Category: Health

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.”)

Discoverer of Catalyst Role of mRNA Had Trouble “Getting His Work Published”

(p. B12) Sidney Altman, a molecular biologist who was awarded the Nobel Prize for Chemistry for sharing in the discovery that ribonucleic acid, or RNA, was not just a carrier of genetic information but could also be a catalyst for chemical reactions in cells — a breakthrough that paved the way for new gene therapies and treatments for viral infections — died on April 5 [2022] in Rockleigh, N.J.

. . .

HAs seems to happen so often in science, Dr. Altman stumbled upon his discovery. “I wasn’t looking for what I found,” he said in a 2010 interview with Harry Kreisler at the Institute for International Studies at the University of California, Berkeley.

He had studied how a small RNA molecule, called transfer RNA, carries genetic code to make new proteins. Some of the code is not necessary, so an enzyme cuts it out before it is used.

Then, in 1978, Dr. Altman began studying an RNA-cutting enzyme from E. coli bacteria that was composed of an RNA molecule and a protein. He managed to separate the two pieces and test them to see how they reacted in the enzyme process. Much to his surprise, he discovered that the protein did not perform as an enzyme without the RNA molecule. He later discovered that the RNA molecule could be the catalyst, even without the protein.

The finding ran completely contrary to what at the time was established theory, which held that it was the proteins that were the catalysts in enzymes.

The discovery of what are now known as ribozymes was so radical that Dr. Altman had trouble getting it accepted.

Joel Rosenbaum, a professor of cell biology at Yale and a colleague of Dr. Altman’s, told Chemistry World magazine that when Dr. Altman first tried to get other scientists to accept his research, “the community of molecular biologists, including several at Yale working on RNA, did not want to believe the work.”

“He had a hard time obtaining invitations to speak at scientific meetings and, indeed, getting his work published,” Dr. Rosenbaum said.

For the full obituary, see:

Dylan Loeb McClain. “Sidney Altman, Who Stumbled on a Breakthrough in Genetics, Dies at 82.” The New York Times (Saturday, April 16, 2022): B12.

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

(Note: the online version of the obituary was updated April 18, 2022, and has the same title as the print version.)

Gary Becker Foresaw a Cure for Obesity that Daniel Kahneman Wrote Was “Implausible”

I have found much of value in Daniel Kahneman’s Thinking, Fast and Slow. But the following passage is not included in what I value.

A famous example of the Chicago approach is titled A Theory of Rational Addiction; it explains how a rational agent with a strong preference for intense and immediate gratification may make the rational decision to accept future addiction as a consequence. I once heard Gary Becker, one of the authors of that article, who is also a Nobel laureate of the Chicago school, argue in a lighter vein, but not entirely as a joke, that we should consider the possibility of explaining the so-called obesity epidemic by people’s belief that a cure for diabetes will soon become available. He was making a valuable point: when we observe people acting in ways that seem odd, we should first examine the possibility that they have a good reason to do what they do. Psychological interpretations should only be invoked when the reasons become implausible—which Becker’s explanation of obesity probably is.

Source: Kahneman, Daniel. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux, 2011, p. 412.

Gary Becker is vindicated again:

(p. A16) An experimental drug has enabled people with obesity or who are overweight to lose about 22.5 percent of their body weight, about 52 pounds on average, in a large trial, the drug’s maker announced on Thursday.

The company, Eli Lilly, has not yet submitted the data for publication in a peer-reviewed medical journal or presented them in a public setting. But the claims nonetheless amazed medical experts.

“Wow (and a double Wow!)” Dr. Sekar Kathiresan, chief executive of Verve Therapeutics, a company focusing on heart disease drugs, wrote in a tweet. Drugs like Eli Lilly’s, he added, are “truly going to revolutionize the treatment of obesity!!!”

Dr. Kathiresan has no ties to Eli Lilly or to the drug.

. . .

The Eli Lilly study lasted 72 weeks and involved 2,539 participants. Many qualified as obese, while others were overweight but also had such risk factors as high blood pressure, high cholesterol levels, cardiovascular disease or obstructive sleep apnea.

They were divided into four groups. All received diet counseling to reduce their calorie intake by about 500 a day.

One group was randomly assigned to take a placebo, while the other three received doses of tirzepatide ranging from 5 milligrams to 15 milligrams. Patients injected themselves with the drug once a week.

. . .

The medications are among a new class of drugs called incretins, which are naturally occurring hormones that slow stomach emptying, regulate insulin and decrease appetite. The side effects include nausea, vomiting and diarrhea. But most patients tolerate or are not bothered by these effects.

For the full story, see:

Gina Kolata. “Experimental Obesity Drug Produces 20% Weight Loss.” The New York Times (Friday, April 29, 2022): A16.

(Note: ellipses added.)

(Note: the online version of the story was updated May 1, 2022, and has the title “Patients Taking Experimental Obesity Drug Lost More Than 50 Pounds, Maker Claims.” Where there is a slight difference in wording between the online and the print versions, the passages quoted above follow the online version.)

Kahneman’s book is:

Kahneman, Daniel. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux, 2011.