Category: Health

When Sri Lanka Government Banned Chemical Fertilizers, Yields Tanked and Prices “Shot Up”

(p. A4) RATNAPURA, Sri Lanka — This year’s crop worries M.D. Somadasa. For four decades, he has sold carrots, beans and tomatoes grown by local farmers using foreign-made chemical fertilizers and pesticides, which helped them reap bigger and richer crops from the verdant hills that ring his hometown.

Then came Sri Lanka’s sudden, and disastrous, turn toward organic farming. The government campaign, ostensibly driven by health concerns, lasted only seven months. But farmers and agriculture experts blame the policy for a sharp drop in crop yields and spiraling prices that are worsening the country’s growing economic woes and leading to fears of food shortages.

Prices for some foodstuffs, like rice, have risen by nearly one-third compared with a year ago, according to Sri Lanka’s central bank. The prices of vegetables like tomatoes and carrots have risen to five times their year-ago levels.

“I haven’t seen times that were as bad as these,” said Mr. Somadasa, a 63-year-old father of two who sells vegetables in the small town of Horana, just outside the island nation’s capital, Colombo. “We can’t find enough vegetables. And with the price hikes, people find it hard to buy the vegetables.”

. . .

President Gotabaya Rajapaksa cited health concerns when his government banned the importation of chemical fertilizers in April [2021], a pledge he had initially made during his 2019 election campaign.

. . .

The push for organic farming didn’t start with Mr. Rajapaksa’s current government, nor when another brother, Mahinda Rajapaksa, currently the prime minister, was president from 2005 to 2015. Some farmers and agriculture industry officials say they are warming to the idea of reducing dependence on chemicals in farming. But the shift was too sudden for farmers who didn’t know how to work organically, said Nishan de Mel, director of Verité Research, a Colombo-based analysis firm.

Verité found in a July [2021] survey that three-quarters of Sri Lanka’s farmers relied heavily on chemical fertilizers, while just about 10 percent cultivated without them. Almost all major crops grown in the country depend on the chemicals. For crops crucial to the economy like rice, rubber and tea, the dependence reaches 90 percent or more.

The April ban went into effect just before what is known as the Yala planting season, which lasts from May to August, and was felt almost immediately. The Verité survey showed that 85 percent of farmers expected a reduction in their harvest because of the fertilizer ban. Half of them feared that their crop yield could fall by as much as 40 percent.

Food prices shot up in September [2021], . . .

For the full story, see:

Aanya Wipulasena and Mujib Mashal. “A Plunge Into Organic Farming Brings Disaster to Sri Lanka.” The New York Times (Wednesday, December 8, 2021): A4.

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

(Note: the online version of the story has the date Dec. 7, 2021, and has the title “Sri Lanka’s Plunge Into Organic Farming Brings Disaster.”)

“Unanticipated Tragedies Are Unpreventable, No Matter How Many Regulations”

(p. A15) Dr. Offit acknowledges the limits of regulatory fixes, noting that, while regulatory guidelines are important, “unanticipated tragedies are unpreventable, no matter how many regulations, training programs, fines, and penalties are put in place.” He contrasts the tragic death in 1999 of 18-year-old Jesse Gelsinger in an early gene-therapy study—aimed at remediating a rare enzyme deficiency—with the triumphant experience of Emily Whitehead, a girl with leukemia treated 11 years later at the same university with genetically manipulated T-cells. Gelsinger’s death has been ascribed to protocol deficiencies, conflicts of interest and inadequate regulation, but “a closer look,” Dr. Offit writes, “shows that the only difference between the outcomes of Emily Whitehead and Jesse Gelsinger were luck and timing.” The specific supportive approach used by Whitehead’s doctors to address a life-threatening complication of her T-cell infusion stemmed directly from the lessons learned during Gelsinger’s ordeal. We recognize successes, Dr. Offit laments, but “never the failures that made those successes possible.”

One anxiety suffusing every page of “You Bet Your Life” is what to make of the Covid-19 vaccines. Dr. Offit, a member of the FDA’s vaccine advisory committee, has been described in The Wall Street Journal as “an outspoken advocate of the science and value of vaccinations,” including the Covid-19 vaccine. He has described its clinical-trial data as “enormously reassuring” and has seen little evidence of “a very rare, serious side effect that would be something that would cause a long term problem.” Yet his review of the history of vaccination and of its complexities evokes surprising empathy for the vaccine-hesitant. He recounts the early days of the Salk polio vaccine, which saved lives yet also tragically transmitted the disease to some patients when the product was inadequately prepared by one of its manufacturers. He notes that “the first vaccines aren’t always the best, safest, and last” and regrets the “disturbing show of hubris” by the Covid vaccine developers.

Ultimately, Dr. Offit emphasizes, we need to come to terms with the fact that all medical technologies carry risk—as does the decision not to avail oneself of them. “A choice not to get a vaccine is not a risk-free choice,” Dr. Offit notes. Either way, he says, “you’re gambling”—so “choose the lesser risk.”

For the full review, see:

David A. Shaywitz. “BOOKSHELF; The Dangers Of Finding a Cure.” The Wall Street Journal (Tuesday, Nov. 09, 2021): A15.

(Note: the online version of the review has the date November 8, 2021, and has the title “BOOKSHELF; ‘You Bet Your Life’ Review: The Dangers of Finding a Cure.”)

The book under review is:

Offit, Paul A. You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation. New York: Basic Books, 2021.

Covid-19 Raised Our Blood Pressure

(p. A12) On Monday [Dec. 6, 2021], scientists reported that blood pressure measurements of nearly a half-million adults showed a significant rise last year, compared with the previous year.

These measurements describe the pressure of blood against the walls of the arteries. Over time, increased pressure can damage the heart, the brain, blood vessels, kidneys and eyes. Sexual function can also be affected.

“These are very important data that are not surprising, but are shocking,” said Dr. Donald M. Lloyd-Jones, president of the American Heart Association, who was not involved in the study.

“Even small changes in average blood pressure in the population,” he added, “can have a huge impact on the number of strokes, heart failure events and heart attacks that we’re likely to be seeing in the coming months.”

The study, published as a research letter in the journal Circulation, is a stark reminder that even in the midst of a pandemic that has claimed more than 785,000 American lives and disrupted access to health care, chronic health conditions must still be managed.

. . .

“We observed that people weren’t exercising as much during the pandemic, weren’t getting regular care, were drinking more and sleeping less,” said Dr. Luke Laffin, the lead author, a preventive cardiologist who is co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic. “We wanted to know, was their blood pressure changing during the pandemic?”

The researchers found that blood pressure readings changed little from 2019 to the first three months of 2020, but increased significantly from April 2020 through December 2020, compared with the same period in 2019.

. . .

The new study found that the average monthly change from April 2020 to December 2020, compared with the previous year, was 1.10 mm Hg to 2.50 mm Hg for systolic blood pressure, and 0.14 to 0.53 for diastolic blood pressure.

The increases held true for both men and women, and in all age groups. Larger increases in both systolic and diastolic blood pressure were seen in women.

The average age of the study participants was just over 45, and slightly more than half were women.

. . .

The causes of an overall increase in blood pressure are not clear, Dr. Laffin and his colleagues said. The reasons may include an increase in alcohol consumption, a decline in exercise, rising stress, a drop in doctors’ visits and less adherence to a medication regimen.

The researchers dismissed a possible effect of weight gain, known to raise blood pressure, saying that the men in the study had lost weight and that the women had not gained more weight than usual.

For the full story, see:

Roni Caryn Rabin. “Does the Pandemic Have Your Blood Pressure Rising? You’re Not Alone.” The New York Times (Tuesday, December 7, 2021): A12.

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

(Note: the online version of the story has the date Dec. 6, 2021, and has the title “The Pandemic Has Your Blood Pressure Rising? You’re Not Alone.”)

The study summarized above is:

Laffin, Luke J., Harvey W. Kaufman, Zhen Chen, Justin K. Niles, Andre R. Arellano, Lance A. Bare, and Stanley L. Hazen. “Rise in Blood Pressure Observed among Us Adults During the Covid-19 Pandemic.” Circulation (2021) Published online: https://doi.org/10.1161/CIRCULATIONAHA.121.057075.

New Nuclear Designs Are “Cheap, Efficient, Extremely Reliable”, “Nearly Carbon-Free” and Much Safer

(p. A17) Jacopo Buongiorno, a nuclear-engineering professor at the Massachusetts Institute of Technology, has calculated that over the life cycle of power plants, which includes construction, mining, transport, operation, decommissioning and disposal of waste, the greenhouse-gas emissions for nuclear power are 1/700th those of coal, 1/400th of gas, and one-fourth of solar. Nuclear also requires 1/2,000th as much land as wind and around 1/400th as much as solar. For any given power output, the amount of raw material used to build a nuclear plant is a small fraction of an equivalent solar or wind farm. Although nuclear waste is obviously more difficult to dispose of, its volume is 1/10,000th that of solar and 1/500th of wind. This includes abandoned infrastructure and all the toxic substances that end up in landfills. One person’s lifetime use of nuclear power would produce about a half-ounce of waste. Even including the Chernobyl disaster, human mortality from coal is 2,000 to 3,000 times that of nuclear, while oil claims 400 times as many lives.

Although the federal government tends to resist nuclear power, many nuclear technologies are being investigated and funded by private capital including molten-salt reactors, liquid-metal reactors, advanced small modular reactors, microreactors and much more. More than 70 development projects are under way in the U.S., with many designs intended to create assembly-line construction facilities to simplify and standardize testing, licensing and installations. One appealing approach is to replace large-scale facilities with many smaller but safer, cheaper and more-manageable ones. The $10 billion 10-year planning and implementation cycle for a large nuclear plant can be cut in half with a small modular reactor and another half with a microreactor.

. . .

Nuclear power is cheap, efficient, extremely reliable and nearly carbon-free. New designs, including smaller reactors, drastically reduce the risk of large-scale radioactive contamination.

. . .

Sacrifice isn’t always the path to progress.

For the full commentary, see:

Andrew I. Fillat and Henry I. Miller. “Nuclear Power Is the Best Climate-Change Solution by Far.” The Wall Street Journal (Friday, Nov. 5, 2021): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 4, 2021, and has the same title as the print version.)

“Precautionary Principle Would Have Vastly Slowed” Anesthesia, Antibiotics, Chemotherapy and Other Medical Innovations

(p. 15) In his new book, “You Bet Your Life,” Paul A. Offit wants to understand the failures and tragedies that help pave the way to medical innovation. For most of human history, anesthesia did not exist. Patients had to be forcibly restrained while their limbs were amputated and their cancers were removed, typically amid piercing screams and unbearable agony. Things did not start to change until the 1840s, when a carnival barker named Gardner Colton charged people 25 cents to sniff “laughing gas,” also known as nitrous oxide, which made them fall down in hysterics and then go to sleep for a few minutes. On Dec. 10, 1844, a dentist named Horace Wells attended Colton’s show. Soon after inhaling the gas (and making a fool of himself), he told a friend that a person could probably “have a tooth extracted or a limb amputated and not feel any pain.”

Wells sought out Colton immediately after the show, and the very next day, he became the first person to use nitrous oxide as an anesthetic: He asked a fellow dentist to extract one of his own teeth. The procedure was painless. Over the following weeks, Wells used nitrous oxide on 15 of his patients. It worked every time. In January 1845, he asked if he could demonstrate his method to specialists in a large amphitheater at the Massachusetts General Hospital. The demonstration failed. Wells gave too little of the anesthetic to his patient, who woke up during the extraction, in intense pain and screaming. Members of the audience shouted out, “Humbug!” Wells was disgraced.

. . .

Offit is a good storyteller, and he has some terrific stories to tell. He also draws important lessons. In the domain of medical innovation, tragedies cannot be prevented, no matter how many regulations we put in place. Science moves forward in fits and starts, with blunders, failures and losses along the way. New discoveries are rarely immediate; we inevitably learn more over time. Ours is not a risk-free world, which means that we need to choose the lesser risk. New technologies are always a gamble.

All of those claims are true, but I think that Offit also pulls out an even deeper and more provocative moral from this history. In life and in public policy, many people in Europe and the United States are drawn to the “precautionary principle,” which essentially calls for a high degree of risk aversion: Whenever an innovation threatens to cause harm, we should be exceedingly cautious before we allow it. Offit’s examples, and the history of medical advances, demonstrate that in its most extreme forms, the precautionary principle is self-defeating. Simply put, precautions kill. Whether we are speaking of anesthesia, heart transplants, antibiotics, chemotherapy or blood transfusions, the precautionary principle would have vastly slowed down innovations that, yes, carried serious risk and led to real harm, but were ultimately a great boon to humanity.

For the full review, see:

Cass R. Sunstein. “Side Effects.” The New York Times Book Review (Sunday, October 17, 2021): 15.

(Note: ellipsis added.)

(Note: the online version of the review was updated Oct. 25, 2021, and has the title “A History of Medical Innovation That Doesn’t Ignore the Side Effects.”)

The book under review is:

Offit, Paul A. You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation. New York: Basic Books, 2021.

N.I.H. Funded EcoHealth Wuhan Research to Make Coronaviruses More Infective and Virulent

(p. A21) EcoHealth Alliance has come under scrutiny because of its collaboration on coronavirus research with researchers at the Wuhan Institute of Virology, which is situated in the city where the pandemic began.

. . .

Last month, The Intercept, an online publication, posted 900 pages of materials related to the N.I.H. grants to EcoHealth Alliance for the research. The materials provided details about experiments designed to provide new insights into the risk that bat coronaviruses have for sparking new pandemics.

In some of their experiments, the researchers isolated genes from bat coronaviruses that encode a surface protein, called spike. Coronaviruses use the spike protein to bind to host cells, the first step to an infection. The spike protein latches onto a cell-surface protein called ACE2.

According to the materials published, the researchers then engineered another bat virus, called WIV1, to carry spike proteins from other bat coronaviruses. They then conducted experiments to see if the engineered WIV1 viruses became better at attaching to ACE2 on cells.

. . .

Dr. Lawrence Tabak, the principal deputy director of the N.I.H., wrote in the letter to Representative Comer that the agency determined that the research proposed by EcoHealth Alliance did not meet the criteria for additional review . . .

. . .

Dr. Tabak noted that in one line of research, the researchers had produced mice genetically engineered to produce the human version of the ACE2 protein on their cells. Infecting these animals with coronaviruses could potentially provide a more realistic sense of the risk that the viruses have of infecting humans than just using dishes of cells.

The N.I.H. required that EcoHealth Alliance notify the agency if the engineered viruses turned out to grow 10 times faster or more than WIV1 would without their new spike proteins.

In some experiments, it turns out, that viruses did grow quickly.

“EcoHealth failed to report this finding right away, as required by the terms of the grant,” Dr. Tabak wrote.

The N.I.H. also sent Representative Comer a final progress report that EcoHealth Alliance submitted to the agency in August [2021].

In the report, the researchers describe finding that WIV1 coronaviruses engineered to carry spike proteins were more virulent. They killed infected mice at higher rates than did the WIV1 virus without spikes from the other coronaviruses.

The filing had been submitted late, the N.I.H. said, nearly two years beyond the grant-specified deadline of 120 days from completion of the work. “Delayed reporting is a violation of the terms and condition of N.I.H. grant award,” Renate Myles, a spokeswoman for the agency, said.

Jesse Bloom, a virologist at the Fred Hutchinson Cancer Center who has called for more research into the origins of the pandemic, said the revelations raised serious questions about the risks of investigating viruses originating from animals, known as zoonotic viruses.

For the full story, see:

Carl Zimmer and Benjamin Mueller. “N.I.H. Says Bat Studies Were Not Submitted Promptly.” The New York Times (Friday, October 22, 2021): A21.

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

(Note: the online version of the story was updated October 28, 2021, and has the title “Bat Research Group Failed to Submit Virus Studies Promptly, N.I.H. Says.”)

CDC Intentionally Overestimated Risk of Heterosexual Spread of AIDS

(p. A17) ‘Follow the science,” we’ve been told throughout the Covid-19 pandemic. But if we had paid attention to history, we would have known that once a disease becomes newsworthy, science gets distorted by researchers, journalists, activists and politicians eager for attention and power—and determined to silence those who challenge their fear-mongering.

When AIDS spread among gay men and intravenous drug users four decades ago, it became conventional wisdom that the plague would soon devastate the rest of the American population.

. . .

In reality, researchers discovered early on that transmission through vaginal intercourse was rare, and that those who claimed to have been infected that way were typically concealing intravenous drug use or homosexual activity. One major study estimated the risk of contracting AIDS during intercourse with someone outside the known risk groups was 1 in 5 million. But the CDC nonetheless started a publicity campaign warning that everyone was in danger. It mailed brochures to more than 100 million households and aired dozens of public-service announcements, like a television ad with a man proclaiming, “If I can get AIDS, anyone can.”

The CDC’s own epidemiologists objected to this message, arguing that resources should be focused on those at risk, as the Journal reported in 1996. But they were overruled by superiors who decided, on the advice of marketing consultants, that presenting AIDS as a universal threat was the best way to win attention and funding. By those measures, the campaign succeeded. Polls showed that Americans became terrified of being infected, and funding for AIDS prevention surged—much of it squandered on measures to protect heterosexuals.

Scientists and public officials sustained the panic by wildly overestimating the prevalence of AIDS. Challenging those numbers was a risky career move, as New York City’s health commissioner, Stephen C. Joseph, discovered in 1988 when he reduced the estimated number of AIDS cases in the city by half. He had good reasons for the reduction—the correct number turned out to be much lower still—but he soon needed police protection. Activists occupied his office, disrupted his speeches, and picketed and spray-painted his home.

Another victim of 1980s-style cancel culture was Michael Fumento, who meticulously debunked the scare in his 1990 book, “The Myth of Heterosexual AIDS.” It received good reviews and extensive publicity, but it was unavailable in much of the country because local bookstores and national chains succumbed to pressure not to sell it. Mr. Fumento’s own publisher refused to keep it in print, and he was forced out of two jobs—one as an AIDS analyst in the federal government.

The AIDS fear-mongers suffered few consequences for their mistakes.

For the full commentary, see:

John Tierney. “Unlearned AIDS Lessons for Covid.” The Wall Street Journal (Monday, October 4, 2021): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary was updated October 3, 2021, and has the same title as the print version.)

Virtual Reality (VR) Used to Better See Cancer Cell Mutations

(p. R3) Chemist and entrepreneur Jackie von Salm recently walked inside a receptor in the brain to inspect a new drug compound. As she looked at the brightly colored, cascading ribbons around her, she noted something: Part of the atomic structure, a series of thick, orange rods and hexagons, jutted toward her in an odd way, suggesting that the compound, a derivative of the psychedelic DMT, might be effective at treating addiction without having hallucinogenic effects.

“This is weird,” says Dr. von Salm, the co-founder and chief scientific officer of Psilera Inc., a Tampa, Fla.-based company working to turn psychedelics into treatments for addiction, neurodegenerative diseases and mood disorders. “But it might be really unique and special.”

The odd positioning of the compound might be the right shape to latch onto serotonin receptors in the brain that are involved with hallucination and addiction. That insight was possible thanks to a technology more closely associated with gamers than scientists: Virtual reality.

Dr. von Salm is one of a growing number of drug-discovery researchers who are using VR to see, in new ways, the molecules they have long studied on computer screens. Their goal is to investigate subtle changes in the distance, shape and chemical properties of atomic structures that could give them clues about how well a drug might work and speed up the drug-discovery process.

. . .

Since 2018, cancer researchers at the University of California San Francisco have been using VR to better understand the genetic mutations in cancer cells that might make a patient resistant to treatment. For example, in VR, it was clear that the reason a drug didn’t bind properly to its protein target in the cancer cell was because of the movement of a portion of the protein called the P-loop. The movement was caused by a mutation in the target.

On a computer monitor, it was difficult to see the tiny change in the movement. “When there are changes like that, the VR is critical,” says Beth Apsel Winger, a hematologist and oncologist at the university’s department of pediatrics.

For the full commentary, see:

Sara Castellanos. “VR Rx.” The Wall Street Journal (Friday, Sept. 10, 2021): R3.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date September 7, 2021, and has the title “Virtual Reality Puts Drug Researchers Inside the Molecules They Study.”)

FTC Slows Serendipitously Discovered Blood Test That Detects 50 Types of Cancer

(p. A13) Scientific breakthroughs are sometimes a matter of serendipity. Eight years ago Meredith Halks-Miller, a pathologist at the genetic-screening company Illumina, stumbled on something unusual while running prenatal blood tests for fetal chromosomal abnormalities. In some blood samples, the fetal genes were normal but the maternal DNA wasn’t. Illumina alerted pregnant women’s doctors to the finding. After further investigation, all the women were diagnosed with cancer, though none had symptoms when their blood was drawn.

This discovery led to the development of a blood test that can now detect 50 types of cancer and has the potential to save tens of thousands of lives a year if it becomes widely available. But regulators may slow the process.

The Federal Trade Commission last month wrapped up an administrative trial in which it seeks to block Illumina’s $8 billion acquisition of Grail, which makes the blood test.

. . .

Grail projects its test could prevent 90,000 to 100,000 cancer deaths each year if it were administered annually to all Americans 50 to 79. The sooner people get access to the test, the more lives will be saved. Illumina estimates that 10,000 lives will be saved over the following nine years for every year that it accelerates bringing the test to market. “By accelerating the global rollout of the test in the European Union, into Africa, into Asia, into Latin America, we believe we can save a lot more lives than that around the world,” Mr. deSouza says.

The company’s dominance in the DNA-testing market, however, attracted regulatory scrutiny. In March the FTC sued Illumina and Grail to block the acquisition, arguing that it would “lessen competition in the U.S. multi-cancer early detection (‘MCED’) test market by diminishing innovation and potentially increasing prices.”

Nonsense, Mr. deSouza says. “Today, there is nobody who is even starting the studies to develop a 50-cancer test like Grail, and once you start the study, it’s still a few years before you actually get the test. We think there will also be blood tests for single cancers, for colorectal cancer and other cancers. Those won’t compete with Grail. They will be complementary to Grail.”

For the full interview, see:

Allysia Finley, interviewer. “THE WEEKEND INTERVIEW; Regulatory Hurdles Block a Cancer Miracle.” The Wall Street Journal (Saturday, Oct. 9, 2021): A13.

(Note: ellipsis added.)

(Note: the online version of the interview has the date October 8, 2021, and has the same title as the print version.)

Insurers Are Paid More When They Negotiate HIGHER Prices for Patients

(p. A1) This year, the federal government ordered hospitals to begin publishing a prized secret: a complete list of the prices they negotiate with private insurers.

The insurers’ trade association had called the rule unconstitutional and said it would “undermine competitive negotiations.” Four hospital associations jointly sued the government to block it, and appealed when they lost.

They lost again, and seven months later, many hospitals are simply ignoring the requirement and posting nothing.

But data from the hospitals that have complied hints at why the powerful industries wanted this information to remain hidden.

It shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test.

And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.

. . .

(p. A14) Customers judge insurance plans based on whether their preferred doctors and hospitals are covered, making it hard for an insurer to walk away from a bad deal. The insurer also may not have a strong motivation to, given that the more that is spent on care, the more an insurance company can earn.

Federal regulations limit insurers’ profits to a percentage of the amount they spend on care. And in some plans involving large employers, insurers are not even using their own money. The employers pay the medical bills, and give insurers a cut of the costs in exchange for administering the plan.

. . .

People carefully weighing two plans — choosing a higher monthly cost or a larger deductible — have no idea that they may also be picking a much worse price when they later need care.

Even for simple procedures, the difference can be thousands of dollars, enough to erase any potential savings.

It’s not as if employers can share that information at open enrollment: They generally don’t know either.

“It’s not just individual patients who are in the dark,” said Martin Gaynor, a Carnegie Mellon economist who studies health pricing. “Employers are in the dark. Governments are in the dark. It’s just astonishing how deeply ignorant we are about these prices.”

. . .

Health economists think of insurers as essentially buying in bulk, using their large membership to get better deals. Some were startled to see numerous instances in which insurers pay more than the cash rate.

. . .

“The worrying thing is that the third party you’re paying to negotiate on your behalf isn’t doing as well as you would on your own,” said Zack Cooper, an economist at Yale who studies health care pricing.

. . .

(p. A15) Hospitals and insurers can also hide behind the contracts they’ve signed, which often prohibit them from revealing their rates.

“We had gag orders in all our contracts,” said Richard Stephenson, who worked for the Blue Cross Blue Shield Association from 2006 until 2017 and now runs a medical price transparency start-up, Redu Health. (The association says those clauses have become less common.)

Mr. Stephenson oversaw a team that made sure the gag orders were being followed. He said he thought insurers were “scared to death” that if the data came out, angry hospitals or doctors might leave their networks.

. . .

The new price data is often published in hard-to-use formats designed for data scientists and professional researchers. Many are larger than the full text of the Encyclopaedia Britannica.

And most hospitals haven’t posted all of it. The potential penalty from the federal government is minimal, with a maximum of $109,500 per year. Big hospitals make tens of thousands of times as much as that; N.Y.U. Langone, a system of five inpatient hospitals that have not complied, reported $5 billion in revenue in 2019, according to its tax forms.

For the full story, see:

Sarah Kliff, Josh Katz and Rumsey Taylor. “Hospital Data Reveals Secrets Behind Billing.” The New York Times (Monday, August 23, 2021): A1 & A14-A15.

(Note: the online version of the story has the date Aug. 22, 2021, and has the title “Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why.”)

“Our Cities Protect Insiders and Leave Outsiders to Suffer”

(p. A15) Mr. Glaeser’s “Survival of the City: Living and Thriving in an Age of Isolation,” written with Harvard health economist David Cutler, shares the pleasing style of its predecessor, an engaging mixture of history and analysis. It has none of the triumphalism of its predecessor, however. In the move to social distancing that began in the spring of 2020, Messrs. Glaeser and Cutler see nothing less than “the rapid-fire deurbanization of our world.”

“Uncontrolled pandemic,” the authors write, poses “an existential threat” to the urban world. Nor is the coronavirus the only problem that cities face. “A Pandora’s Box of urban woes has emerged,” they continue, “including overly expensive housing, violent conflict over gentrification, persistently low levels of upward mobility, and outrage over brutal and racially targeted policing and long prison sentences for minor drug crimes.” These are not disparate problems. Rather, they “all stem from a common root: our cities protect insiders and leave outsiders to suffer.”

In Messrs. Glaeser and Cutler’s view, something has gone deeply wrong with how policy is set in many American cities. Insiders have captured control of how cities operate—and used that control to enrich themselves while providing limited opportunities for newer, younger residents. Consider Los Angeles. In 1970, housing costs in Southern California were much the same as those nationwide. By 1990, building limitations and strong demand had sent prices soaring in many coastal cities. The result: a massive redistribution of wealth from the young to the old.

For the full review, see:

John Buntin. “BOOKSHELF; Saving Our Urban Future.” The Wall Street Journal (Friday, Sept. 10, 2021): A15.

(Note: the online version of the review has the date September 9, 2021, and has the title “BOOKSHELF; ‘Survival of the City’ Review: Saving Our Urban Future.”)

The book under review is:

Glaeser, Edward L., and David Cutler. Survival of the City: Living and Thriving in an Age of Isolation. New York: Penguin Press, 2021.