Health – Page 45 – artdiamondblog.com

Early Medical “Leaps of Ingenuity”

(p. A17) Using a panoply of colorful examples, the author artfully illustrates the frustrations, uncertainty, poorly founded confidence and frequent futility of medical practice in the prescientific age. Employing a consistently light and humorous touch, he effortlessly navigates a cornucopia of fascinating, esoteric and obscure patient histories.
The carefully selected vignettes demonstrate the befuddled mindset of the well-intentioned physicians who were forced to contend with the vagaries of damaged and failing human flesh without the benefit of anesthesia, and armed with little more than the fanciful theories of Galen (a second-century Greek who attributed disease to imbalances of the four “humors”: blood, phlegm, and yellow and black bile) and an elementary knowledge of human anatomy.
Yet despite their lack of mechanistic understanding, these individuals showed leaps of ingenuity no less startling than those of today’s physicians and genome rewriters. To avoid subjecting himself to the dangers of 18th-century surgery to remove a bladder stone, Mr. Morris tells us, the French-born surgeon Claude Martin fashioned an instrument out of a knitting needle and a whalebone handle, which he then inserted through his urethra and used to manually file away the stone.

For the full review, see:
Adrian Woolfson. “BOOKSHELF; Desperate Remedies; Treatments of old for common health ills included tobacco-smoke enemas, arsenic cigarettes–and the “Pigeon’s-Rump Cure.” The Wall Street Journal (Tuesday, Dec. 13, 2018): A17.
(Note: ellipses added.)
(Note: the online version of the review has the date Dec. 12, 2018, and has the title “BOOKSHELF; ‘The Mystery of the Exploding Teeth’ Review: Desperate Remedies; Treatments of old for common health ills included tobacco-smoke enemas, arsenic cigarettes–and the “Pigeon’s-Rump Cure.”)

The book under review, is:
Morris, Thomas. The Mystery of the Exploding Teeth: And Other Curiosities from the History of Medicine. New York: Dutton, 2018.

Kansas City Government Pours Bleach on Food for the Homeless

(p. A17) KANSAS CITY, Mo. — They unfurled colorful blankets on a grassy slope, and unloaded steaming trays of corn dogs, baked beans and vegetable beef soup. Every week for the past three years, the volunteers have gone to a park just outside downtown Kansas City with home-cooked meals for the homeless. They call it a picnic with friends.
But on a cloudy afternoon earlier this month, an inspector from the Kansas City Health Department showed up and called it something else: an illegal food establishment.
She ordered most of the food put into black garbage bags, bundled them on the grass and, in a move that stunned the gathered group, doused the pile with bleach.
Allen Andrews, who has been living on the streets for the past year, said he watched silently as the bleach was poured, thinking back to when he had a home. He remembered how he had sometimes poured bleach on trash he put out for collection, to deter rodents from getting into it.
“They treat us like animals,” Mr. Andrews, 46, said.

For the full story, see:
John Eligon. “‘Where Feeding the Needy Requires Both a Heart and a Permit.” The New York Times (Thursday, Nov. 22, 2018): A17.
(Note: the online version of the story has the date Nov. 21, 2018, and has the title “You Want to Feed the Hungry? Lovely. Let’s See Your Permit.” The online version says that the article appeared on p. A13 of the New York edition. It appeared on p. A17 of the National edition that I subscribe to.)

“Profit Feeds Impact at Scale”

(p. 1) Eric Reynolds will tell you that he is on the verge of freeing much of humanity from the deadly scourge of the cooking fire. He can halt the toxic smoke wafting through African homes, protect what is left of the continent’s forest cover and help rescue the planet from the wrath of climate change.
He is happy to explain, at considerable length, how he will systematically achieve all this while constructing a business that can amass billions in profit from an unlikely group of customers: the poorest people on earth.
He will confess that some people doubt his hold on reality.
“A lot of people think it’s too good to be true,” says Mr. Reynolds, a California-born entrepreneur living in Rwanda. “Most people think I am pretty out there.”
The company he is building across Rwanda, Inyenyeri, aims to replace Africa’s overwhelming dependence on charcoal and firewood with clean-burning stoves powered by wood pellets. The business has just a tad more than 5,000 customers and needs perhaps 100,000 to break even. Even its chief operating officer, Claude Mansell, a veteran of the global consulting company Capgemini, wonders how the story will end.
“Do we know that it’s going to work?” he asks. “I don’t know. It’s never been done before.”
Inyenyeri presents a real-world test of an idea gaining traction among those focused on economic development — that profit-making businesses may be best positioned to deliver critically needed services to the world’s poorest communities.
Governments in impoverished countries lack the finance to attack threats to public health, and many are riddled with corruption (though, by reputation, not Rwanda’s). Philanthropists and international aid organizations play key roles in areas such as immunizing children. But turning plans for basic services into mass-market realities may require the potent incentives of capitalism. It is a notion that has provoked the creation of many businesses, most of them failures.
“Profit feeds impact at scale,” says Mr. Reynolds, now in the midst of a global tour (p. 8) as he courts investment on top of the roughly $12 million he has already raised. “Unless somebody gets rich, it can’t grow.”
More than four decades have passed since Mr. Reynolds embarked on what he portrays as an accidental life as an entrepreneur, an outgrowth of his fascination with mountaineering. He dropped out of college to start Marmot, the outdoor gear company named for the burrowing rodent. There, he profited by protecting Volvo-driving, chardonnay-sipping weekend warriors against the menacing elements of Aspen. Now, he is trying to build a business centered on customers for whom turning on a light switch is a radical act of upward mobility.
. . .
To succeed, a stove had to be so convenient and clean burning that women preferred it over their existing cooking method.
Mr. Reynolds began testing stoves made in Italy, India, the United States and China. He tried making his own.
He came to realize that the magic was in the combination of stove and fuel. He experimented with making charcoal out of corncobs. (“A stupid idea,” he says.) He tried burning banana leaves. Then he discovered wood pellets, which involve compressing wood and eliminating water, the element that produces much of the smoke.
He settled on a Dutch-made stove that reduces wood down to clean-burning gases. Using pellets reduced the need for wood by 90 percent compared with charcoal. But those stoves cost more than $75.
Then came the epiphany: Inyenyeri could supply the stoves for free while collecting revenue from subscriptions for pellets. Rwanda was urbanizing rapidly, and city dwellers rely on charcoal. They would be eager to switch to pellets, which were 30 to 50 percent cheaper.
. . .
(p. 9) The business model would get more attractive as the cost of charcoal climbed, and as innovation inevitably made stoves more efficient. Inyenyeri would also stand to collect revenue from an arrangement it later entered into with the World Bank to sell credits for reducing emissions.
In 2010, Mr. Reynolds sold his house in Boulder and went all in on Inyenyeri. He unloaded his wine cellar, liquidated his retirement accounts and moved to Rwanda with no plan to leave.
. . .
“This business model will happen,” he says. “If it’s not Inyenyeri that’s the first mover, then it will be someone else who learns from our mistakes and does it better. It’s too big of an opportunity.”

For the full story, see:
Peter S. Goodman. “‘A Low-Cost Fix for Africa’s Silent Killer.” The New York Times, SundayBusiness Section (Sunday, Dec. 6, 2018): 1 & 8-9.
(Note: ellipses added.)
(Note: the online version of the story has the date Dec. 5, 2018, and has the title “Toxic Smoke Is Africa’s Quiet Killer. An Entrepreneur Says His Fix Can Make a Fortune.”)

Richest Man in World in 1836 Died of an Infection that Modern Antibiotics Cure

(p. A2) Rising incomes alone cannot capture how much better life has gotten. “Nathan Rothschild was surely the richest man in the world when he died in 1836,” economists Max Roser and Esteban Ortiz-Ospina wrote in 2017. “But the cause of his death was an infection–a condition that can now be treated with antibiotics sold for less than a couple of cents. Today, only the very poorest people in the world would die in the way that the richest man of the 19th century died.”
Mr. Roser is the founder of Our World in Data, a website that tracks the evolution of human welfare over the last few centuries. Scroll through the charts, articles and data sets, and you will be stunned by how much better life has become in just the last few decades: Child mortality, illiteracy and deaths from violence have all plummeted, and life expectancy has gone up.

For the full commentary, see:
Greg Ip. “Stop Calling It ‘Vocational Training’; How we speak about education reflects class prejudice.” The Wall Street Journal (Wednesday, January 3, 2019): A2.
(Note: the online version of the commentary has the date Jan. 2, 2019, and has the title “CAPITAL ACCOUNT; The World Is Getting Quietly, Relentlessly Better.”)

The Roser and Oritz-Ospina piece mentioned above, is:
Max Roser and Esteban Ortiz-Ospina (2018) – “Global Extreme Poverty”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/extreme-poverty’ [Online Resource]

Drones Bringing Vaccine May Be Interpreted by Some as Cargo Cult Vindication

(p. A10) In the village of Cook’s Bay, on the remote side of the remote island of Erromango, in the remote South Pacific nation of Vanuatu, 1-month-old Joy Nowai was given shots for hepatitis and tuberculosis that were delivered by a flying drone on Monday.
It may not have been the first vial of vaccine ever delivered that way, but it was the first in Vanuatu, which is the only country in the world to make its childhood vaccine program officially drone-dependent.
“I am so happy the drone brought the stick medicine to Cook’s Bay as I don’t have to walk several hours to Port Narvin for her vaccines,” her mother, Julie Nowai told a Unicef representative. “It is only 15 minutes’ walk from my home.”
.. . .
. . . , about 20 percent of Vanuatu’s 35,000 children under age 5 do not get all their shots, according to the United Nations Children’s Fund.
So the country, with support from Unicef, the Australian government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, began its drone program on Monday. It will initially serve three islands but may be expanded to many more.
In the future, that expansion may run into some unusual turbulence — Vanuatu is one of the few places where “cargo cults” are still active, and the drones match their central religious dogma: that believers will receive valuable goods delivered by airplane.
That will have to be handled carefully, a Unicef representative said.
. . .
. . . : Vanuatu still has adherents of the John Frum movement, one of the South Pacific cargo cults whose adherents pray for valuables arriving from the sky.
The cults date back more than 100 years, but reached their zenith during and after World War II.
Islanders whose ancestors had been kidnapped by whites to work on plantations in Australia and Fiji watched “silver birds” flown in by the Japanese and American militaries disgorge vast amounts of “cargo” — food, medicines, tools and weapons — which was sometimes shared with them.
The legend spread that the cargo was gifts from the ancestors, but that it had been intercepted and stolen by the foreigners. After the war ended, the cults built airstrips and model planes to lure the “birds” back.

For the full story, see:
Donald G. McNeil Jr. “‘A Buzzing Thing in the Sky’ Delivers Vaccines to Vanuatu.” The New York Times (Tuesday, Dec. 18, 2018): A10.
(Note: ellipses added.)
(Note: the online version of the story has the date Dec. 17, 2018, and has the title “An Island Nation’s Health Experiment: Vaccines Delivered by Drone.”)

Mitch Daniels Views Higher Education as a “Racket” (Health Care Too)

(p. A11) Mr. Daniels, 69, is the most innovative university president in America.
. . .
Mr. Daniels kicks off our conversation with a morality tale: “I’ll speak to an audience of businesspeople and say: Here’s the racket that you should have gone into. You’re selling something, a college diploma, that’s deemed a necessity. And you have total pricing power.” Better than that: “When you raise your prices, you not only don’t lose customers, you may actually attract new ones.”
For lack of objective measures, “people associate the sticker price with quality: ‘If school A costs more than B, I guess it’s a better school.’ ” A third-party payer, the government, funds it all, so that “the customer–that is, the student and the family–feels insulated against the cost. A perfect formula for complacency.” The parallels with health care, he observes, are “smack on.”

For the full interview, see:
Tunku Varadarajan, interviewer. “THE WEEKEND INTERVIEW: College Bloat Meets ‘The Blade’.” The Wall Street Journal (Saturday, Dec. 15, 2018): A11.
(Note: ellipsis added.)
(Note: the online version of the interview has the date Dec. 14, 2018.)

Progress on Cancer Cures Is Slow and Too Few Benefit

(p. 5) The reason is a new generation of cancer treatments that have become available in recent years. Some, called immunotherapy, harness the patient’s own immune system to battle a tumor. Others, known as targeted therapies, block certain molecules that cancers depend on to grow and spread. The medical literature — usually circumspect when it comes to cancer, in light of many overhyped treatments in the past — now fairly gushes with terms like “revolutionary” and “cure.” In this case, the hype feels mostly justified.
. . .
A recent analysis estimated that about 15 percent of patients with advanced cancer might benefit from immunotherapy — and it’s all but impossible to determine which patients will be the lucky ones. Just last week, a study of lung cancer patients demonstrated the overall benefits of combining immunotherapy with traditional chemotherapy. But here, too, the researchers noted that most patients will not respond to the new treatments, and it is not yet possible to predict who will benefit. In some cases, the side effects are terrible — different from those of chemotherapy but often just as dire.

For the full commentary, see:
Robert M. Wachter. “The Problem With Miracle Cancer Cures.” The New York Times, SundayReview Section (Sunday, April 21, 2018): 5.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date April 19, 2018.)

The claim that only 15% benefit, made above, is based on the following:
Howard, Jacqueline. “Hope and Hype around Cancer Immunotherapy.” CNN, Weds., Sept. 27, 2017.
GAY, NATHAN, and VINAY PRASAD. “First Opinion; Few People Actually Benefit from ‘Breakthrough’ Cancer Immunotherapy.” March 8, 2017.

“Outsider Status” of Surgeons “Permitted Greater Risks and Leaps of Faith”

(p. A19) . . . as Arnold van de Laar reminds us in “Under the Knife: A History of Surgery in 28 Remarkable Operations,” a collection of hypervivid anecdotes and oddities, it was only recently that surgeons were considered the equals of what we would now call internists–doctors who diagnose, prescribe medicine and prognosticate.
. . .
. . . , it has been both the bane and the secret glory of surgery as a vocation that it was relegated for so long to the margins of “decent” intellectual or professional life. Its dodgy, outsider status perhaps permitted greater risks and leaps of faith than were available to nonsurgical physicians, who still found themselves making inchworm progress from the dictates of Hippocrates and Galen. Surgeons worked fast to beat pain and gangrene (so fast that in one case, Scottish surgeon Robert Liston cut off a man’s testicles in a rush to amputate his leg). They used whatever materials seemed to make sense–in some cases gold thread, costly but long-lasting; in other cases branding irons.

For the full review, see:
Laura Kolbe. “The Kindest Cuts.” The Wall Street Journal (Saturday, November 15, 2018): A19.
(Note: ellipses added.)
(Note: the online version of the review has the date Nov. 14, 2018, and has the title “BOOKSHELF; ‘Under the Knife’ Review: The Kindest Cuts.”)

The book under review, is:
van de Laar, Arnold. Under the Knife: A History of Surgery in 28 Remarkable Operations. New York: St. Martin’s Press, 2018.

Health Care Premium Costs Continue to Rise

Source of graph: online version of the WSJ article quoted and cited below.

(p. A1) The average cost of employer health coverage offered to workers rose to nearly $20,000 for a family plan this year, according to a new survey, capping years of increases that experts said are chiefly tied to rising prices paid for health services.

For the full story, see:
Anna Wilde Mathews. “‘Health Coverage Costs Firms $20,000 a Family.” The Wall Street Journal (Thursday, Oct. 4, 2018): A1 & A6.
(Note: the online version of the story has the date Oct. 3, 2018, and has the title “Employer-Provided Health Insurance Approaches $20,000 a Year.”)

High-Tech Toilets Could Reduce Feces in Swimming Pools

If the cringeworthy facts reported below were more widely known, demand would greatly increase for the high-tech toilets common in Japan, that shoot water sprays at human rear ends, to quickly, comfortably, and completely remove fecal residue. Why has no one grasped this entrepreneurial opportunity?

(p. A2) Mrs. [Lindsey] Blackstock and several colleagues tested 31 swimming pools and hot tubs in hotels and recreational facilities in Canada for the presence of acesulfame potassium, an artificial sweetener that is largely undigested and almost entirely excreted in urine.
. . .
Using that information, they deduced that a 110,000-gallon pool they studied contained an estimated eight gallons of urine, while a 220,000-gallon pool contained an estimated 20 gallons. The concentrations represented about 0.01% of the total water volume.
“If your eyes are turning red when you’re swimming, or if you’re coughing or have a runny nose, it’s likely there is at least some urine in the pool,” said Michele Hlavsa, chief of the Healthy Swimming Program for the Centers for Disease Control and Prevention.
Urine isn’t a primary source of germs in pools or hot tubs, but feces that clings to the body is. At any time, Dr. Hlavsa said, adults have about 0.14 grams of poop on their bottoms and children have as much as 10 grams.
“When you’re talking about bigger water parks with 1,000 children in a given day, you’re now talking about 10 kilograms or 22 pounds of poop,” she said.
Feces can contain bacteria, viruses and parasites such as E. coli, norovirus and giardia that can lead to outbreaks of diarrhea, vomiting and other illnesses.

For the full commentary, see:
Jo Craven McGinty. “THE NUMBERS; A Sanitary Pool Requires Proper Behavior.” The Wall Street Journal (Saturday, July 21, 2017): A2.
(Note: ellipsis, and bracketed name, added.)
(Note: the online version of the commentary has the date July 21, 2017, and has the title “THE NUMBERS; Is That Pool Really Sanitary? New Chemical Approach Has Answers.”)

Blackstock’s research, described above, was published in:
Jmaiff Blackstock, Lindsay K., Wei Wang, Sai Vemula, Benjamin T. Jaeger, and Xing-Fang Li. “Sweetened Swimming Pools and Hot Tubs.” Environmental Science & Technology Letters 4, no. 4 (April 2017): 149-53.

Buddhist Monks Fear Death

(p. C4) A recent paper in the journal Cognitive Science has an unusual combination of authors. A philosopher, a scholar of Buddhism, a social psychologist and a practicing Tibetan Buddhist tried to find out whether believing in Buddhism really does change how you feel about your self–and about death.
The philosopher Shaun Nichols of the University of Arizona and his fellow authors studied Christian and nonreligious Americans, Hindus and both everyday Tibetan Buddhists and Tibetan Buddhist monks.
. . .
The results were very surprising. Most participants reported about the same degree of fear, whether or not they believed in an afterlife. But the monks said that they were much more afraid of death than any other group did.
Why would this be? The Buddhist scholars themselves say that merely knowing there is no self isn’t enough to get rid of the feeling that the self is there. Neuroscience supports this idea.
. . .
Another factor in explaining why these monks were more afraid of death might be that they were trained to think constantly about mortality. The Buddha, perhaps apocryphally, once said that his followers should think about death with every breath. Maybe just ignoring death is a better strategy.

For the full commentary, see:
Alison Gopnik. “Who’s Most Afraid to Die? A Surprise.” The Wall Street Journal (Saturday, June 9, 2018): C4.
(Note: ellipses added.)
(Note: the online version of the commentary has the date June 6, 2018.)

The print version of the Cognitive Science article discussed above, is:
Nichols, Shaun, Nina Strohminger, Arun Rai, and Jay Garfield. “Death and the Self.” Cognitive Science 42, no. S1 (May 2018): 314-32.