Category: Health

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.)

Crispr Gene-Editing Tried Against Cancer

(p. D4) Doctors have for the first time in the United States tested a powerful gene-editing technique in people with cancer.

The test, meant to assess only safety, was a step toward the ultimate goal of editing genes to help a patient’s own immune system to attack cancer. The editing was done by the DNA-snipping tool Crispr.

The procedure was feasible and safe, early results indicate, but whether it is fighting the disease is unclear. Only three patients have been treated so far, and the longest follow-up is nine months. All three patients are in their 60s, with very advanced cancers that had progressed despite standard treatments like surgery, radiation and chemotherapy.

“The good news is that all of them are alive,” said Dr. Edward A. Stadtmauer, the section chief of hematologic malignancies at the University of Pennsylvania Abramson Cancer Center. He added, “The best response we’ve seen so far is stabilization of their disease.”

For the full story, see:

Denise Grady. “Editing Genes in Bid to Fight Cancer.” The New York Times (Tuesday, November 12, 2019): D4.

(Note: the online version of the story was updated Oct. 7, 2020 [sic], and has the title “Crispr Takes Its First Steps in Editing Genes to Fight Cancer.”)

Art Diamond Discusses “Policy Hurdles in the Fight Against Aging” on Caleb Brown’s Cato Daily Podcast

Caleb Brown, of the Cato Institute, posted an interview with me yesterday (May 27, 2022) on his “Cato Daily Podcast.” The topic, “Policy Hurdles in the Fight against Aging,” is related to a chapter in my book-in-progress on medical entrepreneurship that is to be entitled Less Costs, More Cures: Unbinding Medical Entrepreneurs.

Bennet Chose Pig’s Heart Since “It Was Either Die or Do This Transplant”

(p. A3) A man who had the first transplant to replace his human heart with a genetically-modified pig’s heart without immediate rejection died Tuesday afternoon at the University of Maryland Medical Center in Baltimore, two months after the groundbreaking surgery.

. . .

While Mr. Bennett only lived with the pig heart for a couple of months, Dr. Parsia Vagefi, UT Southwestern Medical Center’s chief of the division of surgical transplantation, said people shouldn’t view the transplant as a failure and that he hopes it serves as a “new beginning” for xenotransplantation.

“I think what this shows is just the enormous amount of progress that’s been made and hopefully it’s just the beginning that we continue to grow on,” he said.

Mr. Bennett wasn’t eligible for a more typical heart transplant because he didn’t comply with doctors’ orders or attend follow-up visits. Several transplant centers—including the Maryland one—declined to list him for the chance to get a human heart, according to David Bennett Jr. , Mr. Bennett’s son. He also didn’t regularly take his medication, the younger Mr. Bennett previously said.

The U.S. Food and Drug Administration had granted Mr. Bennett’s operation emergency authorization on New Year’s Eve. “It was either die or do this transplant,” he said the day before his surgery, according to the University of Maryland Medicine. The handyman and father of two called the transplant his “last choice.”

For the full story, see:

Allison Prang. “Pig-Heart Recipient Dies 2 Months Later.” The Wall Street Journal (Thursday, March 10, 2022): A3.

(Note: ellipsis added.)

(Note: the online version of the story was updated March 9, 2022, and has the title “The Patient Who Received a Pig Heart Dies Two Months After Transplant.” The first two sentences after the ellipsis appear in the online, but not the print, version.)

Imposing Permanent Daylight Savings Time Is Like Imposing Permanent Jet Lag

(p. A19) . . . when the U.S. Senate recently passed a bill to make daylight-saving time permanent, sleep experts became more alarmed.

Legislators picked the wrong time, they say.

Our internal clocks are connected to the sun, which aligns more closely with permanent standard time, says Muhammad Adeel Rishi, a pulmonologist and sleep physician at Indiana University. When the clocks spring forward, our internal clocks don’t change but are forced to follow society’s clock rather than the sun. DST is like permanent social jet lag.

Dr. Rishi is one of the authors of a 2020 position statement from the American Academy of Sleep Medicine, a professional society, supporting making standard time—not daylight-saving time—permanent.

. . .

One of the big problems with permanent DST, objectors note, is that in the winter the sun will rise later and many schoolchildren will be walking to school in the dark.

On the western edge of the eastern time zone in Indiana, for instance, the sun won’t rise in the winter until about 9 a.m., notes Dr. Rishi. “You’re basically putting these kids two hours off from their circadian biology,” he says.

For the full commentary, see:

Sumathi Reddy. “YOUR HEALTH; Body Clock Needs Sun In Morning.” The Wall Street Journal (Thursday, March 24, 2022): A19.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 23, 2022, and has the title “YOUR HEALTH; Why Permanent Daylight-Saving Time Is Seen as Bad for Your Health.”)