Money is important. But I believe that what is even more important is giving doctors and patients the freedom to choose and act, within a system of innovative dynamism.
(p. A2) Decades of data and experience suggest that money is the most important thing in the fight against disease.
For the full commentary, see:
(Note: the online version of the commentary has the date Jan. 16, 2019 [sic], and has the same title as the print version.)
(p. A1) A song called “Tomorrow Will Be Better” became a sensation in mainland China in the 1980s, when the nation was emerging from the poverty and turmoil of Mao Zedong’s rule.
Its inspirational lyrics, which exhorted listeners to “look upward for the wings in the sky,” came to represent a generation that was starting to believe in a brighter future.
Now people in China are listening to the song again—but for a very different reason. Videos of the song are circulating on WeChat and other communications apps, often with taglines expressing sadness about the end of that era.
“The 1980s are gone forever,” wrote one listener. “So long, those years of burning passion,” wrote another.
For many Chinese, especially those who came of age during the past 40 years of reform and opening, China appeared to be on an irreversible path forward toward more growth, openness and opportunity.
But now China’s leader, Xi Jinping, is restoring aspects of Mao’s rule, forcing people to confront a more uncertain future rooted in China’s past.
Xi’s predecessors, beginning with Deng Xiaoping, embraced market forces, growth and limited freedoms. Xi, by contrast, is placing national security over the economy, tightening government control, and putting the Communist Party—and himself—at the center of Chinese society.
A Dec. 16 [2023] article published by the party’s influential journal, Qiushi, elevated Xi to the same historical status as Mao, calling Xi “the People’s leader”—a title previously reserved for China’s Great Helmsman.
Gone is the booming China that inspired many young people and entrepreneurs to take risks and bet on the future. Home prices are falling, youth unemployment is at a record high, private investment is shrinking, the financial system is drowning in debt and deflation is setting in.
. . .
(p. A9) “Xi is dampening the energy and optimism of the Chinese people,” said Susan Shirk, a former senior diplomat during the Clinton administration and author of a recent book, “Overreach: How China Derailed Its Peaceful Rise.”
“In a system so dominated by one leader,” Shirk said, “everyone feels powerless to effect positive change.”
. . .
In Shenzhen, Deng’s reform policies helped transform the former fishing village in the shadow of neighboring Hong Kong into a cosmopolitan city of 13 million, home to globally competitive tech companies such as Tencent.
“Time is money, efficiency is life” was the slogan that guided the city’s early development.
Today, Shenzhen has a new slogan: “Follow the party, start your business”—with the party coming first.
Communist Party direction doesn’t seem to be brightening the city’s future. More than a quarter of Shenzhen’s office space sits empty after Xi started a campaign in 2020 to rein in risk-taking at private firms. The regulatory crackdown wiped out more than $1 trillion in market value from publicly-listed tech firms and triggered layoffs and business retrenchment.
. . .
Faced with growing economic headwinds and challenges to order, Xi is doubling down on Mao-style control, embracing a Mao-era tool as a way to ensure national security.
The practice, called the “Fengqiao experience,” is named after a town in eastern China that gained national fame in the early 1960s when Mao praised the way its officials mobilized people to identify and punish so-called enemies of the proletariat—capitalists, traditionalists and the like.
People were encouraged to report on one another, with husbands informing on wives and children on their parents, leading to some of the most brutal aspects of the Cultural Revolution. After that tumultuous period, the “Fengqiao experience” faded into history.
Xi is trying to revive aspects of it to mobilize people to fix problems at the local level before they lead to widespread social unrest.
. . .
John Ling, an e-commerce entrepreneur in Shanghai in his late 40s, recalls a far more liberal environment in the early 2000s. Lured back home by China’s seemingly limitless opportunities after studying in the U.S., he started a business trading goods online.
Back then, “I did feel like you could realize your American dream in China, as long as you worked hard,” Ling recalled.
Year by year he felt greater government interference. As more capital poured into e-commerce, he said, Beijing grew concerned that the sector was diverting resources away from more strategic areas such as semiconductors, an industry in which China still heavily relies on Western firms.
Ling said it became so difficult to raise fresh funding for e-commerce that he decided to shut his venture earlier this year. “It’s all about hard-tech these days,” he said, referring to sectors now favored by the government. “But can you sustain the entire economy with just hard-tech?”
“It feels like nothing is possible” nowadays, he said.
For the full commentary, see:
(Note: ellipses and bracketed year added.)
(Note: the online version of the commentary was updated December 28, 2023, and has the title “China Wants to Move Ahead, but Xi Jinping Is Looking to the Past.” The fourth and eighth paragraphs quoted above appear in the online, but not the print, version of the commentary. In other sections where the online version is more detailed than the print version, the passages quoted above follow the online version.)
The book by Shirk mentioned above is:
Shirk, Susan L. Overreach: How China Derailed Its Peaceful Rise. New York: Oxford University Press, 2023.
I have personally benefitted from Vernon Smith’s longevity, since he graciously wrote two drafts of a positive blurb for my Openness to Creative Destruction book.
(p. A5) Vernon L. Smith, 97, is a very busy man.
The economist at Chapman University just finished writing a book about Adam Smith and works about eight hours a day, seven days a week in his home office in Colorado Springs, Colo. He enjoys chatting with friends on Facebook and attending concerts with his daughter.
“I still have a lot of stuff to do. I want to keep at it,” said Smith, who won the Nobel Prize in economics in 2002.
. . .
(p. A10) Researchers studying “super agers,” people over 80 who have mental faculties of people decades younger, said strong social relationships are important for keeping brains sharp.
The same is true for people who live beyond 100, said Stacy Andersen, a behavioral neuroscientist at Boston University and co-director of the New England Centenarian Study.
“They have a purpose. They have things they want to go out and do every day,” Andersen said.
Smith says his work and his family keep him motivated and driven.
“I want to go to at least 106,” he said.
For the full story, see:
(Note: ellipsis and bracketed year added.)
(Note: the online version of the story was updated Feb. 15, 2024, and has the title “How to Stay Mentally Sharp Into Your 80s and Beyond.” The last sentence quoted above appears in the online, but not in the print, version of the article.)
My book mentioned above is:
Diamond, Arthur M., Jr. Openness to Creative Destruction: Sustaining Innovative Dynamism. New York: Oxford University Press, 2019.
Doesn’t the FDA do harm by requiring that Apple watch blood pressure monitor be equal in accuracy to a standard clinical blood pressure monitor? Many people will not take the time and effort to get frequent readings from a standard blood pressure monitor in a clinic. But many of them would check their blood pressure conveniently on their watch. Isn’t a less accurate reading better than no reading at all?
(p. A1) Apple’s widening effort to turn its nine-year-old watch from a luxury timepiece into the ultimate all-in-one medical device is taking it into territory that is legally treacherous as well as potentially profitable.
. . .
(p. A2) “The studies that we’ve seen are not yet reassuring that they’re ready for prime time or for clinical use,” said Jordana Cohen, associate professor of medicine and epidemiology at the University of Pennsylvania.
To secure Food and Drug Administration clearance for selling a blood-pressure monitor, companies must demonstrate through the FDA’s 510(k) process that their device’s accuracy is comparable to an existing, already cleared device, she added.
Similarly, tracking glucose through noninvasive skin sensors is generally less precise than direct blood analysis, with factors such as skin tone and temperature affecting accuracy.
For the full story, see:
(Note: ellipsis added.)
(Note: the online version of the story has the date December 28, 2023, and has the title “Apple Keeps Chasing the Ultimate Health-Tracking Watch—but It Could Take Years.”)
(p. A15) Ubiquitous and persuasive, models . . . drive decisions—one reason why, in Ms. Thompson’s view, they require our urgent attention. She tells us that, as a graduate student studying North Atlantic storms, she noticed how different models predicted different overall effects and produced contradictory results.
. . .
The problem is that Model Land is easy to enter but difficult to escape. Having built “a beautiful internally consistent model,” Ms. Thompson writes, it can be “emotionally difficult to acknowledge that the initial assumptions on which the whole thing is built are literally not true.”
There are all sorts of ways that models can lead us astray. A small measurement error on an input can lead to wildly inaccurate forecasts—a phenomenon known as the Butterfly Effect. Fortunately, this type of uncertainty is often manageable. Far more problematic are what Ms. Thompson calls “unquantifiable unknowns”—things that are left out of a model’s calculation because they can’t be anticipated, such as the unexpected arrival of a transformative technology or the abrupt collapse of a robust market. It is not always true, she observes, that the data we have now will be relevant to the future—as traders discovered in the stock-market crash of 1987, when their models catastrophically failed.
. . . We may be inclined to regard models as objective expressions of truth, yet they are deliberately constructed interpretations, imbued with the values and viewpoints of the modelers—primarily, as Ms. Thompson notes, well-educated, middle-class individuals. During the pandemic, models “took more account of harms to some groups of people than others,” resulting in a “moral case” for lockdowns that was “partial and biased.” Modelers who worked from home—while others maintained the supply chain—often overlooked “all of the possible harms” of the actions their models were suggesting. . . .
The promise and peril of models, Ms. Thompson recognizes, has deep resonance in biomedicine, where so-called model organisms, like yeast and zebrafish, have led to foundational insights and accelerated the development of therapeutics. At the same time, treatments that work brilliantly in Model Land often fail in people, devastating patients and disappointing drug developers. The search for improved disease models can be complicated when proponents of one model suppress research into alternative approaches, as the late journalist Sharon Begley documented in a powerful 2019 report. Ms. Thompson perceptively critiques the adoption of singular “gold standard” models, noting that the “solidification” of one set of assumptions can lock us into one way of thinking and close off other important avenues of inquiry.
For the full review see:
(Note: ellipses added.)
(Note: the online version of the review has the date December 27, 2022, and has the title “BOOKSHELF; ‘Escape From Model Land’ Review: Seduced by Numbers.”)
The book under review is:
Thompson, Erica. Escape from Model Land: How Mathematical Models Can Lead Us Astray and What We Can Do About It. New York: Basic Books, 2022.
Sharon Begley’s “powerful” 2019 report, mentioned above, is:
Peter Thiel claims that the British public supports their National Health System because they suffer from the Stockholm Syndrome. The claim is amusing, thought-provoking, and may be partly true. But I suspect that there are other reasons for the British public’s support. I suspect they assume that future advances in health care inevitably will be more expensive than they will be able to afford. They do not understand that in a laissez-faire health system substantial incentives would exist to develop effective low-cost cures and therapies.
(p. 8) It began with a £1 contract.
In the hours after a pandemic was declared in March 2020, Palantir, the secretive American data analytics company, was invited to 10 Downing Street along with other tech groups, including Amazon, Google and Meta, to discuss how it could help the British government respond.
Within days, Palantir’s software was processing streams of data from across England’s National Health Service, with Palantir engineers embedded to help. The company’s services, used by the C.I.A. and Western militaries for more than a decade, were deployed to track emergency room capacity and direct supplies of scarce equipment.
Palantir charged the government just one pound.
The deal provided the company with a valuable toehold. Since then, Palantir, which is chaired by Peter Thiel, the billionaire investor and one of President Donald J. Trump’s major 2016 donors, has parlayed the work into more than £60 million in government health contracts. Its biggest reward may be yet to come: a seven-year contract worth up to £480 million — about $590 million — to overhaul N.H.S. England’s outdated patient data system.
. . .
Palantir declined to comment on its bid but said it was proud to support “the world’s most important private and public institutions.” The company defended the quality of its work and said, “We are now helping to reduce the N.H.S. backlog, cut the amount of time nurses and doctors need to spend on administrative tasks and speed up cancer diagnosis — all while rigorously protecting data privacy.”
. . .
Speaking at Oxford University in January [2023], Mr. Thiel went off script. The N.H.S. makes people sick and should embrace privatization, he said in response to a question. The British public’s support for the service, he said, was “Stockholm syndrome.”
For the full story, see:
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story has the date Sept. 29, 2023, and has the title “How Peter Thiel’s Palantir Pushed Toward the Heart of U.K. Health Care.”)
(p. A15) More than 100 years after the miraculous discovery of insulin to treat diabetes, how are things going? More people are getting the disease. (Between 1959 and 2021, the number of Americans diagnosed with diabetes increased from 1.5 million to 29.7 million, according to federal government surveys.) Patients are doing worse. (Fewer than 1 in 5 Type 1 patients are achieving blood-sugar goals established by the American Diabetes Association.) Diabetes intensifies America’s economic and racial divide. (Type 2 diabetes disproportionately affects the poor, the undereducated and minorities.) And the epidemic is global. (According to the World Health Organization, diabetes is the ninth leading cause of death worldwide.)
If any disease needs to be rethought, it is surely diabetes, and that is the premise of Gary Taubes’s latest book.
. . .
The hero of “Rethinking Diabetes” is Dr. Richard Bernstein, an engineer-turned-doctor who also has Type 1. In the 1970s, he became the first person to use a home glucose meter; looking at his data, he realized that a low-carb diet minimized his glycemic swings. For the past 40 years, in his books, academic papers and other advocacy, he has been the leading low-carb evangelist for people with diabetes.
But Dr. Bernstein is also a controversial figure, and not just because his nutritional guidance defied the medical establishment. I interviewed Dr. Bernstein and wrote about him in 2007. He’s prone to hyperbole and absurdities, such as his claim that insulin-pump patients “all have complications.” More important, his low-carb diet is uncompromising, and his advice is not realistic for everyone. When I interviewed him, he hadn’t eaten an apple since the Nixon administration. Nonetheless, I believe that Dr. Bernstein’s insights about diet and diabetes—and Mr. Taubes’s central argument—are correct. Imperfectly, I follow Dr. Bernstein’s guidance, and I’m far healthier because of it.
Mr. Taubes’s larger point is that we have allowed pharmacological miracles in the treatment of diabetes, insulin being one of them, to supplant food and nutrition as the foundation of good health. He concurs with Dr. Arnoldo Cantani, a 19th-century Italian physician, who said that the remedy for diabetes “is not in the drugstore but in the kitchen.”
For the full review see:
James S. Hirsch. “BOOKSHELF; Beyond Insulin.” The Wall Street Journal (Monday, Jan. 8, 2024): A15.
(Note: ellipsis added.)
(Note: the online version of the review has the date January 7, 2024, and has the title “BOOKSHELF; ‘Rethinking Diabetes’ Review: Beyond Insulin.”)
The book under review is:
Taubes, Gary. Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments. New York: Knopf, 2024.
(p. A13) Indi was born with mitochondrial disease, a degenerative condition that prevents cells from producing energy. When her parents and the Queen’s Medical Centre in Nottingham, England, disagreed over whether she should be kept on life support, the NHS turned to the courts to strip the parents of decision-making authority. The U.K. High Court agreed, overrode the parents’ wishes, and ordered life support removed.
. . .
While the NHS thought continued treatment would be futile, other experts disagreed, including at the Vatican’s Bambino Gesù pediatric hospital. As part of its religious mission, Bambino Gesù specializes in treating children with rare diseases. Doctors there offered a treatment plan they thought could help Indi, free of charge. The Italian government even made her a citizen so that she could be airlifted from England.
. . .
For the U.K., the offer of free treatment by willing doctors ought to have been the end of the story. The government didn’t have to pay another penny. The grateful parents simply wanted the freedom to take their daughter to the experts in Rome.
Instead, the NHS went back to the same court and judge to insist it remained in Indi’s best interests to die in the U.K. The court again agreed and overrode the parents’ desire to take Indi to see the experts in Rome. The judge ordered that they could take her only to one place: to the hospice to die.
The parents had no choice but to comply. Lest they try anything else to save their daughter, the parents were sent to hospice with a security escort and police presence.
Deprived of treatment and with her parents forbidden to help her, Indi died within two days, under the watchful eye of the government that said all along it was looking out for her best interests.
For the full commentary, see:
(Note: ellipses added.)
(Note: the online version of the commentary has the date November 20, 2023, and has the same title as the print version.)
(p. A1) “When you adopt a dog, you’re adopting future heartbreak,” said Emilie Adams, a New Yorker who owns three Rhodesian Ridgebacks. “It’s worth it over time because you just have so much love between now and when they go. But their life spans are shorter than ours.”
In recent years, scientists have been chasing after drugs that might stave off this heartbreak by extending the lives of our canine companions. On Tuesday, the biotech company Loyal announced that it had moved one step closer to bringing one such drug to market. “The data you provided are sufficient to show that there is a reasonable expectation of effectiveness,” an official at the U.S. Food and Drug Administration informed the company in a recent letter. (Loyal provided a copy of the letter to The Times.)
That means that the drug, which Loyal declined to identify for proprietary reasons, has met one of the requirements for “expanded conditional approval,” a fast-tracked authorization for ani-(p. A19)mal drugs that fulfill unmet health needs and require difficult clinical trials. The drug is not available to pet owners yet, and the F.D.A. must still review the company’s safety and manufacturing data. But conditional approval, which Loyal hopes to receive in 2026, would allow the company to begin marketing the drug for canine life extension, even before a large clinical trial is complete.
. . .
. . . the letter, which came after years of discussion between Loyal and the F.D.A., suggests that the agency is open to canine longevity drugs, Ms. Halioua said.
. . .
Aging may be an inevitability, but it is not an unyielding one. Scientists have created longer-lived worms, flies and mice by tweaking key aging-related genes.
These findings have raised the tantalizing possibility that scientists might be able to find drugs that had the same life-extending effects in people. That remains an active area of research, but canine longevity has recently started to attract more attention, in part because dogs are good models for human aging and in part because many pet owners would love more time with their furry family members.
“There’s not a lot you wouldn’t do if you could stack the deck in your favor to preserve the life of your hairy, four-legged child,” said Ms. Adams, the Rhodesian Ridgeback owner.
For the full story, see:
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story was updated Nov. 29, 2023, and has the title “Could a Drug Give Your Pet More Dog Years?”)
(p. 17) At the heart of “Most Delicious Poison” is an evolutionary oxymoron that sustains life as we know it: Poisons — in deserts or rainforests, at the corner bar or in your fridge — threaten life while offering possibilities for persistence, and the pleasures that we take from substances that would otherwise be deadly hint at the ways life on earth manages to thrive in a landscape of toxins. . . .
“Scratch beneath the surface of a coffee bean, a red pepper flake, a poppy capsule, a Penicillium mold, a foxglove leaf, a magic mushroom, a marijuana bud, a nutmeg seed or a brewer’s yeast cell, and we find a bevy of poisons,” Whiteman writes.
Caffeine is another natural wonder best approached with caution. “Caffeine and the human mind,” says Whiteman, can seem like a match made in heaven. “Taken in the appropriate doses, caffeine not only feels life-giving but is: Drink a few cups a day and you won’t live forever but a little longer.” Whiteman sorts through data suggesting as much, though, anecdotally, on a fall morning in the dark, it sure feels true.
But caffeine can be deadly. In October of this year [2023], the parents of a University of Pennsylvania student with a congenital heart condition sued Panera Bread over their “Charged Lemonade,” on the grounds that a substance containing three Red Bulls’ worth of caffeine should have been marketed as an energy drink, potentially saving their daughter’s life.
And yet used in moderation, the poison that we drink in pumpkin spice lattes blocks adenosine receptors — adenosine being a brain-produced neurotransmitter that would otherwise encourage you to rest.
. . .
Big Pharma’s relationship to Indigenous knowledge is a recurring motif. “Indigenous healers have yielded nearly 50 percent of all modern drugs we use today,” writes Whiteman.
For the full review, see:
(Note: ellipses added.)
(Note: the online version of the review was updated Dec. 4, 2023, and has the title “All Things in Moderation, Especially When They’re Toxic.”)
The book under review is:
Whiteman, Noah. Most Delicious Poison: The Story of Nature’s Toxins―from Spices to Vices. New York: Little, Brown Spark, 2023.
Presumably the Reverend William J. Barber II knows what chair designs reduce the chronic pain he feels from the ankylosing spondylitis he has endured “for almost 40 years.” He has what Hayek called “local knowledge” that is not possessed by the government legislators and enforcers of the Americans with Disabilities Act. Regulations keep individuals from using their local knowledge, with results that can be outrageously unfair.
(p. A15) AMC Theaters has apologized to the Rev. William J. Barber II, a civil rights leader, after he was escorted from a Greenville, N.C., theater after employees refused to allow him to use a chair he needs to manage a painful medical condition, he said.
Mr. Barber, 60, was attending a Tuesday afternoon screening of “The Color Purple” with his mother, Eleanor Barber, 90. He said he tried to use the chair, which an assistant carried for him, by placing it in an area reserved for handicapped seating, saying he had done so before in theaters, at Broadway plays and even on a visit to the White House.
He said a theater employee told him that he would not be able to use the chair, which looks like a small stool, because it did not comply with guidelines in the Americans with Disabilities Act.
. . .
Mr. Barber has a condition called ankylosing spondylitis, and walks slowly with the aid of a cane. He said the disease attacks his joints “like a guided missile” and has forced him to live with chronic pain for almost 40 years. “I describe it like that because it’s a war to live with it,” he said.
He added that people with disabilities often fight invisible battles that can be difficult for people not living with disabilities to understand.
For the full story, see:
(Note: ellipsis added.)
(Note: the online version of the story has the date Dec. 28, 2023, and has the title “AMC Theaters Apologizes to Civil Rights Leader Removed From Movie Theater.”)
