(p. A4) YEKATERINBURG, Russia — Patients with unexplained pneumonias started showing up at hospitals; within days, dozens were dead. The secret police seized doctors’ records and ordered them to keep silent. American spies picked up clues about a lab leak, but the local authorities had a more mundane explanation: contaminated meat.
It took more than a decade for the truth to come out.
In April and May 1979, at least 66 people died after airborne anthrax bacteria emerged from a military lab in the Soviet Union. But leading American scientists voiced confidence in the Soviets’ claim that the pathogen had jumped from animals to humans. Only after a full-fledged investigation in the 1990s did one of those scientists confirm the earlier suspicions: The accident in what is now the Russian Urals city of Yekaterinburg was a lab leak, one of the deadliest ever documented.
Nowadays, some of the victims’ graves appear abandoned, their names worn off their metal plates in the back of a cemetery on the outskirts of town, where they were buried in coffins with an agricultural disinfectant. But the story of the accident that took their lives, and the cover-up that hid it, has renewed relevance as scientists search for the origins of Covid-19.
It shows how an authoritarian government can successfully shape the narrative of a disease outbreak and how it can take years — and, perhaps, regime change — to get to the truth.
“Wild rumors do spread around every epidemic,” Joshua Lederberg, the Nobel-winning American biologist, wrote in a memo after a fact-finding trip to Moscow in 1986. “The current Soviet account is very likely to be true.”
Many scientists believe that the virus that caused the Covid-19 pandemic evolved in animals and jumped at some point to humans. But scientists are also calling for deeper investigation of the possibility of an accident at the Wuhan Institute of Virology.
There is also widespread concern that the Chinese government — which, like the Soviet government decades before it, dismisses the possibility of a lab leak — is not providing international investigators with access and data that could shed light on the pandemic’s origins. Continue reading “Leading American Scientists Endorsed False Soviet Denial of Anthrax Lab Leak”
Category: Health
Air Conditioning as a “Powerful Solution” to Global Warming
(p. A11) SEATTLE — For two decades, Becky Lichenstein embraced a custom of the Seattle area: doing without air-conditioning. . . .
But summers in the Pacific Northwest aren’t what they once were. With more regular bouts of soaring temperatures, Ms. Lichenstein a few years ago surrendered and bought a portable air-conditioning unit. This year, considering a changing climate and how it’s hitting home, she decided to turn to a more powerful solution — a permanent system installed just this week.
“I’m very grateful that I’m getting it done,” said Ms. Lichenstein, as workers finalized the installation at her split-level home in Tacoma, south of Seattle.
. . .
. . . , like many parts of the country where air-conditioning was once considered an afterthought or a luxury, the region’s relationship with air-conditioning has started to change. In 2013, just 31 percent of households in the Seattle metro area had some sort of air-conditioning, according to data in the federal government’s American Housing Survey. Just six years later, that had risen to 44 percent, accounting for hundreds of thousands of new units.
For the full story, see:
(Note: ellipses added.)
(Note: the online version of the story was updated June 30, 2021 and has the title “Air-Conditioning Was Once Taboo in Seattle. Not Anymore.”)
“Anti-Heroism Goes Too Far”
(p. 11) In “Extra Life,” Steven Johnson, a writer of popular books on science and technology, tells the stories behind what he calls, in an understatement, “one of the greatest achievements in the history of our species.” Starting in the second half of the 19th century, the average life span began to climb rapidly, giving humans not just extra life, but an extra life. In rich countries, life expectancy at birth hit 40 by 1880, 50 by 1900, 60 by 1930, 70 by 1960, and 80 by 2010.
. . .
It’s been a long time since the history of technology has been recounted as the triumph of plucky heroes, and Johnson’s stories reflect today’s more sophisticated understanding.
. . .
Sometimes the anti-heroism goes too far — Norman Borlaug, whose Green Revolution saved a billion lives, is unmentioned. But altogether, Johnson is a fine storyteller. Among his cast of characters are John Graunt (1620–74), the British haberdasher who studied mortality reports as a hobby and thereby invented epidemiology; Joseph Bazalgette (1819–91), the man behind “one of the 19th century’s greatest engineering achievements,” which you probably did not guess was the London sewers; “Moldy Mary” Hunt (1910–91), the Peoria bacteriologist who scoured fruit markets for the perfect rotten cantaloupe, the one with a strain of mold that enabled the mass production of penicillin; John Stapp (1910–99), who strapped himself into his invention, the rocket sled, and safely decelerated from 628 miles per hour to 0 in 1.4 seconds; and Dilip Mahalanabis, 86, the Indian pediatrician who discovered that a bit of salt and sugar dissolved in clean water could stop fatal diarrhea and thereby saved the lives of nearly 60 million people.
For the full review, see:
Steven Pinker. “Modern Miracle.” The New York Times Book Review (Sunday, June 13, 2021): 11.
(Note: ellipses added.)
(Note: the online version of the review has the date May [sic] 11, 2021, and has the title “How Humans Gained an ‘Extra Life’.”)
The book under review is:
Johnson, Steven. Extra Life: A Short History of Living Longer. New York: Riverhead Books, 2021.
Warburg Focused on Cancer’s “Ravenous” Metabolizing of Sugars
(p. A15) Hours before Nazi Germany invaded the Soviet Union in 1941, SS leader Heinrich Himmler convened a perplexing meeting. He and his minions put aside preparations for the offensive to chitchat about a gay biochemist of Jewish descent in Berlin. Not to rage about the man, or plot his downfall—to the contrary, the Nazis believed this scientist could save the Reich, by ridding it of a threat they feared every bit as much as Jews, homosexuals and communists—the scourge of cancer.
That scientist, Otto Warburg, is the subject of “Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer–Diet Connection,” an eye-opening work by journalist Sam Apple.
. . .
There’s no doubt Warburg was brilliant—the greatest biochemist of his day—and in the 1930s he focused on cancer, a major concern of the Nazis. Cancer deaths skyrocketed 287% in Germany between 1876 and 1910, “making a quiet mockery of the extraordinary march of German science,” Mr. Apple notes. From the Führer down, Nazi leaders trembled at the disease, and they enacted surprisingly modern measures to fight cancer. They railed against cigarettes, encouraged women to examine their breasts for lumps and worked to eliminate pesticides and artificial preservatives in food.
In his lab, Warburg made seemingly fundamental discoveries about how cancer worked.
. . .
The second half of “Ravenous” shifts into the (somewhat tenuous) links between Warburg’s research and our modern understanding of cancer. The biochemical complexities get a bit gnarly—there’s a dizzying amount of detail, making it hard to follow the main thread on occasion. Among other things, Warburg discovered that cancer cells gobble up far more glucose (a sugar) than their nonmalignant neighbors—“eating like shipwrecked sailors,” Mr. Apple writes. Oddly, cancer cells also metabolize sugars through fermentation, in a manner analogous to yeast cells. Biochemically, fermentation is normally a backup power generator for human cells, used only when oxygen runs low. Warburg found that cancer cells were running the backup generator all the time.
. . .
. . ., it’s not clear how much credit Warburg deserves. I walked away from “Ravenous” thinking of Otto Warburg as a sort of Sigmund Freud of cancer research. Freud got One Big Thing right—that the unconscious drives much of human behavior. But he was wrong on nearly every detail. Similarly, Warburg explicitly rejected good evidence for the insulin-cancer link during his lifetime, among other blunders, making it tricky to uphold him as a pioneer of modern cancer research.
Nevertheless, history will show that Otto Warburg always insisted that cancer was intimately tied to metabolism. As one latter-day biologist noted, marveling over Warburg’s rehabilitation, “We found out that son of a bitch was right.”
For the full review, see:
(Note: ellipses added.)
(Note: the online version of the review has the date June 15, 2021, and has the title “BOOKSHELF; ‘Ravenous’ Review: Untangling a Disease.”)
The book under review is:
Apple, Sam. Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection. New York: Liveright Publishing Corp., 2021.
Federal Central Planners (and Cronies) Spent Hundreds of Millions of Strategic National Stockpile Funds on Emergent’s Outdated, Marginal Anthrax Vaccine, Leaving N95 Masks Unfunded
(p. 1) WASHINGTON — A year ago, President Donald J. Trump declared a national emergency, promising a wartime footing to combat the coronavirus. But as Covid-19 spread unchecked, sending thousands of dying people to the hospital, desperate pleas for protective masks and other medical supplies went unanswered.
Health workers resorted to wearing trash bags. Fearful hospital officials turned away sick patients. Governors complained about being left in the lurch. Today the shortage of basic supplies, alongside inadequate testing and the slow vaccine rollout, stands as a symbol of the broken federal response to a worldwide calamity that has killed more than a half-million Americans.
Explanations about what went wrong have devolved into partisan finger pointing, with Mr. Trump blaming the Obama administration for leaving the cupboard bare, and Democrats in Congress accusing Mr. Trump of negligence.
An investigation by The New York Times found a hidden explanation: Government purchases for the Strategic National Stockpile, the country’s emergency medical reserve where such equipment is kept, have largely been driven by the demands and financial interests of a handful of biotech firms that have specialized in products that address terrorist threats rather than infectious disease.
Chief among them is Emergent BioSolutions, a Maryland-based company now manufacturing Covid-19 vaccines for AstraZeneca and Johnson & Johnson. Last year, as the pandemic raced across the country, the government paid Emergent $626 million for products that included vaccines to fight an entirely different threat: a terrorist attack using anthrax.
Throughout most of the last decade, the government has spent nearly half of the stockpile’s half-billion-dollar annual budget on the company’s anthrax vaccines, The Times found. That left the government with less money to buy supplies needed in a pandemic, despite repeatedly being advised to do so.
Under normal circumstances, Emergent’s relationship with the federal stockpile would be of little public interest — an obscure contractor in an obscure corner of the federal bureaucracy applying the standard tools of Washington, like well-connected lobbyists and campaign contributions, to create a business heavily dependent on taxpayer dollars.
Security concerns, moreover, keep most information about (p. 18) stockpile purchases under wraps. Details about the contracts and inventory are rarely made public, and even the storage locations are secret.
But with the stockpile now infamous for what it doesn’t have, The Times penetrated this clandestine world by examining more than 40,000 pages of documents, some previously undisclosed, and interviewing more than 60 people with inside knowledge of the stockpile.
Former Emergent employees, government contractors, members of Congress, biodefense experts and current and former officials from agencies that oversee the stockpile described a deeply dysfunctional system that contributed to the shocking shortages last year. Their accounts were confirmed by federal budget and contracting records, agency planning documents, court filings, corporate disclosures and transcripts of congressional hearings and investor presentations. Continue reading “Federal Central Planners (and Cronies) Spent Hundreds of Millions of Strategic National Stockpile Funds on Emergent’s Outdated, Marginal Anthrax Vaccine, Leaving N95 Masks Unfunded”
Shi Modified Bat Coronaviruses in Low Biosafety Wuhan Labs
(p. A1) Shi Zhengli, a top Chinese virologist, is once again at the center of clashing narratives about her research on coronaviruses at a state lab in Wuhan, the city where the pandemic first emerged.
The idea that the virus may have escaped from a lab had long been widely dismissed by scientists as implausible and shunned by others for its connection with former President Donald J. Trump. But fresh scrutiny from the Biden administration and calls for greater candor from prominent scientists have brought the theory back to the fore.
. . .
(p. A8) The Wuhan Institute of Virology employs nearly 300 people and is home to one of only two Chinese labs that have been given the highest security designation, Biosafety Level 4. Dr. Shi leads the institute’s work on emerging infectious diseases, and over the years, her group has collected over 10,000 bat samples from around China.
Under China’s centralized approach to scientific research, the institute answers to the Communist Party, which wants scientists to serve national goals. “Science has no borders, but scientists have a motherland,” Xi Jinping, the country’s leader, said in a speech to scientists last year.
Dr. Shi herself, though, does not belong to the Communist Party, according to official Chinese media reports, which is unusual for state employees of her status.
. . .
. . . some of her most notable findings have since drawn the heaviest scrutiny. In recent years, Dr. Shi began experimenting on bat coronaviruses by genetically modifying them to see how they behave.
In 2017, she and her colleagues at the Wuhan lab published a paper about an experiment in which they created new hybrid bat coronaviruses by mixing and matching parts of several existing ones — including at least one that was nearly transmissible to humans — in order to study their ability to infect and replicate in human cells.
Proponents of this type of research say it helps society prepare for future outbreaks. Critics say the risks of creating dangerous new pathogens may outweigh potential benefits.
The picture has been complicated by new questions about whether American government funding that went to Dr. Shi’s work supported controversial gain-of-function research. The Wuhan institute received around $600,000 in grant money from the United States government, through an American nonprofit called EcoHealth Alliance. The National Institutes of Health said it had not approved funding for the nonprofit to conduct gain-of-function research on coronaviruses that would have made them more infectious or lethal.
Dr. Shi, in an emailed response to questions, argued that her experiments differed from gain-of-function work because she did not set out to make a virus more dangerous, but to understand how it might jump across species.
“My lab has never conducted or cooperated in conducting GOF experiments that enhance the virulence of viruses,” she said.
. . .
Concerns have centered not only on what experiments Dr. Shi conducted, but also on the conditions under which she did them.
Some of Dr. Shi’s experiments on bat viruses were done in Biosafety Level 2 labs, where security is lower than in other labs at the institute. That has raised questions about whether a dangerous pathogen could have slipped out.
Ralph Baric, a prominent University of North Carolina expert in coronaviruses who signed the open letter in Science, said that although a natural origin of the virus was likely, he supported a review of what level of biosafety precautions were taken in studying bat coronaviruses at the Wuhan institute. Dr. Baric conducted N.I.H.-approved gain-of-function research at his lab at the University of North Carolina using information on viral genetic sequences provided by Dr. Shi.
Dr. Shi said that bat viruses in China could be studied in BSL-2 labs because there was no evidence that they directly infected humans, a view supported by some other scientists.
For the full story, see:
(Note: ellipses added.)
(Note: the online version of the story has the date June 14, 2021, and has the title “A Top Virologist in China, at Center of a Pandemic Storm, Speaks Out.”)
Labrador Noses May Be Cheaper and More Accurate Than Rapid Antigen Test at Detecting Covid-19
(p. A1) . . . three Labradors, operating out of a university clinic in Bangkok, are part of a global corps of dogs being trained to sniff out Covid-19 in people. Preliminary studies, conducted in multiple countries, suggest that their detection rate may surpass that of the rapid antigen testing often used in airports and other public places.
. . .
(p. A6) . . . as a group, the dogs being trained in Thailand — Angel, Bobby, Bravo and three others, Apollo, Tiger and Nasa — accurately detected the virus 96.2 percent of the time in controlled settings, according to university researchers. Studies in Germany and the United Arab Emirates had lower but still impressive results.
Sniffer dogs work faster and far more cheaply than polymerase chain reaction, or P.C.R., testing, their proponents say. An intake of air through their sensitive snouts is enough to identify within a second the volatile organic compound or cocktail of compounds that are produced when a person with Covid-19 sheds damaged cells, researchers say.
“P.C.R. tests are not immediate, and there are false negative results, while we know that dogs can detect Covid in its incubation phase,” said Dr. Anne-Lise Chaber, an interdisciplinary health expert at the School of Animal and Veterinary Sciences at the University of Adelaide in Australia who has been working for six months with 15 Covid-sniffing dogs.
Some methods of detection, like temperature screening, can’t identify infected people who have no symptoms. But dogs can, because the infected lungs and trachea produce a trademark scent. And dogs need fewer molecules to nose out Covid than are required for P.C.R. testing, Thai researchers said.
The Thai Labradors are part of a research project run jointly by Chulalongkorn University and Chevron. The oil company had previously used dogs to test its offshore employees for illegal drug use, and a Thai manager wondered whether the animals could do the same with the coronavirus.
. . .
Dogs, whose wet snouts have up to 300 million olfactory receptors compared with roughly six million for humans, can be trained to memorize about 10 smell patterns for a specific compound, Dr. Kaywalee said. Dogs can also smell through another organ nestled between their noses and mouths.
Some research has suggested that dogs of various breeds may be able to detect diabetes, Parkinson’s disease, malaria and certain cancers — that is, the volatile organic compounds or bodily fluids associated with them.
Labradors are among the smartest breeds, said Lertchai Chaumrattanakul, who leads Chevron’s part of the dog project. They are affable, too, making them the ideal doggy detector: engaged and eager.
Mr. Lertchai noted that Labradors are expensive, about $2,000 each in Thailand. But the cotton swabs and other basic equipment for canine testing work out to about 75 cents per sample. That is much cheaper than what’s needed for other types of rapid screening.
For the full commentary, see:
(Note: ellipses added.)
(Note: the online version of the commentary has the date May 31, 2021, and has the title “On the Covid Front Lines, When Not Getting Belly Rubs.”)
The Promise of Gene Editing Is Greater Than the Peril
(p. C1) The Berkeley biochemist [Jennifer Doudna] had helped to invent a powerful new technology that made it possible to edit the human genome—an achievement that made her the recipient of a Nobel Prize in 2020. The innovation was based on a trick that bacteria have used for more than a billion years to fight off viruses, a talent very relevant to us humans these days. In their DNA, bacteria develop clustered, repeated sequences (what scientists call CRISPRs) that can recognize and then chop up viruses that attack them. Dr. Doudna and others adapted the system to create a tool that can edit DNA—opening up the potential for curing genetic diseases, creating healthier babies, inventing new vaccines, and helping humans to fight their own wars against viruses.
. . .
(p. C2) . . . the advances in CRISPR technology, combined with the havoc wrought by the Covid-19 pandemic, have pushed me to be more open to gene editing. I now see the promise of CRISPR more clearly than the peril. If we are wise in how we use it, biotechnology can make us more able to fend off lethal viruses and overcome serious genetic defects.
After millions of centuries during which evolution happened “naturally,” humans now can hack the code of life and engineer our own genetic futures. Or, for those who decry gene editing as “playing God,” let’s put it this way: Nature and nature’s God, in their wisdom, have evolved a species that can modify its own genome.
For the full commentary, see:
(Note: ellipses, and bracketed name, added.)
(Note: the online version of the commentary has the date Feb. 19, 2021, and has the same title as the print version.)
Isaacson’s commentary is related to his book:
Isaacson, Walter. The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race. New York: Simon & Schuster, 2021.
DNA Evidence Supports John Locke’s Vacuum Domicilium Argument for Europeans Claiming New World Land Ownership
(p. A21) The population size of “pre-contact” Hispaniola . . . [is] a contested issue until the present day, not least because of its profound emotional and moral resonance in light of the destruction of that world. Modern scholars have generally estimated the population at 250,000 to a million people.
Some of the arguments for large population numbers in the pre-contact Americas have been motivated by an attempt to counter a myth, perpetuated by apologists for colonialism like the philosopher John Locke, that the Americas were a vast “vacuum domicilium,” or empty dwelling, populated by a handful of Indigenous groups whose displacement could be readily justified. In a similar vein, some of the arguments for large population sizes have been motivated by a desire to underscore how disastrous the arrival of Europeans was for Indigenous people.
By any measure, the arrival of Europeans was catastrophic for Indigenous Americans. This is true whether the numbers of people were in the hundreds of thousands or millions — or for that matter, the tens of thousands. It is questionable to pin our judgments of human atrocities to a specific number. To learn from the past, it is crucial to be willing to accept new and compelling data when they become available.
In the case of the pre-contact population of Hispaniola, such data have arrived. By analyzing the DNA of ancient Indigenous Caribbean people, a study published in Nature on Wednesday [Dec. 16, 2020] by one of us (Professor Reich) makes clear that the population of Hispaniola was no more than a few tens of thousands of people. Almost all prior estimates have been at least tenfold too large.
. . .
The finding about the pre-contact population size in Hispaniola was made possible by a new scientific advance: We are now able to detect “DNA cousins” in ancient genomes — taking two people and determining whether they share large segments of DNA inherited from a recent ancestor. This is similar to what personal ancestry companies like 23andMe and Ancestry do with living people.
When the Reich team applied this method to 91 ancient individuals for whom it had sequenced enough of the genome to carry out this analysis, it found 19 pairs of DNA cousins living on different large islands or island groups in the Caribbean: for example, an individual in Hispaniola with a cousin in the Bahamas, and another individual in Hispaniola with a cousin in Puerto Rico. This meant that the entire population had to be very small; you wouldn’t find that random pairs of people had such a high probability of being closely related if the entire population was large.
For the full commentary, see:
(Note: ellipses, bracketed word, and bracketed year, added.)
(Note: the online version of the commentary has the date Dec. 23, 2020, and has the title “Ancient DNA Is Changing How We Think About the Caribbean.”)
The paper in Nature mentioned above is:
Fernandes, Daniel M., Kendra A. Sirak, Harald Ringbauer, Jakob Sedig, Nadin Rohland, Olivia Cheronet, Matthew Mah, Swapan Mallick, Iñigo Olalde, Brendan J. Culleton, Nicole Adamski, Rebecca Bernardos, Guillermo Bravo, Nasreen Broomandkhoshbacht, Kimberly Callan, Francesca Candilio, Lea Demetz, Kellie Sara Duffett Carlson, Laurie Eccles, Suzanne Freilich, Richard J. George, Ann Marie Lawson, Kirsten Mandl, Fabio Marzaioli, Weston C. McCool, Jonas Oppenheimer, Kadir T. Özdogan, Constanze Schattke, Ryan Schmidt, Kristin Stewardson, Filippo Terrasi, Fatma Zalzala, Carlos Arredondo Antúnez, Ercilio Vento Canosa, Roger Colten, Andrea Cucina, Francesco Genchi, Claudia Kraan, Francesco La Pastina, Michaela Lucci, Marcio Veloz Maggiolo, Beatriz Marcheco-Teruel, Clenis Tavarez Maria, Christian Martínez, Ingeborg París, Michael Pateman, Tanya M. Simms, Carlos Garcia Sivoli, Miguel Vilar, Douglas J. Kennett, William F. Keegan, Alfredo Coppa, Mark Lipson, Ron Pinhasi, and David Reich. “A Genetic History of the Pre-Contact Caribbean.” Nature 590, no. 7844 (Feb. 4, 2021): 103-10.
Lack of Competition Allows Carlsbad Medical Center to Sue Thousands of Patients
(p. D1) An examination of court records by The New York Times found almost 3,000 lawsuits filed by Carlsbad Medical Center against patients over medical debt since 2015, more than 500 of them through August of this year alone. Few hospitals sue so many patients so often.
. . .
Carlsbad Medical Center is not the only hospital to have filed reams of lawsuits over unpaid bills. In Memphis, Methodist Le Bonheur Healthcare, a nonprofit hospital, filed 8,300 lawsuits from 2014 through 2018, including some against its own em-(p. D6)ployees, according to an investigation by the journalism nonprofit groups ProPublica and MLK50.
. . .
People across the country are coping with soaring medical costs, opaque pricing and surprise bills, but these issues are felt acutely in one-hospital towns like Carlsbad, where residents have few options for care — and must pay whatever prices the hospital sets.
“Hospitals that have little competition can negotiate higher rates, because the insurer wants that hospital in their network,” said Sara Collins of the nonprofit Commonwealth Fund.
. . .
Carlsbad Medical Center is owned by Community Health Systems, a chain of hospitals based in Franklin, Tenn. An investigation in 2014 by the Santa Fe New Mexican newspaper found that the three hospitals charging the highest prices in the state were all owned by that chain.
In 2015, the company paid $98 million to the federal government to settle charges that it had inflated revenue by admitting patients unnecessarily. Community Health Systems admitted no wrongdoing.
. . .
There are alternative hospitals near Carlsbad, but the closest is more than 40 minutes away, in the town of Artesia — which residents may find too far to drive to in an emergency.
. . .
Artesia General has no debt-collection suits against patients on record since 2015. Neither does Presbyterian Hospital in Albuquerque — which, at 450 licensed beds, is almost four times as large as the hospital in Carlsbad.
By contrast, other hospitals owned by Community Health Systems in New Mexico also regularly file suits over unpaid bills. Lea Regional Medical Center in Hobbs has filed almost 2,000 such suits since 2015. Mountain View Regional Medical Center in Las Cruces has filed about 2,000 suits against patients in that time; almost half of them came just this year.
In Carlsbad, these lawsuits flood the docket. District Judge Lisa Riley, who has been on the bench in Eddy County since 2011, estimated that about one-third of all civil cases that come across her desk involve unpaid medical debt.
. . .
She, too, was a target of the hospital before she became a judge. Her husband had been disputing emergency room charges when the hospital sued; the case was resolved and dismissed. (Judge Riley would not comment further, citing ethics restrictions that prohibit judges from making statements about matters that might appear in court.)
Judge Riley’s case and others from Carlsbad appear in an upcoming book called “The Price We Pay,” by Dr. Marty Makary, a surgeon at Johns Hopkins University who studies the costs of American health care and led the study of hospital suits in Virginia.
Debt collection is common in the health care industry, he said, but lawsuits are a traumatic way to force patients to pay. Normally hospitals simply refer unpaid bills to debt collectors; fewer file lawsuits and then garnish wages or place liens on homes.
In his study of Virginia, 36 percent of hospitals garnished the wages of patients owing money, with 10 percent doing so frequently. (Even his own institution, however, has come under fire for suing the poor.)
When seeking payment for medical bills, “Collections agencies may harass you with phone calls,” Dr. Makary said. “They may send a note to your credit bureau, but they’re not reaching into your paycheck.”
Many of these patients are low-paid workers with little savings. Dr. Makary’s study found that Walmart was the most common employer of those whose wages were garnished over medical bills. “These are hardworking Americans who did nothing wrong,” he said.
The cost of care differs from institution to institution, partly because hospitals have broad discretion in setting prices. Charges for the same services vary widely, even when hospitals have similar patient demographics, and the amounts billed have little relationship to quality.
If you are a hospital executive, “you could charge whatever you want,” said Dr. Makary. “You could charge $1 million for an X-ray.”
For the full story, see:
(Note: ellipses added.)
(Note: the online version of the story was updated Dec. 2, 2019, and has the title “As Patients Struggle With Bills, Hospital Sues Thousands.”)
The Makary book mentioned above is:
Makary, Marty. The Price We Pay: What Broke American Health Care–and How to Fix It. New York: Bloomsbury Publishing, 2019.
Can the Methods of ACT UP Bring Quicker Cures for Other Maladies?
Amar Bhidé has a thought-provoking article in which he asks the public choice question of how to overcome government regulators who slow the development of breakthrough drugs. He holds up, as a main example to ponder, the AIDs ACT UP movement that is often given credit for winning concessions from the FDA that spurred the availability of a drug cocktail that greatly extended and improved the lives of AIDs patients. The passages quoted below are from a review of a book that may be a promising source for learning more about what ACT UP did and how they did it.
(p. C3) In her 2012 book, “The Gentrification of the Mind,” Sarah Schulman delved into the silence still surrounding AIDS in America.
. . .
Schulman has gone from witness to a sort of living archive. She is a former member of AIDS Coalition to Unleash Power, the influential direct-action group committed to ending AIDS. Her new book, “Let the Record Show,” is based on 17 years of interviews she conducted with nearly 200 members of the organization.
. . .
The effect is rather like standing in the middle of that large room, where anyone could speak up and share an idea. Everyone is talking; small stories branch off, coalesce pages later. Speakers shade in one another’s stories, offer another angle, disagree passionately. You turn a page, and the same people have their arms linked together at a protest. Shadows start to fall; in squares of gray text, deaths are marked, moments for remembrance. So many people leave the room.
. . .
This is not reverent, definitive history. This is a tactician’s bible.
The organizational brilliance of ACT UP emerged out of necessity. The group was founded in 1987, incited by Larry Kramer’s famous call to action. The members were infected, their lovers were sick and dying. There wasn’t time to obsess over process, to contest every comma in a letter. The anarchistic framework asked only that members be “committed to direct action to end the AIDS crisis.”
. . .
When Schulman herself returns to the individual, it is to think again about the figure of the bystander. Why did these particular people rise to the moment and not others?
What thread connected an H.I.V.-positive stockbroker, a retired chemist from Queens, addicts, art students, lifelong activists, people who just happened to be in the next room at the center and wandered in, What was going on in there? For some it was their first experience of gay community; for others it was where they went when the community began to vanish. All of them became autodidacts in drug research, policy, media relations.
For the full review, see:
Parul Sehgal. “Remembering Those Who Stood Up.” The New York Times (Wednesday, May 5, 2021): C3.
(Note: ellipses added. In the original, the words NOT italicized above, were the only words that WERE italicized.)
(Note: the online version of the review has the date May 4, 2021, and has the title “A New Testament to the Fury and Beauty of Activism During the AIDS Crisis.”)
The book under review is:
Schulman, Sarah. Let the Record Show: A Political History of ACT UP New York, 1987-1993. New York: Farrar, Straus and Giroux, 2021.
The article mentioned above by Bhidé is:
Bhidé, Amar. “Constraining Knowledge: Traditions and Rules That Limit Medical Innovation.” Critical Review 29, no. 1 (Jan. 2017): 1-33.