How “Single-Payer” Socialized Medicine Works for American Indians

(p. A1) EAGLE BUTTE, S.D.—Kate Miner walked into the Indian Health Service hospital, seeking help for a cough that wouldn’t quit.

An X-ray taken of Ms. Miner’s lungs that day, Oct. 19, 2016, found signs of cancer.

What exactly the IHS doctor said to Ms. Miner about her exam remains in dispute. Notations in her medical file indicate the doctor told her to come back for a lung scan the next day. Her family says they never were given such instructions and weren’t told of the two masses the X-ray revealed.

What is clear is that no further tests were done. And no IHS provider followed up when Ms. Miner returned twice more to the hospital, the only one on the Cheyenne River Reservation, over the next six months, medical records show.

Finally, on May 7, 2017, as the 67-year-old Ms. Miner lay crumpled on a hospital cot, the right side of her body shaking, a physician assistant ordered a CT scan, after her family insisted, according to the records and family members.

“You have two very large masses in your right lung. It’s probably a malignancy,” Ms. Miner’s daughter Kali Tree Top recalled the physician assistant saying.

Ms. Miner reached for her daughter’s hand and started to cry.

Ms. Miner’s encounters with the IHS, and her family’s repeated efforts to get her help there, illustrate how the federal agency can fail the patients who need it most.

For the full story, see:

Dan Frosch. “A Tragic Journey Through the Indian Health Service.” The Wall Street Journal (Tuesday, December 24, 2019): A1 & A8.

(Note: the online version of the story was updated December 23, 2019, and has the title “Kate Miner’s Tragic Journey Through the U.S. Indian Health Service.”)

Opposed by China and WHO, Trump Administration Declared Covid-19 Public Health Emergency on January 31, 2020

(p. A1) The U.S. imposed entry restrictions on foreign nationals and quarantines on Americans returning from the Chinese province at the center of the coronavirus outbreak, as markets tumbled over fears about the impact on global growth.

Health and Human Services Secretary Alex Azar declared a public health emergency Friday [Jan. 31, 2020]. He said foreign citizens who have traveled anywhere in China within the past 14 days would be denied U.S. entry, while Americans who visited Hubei province would be quarantined for up to two weeks.

. . .

(p. A8) “Many countries have offered China support in various means. In sharp contrast, certain U.S. officials’ words and actions are neither factual nor appropriate,” Chinese Foreign Ministry spokeswoman Hua Chunying said. “Just as the WHO recommended against travel restrictions, the U.S. rushed to go in the opposite way.”

For the full story, see:

Alex Leary and Brianna Abbott. “U.S. Curbs Entry to Combat Virus.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A8.

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

(Note: the online version of the story has the date January 31, 2020, and has the title “U.S. Imposes Entry Restrictions Over Coronavirus.”)

Wasteful Administrative Health Care Costs

The study quoted from below suggests that the main cure for wasteful administrative costs is a “single payer” system, which is a politically correct euphemism for socialized medicine. I suggest that a better cure would be to eliminate the government middle-man, and make the patient be the payer. The patient as payer would seek and buy low-cost cures or therapies, which would shift efforts at healthcare innovation toward lower cost innovations. As has been suggested for education, vouchers could provide poor patients with the means to pay for basic care.

(p. B4) Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.
A new study, published Monday [October 7, 2020] in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.

. . .

Teresa Rogstad of Humana and Natasha Parekh, a physician with the University of Pittsburgh, were co-authors of the study, which combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy.

. . .

The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.

. . .

The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. Despite this high cost, the authors found no studies that evaluate approaches to reducing it.

For the full commentary, see:

Austin Frakt. “THE NEW HEALTH CARE; Up to 25% of Health Costs Called Wasteful.” The New York Times (Tuesday, October 8, 2019): B4.

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

(Note: the online version of the commentary has the date Oct. 7, 2019, and has the title “THE NEW HEALTH CARE; The Huge Waste in the U.S. Health System.”)

The print version of the academic article in JAMA mentioned above is:

Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the Us Health Care System: Estimated Costs and Potential for Savings.” JAMA 322, no. 15 (Oct. 15, 2019): 1501-09.

Even Chimps Seek Cool Comfort

Some humans reject air conditioning. Chimps are unable to create air conditioning. But when they discover a cool cave in a hot summer, they spend time in the cave.

(p. D2) Everyone needs to cool off on a scorching summer day, even chimpanzees. Where do the primates go on sizzling days when woodlands and forests don’t provide respite from the heat?

Caves.

. . .

In southeastern Senegal, temperatures spike to 110 degrees Fahrenheit and fires burn large parts of the landscape over a seven-month dry season. Several natural cave formations pock the terrain, and they can be up to 55 degrees cooler than the surrounding grasslands.

For the full story, see:

Priyanka Runwal. “Why Chimp Moms Flock to Caves on the Savanna.” The New York Times (Tuesday, August 11, 2020): D2.

(Note: ellipsis added.)

(Note: the online version of the story was updated on August 6, 2020, and has the same title as the print version.)

See also:

Diamond, Arthur M., Jr. “Keeping Our Cool: In Defense of Air Conditioning.” Economics & Business Journal: Inquiries & Perspectives 8, no. 1 (Oct. 2017): 1-36.

Young Doctor “Taken Aback” by Deaths Under Nationalized Medicine

(p. 26) Westaby’s book will be a balm to the hearts of curmudgeons everywhere. Sidestepping the contemporary hand-wringing about the lack of empathy in medicine, Westaby, a British surgeon, positions empathy as a threat to the surgical career: “Heart surgery,” he writes, “needs to be an impersonal, technical exercise.”

. . .

The deaths that truly madden him are those that could have been prevented by available technologies not then funded by the British National Health Service (N.H.S.), his employer.

. . .

As a young doctor who imagines nationalized medicine as a way toward comprehensive care for all my patients, I was taken aback.

For the full review, see:

Rachel Pearson. “SHORTLIST; Medical Memoirs.” The New York Times Book Review (Sunday, July 2, 2017): 26.

(Note: the online version of the review has the date June 27, 2017, and has the title “SHORTLIST; Four Timely Memoirs from the Halls of Medicine.”)

The book under review is:

Westaby, Stephen. Open Heart: A Cardiac Surgeon’s Stories of Life and Death on the Operating Table. New York: Basic Books, 2017.

Scientists Shocked to Discover a New Structure in Human Body

Some have claimed that we have picked all the low-hanging fruit and that there is little yet to be discovered. But if we remain curious, alert to serendipitous inconsistencies or surprises, we still have a lot to be learned. The default is to not see, or at least to soon forget, when we see the unexpected. To see and remember is hard enough. In the passages quoted below the researchers saw, remembered, and followed up. (Another example would be when Nick Steinsberger saw, remembered, and followed-up on the unexpected positive effects of the accidentally too watery fracking mixture injected into a well.)

(p. D5) A team of researchers in the Netherlands has discovered what may be a set of previously unidentified organs: a pair of large salivary glands, lurking in the nook where the nasal cavity meets the throat. If the findings are confirmed, this hidden wellspring of spit could mark the first identification of its kind in about three centuries.

Any modern anatomy book will show just three major types of salivary glands: one set near the ears, another below the jaw and another under the tongue. “Now, we think there is a fourth,” said Dr. Matthijs Valstar, a surgeon and researcher at the Netherlands Cancer Institute and an author on the study, published last month in the journal Radiotherapy and Oncology.

The study was small, and examined a limited patient population, said Dr. Valerie Fitzhugh, a pathologist at Rutgers University who wasn’t involved in the research. But “it seems like they may be onto something,” she said. “If it’s real, it could change the way we look at disease in this region.”

Even without a direct therapeutic application, Dr. Yvonne Mowery, a radiation oncologist at Duke University, said she “was quite shocked that we are in 2020 and have a new structure identified in the human body.”

Dr. Valstar and his colleagues, who usually study data from people with prostate cancer, didn’t set out on a treasure hunt for unidentified spit glands.

. . .

While perusing a set of scans from a machine that could visualize tissues in high detail, the researchers noticed two unfamiliar structures dead center in the head: a duo of flat, spindly glands, a couple of inches in length, draped discreetly over the tubes that connect the ears to the throat.

Puzzled by the images, they dissected tissue from two cadavers and found that the glands bore similarities to known salivary glands that sit below the tongue. The new glands were also hooked up to large draining ducts — a hint that they were funneling fluid from one place to another.

It’s not completely clear how the glands eluded anatomists. But “the location is not very accessible, and you need very sensitive imaging to detect it,” said Dr. Wouter Vogel, a radiation oncologist at the Netherlands Cancer Institute and an author on the study.

. . .

Dr. Fitzhugh added that it should be easier to spot the camera-shy glands with traditional techniques “now that they know to look for it.”

For the full story, see:

Katherine J. Wu. “The Human Anatomy Yields a New Surprise.” The New York Times (Tuesday, October 27, 2020): D5.

(Note: ellipses added.)

(Note: the online version of the story was updated on Oct. 21, 2020, and has the title “Doctors May Have Found Secretive New Organs in the Center of Your Head.”)

The academic article mentioned above is:

Valstar, Matthijs H., Bernadette S. de Bakker, Roel J. H. M. Steenbakkers, Kees H. de Jong, Laura A. Smit, Thomas J. W. Klein Nulent, Robert J. J. van Es, Ingrid Hofland, Bart de Keizer, Bas Jasperse, Alfons J. M. Balm, Arjen van der Schaaf, Johannes A. Langendijk, Ludi E. Smeele, and Wouter V. Vogel. “The Tubarial Salivary Glands: A Potential New Organ at Risk for Radiotherapy.” Radiotherapy and Oncology (published online in advance of print on Sept. 23, 2020).

Costs and Difficulties of Clinical Trials Delay “Most Promising Experimental Drugs”

(p. A6) As the coronavirus pandemic continues to wreak havoc in the United States and treatments are needed more than ever, clinical trials for some of the most promising experimental drugs are taking longer than expected.

Researchers at a dozen clinical trial sites said that testing delays, staffing shortages, space constraints and reluctant patients were complicating their efforts to test monoclonal antibodies, man-made drugs that mimic the molecular soldiers made by the human immune system.

As a result, once-ambitious deadlines are slipping. The drug maker Regeneron, which previously said it could have emergency doses of its antibody cocktail ready by the end of summer, has shifted to talking about how “initial data” could be available by the end of September [2020].

And Eli Lilly’s chief scientific officer said in June that its antibody treatment might be ready in September, but in an interview this week, he said he now hopes for something before the end of the year.

“Of course, I wish we could go faster — there’s no question about that,” said the Eli Lilly executive, Dr. Daniel Skovronsky. “I guess in my hopes and dreams, we enroll the patients in a week or two, but it’s taking longer than that.”

For the full story, see:

Katie Thomas. “Clinical Trials of Drugs For Virus Are Delayed By a Swamped System.” The New York Times (Saturday, August 15, 2020): A6.

(Note: bracketed year added.)

(Note: the online version of the story has the date Aug. 14, 2020, and has the title “Clinical Trials of Coronavirus Drugs Are Taking Longer Than Expected.”)

Invading Mussels Gave Lake Michigan Sparkling Clarity

(p. 12) Having just moved back to Chicago from Mexico, she had seen Lake Michigan with fresh eyes. “Have you noticed how blue the lake is now?” she asked me one day. I had not. “It’s, like, Caribbean blue,” she said. The next time I went down to the lakeside I noticed what she meant. The lake of my childhood had always vacillated somewhere between a slate blue and the gray found in the seams of an old tennis ball. But suddenly it had taken on a kind of hyperclarity; it sparkled. The lake was so clean, I read online, that passing airplanes could see shipwrecks resting on the lake bottom. Thanks to climate change, the lake was approaching Caribbean temperatures, as well; it hit 80 degrees one recent July, when it would normally be in the high 50s. I remember feeling pleased by this change, but also slightly unsettled, the same way we feel on an unseasonably warm winter’s day. It was too good to be good.

And so it came as a revelation to me to read Dan Egan’s deeply researched and sharply written “The Death and Life of the Great Lakes.” Dipping into this book was like opening the secret diary of a mercurial and mysterious parent. I learned that the reason the lake had become so clear was that it had been invaded by a dastardly pair of bivalves — the zebra and quagga mussels — which had hitched a ride on a shipping barge from either the Black or Caspian Seas and then quietly but ceaselessly colonized the lake. They set about cleaning up the water with hyperactive single-mindedness, eventually sucking up 90 percent of the lake’s phytoplankton. The water is now three times clearer than it was in the 1980s.

For the full review, see:

Robert Moor. “Five Alive.” The New York Times Book Review (Sunday, May 28, 2017): 12.

(Note: the online version of the review has the date May 23, 2017, and has the title “April’s Book Club Pick: ‘The Death and Life of the Great Lakes,’ by Dan Egan.”)

The book under review is:

Egan, Dan. The Death and Life of the Great Lakes. New York: W. W. Norton & Company, 2017.

W.H.O. Helped Authoritarian Communist Chinese Leaders Conceal Origin of Covid-19

(p. A1) GENEVA — On a cold weekend in mid-February [2020], when the world still harbored false hope that the new coronavirus could be contained, a World Health Organization team arrived in Beijing to study the outbreak and investigate a critical question: How did the virus jump from animals to humans?

At that point, there were only three confirmed deaths from Covid-19 outside China and scientists hoped that finding an animal source for the coronavirus would unlock clues about how to stop it, treat it and prevent similar outbreaks.

“If we don’t know the source then we’re equally vulnerable in the future to a similar outbreak,” Michael Ryan, the World Health Organization’s emergency director, had said that week in Geneva. “Understanding that source is a very important next step.”

What the team members did not know was that they would not be allowed to investigate the source at all. Despite Dr. Ryan’s pronouncements, and over the advice of its emergency committee, the organization’s leadership had quietly negotiated terms that sidelined its own experts. They would not question China’s initial response or even visit the live-animal market in the city of Wuhan where the outbreak seemed to have originated.

Nine months and more than 1.1 million deaths later, there is still no transparent, independent investigation into the source of the virus. Notoriously allergic to outside scrutiny, China has impeded the effort, while leaders of the (p. A8) World Health Organization, if privately frustrated, have largely ceded control, even as the Trump administration has fumed.

. . .

. . . , the health organization pushed misleading and contradictory information about the risk of spread from symptomless carriers. Its experts were slow to accept that the virus could be airborne. Top health officials encouraged travel as usual, advice that was based on politics and economics, not science.

The W.H.O.’s staunchest defenders note that, by the nature of its constitution, it is beholden to the countries that finance it. And it is hardly the only international body bending to China’s might. But even many of its supporters have been frustrated by the organization’s secrecy, its public praise for China and its quiet concessions. Those decisions have indirectly helped Beijing to whitewash its early failures in handling the outbreak.

. . .

China’s authoritarian leaders want to constrain the organization; President Trump, who formally withdrew the United States from the body in July, now seems intent on destroying it; and European leaders are scrambling to reform and empower it.

The search for the virus’s origins is a study in the compromises the W.H.O. has made.

. . .

The W.H.O. has repeatedly said that investigations are underway but has done little to clarify the uncertainty. Chinese health and diplomatic officials did not respond to repeated interview requests and have been publicly silent on what happened.

“This is part of the Chinese psyche — to demonstrate to the world that they do the very best science,” said Peter Daszak, a disease ecologist and president of EcoHealth Alliance in New York. “But in this case, it didn’t work. And I think that is the reason why we don’t know much more.”

. . .

. . . Dr. Tedros, . . . decided against declaring an international emergency after convening a committee to advise him.

What was not publicly known, though, was that the committee’s Jan. 23 decision followed intense lobbying, notably by China, according to diplomats and health officials. Committee members are international experts largely insulated from influence. But in Geneva, China’s ambassador made it clear that his country would view an emergency declaration as a vote of no confidence.

China also presented data to the committee, portraying a situation under relative control.

Half the committee said it was too early to declare an emergency. The outcome surprised many countries, as did Dr. Tedros when he publicly praised both Mr. Xi and China’s pneumonia surveillance system.

“It was that system that caught this event,” he said during a news conference.

That was wrong. China’s surveillance system had failed to spot the outbreak, a failure that experts now say allowed its spread to accelerate.

. . .

(p. A9) On the origins of the virus, the experts mostly shifted the onus to China, asking the government to prioritize a “rigorous investigation.” But they also assured people that numerous investigations were underway.

“It was an absolute whitewash,” said Lawrence O. Gostin, a professor of global health law at Georgetown University. “But the answer was, that was the best they could negotiate with Xi Jinping.”

. . .

In January, Dr. Tedros had announced that China had agreed to share biological samples. Nothing ever came of it.

Then the thesis about the origin of the outbreak suddenly pivoted.

Dr. Gao, the director of China’s C.D.C., told the journal Science in March that the virus may not have originated at the market. Maybe, he said, it “could be a place where the virus was amplified,” meaning it began elsewhere but spread wildly there.

Then Dr. Gao told a local TV station that animal samples from the market did not contain the virus. That indicated at least that samples had been taken from animals. Yet the details remained concealed.

For the full story, see:

Selam Gebrekidan, Matt Apuzzo, Amy Qin, and Javier C. Hernández. “W.H.O. Ceded Control to China In Murky Hunt for Virus Origin.” The New York Times (Tuesday, November 3, 2020): A1 & A8-A9.

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

(Note: the online version of the story has the date Nov. 2, 2020, and has the title “In Hunt for Virus Source, W.H.O. Let China Take Charge.”)

Expense of Clinical Trials Reduce the Incentive to Re-Purpose Old, Cheap, Off-Patent Vaccines

(p. A5) “Retrospective studies are great and they provide some hints, but there are caveats,” said Dr. Shyam Kottilil, a professor of medicine with the Institute of Human Virology at the University of Maryland School of Medicine. “It’s very difficult to establish causality.”

Interest in the cross-protective effects of vaccines has led to efforts to repurpose old vaccines that may have potential to provide at least transient protection against the coronavirus until a specific vaccine against SARS-CoV-2 is developed and proven safe and effective, he said.

“But nobody knows whether this approach will work unless we test them,” Dr. Kottilil said. “To endorse this, you need to do really good randomized clinical trials.” There is little incentive for private companies to invest in expensive trials because the old vaccines are cheap and off-patent, he added.

For the full story, see:

Roni Caryn Rabin. “Are Past Vaccinations a Shield? It’s Doubtful.” The New York Times (Thursday, July 30, 2020): A5.

(Note: the online version of the story has the date July 29, 2020, and has the title “Old Vaccines May Stop the Coronavirus, Study Hints. Scientists Are Skeptical.”)

The Son of Jonas Salk Calls Operation Warp Speed “Absolutely Extraordinary”

A screen capture from the Replica Edition of the NYT, p. A4 for Thurs., Nov. 18, 2020.

(p. A4) A 76-year-old man in La Jolla, Calif., says he will get a coronavirus but not the way he got a polio vaccine when he was 9 — lined up in the kitchen next to his two siblings. Their father had sterilized the needles and syringes by boiling them on the stove.

The father was Dr. Jonas Salk, who had developed the vaccine.

. . .

At the time, the vaccine had gone through trials with small numbers of children. A trial with 1.8 million children did not begin until the next year, and the vaccine did not receive approval as safe and effective until a year after that — a timetable that he said made the development of coronavirus vaccine candidates in just months “absolutely extraordinary.” He said he had been concerned about pressure from the Trump administration to have a vaccine ready by Election Day. But he also said the decision to back the development of vaccines through Operation Warp Speed, the federal effort to accelerate vaccine development, “was quite positive.”

For the full story, see:

Barron, James. “Coronavirus Update; ‘l Just Didn’t Feel the Shot’.” The New York Times (Wednesday, November 18, 2020): A4.

(Note: ellipsis added.)

(Note: after considerable time spent searching, I was unable to find this article on the nytimes.com web site. I searched on 11/21/20 for the article that had appeared in-print on 11/18/20. In my experience, it is extremely rare for so recent a print article to be missing from the online web site. So, for documentary purposes, I have reproduced a screen capture of the article from the Replica Edition. (For subscribers to the NYT, The Replica Edition provides an online replica of the print edition for the previous 30 days of issues of the NYT.)