Category: Health

Cerebrospinal Fluid From Young Mice Improves the Memories of Old Mice

(p. D3) Five years ago, Tal Iram, a young neuroscientist at Stanford University, approached her supervisor with a daring proposal: She wanted to extract fluid from the brain cavities of young mice and to infuse it into the brains of older mice, testing whether the transfers could rejuvenate the aging rodents.

. . .

Dr. Iram persevered, working for a year just to figure out how to collect the colorless liquid from mice. On Wednesday [May 11, 2022], she reported the tantalizing results in the journal Nature: A week of infusions of young cerebrospinal fluid improved the memories of older mice.

. . .

Cerebrospinal fluid made for a logical target for researchers interested in aging. It nourishes brain cells, and its composition changes with age. Unlike blood, the fluid sits close to the brain.

But for years, scientists saw the fluid largely as a way of recording changes associated with aging, rather than countering its effects. Tests of cerebrospinal fluid, for example, have helped to identify levels of abnormal proteins in patients with significant memory loss who went on to develop Alzheimer’s disease.

. . .

“This is a very cool study that looks scientifically solid to me,” said Matt Kaeberlein, a biologist who studies aging at the University of Washington and was not involved in the research. “This adds to the growing body of evidence that it’s possible, perhaps surprisingly easy, to restore function in aged tissues by targeting the mechanisms of biological aging.”

Dr. Iram tried to determine how the young cerebrospinal fluid was helping to preserve memory by analyzing the hippocampus, a portion of the brain dedicated to memory formation and storage. Treating the old mice with the fluid, she found, had a strong effect on cells that act as precursors to oligodendrocytes, which produce layers of fat known as myelin that insulate nerve fibers and ensure strong signal connections between neurons.

The authors of the study homed in on a particular protein in the young cerebrospinal fluid that appeared involved in setting off the chain of events that led to stronger nerve insulation. Known as fibroblast growth factor 17, or FGF17, the protein could be infused into older cerebrospinal fluid and could partially replicate the effects of young fluid, the study found.

Even more strikingly, blocking the protein in young mice appeared to impair their brain function, offering stronger evidence that FGF17 affects cognition and changes with age.

. . .

But Dr. Wyss-Coray said that the study filled a critical gap in the understanding of how the brain’s environment changes as people age.

“The question is, ‘How can you maintain cognitive health until you die? How can you make the brain resilient to this relentless degeneration of the body?’” he said, “and what a growing number of studies show is that as we learn more about the aging process itself, maybe we can slow down aspects of aging and maintain tissue integrity or even rejuvenate tissues.”

For the full story, see:

Benjamin Mueller. “A Step Toward Refreshing Memory.” The New York Times (Tuesday, May 17, 2022): D3.

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

(Note: the online version of the story has the date May 11, 2022, and has the title “Spinal Fluid From Young Mice Sharpened Memories of Older Rodents.”)

The academic article in Nature that reports the results discussed in the passages quoted above is:

Iram, Tal, Fabian Kern, Achint Kaur, Saket Myneni, Allison R. Morningstar, Heather Shin, Miguel A. Garcia, Lakshmi Yerra, Robert Palovics, Andrew C. Yang, Oliver Hahn, Nannan Lu, Steven R. Shuken, Michael S. Haney, Benoit Lehallier, Manasi Iyer, Jian Luo, Henrik Zetterberg, Andreas Keller, J. Bradley Zuchero, and Tony Wyss-Coray. “Young CSF Restores Oligodendrogenesis and Memory in Aged Mice Via Fgf17.” Nature 605, no. 7910 (May 19, 2022): 509-15.

Gillies Created Reconstructive Surgery “Through Trial and Error”

(p. C6) During World War I, a handful of soldiers who had suffered catastrophic facial wounds traveled to Paris on a journey of last resort.

. . .

Trench warfare produced a huge number of facial injuries, and bespoke masks could never keep up with the demand.

. . .

But masks were of limited value, because they could conceal, but never heal, grievous wounds. Disfigured men needed a medical breakthrough to help them. Ms. Fitzharris, the author of “The Butchering Art” (2017), a history of Victorian medicine, chronicles the life of the British plastic surgeon Harold Delf Gillies, whose innovations and operating-room magic saved thousands of warriors from their fates and allowed them to walk in the world again. Both heartbreaking and inspiring, “The Facemaker” tells a profound story of survival, resurrection and redemption.

Born in New Zealand and educated in England, Gillies entered the Royal Army Medical Corps early in the war, at age 32. A champion amateur golfer, he began his soldiering as a novice military doctor. The second Battle of Ypres, in May 1915, was his baptism by fire. It was there, Ms. Fitzharris says, that he “first stepped into a field hospital’s makeshift operating theater,” where he labored around the clock, standing on a floor awash with blood. A month later, he was assigned to the Allied Forces base hospital in Étaples, France. The dental surgeon Auguste Charles Valadier showed him how to use bone grafts to reconstruct faces without distorting the features and to restore a patient’s ability to speak and eat.

That summer, Gillies sought out Hippolyte Morestin, an eccentric French surgeon devoted to achieving high-quality aesthetic results. Gillies watched Morestin remove a large cancerous growth from a patient’s face and close the wound with a flap of skin from the patient’s neck. It was a turning point for Gillies, who would describe the moment as “the most thrilling thing I had ever seen. I fell in love with the work on the spot.”

. . .

[Gillies’s] . . . key insight was that a multidisciplinary approach was needed: the combined work of plastic surgeons, dental surgeons, nurses, radiologists, artists, sculptors and photographers.

Gillies conceded it was “a strange new art,” without textbooks, precedent, or experience to guide its practice. Through trial and error, he re-created missing mouths and noses, filled in gaping voids of bone and flesh, restored obliterated jaws, treated horrific burns, and performed skin grafts. Until then, most surgeons had stitched together the edges of a gaping wound, a process that could cause necrosis and cellular destruction as well as further disfigurement. Among other things, Gillies learned that, to achieve the best results, he needed to perform surgery incrementally and space operations out over time, to allow patients to recover from one surgery to the next. Some men required 15 or 20 operations, occasionally as many as 40. “Never do today what can be put off till tomorrow” became his motto.

And Gillies mastered the use of the flaps, which are made to cover a wound and which have, as Ms. Fitzharris tells us, their “own blood supply in the form of a single large artery or multiple smaller blood vessels.” Gillies’s greatest invention was the tubed pedicle—a flap of skin attached to a “protective, infection-resistant cylinder,” which was itself attached to the injury site. It “dramatically reduced the chance for infection,” Ms. Fitzharris writes.

For the full review, see:

James L. Swanson. “Repairing the Wounds of War.” The Wall Street Journal (Saturday, May 28, 2022): C6.

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

(Note: the online version of the review has the date May 27, 2022, and has the title “‘The Facemaker’ Review: Repairing the Wounds of War.”)

The book under review is:

Fitzharris, Lindsey. The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War. New York: Farrar, Straus and Giroux, 2022.

Lacking Government Approval During Pandemic, “State-of-the-Art Testing Machines . . . Weren’t Turned On”

(p. 12) The ethics manual of the American College of Physicians states that “the ethical imperative for physicians to provide care” overrides “the risk to the treating physician, even during epidemics.” Nevertheless, for most of human history, doctors often ran away in the face of widespread contagious disease.

. . .

When health workers stick around to treat patients, even at risk to their own lives, it is something to be celebrated, and the journalist Marie Brenner does just that in “The Desperate Hours,” an account of how workers at New York-Presbyterian, an academic health system, coped with the Covid surge in New York City beginning in the spring of 2020. The book details both medical heroism and corporate cowardice, prescient decisions and howling missteps, all against the backdrop of a swirling and mysterious pandemic that claimed the lives of more than 30,000 residents, not to mention 35 New York-Presbyterian employees.

Along the way we encounter some eye-opening anecdotes. Early on, New York City hospitals were faced with an alarming dearth of masks and a near rebellion by workers on the front lines. In response, New York-Presbyterian’s chief operating officer, Dr. Laura Forese, a pediatric orthopedic surgeon, assured staff members that “masks would not be necessary” unless workers were in direct contact with infected patients. Though she was working off mistaken C.D.C. guidelines, it was “advice and regulation that countermanded every bit of common sense understood by public health officials since the Black Plague,” Brenner writes.

. . .

Yet state-of-the-art testing machines at New York-Presbyterian weren’t turned on because the leadership was waiting for the government to approve their use. When doctors and nurses complained, the communications office attempted to throttle them and even threatened them with demotions or dismissal. It is part of what Dr. Steve Corwin, New York-Presbyterian’s chief executive, calls “a failure of imagination on our part.”

The book has its share of heroes who buck the strictures of the system to speak the truth about what was coming (or had already arrived). No one was more heroic than Dr. Nathaniel Hupert, an infectious-disease modeler at New York-Presbyterian who raised the alarm about the pandemic in February 2020 but was largely ignored.

“This is going to be historically bad, rivaling the medical consequences of 1918, but far exceeding it in terms of global financial impact,” he warned his colleagues. “If we get through this, it will be the sort of thing that we will tell our grandchildren about.” Yet when Hupert showed his projections at a planning meeting, the medical school dean told him, “I think we will be all right.”

. . .

Compounding the disaster was that little guidance was coming from executives on how to navigate the crisis, including how to potentially ration beds and ventilators (which fortunately did not come to pass). “The amount of moral damage they did to a lot of people while they get paid millions of dollars is disgusting,” a critical-care physician says bitterly.

For the full review, see:

Sandeep Jauhar. “Plagued.” The New York Times Book Review (Sunday, July 3, 2022): 12.

(Note: ellipses added.)

(Note: the online version of the review has the date June 19, 2022, and has the title “Facing Death During the Pandemic.”)

The book under review is:

Brenner, Marie. The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines. New York: Flatiron Books, 2022.

Spreading Smallpox Inoculation to Impress Voltaire

(p. A15) Dimsdale had been summoned by Catherine the Great to inoculate not only the empress herself but also her 13-year-old heir, the Grand Duke Paul.

. . .

As Lucy Ward dramatically relates in “The Empress and the English Doctor: How Catherine the Great Defied a Deadly Virus,” Catherine’s invitation was a high-stakes affair, a testament to Dimsdale’s writings on the methodology of smallpox inoculation and his reputation for solicitous care. His Quaker upbringing had encouraged a brand of outcome- rather than ego-led practice.

. . .

As devastating as smallpox was, for the empress herself and the grand duke who would succeed her to personally undergo inoculation was a risk to both patient and doctor. On the success side stood immunity from the disease, an almost holy example for Catherine’s people, and as-yet-untold riches for her nervous doctor. On the other side, not only the fact that all Russia would refuse the treatment if their “Little Mother” died, but also a disaster for Dimsdale and the son who had accompanied him. Geopolitics came into play too—if things went wrong, some would interpret it as a foreign assassination.

. . .

With a happy result for her and her less-robust son, Catherine sets about publicizing the success. Dimsdale receives the equivalent of more than $20 million and a barony. Bronze medals are cast of Catherine’s profile, reading “She herself set an example.” It helps that Catherine was competitive beyond reason: “we have inoculated more people in a month than were inoculated in Vienna in eight,” she wrote to Voltaire, determined to beat Empress Maria Theresa’s efforts.

For the full review, see:

Catherine Ostler. “BOOKSHELF; Inoculate Conception.” The Wall Street Journal (Thursday, June 23, 2022): A15.

(Note: ellipses added.)

(Note: the online version of the review was updated June 22, 2022, and has the title “BOOKSHELF; ‘The Empress and the English Doctor’ Review: Inoculate Conception.”)

The book under review is:

Ward, Lucy. The Empress and the English Doctor: How Catherine the Great Defied a Deadly Virus. London, UK: Oneworld Publications, 2022.

Organic Strawberries Blamed for Hepatitis A Outbreak

(p. A21) Public health officials said they were investigating an outbreak of hepatitis A in the United States and Canada that is potentially linked to organic strawberries.

American health officials said the outbreak most likely came from fresh organic strawberries branded as FreshKampo and H-E-B that were bought between March 5 and April 25.

The strawberries were sold at stores including Aldi, H-E-B, Kroger, Safeway, Sprouts Farmers Market, Trader Joe’s, Walmart and Weis Markets, the Food and Drug Administration said.

. . .

In the United States, the F.D.A. said it had identified 17 cases of hepatitis A linked to the strawberries — 15 in California and one each in Minnesota and North Dakota. Twelve people have been hospitalized, the agency said.

. . .

Hepatitis A is a contagious virus that may cause liver disease.

. . .

Symptoms usually develop 15 to 20 days after eating the contaminated food and can include fatigue, nausea, vomiting, abdominal pain, jaundice, dark urine and pale stool, the F.D.A. said.

For the full story see:

Michael Levenson. “Strawberries Linked to Hepatitis A Outbreak, F.D.A. Says.” The New York Times (Wednesday, June 1, 2022): A21.

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

(Note: the online version of the story has the date May 31, 2022 and has the title “Hepatitis A Outbreak in U.S. and Canada Linked to Strawberries.”)

Dr. Zelenko’s pre-Covid-19 memoir is:

Zelenko, Vladmir. Metamorphosis. Lakewood, NJ: Israel Bookshop Publications, 2019.

A highly credentialed Yale academic presented evidence of the promise of hydroxychloroquine for early outpatient treatment in:

Risch, Harvey A. “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients That Should Be Ramped-up Immediately as Key to the Pandemic Crisis.” American Journal of Epidemiology 189, no. 11 (Nov. 2020): 1218–26.

“Quiet, Unassuming” Dr. Zelenko Got Twitter Suspension and Death Threats for Speaking on Hydroxychloroquine

Dr. Zelenko was stricken with a rare form of lung cancer in 2018, shortly before the Covid-19 pandemic. I wonder if that increased his personal sense of urgency to find a cure for Covid-19?

(p. A21) Vladimir Zelenko, a self-described “simple country doctor” from upstate New York who rocketed to prominence in the early days of the Covid-19 pandemic when his controversial treatment for the coronavirus gained White House support, died on Thursday in Dallas. He was 48.

. . .

Like many health care providers, he scrambled when the coronavirus began to appear in his community. Within weeks he had landed on what he insisted was an effective cure: a three-drug cocktail of the antimalarial drug hydroxychloroquine, the antibiotic azithromycin and zinc sulfate.

. . .

“At the time, it was a brand-new finding, and I viewed it like a commander in the battlefield,” Dr. Zelenko told The New York Times. “I realized I needed to speak to the five-star general.”

On March 28, [2020] the Food and Drug Administration granted emergency authorization to doctors to prescribe hydroxychloroquine and another antimalarial drug, chloroquine, to treat Covid. Mr. Trump called the treatment “very effective” and possibly “the biggest game changer in the history of medicine.”

But, as fellow medical professionals began to point out, Dr. Zelenko had only his own anecdotal evidence to support his case, and what little research had been done painted a mixed picture.

Still, he became something of a folk hero on the right, someone who offered not just hope amid the pandemic but also an alternative to the medical establishment and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who insisted that months of research would be needed to find an effective treatment.

. . .

A quiet, unassuming man, Dr. Zelenko seemed unprepared for the attention he received, which included harassing phone calls and even death threats. In May 2020, a federal prosecutor opened an investigation into whether he had falsely claimed F.D.A. approval for his research.

. . .

After the F.D.A. rescinded its approval of hydroxychloroquine as a Covid treatment, he founded a company, Zelenko Labs, to promote other nonconventional treatments for the disease, including vitamins and quercetin, an anti-inflammatory drug.

And while he claimed to be apolitical, he embraced the image of a victim of the establishment. He founded a nonprofit, the Zelenko Freedom Foundation, to press his case. In December 2020, Twitter suspended his account, stating that it had violated standards prohibiting “platform manipulation and spam.”

. . .

In a memoir, “Metamorphosis” (2018), Dr. Zelenko wrote that he grew up nonreligious and entered Hofstra University as an avowed atheist.

“I enjoyed debating with people and proving to them that G-d did not exist,” he wrote. “I studied philosophy and was drawn to nihilistic thinkers such as Sartre and Nietzsche.”

But after a trip to Israel, he began to change his mind. He gravitated toward Orthodox Judaism, and in particular the Chabad-Lubavitch movement.

He graduated from Hofstra in 1995 with a degree in chemistry, and he received his medical degree from the State University of New York at Buffalo in 2000.

. . .

In 2018, doctors found a rare form of cancer in his chest and, in hopes of treating it, removed his right lung.

For the full obituary see:

Clay Risen. “Vladimir Zelenko, 48, ‘Country Doctor’ Who Pushed Unfounded Covid Remedy.” The New York Times (Saturday, July 2, 2022): A21.

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

(Note: the online version of the obituary has the date July 1, 2022 and has the title “Vladimir Zelenko, 48, Dies; Promoted an Unfounded Covid Treatment.”)

Dr. Zelenko’s pre-Covid-19 memoir is:

Zelenko, Vladmir. Metamorphosis. Lakewood, NJ: Israel Bookshop Publications, 2019.

A highly credentialed Yale academic presented evidence of the promise of hydroxychloroquine for early outpatient treatment in:

Risch, Harvey A. “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients That Should Be Ramped-up Immediately as Key to the Pandemic Crisis.” American Journal of Epidemiology 189, no. 11 (Nov. 2020): 1218–26.

Rectal Cancer “Vanished” in All 18 in Clinical Trial: An “Astonishing” and “Unheard-Of” Result

(p. A18) It was a small trial, just 18 rectal cancer patients, every one of whom took the same drug.

But the results were astonishing. The cancer vanished in every single patient, undetectable by physical exam, endoscopy, PET scans or M.R.I. scans.

Dr. Luis A. Diaz Jr. of Memorial Sloan Kettering Cancer Center, an author of a paper published Sunday [June 5, 2022] in the New England Journal of Medicine describing the results, which were sponsored by the drug company GlaxoSmithKline, said he knew of no other study in which a treatment completely obliterated a cancer in every patient.

“I believe this is the first time this has happened in the history of cancer,” Dr. Diaz said.

Dr. Alan P. Venook, a colorectal cancer specialist at the University of California, San Francisco, who was not involved with the study, said he also thought this was a first.

A complete remission in every single patient is “unheard-of,” he said.

. . .

Dr. Kimmie Ng, a colorectal cancer expert at Harvard Medical School, said that while the results were “remarkable” and “unprecedented,” they would need to be replicated.

The inspiration for the rectal cancer study came from a clinical trial Dr. Diaz led in 2017 that Merck, the drugmaker, funded. It involved 86 people with metastatic cancer that originated in various parts of their bodies.

. . .

Tumors shrank or stabilized in about one-third to one-half of the patients, and they lived longer. Tumors vanished in 10 percent of the trial’s participants.

That led Dr. Cercek and Dr. Diaz to ask: What would happen if the drug were used much earlier in the course of disease, before the cancer had a chance to spread?

. . .

Perhaps, Dr. Cercek and Dr. Diaz reasoned, immunotherapy with a checkpoint inhibitor would allow such patients to avoid chemotherapy, radiation and surgery.

Dr. Diaz began asking companies that made checkpoint inhibitors if they would sponsor a small trial. They turned him down, saying the trial was too risky. He and Dr. Cercek wanted to give the drug to patients who could be cured with standard treatments. What the researchers were proposing might end up allowing the cancers to grow beyond the point where they could be cured.

“It is very hard to alter the standard of care,” Dr. Diaz said. “The whole standard-of-care machinery wants to do the surgery.”

Finally, a small biotechnology firm, Tesaro, agreed to sponsor the study. Tesaro was bought by GlaxoSmithKline, and Dr. Diaz said he had to remind the larger company that they were doing the study — company executives had all but forgotten about the small trial.

Their first patient was Sascha Roth, then 38.

. . .

Soon, she was scheduled to start chemotherapy at Georgetown University, but a friend had insisted she first see Dr. Philip Paty at Memorial Sloan Kettering. Dr. Paty told her he was almost certain her cancer included the mutation that made it unlikely to respond well to chemotherapy. It turned out, though, that Ms. Roth was eligible to enter the clinical trial. If she had started chemotherapy, she would not have been.

. . .

After the trial, Dr. Cercek gave her the news.

“We looked at your scans,” she said. “There is absolutely no cancer.” She did not need any further treatment.

“I told my family,” Ms. Roth said. “They didn’t believe me.”

But two years later, she still does not have a trace of cancer.

For the full story, see:

Gina Kolata. “Study on Rectal Cancer Results in Complete Remission.” The New York Times (Tuesday, June 7, 2022): A18.

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

(Note: the online version of the story has the date June 5, 2022, and has the title “A Cancer Trial’s Unexpected Result: Remission in Every Patient.” The online version of the article says that the title of the print version was “Rectal Cancer Drug Trial Results in Complete Remission.” But my National edition of the article had the title “Study on Rectal Cancer Results in Complete Remission.”)

The paper mentioned above in The New England Journal of Medicine is:

Cercek, Andrea, Melissa Lumish, Jenna Sinopoli, Jill Weiss, Jinru Shia, Michelle Lamendola-Essel, Imane H. El Dika, Neil Segal, Marina Shcherba, Ryan Sugarman, Zsofia Stadler, Rona Yaeger, J. Joshua Smith, Benoit Rousseau, Guillem Argiles, Miteshkumar Patel, Avni Desai, Leonard B. Saltz, Maria Widmar, Krishna Iyer, Janie Zhang, Nicole Gianino, Christopher Crane, Paul B. Romesser, Emmanouil P. Pappou, Philip Paty, Julio Garcia-Aguilar, Mithat Gonen, Marc Gollub, Martin R. Weiser, Kurt A. Schalper, and Luis A. Diaz. “PD-1 Blockade in Mismatch Repair–Deficient, Locally Advanced Rectal Cancer.” New England Journal of Medicine 386, no. 25 (June 23, 2022): 2363-76.

When HR Team-Building Is on Fire

(p. B2) Walking barefoot across hot coals, an ancient religious ritual popularized in recent years as a corporate team-building exercise, has once again bonded a group of co-workers through the shared suffering of burned feet.

In the latest case of the stunt going wrong, 25 employees of a Swiss ad agency were injured Tuesday [June 14, 2022] evening while walking over hot coals in Zurich, officials said. Ten ambulances, two emergency medical teams and police officers from multiple agencies were deployed to help, according to the Zurich police. Thirteen people were briefly hospitalized.

. . .

Mr. Willey, who taught for years at the University of Pittsburgh, once shared the world record for the longest distance walked on hot coals.

The promises made by corporate retreat organizers are frequently unjustified, Mr. Willey said.

“They’re telling you that it’s all in your mind, and this will give you powers that will continue,” he said. “It’s not in your mind. Anybody can do it. And I don’t think the confidence you get from it is necessarily going to last that long.”

Mr. Willey said that coals at 1,000 degrees are safe to walk on for 20 feet or more, adding that he walked on coals at that temperature for 495 feet without getting a blister.

On his website, he writes that at a brisk walk your bare foot comes into contact with coals for just around a second, which is not enough time for heat to be transmitted painfully from coals to the human flesh. Both the coals and skin have vastly lower thermal conductivity than, for instance, metal, he said.

But mistakes can lead to injuries. These include curling your toes and trapping a coal between them; walking on coals that are too hot; choosing the wrong type of wood, since some get hotter than others; and performing a fire walk on a beach, where your feet might sink into sand, Mr. Willey said.

For the full story, see:

Alex Traub. “Company’s Team-Building Exercise Involved Hot Coals. It Ended Badly.” The New York Times (Monday, June 20, 2022): B2.

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

(Note: the online version of the story has the date June 17, 2022, and has the title “Walking on Hot Coals: A Company Event Goes Wrong.”)

Key Healthcare Issue Is Not How to Divvy Up a Fixed Pie, But How to Grow the Pie Through New Cures

(p. A23) . . . in the second phase of my illness, once I knew roughly what was wrong with me and the problem was how to treat it, I very quickly entered a world where the official medical consensus had little to offer me. It was only outside that consensus, among Lyme disease doctors whose approach to treatment lacked any C.D.C. or F.D.A. imprimatur, that I found real help and real hope.

And this experience made me more libertarian in various ways, more skeptical not just of our own medical bureaucracy, but of any centralized approach to health care policy and medical treatment.

This was true even though the help I found was often expensive and it generally wasn’t covered by insurance; like many patients with chronic Lyme, I had to pay in cash. But if I couldn’t trust the C.D.C. to recognize the effectiveness of these treatments, why would I trust a more socialized system to cover them? After all, in socialized systems cost control often depends on some centralized authority — like Britain’s National Institute for Health and Care Excellence or the controversial, stillborn Independent Payment Advisory Board envisioned by Obamacare — setting rules or guidelines for the system as a whole. And if you’re seeking a treatment that official expertise does not endorse, I wouldn’t expect such an authority to be particularly flexible and open-minded about paying for it.

Quite the reverse, in fact, given the trade-off that often shows up in health policy, where more free-market systems yield more inequalities but also more experiments, while more socialist systems tend to achieve their egalitarian advantages at some cost to innovation. Thus many European countries have cheaper prescription drugs than we do, but at a meaningful cost to drug development. Americans spend obscene, unnecessary-seeming amounts of money on our system; America also produces an outsize share of medical innovations.

And if being mysteriously sick made me more appreciative of the value of an equalizing floor of health-insurance coverage, it also made me aware of the incredible value of those breakthroughs and discoveries, the importance of having incentives that lead researchers down unexpected paths, even the value of the unusual personality types that become doctors in the first place. (Are American doctors overpaid relative to their developed-world peers? Maybe. Am I glad that American medicine is remunerative enough to attract weird Type A egomaniacs who like to buck consensus? Definitely.)

Whatever everyday health insurance coverage is worth to the sick person, a cure for a heretofore-incurable disease is worth more. The cancer patient has more to gain from a single drug that sends the disease into remission than a single-payer plan that covers a hundred drugs that don’t.

. . .

. . ., the weakness of the liberal focus on equalizing cost and coverage is the implicit sense that medical care is a fixed pie in need of careful divvying, rather than a zone where vast benefits await outside the realm of what’s already available.

. . .

. . . once you’ve become part of the American pattern of trying anything, absolutely anything in order to feel better — and found that spirit essential to your own recovery — the idea of medical cost control as a primary policy goal inevitably loses some of its allure, and the American way of medical spending looks a little more defensible. To just try things without counting the cost can absolutely run to excess. But sometimes what seems like waste on the technocrat’s ledger is the lifeline that a desperate patient needs.

For the full commentary, see:

Ross Douthat. “Being Sick Changed My Views on Health Care.” The New York Times (Thursday, January 20, 2022): A23.

(Note: ellipses added.)

(Note: the online version of the commentary has the date January 19, 2022, and has the title “How Being Sick Changed My Health Care Views.”)

The commentary quoted above is related to the author’s book:

Douthat, Ross. The Deep Places: A Memoir of Illness and Discovery. New York: Convergent Books, 2021.

“Don’t Give Up and Say There’s No Point”

(p. A18) TOKYO—The world’s oldest verified living person, Kane Tanaka of Japan, has died at age 119.

. . .

According to Japanese news accounts, Ms. Tanaka loved chocolate and carbonated drinks and hoped to live to 120. Her motto was “Don’t give up and say there’s no point. Live with all your heart.”

For the full story, see:

Chieko Tsuneoka. “World’s Oldest Person Dies at 119.” The Wall Street Journal (Tuesday, April 26, 2022): A18.

(Note: ellipsis added.)

(Note: the online version of the story was updated April 25, 2022, and has the title “World’s Oldest Person, Japan’s Kane Tanaka, Dies at 119.” The print version has a longer first sentence than the online version, which is quoted above.)

“Byzantine Health Care System” Slowed Rollout of Effective COVID Anti-Viral Medication Paxlovid

(p. A16) GREENBELT, Md. — Last month, the owner of a small pharmacy here secured two dozen courses of Pfizer’s new medication for treating Covid-19, eager to quickly provide them to his high-risk customers who test positive for the virus.

More than a month later, the pharmacy, Demmy’s, has dispensed the antiviral pills to just seven people. The remaining stock is sitting in neatly packed rows on its shelves here in the suburbs of Washington, D.C. And the owner, Adeolu Odewale, is scrambling to figure out how to get the medication, Paxlovid, to more people as cases have increased over 80 percent in Maryland in recent days.

“I didn’t expect that I was still going to be sitting on that many of them,” he said of the pills he still has on hand. “It’s just that people need to know how to get it.”

. . .

But with the medication now more abundant, pharmacists, public health experts and state health officials say that encouraging the right people to take it, and making it easier for them to access, could help blunt the effects of another Covid wave.

State health officials say that many Americans who would be good candidates for Paxlovid do not seek it out because they are unaware they qualify for it, hesitant about taking a new medication, or confused by the fact that some providers interpret the eligibility guidelines more narrowly than others.

Since the medication has to be prescribed by a doctor, nurse practitioner or physician assistant, people have to navigate an often byzantine health care system in search of a prescription, then find a pharmacy that carries the treatment, all within five days of developing symptoms. The medication, prescribed as three pills taken twice a day for five days, is meant to be started early in the course of infection.

. . .

More than 630,000 courses of the drug — roughly a third of the supply distributed to date — are currently available, and the federal government has been sending 175,000 courses to states each week, according to federal data.

. . .

Giving pharmacists prescribing power could help people get the treatment much more quickly and easily, public health experts say. But regulators at the F.D.A. and other federal health officials believe there is reason to not allow pharmacists to prescribe Paxlovid themselves, even though some Canadian pharmacists can do so. The treatment can interfere with certain medications and should be prescribed at a lower dose for people with kidney impairment, which is measured with a blood test.

Pharmacists say that they are highly trained and well equipped to conduct such screening themselves. Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, said pharmacists could get Paxlovid to patients faster if they could prescribe it, “without having to call a physician’s office and wait for a call back, and hope it happens within five-day period.”

For the full story, see:

Noah Weiland. “Plenty of Covid Pills, Not Many Prescriptions.” The New York Times (Wednesday, April 27, 2022): A16.

(Note: ellipses added.)

(Note: the online version of the story has the date April 26, 2022, and has the title “With Supply More Abundant, Pharmacies Struggle to Use Up Covid Pills.” The online version says that the article appeared on p. A18 of the print version, but in my National edition of the print version, it appeared on p. A16.)