” Today, based in Renton, Wash., Providence is one of the largest nonprofit health systems in the country, with 51 hospitals and more than 900 clinics. Its revenue last year exceeded $27 billion.

Providence is sitting on $10 billion that it invests, Wall Street-style, alongside top private equity firms. It even runs its own venture capital fund.

For the full story, see:

Jessica Silver-Greenberg and Katie Thomas. “Entitled to Free Treatment But Hounded by Hospitals.” The New York Times, First Section (Sunday, September 25, 2022): 1 & 22-23.

(Note: the online version of the story was updated Dec. [sic] 15, 2022, and has the title “They Were Entitled to Free Care. Hospitals Hounded Them to Pay.”)

As People Die of “Old Age” Will the FDA Ever Approve Longevity Drugs?

The FDA has required that new drugs be proven to be effective against a disease, and the FDA has refused to consider old age to be a disease. Perhaps as more government institutions give “old age” as the reason for a death, the FDA will reconsider.

(p. A6) LONDON — Queen Elizabeth II died of “old age,” according to her death certificate, which was released on Thursday by the registrar general of Scotland. The certificate, which lists her occupation as Her Majesty the Queen, also notes that the queen died at 3:10 p.m. on Sept. 8 [2022] at Balmoral Castle.

The first fact is indisputable, given that the queen was 96. But the report offers no further details about the cause of her death, which came two days after she was photographed standing and smiling as she greeted Britain’s new prime minister, Liz Truss.

For the full story, see:

Mark Landler. “Record Says Queen Died of ‘Old Age’.” The New York Times (Friday, September 30, 2022): A6.

(Note: bracketed year added.]

(Note: the online version of the story has the date Sept. 29, 2022, and has the title “Queen’s Death Certificate Reveals Cause and Time of Death.”)

One Cause of Increasing Burnout of Physicians Is “the Politicization of Science”

(p. A25) Ten years of data from a nationwide survey of physicians confirm another trend that’s worsened through the pandemic: Burnout rates among doctors in the United States, which were already high a decade ago, have risen to alarming levels.

Results released this month and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier.

“This is the biggest increase of emotional exhaustion that I’ve ever seen, anywhere in the literature,” said Bryan Sexton, the director of Duke University’s Center for Healthcare Safety and Quality, who was not involved in the survey efforts.

. . .

The increase in burnout is most likely a mix of new problems and exacerbated old ones, Dr. Shanafelt said. For instance, the high number of messages doctors received about patients’ electronic health records was closely linked to increased burnout before the pandemic. After the pandemic, the number of messages from patients coming into physicians’ In Baskets, a health care closed messaging system, increased by 157 percent.

And physicians pointed to the politicization of science, labor shortages and the vilification of health care workers as significant issues.

For the full story, see:

Oliver Whang. “New Survey Suggests An Alarming Increase In Physician Burnout.” The New York Times (Friday, September 30, 2022): A25.

(Note: ellipsis added.]

(Note: the online version of the story has the date Sept. 29, 2022, and has the title “Physician Burnout Has Reached Distressing Levels, New Research Finds.”)

Lethality of Ebola in West Africa Mainly Due to “the Contingent History of a Population Made Vulnerable”

(p. 22) As Farmer writes in his new book, “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History,” by the time he arrived in the capital city of Freetown in late September, “western Sierra Leone was ground zero of the epidemic, and Upper West Africa was just about the worst place in the world to be critically ill or injured.”

. . .

Farmer notes that even severe cases of Ebola rarely produce the horror-film symptoms featured so prominently in Preston’s “Hot Zone”: patients bleeding from their eyeballs, their organs liquefied in a matter of hours. Most cases instead involve fluid and electrolyte loss caused by vomiting and diarrhea, which can often be treated with basic supportive and critical care, like intravenous fluid replenishment or dialysis. Ebola was so lethal in upper West Africa not because the virus itself conveyed an inevitable death sentence, but because countries like Liberia and Sierra Leone lacked these health care essentials. “For all their rainfall,” Farmer writes, “their citizens are stranded in the medical desert.”

. . .

“This was not,” Farmer writes, “a history of inevitable mortality that resulted from ancient evolutionary forces.  . . .   It was the contingent history of a population made vulnerable.”

For the full review, see:

Steven Johnson “A Preventable Epidemic.” The New York Times Book Review (Sunday, December 13, 2020): 22.

(Note: ellipses between paragraphs, added; ellipsis internal to last paragraph, in original.)

(Note: the online version of the review has the date Nov. 17, 2020, and has the title “The Deadliness of the 2014 Ebola Outbreak Was Not Inevitable.”)

The book under review is:

Farmer, Paul. Fevers, Feuds, and Diamonds: Ebola and the Ravages of History. New York: Farrar, Straus and Giroux, 2020.

To Get Fed Funding, Rural Hospitals Must Agree to Transfer In-Patients to Bigger Hospitals that Do Not Want the Transfers

(p. A1) CASCADE, Idaho — It was 3 a.m. at the 10-bed hospital near the River of No Return, and by every measure, Ella Wenrich should have been dead.

Gastrointestinal bleeding had sent her hemoglobin level — typically above 12 — down to 3.3, and she needed an enormous blood transfusion at a larger medical center. But amid a surge in Covid cases, every major facility within 400 miles refused to take her. The smallest hospital in Idaho was, once again, on its own.

. . .

For 46 million Americans, rural hospitals are a lifeline, yet an increasing number of them are closing. The federal government is trying to resuscitate them with a new program that offers a huge infusion of cash to ease their financial strain. But it comes with a bewildering condition: They must end all inpatient care.

The program, which invites more than 1,700 small institutions to become federally designated “rural emergency hospitals,” would inject monthly payments amounting to more than $3 million a year into each of their budgets, a game-changing total for many that would not only keep them open (p. A16) but allow them to expand services and staff. In return, they must commit to discharging or transferring their patients to bigger hospitals within 24 hours.

The government’s reasoning is simple: Many rural hospitals can no longer afford to offer inpatient care. A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide outpatient services that the community needs.

But the new opportunity is presenting many institutions with an excruciating choice.

“On one hand, you have a massive incentive, a ‘Wow!’ kind of deal that feels impossible to turn down,” said Harold Miller, the president of the nonprofit Center for Healthcare Quality and Payment Reform. “But it’s based on this longstanding myth that they’ve been forced to deliver inpatient services — not that their communities need those services to survive.”

Some rural health care providers and health policy analysts say the officials behind the rule are out of touch with the difficulties of transferring rural patients. Bigger hospitals — bogged down with Covid surges, pediatric R.S.V. patients and their own financial woes — are increasingly unwilling to accept transferred patients, particularly from small field hospitals unaffiliated with their own systems.

There are also blizzards, downed cattle fences and mountain pass roads that close for months at a time.

. . .

Cascade Medical Center, where Ms. Wenrich was treated, seems like exactly the type of hospital that federal officials had in mind.

This former lumber mill community is home to less than a thousand people, but the hospital serves patients from across 2,800 square miles; patients travel up to eight hours round trip from homes without addresses.

For the full story, see:

Emily Baumgaertner and Michael Hanson. “Hospital Funding Has Catch: Cut Inpatient Care.” The New York Times (Saturday, December 10, 2022): A1 & A18-A19.

(Note: ellipses added.)

(Note: the online version of the story was updated Dec. 13, 2022, and has the title “A Rural Hospital’s Excruciating Choice: $3.2 Million a Year or Inpatient Care?”)

“It’s Not Clear What We Are and Aren’t Allowed to Say”

(p. B1) When Gov. Gavin Newsom signed into law a bill that would punish California doctors for spreading false information about Covid-19 vaccines and treatments, he pledged that it would apply only in the most “egregious instances” of misleading patients.

It may never have the chance.

Even before the law, the nation’s first of its kind, takes effect on Jan. 1 [2023], it faces two legal challenges seeking to declare it an unconstitutional infringement of free speech. The plaintiffs include doctors who have spoken out against government and expert recommendations during the pandemic, as well as legal organizations from both sides of the political spectrum.

“Our system opts toward a presumption that speech is protected,” said Hannah Kieschnick, a lawyer for the Northern California branch of the American Civil Liberties Union, which submitted a friend-of-the-court brief in favor of one of the challenges, filed last month in U.S. District Court for the Central District of California.

That lawsuit and another, filed this month in the Eastern District of California, have become an extension of the broader cultural battle over the Covid-19 pandemic, which continues to divide Americans along stark partisan lines.

. . .

(p. B5) The plaintiffs in California have sought injunctions to block the law even before it goes into effect, arguing that it was intended to silence dissenting views.

One of them, Dr. Tracy Hoeg, a physician and epidemiologist who works in Grass Valley, near Sacramento, has written peer-reviewed studies since the pandemic began that questioned some aspects of government policies adopted to halt the spread of Covid-19.

Those studies, on the efficacy of masks for schoolchildren and the side effects of vaccines on young men, exposed her to vehement criticism on social media, she said, partly because they fell outside the scientific consensus of the moment.

She noted that the medical understanding of the coronavirus continues to evolve, and that doctors should be open to following new evidence about treatment and prevention.

“It’s going to cause this very broad self-censorship and self-silencing from physicians with their patients because it’s not clear what we are and aren’t allowed to say,” said Dr. Hoeg, one of five doctors who filed a challenge in the Eastern District. “We have no way of knowing if some new information or some new studies that come out are accepted by the California Medical Board as consensus yet.”

. . .

Dr. Jeff Barke, a physician who has treated Covid patients at his office in Newport Beach in Southern California, said the law was an attempt by the state to impose a rigid orthodoxy on the profession that would rule out experimental or untested treatments.

Those include treatments with ivermectin and hydroxychloroquine that he said he had found to be effective at treating the coronavirus, despite studies suggesting otherwise. “Who determines what false information is?” he said.

. . .

“What comes next?” he said. “How I talk to patients about cancer? How I talk to patients about obesity or diabetes or asthma or any other illnesses? When they have a standard of care that they think is appropriate and they don’t want me going against their narrative, then they’ll say Barke’s spreading misinformation.”

For the full story, see:

Steven Lee Myers. “Law to Stem Medical Misinformation Is Facing a Free Speech Challenge.” The New York Times (Thursday, December 1, 2022): B1 & B5.

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

(Note: the online version of the story has the date Nov. 30, 2022, and has the title “Is Spreading Medical Misinformation a Doctor’s Free Speech Right?”)