Health – Page 25 – artdiamondblog.com

Lister Used Data, Results, and Amiability to Convince Physicians to Sterilize Hands, Scalpels, and Wounds

(p. C6) What was the most dangerous place in the vast territories of the British Empire in the 19th century? Was it the savage savannas of Zululand? Perhaps the frozen wastes of the Northwest Passage, or the treacherous high passes of the Hindu Kush?

To judge from “The Butchering Art,” a fine and long overdue biography of the great physician Joseph Lister by Lindsey Fitzharris, the answer might be a much more domestic corner of empire: the Victorian teaching hospital.

. . .

Infection rates plummeted when Lister used carbolic acid to wash hands and scalpels, to dress wounds, and to sterilize sutures. He even sprayed it into the air of the operating room. But other physicians were skeptical and bitterly resisted the notion that their sloppy and unhygienic practices were the cause of so many deaths.

. . .

Lister won over his opponents, not with bile and rhetoric but with a relentless focus on data and results, coupled with his innate amiability. He paid particular attention to audiences of medical students, perhaps anticipating Max Planck’s observation that bitter disciples of old dogmas are never won over by new theories, they simply die off and are replaced by a new generation.

The modesty and compassion of Lister would have been remarkable in any man, let alone a surgeon. His patients and students adored him. Lister taught his residents that “every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.” After he drained a young girl’s knee abscess, the girl showed him her doll, which was missing a leg. As Ms. Fitzharris writes, “The girl fumbled around under her pillow and—much to Lister’s amusement—produced the severed limb.” Lister called for needle and thread and “stitched the limb back onto the doll and with quiet delight handed it back to the little girl.”

For the full review, see:

John J. Ross. “BOOKSHELF; The Butchering Art.” The Wall Street Journal (Saturday, Oct. 14, 2017): C6.

(Note: ellipses added.)

(Note: the online version of the review has the date Oct. 13, 2017, and has the title “BOOKSHELF; Review: ‘The Butchering Art’ Resurrects Joseph Lister.”)

The book under review is:

Fitzharris, Lindsey. The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine. New York: Farrar, Straus and Giroux, 2017.

The reviewer repeats the plausible but debunked view of Planck that old scientists do not change their views. The debunking occurs in:

Diamond, Arthur M., Jr. “Age and the Acceptance of Cliometrics.” Journal of Economic History 40, no. 4 (Dec. 1980): 838-41.

Hull, David L. , Peter D. Tessner, and Arthur M. Diamond, Jr. “Planck’s Principle: Do Younger Scientists Accept New Scientific Ideas with Greater Alacrity Than Older Scientists?” Science 202 (Nov. 17, 1978): 717-23.

Stimulant Ephedrine Was Known and Used in Bronze Age

Ephedrine currently has a variety of medical uses, including as a decongestant.

(p. A4) Bronze Age humans have been credited with a number of civilizational advancements: the invention of irrigation, the wheel, writing systems and the ability to forge weapons and tools from the durable metal that lends the era its name.

Now, strands of human hair discovered in an ancient burial cave in Spain suggest another novelty: a proclivity for consuming psychoactive drugs.

. . .

The findings, published Thursday [April 6, 2023] in Scientific Reports of the journal Nature, provide the first direct evidence that ancient Europeans consumed psychoactive drugs much like their pre-Columbian brethren in Mesoamerica, the researchers said.

Elisa Guerra-Doce, the lead author of the study, said researchers were stunned by the results, especially because the cave interiors yielded no detectable signs of the drugs’ presence. A chemical analysis of the hair revealed evidence of three alkaloid substances known to produce altered states of consciousness: ephedrine, atropine and scopolamine.

The compounds themselves are produced by flora native to Minorca. Atropine and scopolamine, powerful hallucinogens, can be found in plants in the nightshade family, among them mandrake, henbane and thorn apple. Ephedrine, a stimulant, can be extracted from joint pine.

“These findings are so singular,” said Ms. Guerra-Doce, an expert in the anthropology of intoxication at the University of Valladolid in Spain. “Sometimes when people think about drugs, they think it’s a modern practice. These results tell a different story.”

. . .

The three compounds have a long history of human use. Ephedrine is a stimulant that provides bursts of energy and mental clarity, and it can stave off sleepiness. Atropine and scopolamine are powerful deliriants that can produce hallucinations and out-of-body experiences.

For the full story, see:

Andrew Jacobs. “Scientists See Bronze Age In New Light: It Was Trippy.” The New York Times (Friday, April 7, 2023): A4.

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

(Note: the online version of the story has the date April 6, 2023, and has the title “Tripping in the Bronze Age.”)

The academic paper mentioned in the passage quoted above is:

Guerra-Doce, E., C. Rihuete-Herrada, R. Micó, R. Risch, V. Lull, and H. M. Niemeyer. “Direct Evidence of the Use of Multiple Drugs in Bronze Age Menorca (Western Mediterranean) from Human Hair Analysis.” Scientific Reports 13, no. 1 (April 6, 2023): article #4782.

“Flowers Never Bend, With the Rainfall”

Sometimes when I am in a dark mood I wonder how you keep moving forward when you do not know how much time is left. Some seek an answer in religion. I am more open to a kind of stoicism combined with the other gift of Prometheus: blind hope.

(p. 3) A few months into treatment, I realized that Josh might not make it to the next spring, when we would normally visit my extended family in Greece. I told Dr. Sara that I would like to take my husband to Greece, because he might not get the chance again.

. . .

My diary reminds me that while we were there, I asked Josh what he would do differently in life. “Not get cancer,” he said.

. . .

As for me, I kept hearing the lyrics to a Simon and Garfunkel song in my head: “So, I’ll continue to continue to pretend, my life will never end, and flowers never bend, with the rainfall.” It was my soundtrack.

For the full commentary, see:

Anemona Hartocollis. “My Husband’s Doctor, Onscreen.” The New York Times, SundayStyles Section (Sunday, November 20, 2022): 1-3.

(Note: the online version of the commentary was updated June 20, 2023 [sic], and has the title “Cancer, My Husband’s Doctor, and Catherine Deneuve.”)

Some High Performers Find Ways to Avoid Accumulating Microstresses

(p. C5) Have you had days that exhaust you extraordinarily without any particular reason why?

. . .

There’s a common but little-understood reason for that exhaustion. We call it “microstress”—brief, frequent moments of everyday tension that accumulate and impede us even though we don’t register them.

. . .

One study published in the journal Biological Psychology in 2015 found that exposure to social stress within two hours of a meal leads your body to metabolize the food in a way that adds 104 calories on average. “If this happens daily, that’s 11 pounds gained per year,” noted Lisa Feldman Barrett, a psychology professor at Northeastern University and author of “Seven and a Half Lessons About the Brain.”

. . .

In our research, we observed that some of the high performers—a small subset that we came to call the “Ten Percenters”—were much better at coping with microstress than the rest of those we studied, and perhaps than the rest of us, too. What do they do differently?

. . .

. . ., they’re better at removing themselves from interactions that generate microstress in their lives, whether or not they realize the dynamic. Ten Percenters are more likely to shape these interactions by dealing with simmering disagreements head-on or by limiting such contacts.

. . .

Our Ten Percenters were also thoughtful about not creating the kinds of conditions that cause microstress for others. Think about what happens—to both of you—when you push your child too hard on their grades and it comes back in the form of a rebellious attitude. Or the stress you may create as a manager by unnecessarily shifting expectations. Stopping this cycle helps to prevent microstress from boomeranging back on us.

For the full essay, see:

Rob Cross and Karen Dillon. “Combating the ‘Microstress’ That Causes Burnout.” The Wall Street Journal (Saturday, April 22, 2023): C5.

(Note: ellipses added.)

(Note: the online version of the essay has the date April 21, 2023, and has the same title as the print version.)

The essay quoted above is adapted from Cross and Dillon’s book:

Cross, Rob, and Karen Dillon. The Microstress Effect: How Little Things Pile Up and Create Big Problems—and What to Do About It. Boston, MA: Harvard Business Review Press, 2023.

Betting on Elections Is a Form of Free Speech

(p. A17) The Commodity Futures Trading Commission has moved to shut down PredictIt, an online marketplace for futures contracts on the outcomes of political events, effective Feb. 15, 2023. This is a blow to investors in these contracts, such as those on the presidential election of 2024, who are left uncertain as to how their positions will be unwound. And it’s a blow to the public at large, because political futures have proven to have better predictive power than polls.

. . .

. . . in early 2020, . . . PredictIt listed a contract on whether the World Health Organization would declare Covid-19 a pandemic. According to John Phillips, chief executive of Aristotle, the firm that operates PredictIt, the CFTC telephoned to complain about that contract, saying it was in poor taste. The contract had already expired.

. . .

If investors can express their opinions on the future prices of corn and pork bellies, surely the First Amendment also protects their ability to do the same on elections and other political matters. It’s a matter of free speech that you can put your money where your mouth is.

For the full commentary, see:

Donald Luskin. “The Feds Don’t Want You Betting on Elections.” The Wall Street Journal (Wednesday, Nov. 2, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 1, 2022, and has the same title as the print version.)

Open Is Good (Hearts, Minds, Societies, and Windows)

Windows are liberating. The person in the room can decide how much air and light to let in. So I have never liked when central planners who control buildings omitted windows that could be opened. Other things equal, let people choose. Florence Nightingale wanted open windows, partly based on the mistaken miasma theory of disease. John Snow famously and courageously showed that cholera was caused by bad water, not bad air, thereby jump-starting the process of experts rejecting the miasma theory. But although the miasma theory was not universally applicable (some bad things spread in ways other than the air) and was wrong in some details (what was bad about some of the air was not the air itself, but the pathogens in the air), some of the actions that had been taken on the basis of miasma theory had positive effects. Ventilation was good because the air did sometimes have something bad in it–bacteria and viruses. Closing up buildings kept the bad inside to spread and infect. So now, fortunately, we are back to recognizing that ventilation has important good effects. In the meantime less harm would have been done if our buildings and our other rules had allowed more individual liberty to choose (windows that could be opened), and less centrally planned mandates (windows sealed closed).

(p. D1) One of the paramount lessons of the Covid-19 pandemic is that fresh air matters. Although officials were initially reluctant to acknowledge that the coronavirus was airborne, it soon became clear that the virus spread easily through the air indoors. As the pandemic raged on, experts began urging building operators to crank up their ventilation systems and Americans to keep their windows open. The message: A well-ventilated building could be a bulwark (p. D5) against disease.

It was not a novel idea. More than a century ago, when infectious diseases ravaged cities in the United States and Europe, public health reformers preached the power of good ventilation, and open-air homes, hospitals and schools sprang up in New York, London and other locales on both sides of the Atlantic.

But over the last century, society lost hold of that idea. Scientific advances turned pathogens into problems that could be solved at the individual, biomedical level, with medicines and vaccines, rather than through infrastructure or societal change. Skylines became crowded with air-conditioned towers. An energy crisis encouraged engineers to seal structures tightly. And by the time the coronavirus arrived, Americans were spending their days in schools, offices and homes that could barely breathe.

. . .

Germ theory had not yet gained widespread acceptance; instead, the longstanding theory of miasma held that disease was the result of “bad air.” So sanitary reformers began calling for an overhaul of urban spaces, including improvements in ventilation. “An abundant supply of fresh air, at a proper temperature, is the first requisite of health in every place,” the Citizens’ Association of New York wrote in a report published in 1865.

. . .

Similar reforms were also underway in hospitals thanks, in part, to the crusading work of Florence Nightingale, the British nurse who was stationed at a filthy military hospital during the Crimean War in 1854. The nurse, who believed in the healing power of “air from without,” helped popularize pavilion-style hospitals, which featured long, narrow wards with a row of large, open windows running along each wall.

. . .

Ventilation rates fell and then plummeted further during the energy crisis of the 1970s, when buildings were sealed even more tightly. “In fact,” said James Lo, an architectural engineer at Drexel University, “a lot of effort pre-Covid is to try to reduce the amount of ventilation because people don’t want to spend the energy.”

. . .

In the United States today, the American Society of Heating, Refrigerating and Air-Conditioning Engineers, or ASHRAE, sets widely used indoor air quality standards and specifies minimum ventilation rates. In practice, these rates typically govern how buildings are designed, rather than how they are operated day to day, and many structures deliver less fresh air than they were designed to provide, experts said.

The standards define acceptable indoor air quality as air that does not have “harmful” levels of “known contaminants,” and with which at least 80 percent of occupants are satisfied. But infectious disease is not a focus.

“It says nothing about, ‘Does this level of air quality protect you from risk of infection when the seasonal flu is going around, or when there’s a novel epidemic disease, like Covid?’” said William Bahnfleth, an architectural engineer at Penn State University and the chairman of the epidemic task force at ASHRAE.

For the full story, see:

Emily Anthes. “The New War on Bad Air.” The New York Times (Tuesday, June 20 [sic], 2023): D1 & D5.

(Note: ellipses added.)

(Note: the online version of the story was updated June 23, 2023, and has the same title as the print version.)

Roughly 5,000 New Species Found in Clarion Clipperton Zone of Pacific Ocean

(p. B3) Researchers from the Natural History Museum London analyzed samples of bottom-dwelling animals collected on expeditions to the 2.3 million-square-mile area, known as the Clarion Clipperton Zone, which lies halfway between Hawaii and Mexico. Of the 5,578 species found in the zone, between 88% and 92% are new to science, according to the paper, published Thursday [May 24, 2024] in the journal Current Biology.

. . .

Adrian Glover, an author of the study and merit researcher at the museum, spent several months at sea collecting samples earlier this year.

. . .

“It doesn’t rival coral reefs or rainforests for diversity,” Glover said. “But it is actually higher than soft sediments along the continental shelf, which is just totally bizarre.”

Glover said new marine invertebrates are valuable because they can contain unusual chemical compounds that could potentially be turned into anticancer, antifungal or antiviral drugs.

For the full story, see:

Eric Niiler. “New Species Discovered Deep in Pacific.” The Wall Street Journal (Friday, May 25, 2023): B3.

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

(Note: the online version of the story was updated May 25, 2023, and has the title “Thousands of New Species Discovered in Ocean Area Targeted by Deep-Sea Miners.”)

The academic paper summarized above is:

Rabone, Muriel, Joris H. Wiethase, Erik Simon-Lledo´, Aidan M. Emery, Daniel O.B. Jones, Thomas G. Dahlgren, Guadalupe Bribiesca-Contreras, Helena Wiklund, Tammy Horton, and Adrian G. Glover. “How Many Metazoan Species Live in the World’s Largest Mineral Exploration Region?” Current Biology 33, no. 12 (June 19, 2023): 2383–96.

Much of Pandemic Funding to Improve Ventilation in Schools “Is Sitting Untouched in Most States”

(p. 1) As the next presidential election gathers steam, extended school closures and remote learning have become a centerpiece of the Republican argument that the pandemic was mishandled, the subject of repeated hearings in the House of Representatives and a barrage of academic papers on learning loss and mental health disorders among children.

But scientists who study viral transmission see another lesson in the pandemic school closures: Had the indoor air been cleaner (p. 16) and safer, they may have been avoidable. The coronavirus is an airborne threat, and the incidence of Covid was about 40 percent lower in schools that improved air quality, one study found.

The average American school building is about 50 years old. According to a 2020 analysis by the Government Accountability Office, about 41 percent of school districts needed to update or replace the heating, ventilation and air-conditioning systems in at least half of their schools, about 36,000 buildings in all.

There have never been more resources available for the task: nearly $200 billion, from an array of pandemic-related measures, including the American Rescue Plan Act. Another $350 billion was allotted to state and local governments, some of which could be used to improve ventilation in schools.

“It’s a once-in-a-generation opportunity to fix decades of neglect of our school building infrastructure,” said Joseph Allen, director of the Healthy Buildings program at the Harvard T.H. Chan School of Public Health.

Schoolchildren are heading back to classrooms by the tens of millions now, yet much of the funding for such improvements is sitting untouched in most states.

Among the reasons: a lack of clear federal guidance on cleaning indoor air, no senior administration official designated to oversee such a campaign, few experts to help the schools spend the funds wisely, supply chain delays for new equipment, and insufficient staff to maintain improvements that are made.

Some school officials simply may not know that the funds are available. “I cannot believe the amount of money that is still unspent,” Dr. Allen said. “It’s really frustrating.”

For the full story, see:

Apoorva Mandavilli. “Bad Ventilation Remains Threat To U.S. Students.” The New York Times, First Section (Sunday, Aug. 27, 2023): 1 & 16.

(Note: the online version of the story was updated Aug. 28, 2023, and has the title “Covid Closed the Nation’s Schools. Cleaner Air Can Keep Them Open.”)

Nursing Slots Filled Via Gig Apps Give More Control to Nurses and More Uncertainty to Hospitals

(p. A3) Hospitals are joining the gig economy.

Some of the nation’s largest hospital systems including Providence and Advocate Health are using apps similar to ride-hailing technology to attract scarce nurses. An app from ShiftKey lets workers bid for shifts. Another, CareRev, helps hospitals adjust pay to match supply, lowering rates for popular shifts and raising them to entice nurses to work overnight or holidays.

The embrace of gig work puts hospitals in more direct competition with the temporary-staffing agencies that siphoned away nurses during the pandemic. The apps help extend hospitals’ labor pool beyond their employees to other local nurses who value the highly flexible schedules of gig work.

. . .

Gig apps give nurses even more control than other common temporary-employment options that lock in workers for multiweek contracts, at least. It opens shifts to a broader labor pool, too, but also a more fluid one, hospital executives said.

That means less certainty for employers.

For the full story, see:

Melanie Evans. “Gig Work Helps Hospitals Fill Nursing Shifts.” The Wall Street Journal (Wednesday, April 19, 2023): A3.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 18, 2023, and has the title “Nurse Shortage Pushes Hospitals Into the Gig Economy.”)

FDA Commissioner Said FDA Was “Too Slow” to Allow Foreign Firms to Supply Baby Formula to Fill Empty Shelves in U.S. Stores

(p. A3) Federal health regulators outlined plans Friday [Sept. 30, 2022] that will allow overseas baby-formula makers to continue selling their products in the U.S. long term following a baby-formula shortage that led to empty shelves at some stores.

. . .

The guidance is expected to help bolster the supply chain for baby formula and could be a financial gain for global manufacturers that have long sought to enter the concentrated U.S. market, where Abbott Laboratories and Reckitt Benckiser Group account for most infant- and toddler-formula sales.

. . .

The FDA responded by temporarily letting foreign manufacturers ship their products to the U.S. FDA Commissioner Robert Califf commissioned an external review of the agency’s food division, saying in congressional testimony that the agency’s response to the shortage was too slow.

For the full story, see:

Stephanie Armour. “FDA Sets New Plan On Baby Formula.” The Wall Street Journal (Saturday, Oct. 1, 2022): A3.

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

(Note: the online version of the story has the date September 30, 2022, and has the title “Overseas Baby-Formula Makers Given Path to Keep Selling in U.S.”)

Increasing Patient Administrative Burdens Reduce Health Care Benefits and Efficiency

If we want a health system that is effective, efficient, and innovative, we need to have prices that transparently and accurately reflect the real costs of providing care. This would include all costs, including what the physician Chavi Karkowsky (quoted below) calls “administrative costs.” If we do not take account of the patient’s administrative costs, we will have a system that is ineffective, inefficient, and stagnant. And we will have set up perverse incentives that block entrepreneurs from improving the system. A true accounting will reveal higher costs, and that will raise concerns about too limited access to health care. But true prices also will provide information and incentives for medical entrepreneurs to find lower-cost ways to make health care more effective and more efficient. In the short-term, concerns about access could be addressed by a health care voucher system, analogous to what Milton Friedman proposed for education, or by a health insurance system like that proposed by Susan Feigenbaum.

Several years ago, I was called urgently to our small obstetric triage unit because a pregnant patient was very sick.

. . .

Within minutes, a team was swarming the triage bay — providing oxygen, applying the fetal heart rate and contraction monitor, placing IVs. I called the neonatal intensive care unit, in case labor progressed, to prepare for a very preterm baby. In under an hour, we had over a dozen people, part of a powerful medical system, working to get her everything she might need.

Breathing quickly behind her oxygen mask, my patient explained that she had noticed symptoms of a urinary tract infection about four days ago; she had gone to her doctor the next day and had gotten an antibiotics prescription. But the pharmacy wouldn’t fill it — something about her insurance, or a mistake with her record. She tried calling her doctor’s office, but it was the weekend, and she couldn’t get through. She read on the internet to drink water and cranberry juice, so she kept trying that. She called 9-1-1 in the middle of the night when she woke up and felt as if she couldn’t breathe.

This is the story of our medical system — quick, massive, powerful, able to assemble a team in under an hour and willing to spend thousands of dollars when a patient is sick.

This is also the story of a medical system that didn’t think my patient was worth a $12 medication to prevent any of this from happening.

This patient’s story is a result of the space between the care that providers want to give and the care that the patient actually receives. That space is full of barriers — tasks, paperwork, bureaucracy. Each is a point where someone can say no. This can be called the administrative burden of health care. It’s composed of work that is almost always boring but sometimes causes tremendous and unnecessary human suffering.

The administrative burden includes many of the chores we all hate: calling doctor’s offices, lining up referrals, waiting in the emergency room, sorting out bills from a recent surgery, checking on prescription refills.

. . .

There’s a general sense that all that unpaid labor required to get medical care is increasing.

. . .

At the same time, creating administrative burden is a time-honored tactic for insurance companies. “When you’re trying to incentivize things, and you don’t want to push up the dollar cost, you can push up the time cost,” said Andrew Friedson, the director of health economics at the Milken Institute.

Administrative burden can work as a technique to keep costs down. However, part of the problem, Dr. Friedson said, is that we don’t count the burden to patients, and so it doesn’t factor into policy decisions. There’s nobody measuring the time spent on the phone plus lost wages plus complications from delayed care for every single patient in the United States. A recent study co-written by Michael Anne Kyle, a research fellow at Harvard Medical School, found that about a quarter of insured adults reported their care was delayed or missed entirely because of administrative tasks.

. . .

One of the first steps to any comprehensive solution would be a true accounting of the costs of administrative burden. Maybe we in the medical system do have to start counting up the hours patients and providers spend on the phone, in waiting rooms and filling out forms. That would be difficult: It’s not a metric the health care industry is used to evaluating. But it’s not harder than doing the work itself, as patients do.