Category: Health

Data Set Too Small to Support Claim of 250,000 Annual ER Deaths Due to Misdiagnosis

(p. A17) A shocking headline recently claimed that every year 250,000 people in the U.S. die after misdiagnosis in the emergency room. Even more shocking, the statistic was extrapolated from the death of one man—in a Canadian emergency room more than a decade ago.

. . .

The statistical methods used to arrive at the report’s estimate of 250,000 deaths are very bad, resulting in inaccurate findings that exaggerate potential harm in ERs. The estimate was derived from a single study that included only 503 patients discharged from two Canadian emergency rooms from August to December 2004. Researchers found that among the 503 patients, one person unexpectedly died related to a delay in diagnosis by an ER physician. The patient had signs of an aortic dissection—a tear in the major vessel that carries blood from the heart. For reasons we don’t know, the diagnosis was delayed for seven hours.

The goal of the Canadian study was to measure all kinds of medical errors, not to estimate the death rate from erroneous or late diagnoses. The sample size wasn’t big enough for that. Had nobody in the study sample died, would that mean that ERs never make fatal errors? Obviously not.

The AHRQ report misused this single death to estimate a death rate across the entire U.S. Dividing one death by 503 patients, the researchers estimate a death rate of 0.2%. They then multiply 0.2% by total annual ER visits in the U.S.—130 million—and come up with 250,000 deaths.

For the full commentary, see:

Kristen Panthagani. “A Study Sounds a False Alarm About America’s Emergency Rooms.” The Wall Street Journal (Friday, Dec. 30, 2022): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date December 29, 2022, and has the same title as the print version.)

Longevity Proof of Concept–A Jellyfish That Can Return to a Younger Form

(p. A15) When Benjamin Franklin wrote that “nothing can be said to be certain, except death and taxes,” he must have thought he was stating an eternal truth. But if biotechnology researcher Nicklas Brendborg is to be believed, Franklin’s joke may need some updating. According to Mr. Brendborg, scientists have discovered a jellyfish the size of a fingernail that responds to stress by “ageing backwards,” reversing the normal direction of its development to become a bottom-dwelling polyp. This trick can be repeated over and over again with “no physiological recollection of having been older,” he explains, making this jellyfish “an example of the holy grail of ageing research—biological immortality.”

This tiny Methuselah is one of the striking examples in Mr. Brendborg’s breezy survey of the science of longevity, “Jellyfish Age Backwards,” which the author has translated from the Danish with Elizabeth DeNoma.

. . .

Short chapters built from short, declarative sentences combine with familiar material to give “Jellyfish Age Backwards” the feel of an introductory survey rather than a novel argument. Perhaps its piecewise construction is only a reflection of the disjointed state of the subject, where researchers are pulling on various threads but have not yet managed to knit them into a coherent whole. Mr. Brendborg finishes with a ringing declaration that the “noble” efforts of medical science will “eventually defeat” aging. But biology is complicated, as the author admits, and the strands of this multivariate and complex phenomenon may eventually prove to be tangled in some unresolvable knot.

For the full review, see:

Richard Lea. “BOOKSHELF; Dying Young At a Late Age.” The Wall Street Journal (Friday, Dec. 30, 2022): A15.

(Note: the online version of the review has the date December 29, 2022, and has the title “BOOKSHELF; ‘Jellyfish Age Backwards’ Review: Dying Young at a Late Age.”)

The book under review is:

Brendborg, Nicklas. Jellyfish Age Backwards: Nature’s Secrets to Longevity. Translated by Elizabeth DeNoma. New York: Little, Brown & Company, 2023.

Firing an Actor “Early Could Be a Motivator for the Remaining Cast”

The ability to fire at will gives the entrepreneur (and the movie director) the ability to put together the right team for a project. Keeping those employed who are not doing their jobs, can be demoralizing for those who are doing their jobs.

(p. C1) When the writer and director Mike Nichols was young, he had an allergic reaction to a whooping cough vaccine. The result was a complete and lifelong inability to grow hair. One way to read Mark Harris’s crisp new biography, “Mike Nichols: A Life,” is as a tender comedy about a man and his wigs.

. . .

(p. C5) Harris is the author of two previous books, “Pictures at a Revolution: Five Movies and the Birth of the New Hollywood” and “Five Came Back: A Story of Hollywood and the Second World War.” He’s also a longtime entertainment reporter with a gift for scene-setting.

He’s at his best in “Mike Nichols: A Life” when he takes you inside a production. His chapters on the making of three films in particular — “The Graduate,” “Silkwood” and “Angels in America” — are miraculous: shrewd, tight, intimate and funny. You sense he could turn each one into a book.

Nichols was an actor’s director. &nbsp. . .  But he had a steely side.

He fired Gene Hackman during week one on “The Graduate.” Hackman was playing Mr. Robinson and it wasn’t working, in part because, at 37, he looked too young for the role.

Sacrificing someone early could be a motivator for the remaining cast, he learned. He fired Mandy Patinkin early in the filming of “Heartburn,” and brought in Jack Nicholson to play Meryl Streep’s faithless husband.

For the full review, see:

Dwight Garner. “BOOKS OF THE TIMES; The Wit and Wigs Of a Star-Studded Life.” The New York Times (Tuesday, January 26, 2021): C1 & C5.

(Note: ellipses added.)

(Note: the online version of the review was updated Jan. 29, 2021, and has the title ‘BOOKS OF THE TIMES; ‘Mike Nichols’ Captures a Star-Studded Life That Shuttled Between Broadway and Hollywood.”)

The book under review:

Harris, Mark. Mike Nichols: A Life. New York: Penguin Press, 2021.

Recent Degrowth Policies Will “Reduce Medicare and Social Security Tax Revenue by at Least $400 Billion”

(p. A13) President Biden released his 2024 budget request Thursday while continuing to accuse Republicans of scheming to cut benefits for seniors. But he’s got it backward. By advancing policies that hinder the economic growth that drives prosperity, Mr. Biden and his Democratic colleagues are the ones depriving Social Security and Medicare of the hundreds of billions of dollars those programs need to remain solvent.

. . .

My own research on the Biden agenda’s effect on Social Security and Medicare makes clear that low economic growth translates into smaller benefits for seniors. These programs give the elderly a share of the earnings of the nation’s current workers. The more people who work, and the more each worker earns, the more payroll tax revenue is available to fund Social Security and Medicare. I estimate that degrowth policies since 2020 will cumulatively reduce Medicare and Social Security tax revenue by at least $400 billion—and perhaps as much as $900 billion. The tax base will shrink even more if Mr. Biden succeeds in levying higher wealth and business taxes.

For the full commentary, see:

Casey B. Mulligan. “Biden’s Assault on Social Security.” The Wall Street Journal (Monday, March 10, 2023): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date March 9, 2023, and has the title “Biden’s Budget Is an Assault on Social Security.”)

A somewhat more detailed version of Mulligan’s argument can be found in:

Mulligan, Casey B. “Payroll Tax Revenues Down $400 to $900 Billion Due to Lower Wages and Less Growth.” Washington, D.C.: Committee to Unleash Prosperity, March 2023.

“The Reliability of Science Is Based” on Free Speech

Theoretical physicist Carlo Rovelli’s argument should be pondered by global warming and Covid scientists who want to censor and cancel those with whom they disagree. They should also read John Stuart Mill’s On Liberty.

(p. C5) Science is a process that builds upon existing theories and knowledge by continuously revising them. Every aspect of scientific knowledge can be questioned, including the general rules of thinking that appear to be most certain.

. . .

Consider a folk healer’s herbal medicine. Can we say this treatment is “scientific”? Yes, if it is proven to be effective, even if we have no idea why it works. In fact, several common medications used today have their origin in folk treatments, and we are still not sure how they work. This does not imply that folk treatments are generally effective. To the contrary, most of them are not. What distinguishes scientific medicine from nonscientific medicine is the readiness to seriously test a treatment and to be ready to change our minds if something is shown not to work.

Exaggerating a bit, one could say that the core of modern medicine is not much more than the accurate testing of treatments. A homeopathic doctor is not interested in rigorously testing his remedies: He continues to administer the same remedy even if a statistical analysis shows that the remedy is ineffective. He prefers to stick to his theory. A research doctor in a modern hospital, on the contrary, must be ready to change his theory if a more effective way of understanding illness, or treating it, becomes available.

. . .

What makes modern science uniquely powerful is its refusal to believe that it already possesses ultimate truth. The reliability of science is based not on certainty but on a radical lack of certainty. As John Stuart Mill wrote in “On Liberty” in 1859, “The beliefs which we have most warrant for, have no safeguard to rest on, but a standing invitation to the whole world to prove them unfounded.”

. . .

There is no secure method for avoiding error. Our point of departure is always just the ramshackle, error-filled totality of what we think we know. But uncertainty does not make knowledge worthless. If our theory is contradicted by experiment, this remains a real fact, solid as rock, even if we don’t yet know with clarity where our mistake lies. The fact that the assumptions in our reasoning can be mistaken doesn’t change the fact that scientific reasoning is our best cognitive tool.

For the full essay, see:

Carlo Rovelli. “The Best Reason to Trust Science.” The Wall Street Journal (Saturday, March 11, 2023): C5.

(Note: ellipses added.)

(Note: the online version of the essay has the date March 9, 2023, and has the same title as the print version.)

Rovelli’s essay quoted above is based on his book:

Rovelli, Carlo. Anaximander and the Birth of Science. New York: Riverhead Books, 2023 (2011).

Mill’s wonderful defense of freedom, mentioned above, is:

Mill, John Stuart. On Liberty and Other Essays, Oxford World’s Classics. New York: Oxford University Press, USA, 2008 (1859).

Electrobiome Scientists Hope Manipulating Microcurrents Can Cure “Dozens of Ailments”

(p. 10) A decade ago Adee became especially intrigued by some highly secret taxpayer-funded work performed by the Pentagon’s ultra-costly fun factory, the Defense Advanced Research Projects Agency, inventors (they claim) of the internet. Lately the agency has been conducting, if that be the word, experiments on how best to harness the body’s minute pulses of cellular battery power, and turn them to military advantage — by killing people, that is. Might electricity help our G.I.s to whack our enemies ever more quickly and efficiently, tuning a soldier’s brain by jolting it with carefully targeted surges of electric shocks?

“We Are Electric” begins with a highly seductive scenario: Adee is flown from Europe to a clandestine Pentagon facility in the mountains of Southern California.

. . .

The lights dim, and a tsunami of simulated assaults then commences, overwhelming the scene. DARWARS — Ambush! they call it. Computer-generated enemy troops flood onto the field, squadrons of Humvees, faceless men with suicide belts, all attacking without mercy, and at all of which Adee fires her gun, wildly. Mostly, she misses.

Then the smoke clears, her DARPA handler-bros return and this time they turn on the juice. The lights dim once again, the faux-soldiers pour in and everything changes. Through the smoke and din and confusion of battle, there emerges from within Adee’s terrified mind the calculating confidence of a cool and logically-directed assassin. One by one she picks off the invaders. She fires and fires until her magazine is depleted. The battlespace falls silent. The smoke clears once again.

. . .

Dozens of ailments may yet be cured, say the believers, by manipulating the ions down the billions of miles of invisible circuitry that lies deep within our bodies.

Sally Adee has written an absorbing and fast-paced account of a field of research that could thus herald a whole new era of paradigm-shifting medicine. Moreover, she has done so without apparently drinking the Kool-Aid of today’s many bioelectricity boosters.

For the full review, see:

Simon Winchester. “Charged Up.” The New York Times Book Review (Sunday, March 26, 2023): 10.

(Note: the online version of the review has the date February 28, 2023, and has the title “Meet the Electrome. It Can Turn You Into an Assassin.”)

The book under review is:

Adee, Sally. We Are Electric: Inside the 200-Year Hunt for Our Body’s Bioelectric Code, and What the Future Holds. New York: Hachette Books, 2023.

Exercise Can Beat Meds in Countering Anxiety and Depression

(p. A15) . . . a new paper evaluating studies of the impact of exercise on mood shows that physical activity, of any kind, is just as effective as antidepressants at reducing feelings of anxiety and depression—and sometimes more effective.

Dr. Ben Singh, a research fellow at the University of South Australia, was the lead author of the study, which appeared in February in the British Journal of Sports Medicine. He and 12 other scientists combed the research literature for all randomly controlled studies published before 2022 that involved adding exercise to a person’s “usual care,” to see how physical activity might relieve psychological distress.

. . .

“Any type of movement is effective: a bike ride, yoga or Pilates” said Dr. Singh. He mentioned that resistance training (like my Zoom workout) was best for reducing symptoms of depression, while yoga and Pilates were best at tamping down anxiety. “The higher the intensity, the better,” Dr. Singh said. “But just a walk around your neighborhood is effective, too.”

For the full commentary, see:

Susan Pinker. “MIND AND MATTER: Exercise Can Be the Best Antidepressant.” The Wall Street Journal (Saturday, March 25, 2023): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 23, 2023, and has the same title as the print version.)

The “new paper” mentioned above is:

Singh, Ben, Timothy Olds, Rachel Curtis, Dorothea Dumuid, Rosa Virgara, Amanda Watson, Kimberley Szeto, Edward Connor, Ty Ferguson, Emily Eglitis, Aaron Miatke, Catherine E. M. Simpson, and Carol Maher. “Effectiveness of Physical Activity Interventions for Improving Depression, Anxiety and Distress: An Overview of Systematic Reviews.” British Journal of Sports Medicine (Feb. 16, 2023), DOI:10.1136/bjsports-2022-106195.

The “Affordable” Care Act Gives Huge Drug Subsidies to Rich, Urban “Nonprofit” Hospitals

(p. A1) A decades-old federal program that offered big drug discounts to a small number of hospitals to help low-income patients now benefits some of the most successful nonprofit health systems in the U.S.

Under the program, hospitals buy drugs at reduced prices and sell them to patients and their insurers for much more, often at facilities in affluent communities.

One participant is the Cleveland Clinic’s flagship hospital, which reported $1.35 billion in net income last year. The hospital doesn’t admit enough Medicaid and low-income Medicare patients to qualify for low-cost drugs under the program’s original requirements. But a quirk in federal law allowed the hospital to qualify as a “rural referral center,” despite its location near the center of Cleveland.

Despite the benefits, the program hasn’t resulted in new drug discounts for low-income Cleveland Clinic patients, nor has it caused the hospital to increase the financial assistance it offers to those who can’t afford care. (p. A10) The charity care the main hospital writes off represents less than 2% of its patient revenue, according to a Wall Street Journal analysis of hospital Medicare filings.

. . .

The hospital’s $1.35 billion net income figure for 2021, she said, includes investment returns.

Cleveland Clinic’s adoption of the drug-discount program at its main hospital in April 2020 produced about $136 million in savings on drugs that year, the spokeswoman said.

The federal drug-discount program, known as 340B after the statutory provision that created it, requires pharmaceutical companies to sell drugs to participating hospitals at reduced prices. The program has grown rapidly in recent years. It now includes about 2,600 nonprofit and government hospitals, which spent at least $38 billion on discounted drugs last year, according to the Health Resources and Services Administration, the federal agency known as HRSA that oversees the program.

What the hospitals do with their valuable discounts isn’t always clear.

The program doesn’t require participating hospitals to pass on drug discounts to patients, insurers or Medicare. There is no rule limiting how much they can charge for the drugs. They don’t have to report how much they make from such sales, nor do they have to spend any profits to benefit low-income patients.

. . .

The 2010 Affordable Care Act brought a big expansion of 340B, adding new categories including critical access hospitals, which are small, typically rural facilities, and rural referral centers, which are supposed to be rural hospitals that treat a large volume of patients, including many complicated cases.

Under the federal definition of rural referral centers, hospitals that aren’t in rural locations could still qualify if they meet other criteria—minimally, having at least 275 beds. There is no requirement to serve rural patients.

. . .

“We were trying to help rural hospitals,” said Robert Kocher, an Obama White House health adviser involved in crafting the ACA who is now at venture-capital firm Venrock. “It would not be our intention to have a medical center in Cleveland, Boston or Chicago be included.”

For the full story, see:

Anna Wilde Mathews, Paul Overberg, Joseph Walker and Tom McGinty. “Drug Discounts Aimed at Needy Boost Hospitals.” The Wall Street Journal (Wednesday, Dec. 21, 2022): A1 & A10.

(Note: ellipses added.)

(Note: the online version of the story has the date December 20, 2022, and has the title “Many Hospitals Get Big Drug Discounts. That Doesn’t Mean Markdowns for Patients.”)

Government Contractor UNOS Is 15 Times More Likely to Lose or Damage Transplant Organs as Private Airlines Are to Lose or Damage Luggage

(p. A24) Where Tonya lives in California, the wait for a kidney from a deceased donor is up to 10 years. Tonya, like many on dialysis to treat kidney failure, knows the odds of her surviving the wait are slim; the median survival time for patients on dialysis is five years.

. . .

Everyday Americans are doing their part, signing up to be organ donors, but the organizations in charge of organ recovery (known as organ procurement organizations, or O.P.O.s) have been plagued with inefficiencies and abuses, and the contractor that runs the national system — the United Network for Organ Sharing (UNOS) — has been failing to oversee them.

The organ procurement system is made up of 56 organizations, each with a monopoly in its jurisdiction. When someone dies and can donate an organ, O.P.O.s are supposed to go to the hospital, talk to the person’s family and manage the process of transporting donated organs to those in need, but all too often they have failed to show up — literally.

. . .

Tonya asked the government to hold these organizations accountable, and naïvely, we thought it would be that simple. Our efforts would surely get Tonya a kidney.

She did everything she could to push for change, everything that our government asks of concerned citizens: She wrote an opinion essay; appeared in a government video; wrote letters to members of the Biden administration, including the Centers for Medicare and Medicaid Services (C.M.S.) administrator Chiquita Brooks-LaSure and the head of the Health Resources and Services Administration, Carole Johnson; worked with members of Congress, including Representative Katie Porter; and even testified before the House Oversight Subcommittee on Economic and Consumer Policy in May 2021.

There she told the committee she would die without the federal government’s urgent action. A year and a half later, on Dec. 30, 2022, Tonya died of complications from kidney failure.

. . .

After the video Tonya and I made, in 2020 the Trump administration finalized a rule bringing accountability to the forefront, and the Biden administration has inherited it. This is a good start: The new rule changes the metrics by which O.P.O.s are evaluated and requires that they face decertification for failure to perform. But the rule would not replace a single failing organ contractor until 2026, which is not acceptable.

. . .

To make matters worse, in the Biden administration’s 2023 budget, the C.M.S. requested flexibility to recertify failing O.P.O.s so they can keep their contracts even after 2026. If we allow failing O.P.O.s to keep operating, then we essentially nullify the reform we’ve worked so hard for and ensure further delays and more deaths.

. . .

When the Senate Finance Committee finally began investigating, it found that UNOS has systematically failed to provide oversight. At the committee hearing, doctors and transplant professionals testified that they have been afraid to criticize UNOS publicly, for fear it will retaliate against their patients. Also at the hearing, Senators Elizabeth Warren, Charles Grassley and Rob Portman called out another mind-boggling fact: From 2014 to 2019, UNOS was 15 times as likely to lose or damage an organ in transit as an airline is a passenger’s luggage.

For the full commentary, see:

Kendall Ciesemier. “She Feared the Organ Donation System Would Kill Her. It Did..” The New York Times (Wednesday, February 1, 2023): A24.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Jan. 28, 2023, and has the title “Tonya Ingram Feared the Organ Donation System Would Kill Her. It Did.”)

Mary Grimaldi Died of Measles a Few Days Before the Government Approved the Vaccine That Would Have Saved Her

(p. A15) Members of my own family have . . . chosen not to vaccinate their children against measles, even as my mother laments that the measles vaccine didn’t arrive in time for Sissy, as Maura was known in our family. She recently told me that she wishes she had found a way to enroll Sissy in the measles-vaccine trial, which involved 50,000 children over several years in the early 1960s.

. . .

Until the vaccine, the only way to gain immunity to measles was to contract the disease. Sissy was exposed as an infant when my brothers caught it, but the case wasn’t severe enough to give her immunity. “She’ll have to get the shot when it’s available,” the family pediatrician, Dr. George Herman, told my mother.

Why did it take so long for that to happen? Culturing the virus from the blood serum of young David Edmondston, and then weakening or “attenuating” it enough for a vaccine, was no easy feat. “The hardest vaccine to make is a live, attenuated vaccine,” said Dr. Offit. He would know: It took him and fellow virologists 26 years to develop a safe and effective vaccine against rotavirus, which can cause potentially fatal diarrhea in infants. “It is all trial and error. Nine years is fast,” Dr. Offit said.

It wasn’t fast enough for Sissy.

. . .

The Kansas City Times ran a short obituary. The paper asked my parents if they wanted to report the cause of death, and my mother said yes, “so that other parents would know to get the vaccine when it was available.”

A few pages away was an article headlined “O.K. on Measles Vaccine; Two Forms Released by Government and Surgeon General Predicts a Sharp Drop in the Disease Next Season.” “This is one of our most significant advances toward decreasing or eliminating one of our most serious childhood diseases,” said U.S. Surgeon General Luther Terry. An editorial in the paper on the vaccine news concluded, “The disease and its sometimes tragic consequences are on the way out with other ancient plagues.”

For the full essay, see:

James V. Grimaldi. “My Family and the Measles Vaccine.” The Wall Street Journals (Saturday, March 25, 2023): A15.

(Note: ellipses added.)

(Note: the online version of the essay has the March 23, 2023, and has the same title as the print version.)

Allow Entrepreneurial Competition in Medicine by Ending Obamacare’s Ban on Physician-Owned Hospitals

(p. A17) A tiny paragraph in the enormous Affordable Care Act prohibits physicians from building or owning hospitals. Any existing physician-owned hospital built before 2010 is prohibited from growing beyond the size it was when the bill passed. This law limits competition, defies common sense and is likely contributing to higher prices for Medicare and reduced access to treatment for millions of Americans.

. . .

. . . recent research affirms the power of American entrepreneurship to lower costs and improve quality. Doctors, whether at the bedside or the forefront of scientific innovation, are well-suited to reimagine healthcare operations, lower costs and improve the quality of care.

Specialty physician-owned hospitals focused on cardiology and cardiac surgery were found to deliver higher-quality care than nonprofit hospitals, with lower rates of hospital readmission or mortality for high-risk surgery. Physician-owned specialty hospitals for orthopedic procedures, such as hip and knee replacements, offered lower costs and higher quality than nonprofit counterparts.

. . .

Healthy competition drives job creation, innovation and long-term economic growth. The federal government doesn’t prohibit plumbers from owning plumbing companies, radio hosts from owning radio stations or farmers from owning farmers markets. It’s time to reopen the free market in healthcare and let the power of competition do its work.

For the full commentary, see:

James Lankford and Brian J. Miller. “End ObamaCare’s Ban on Physician-Owned Hospitals.” The Wall Street Journal (Tuesday, Feb. 21, 2023): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date February 20, 2023, and has the same title as the print version.)