Category: Health

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.)

“Greatness in Science Often Comes From the Well-Prepared Mind Turning a Chance Observation Into a Major Discovery”

(p. 27) Takuo Aoyagi, a Japanese engineer whose pioneering work in the 1970s led to the modern pulse oximeter, a lifesaving device that clips on a finger and shows the level of oxygen in the blood and that has become a critical tool in the fight against the novel coronavirus, died on April 18 [2020] in Tokyo.

. . .

Mr. Aoyagi’s contribution to medical science was built on decades of innovation and invention. In an essay about Mr. Aoyagi, John W. Severinghaus, a professor emeritus of anesthesia at the University of California, San Francisco, wrote in 2007 that Mr. Aoyagi’s “dream” had been to detect oxygen saturation levels without having to draw blood.

. . .

But he soon ran into a problem. Blood does not flow smoothly like an open tap, but pulses through the body irregularly, thus preventing an accurate recording of dye levels. The problem, however, turned out to be an opportunity. By devising a mathematical formula to correct for this “pulsatile noise,” he created a device that measured oxygen levels with greater accuracy than before.

“Greatness in science, often, as here, comes from the well-prepared mind turning a chance observation into a major discovery,” Dr. Severinghaus wrote.

For the full obituary, see:

John Schwartz and Hikari Hida. “Takuo Aoyagi, 84; Invented Medical Device.” The New York Times, First Section (Sunday, May 3, 2020): 27.

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

(Note: the online version of the obituary was updated June 20, 2020, and has the title “Takuo Aoyagi, an Inventor of the Pulse Oximeter, Dies at 84.”)

The essay about Aoyagi mentioned above is:

Severinghaus, John W. “Takuo Aoyagi: Discovery of Pulse Oximetry.” Anesthesia & Analgesia 105, no. 6 (Dec. 2007): S1-S6.

“The F.D.A. and the Drug Houses Were in Bed Together”

(p. A22) Dr. John S. Najarian, a groundbreaking transplant surgeon who made headlines for taking on difficult cases, and who weathered a different type of headline when he was accused, and then exonerated, of improprieties related to a drug he had developed, died on Aug. 31 in Stillwater, Minn., east of Minneapolis.

. . .

In November 1982, Dr. Najarian performed what may have been his highest-profile surgery. The patient was Jamie Fiske, who became the youngest successful liver transplant recipient when Dr. Najarian performed the operation a few weeks before her first birthday. Her parents had made a widely publicized appeal for a donor.

“They were told that she wouldn’t survive that kind of an operation,” Dr. Najarian said in an oral history recorded in 2011 for the University of Minnesota’s Academic Health Center. “I’m not the kind of guy that takes that lightly. So I told them, ‘If a liver becomes available, we’ll transplant it, and it will work’ — a pretty brash statement, but it did.”

Dr. Najarian’s success with transplants was aided by a drug he developed in 1970, a type of antilymphocyte globulin known as Minnesota ALG, which addressed the biggest problem with early transplants: the rejection of the new organ. He said the drug, which he began using around 1970, gave the Minnesota transplant teams notably better results than other surgical centers were getting with a product offered by a pharmaceutical company.

“Everybody thought we were lying,” Dr. Najarian said, “because we could take patients and we could transplant them, and 65 to 70 percent of them did extremely well, whereas they were lucky to have 50 percent with the commercially available product from Upjohn.”

Other transplant centers began asking for the product, and it turned into a multimillion-dollar business for the university. But in 1992, the Food and Drug Administration, which had approved ALG as an investigational drug but not for interstate sale, stopped the program, and the federal authorities began an investigation. The university turned on Dr. Najarian, pressuring him to resign, and in 1995 he was charged with violating drug safety laws and other crimes.

Dr. Najarian maintained that the case was an attempt by the pharmaceutical industry and its friends in the F.D.A. to squash a successful treatment that was costing drug companies money by besting their products.

“The F.D.A. and the drug houses were in bed together,” he said bluntly in the oral history.

His trial in federal court in St. Paul, Minn., in 1996 provided vindication. Judge Richard Kyle threw out six of the charges, and a jury acquitted him of the other 15. The judge then took the extraordinary step of blasting the F.D.A. and the prosecutors.

“I have some questions as to why we were here at all,” Judge Kyle said.

The F.D.A., he added, “was certainly aware of what was going on, and yet they came in here as a witness to testify that somehow they were hoodwinked by this defendant and his colleagues and other people at the university.”

“We had a program here in Minnesota,” the judge added, “which, for all its problems and shortcomings, was a good program, literally saved thousands of lives.”

For the full obituary, see:

Neil Genzlinger. “John Najarian, 92, Revered Transplant Surgeon Who Took Tough Cases, Dies.” The New York Times (Monday, September 29, 2020): A22.

(Note: ellipsis added.)

(Note: the online version of the obituary was updated Sept. 19, 2020, and has the title “John Najarian, Pioneering Transplant Surgeon, Dies at 92.”)

Natural Experiments Are Equal to Randomized Double-Blind Clinical Trials in Showing Causality

(p. B6) . . . randomized controlled trials are the gold standard in medicine. Using randomization (by, say, flipping a coin to assign patients to a new treatment or not) is the best way to determine whether treatments work.

Unfortunately, randomized trials take time — which is a problem when doctors need answers now. So doctors and public health officials have been turning to available real-world data on patient outcomes and trying to make sense of them.

. . .

“Large-scale randomized evaluations have been less common in economics, prioritizing the need for economists to identify often creative but sometimes narrow natural experiments to estimate the causal effects of treatments,” said Amitabh Chandra, an economist at the Harvard Business School and the Kennedy School of Government.

Ashish Jha, recently appointed the dean of the Brown University School of Public Health, said that while “natural experiments have causal interpretations, typical associational studies in medicine do not, which may make some medical researchers less comfortable interpreting the results.”

. . .   Most doctors can relate to recent comments by the Food and Drug Administration director Stephen Hahn in last week’s congressional pandemic hearing. “In a rapidly moving situation like we have now with Covid-19,” he said, decisions are made “based on the data that’s available to us at the time.”

For the full commentary, see:

Anupam B. Jena and Christopher M. Worsham. “THE UPSHOT; What Coronavirus Researchers Can Learn From Economists.” The New York Times (Thursday, July 2, 2020): B6.

(Note: ellipses added.)

(Note: the online version of the commentary has the date June 30, 2020, and has the same title as the print version.)

Advanced Colon Cancer Patients Lived Longer When They Drank Coffee

(p. D6) Researchers studied 1,171 patients diagnosed with advanced or metastatic colon or rectal cancer who could not be treated with surgery.

. . .

Compared with people who drank none, those who drank a cup a day had an 11 percent increased rate of overall survival, and a 5 percent increased rate of living progression-free. The more coffee they drank, the better. Those who drank four or more cups a day had a 36 percent increased rate of overall survival and a 22 percent increased rate of surviving without their disease getting worse. Whether the coffee was decaf or regular made little difference.

The study, in JAMA Oncology, controlled for race, smoking, alcohol intake, aspirin use, diabetes, and the addition of milk, nondairy creamers or sweeteners to the coffee.

For the full story, see:

Nicholas Bakalar. “Coffee for Better Outcomes.” The New York Times (Tuesday, September 29, 2020): D6.

(Note: ellipsis added.)

(Note: the online version of the story was updated September 23, 2020, and has the title “Drinking Coffee Tied to Better Outcomes in Colon Cancer Patients.”)

The article in JAMA Oncology mentioned above is:

Mackintosh, Christopher, Chen Yuan, Fang-Shu Ou, Sui Zhang, Donna Niedzwiecki, I-Wen Chang, Bert H. O’Neil, Brian C. Mullen, Heinz-Josef Lenz, Charles D. Blanke, Alan P. Venook, Robert J. Mayer, Charles S. Fuchs, Federico Innocenti, Andrew B. Nixon, Richard M. Goldberg, Eileen M. O’Reilly, Jeffrey A. Meyerhardt, and Kimmie Ng. “Association of Coffee Intake with Survival in Patients with Advanced or Metastatic Colorectal Cancer.” JAMA Oncology (published online in advance of print on Sept. 17, 2020).

Litan and Mankiw Endorse Paying People to Take Vaccine

(p. 5) What’s the best way to get the economy back on track after the Covid-19 recession? Simple: Achieve herd immunity. And what’s the best way to achieve herd immunity? Again, simple: Once a vaccine is approved, pay people to take it.

That bold proposal comes from Robert Litan, an economist at the Brookings Institution. Congress should enact it as quickly as possible.

. . .

Recent research by the University of Chicago economists Austan Goolsbee and Chad Syverson has found that the government-mandated shutdowns account for just a small part of the decline in economic activity. The main reason people aren’t spending is that they are afraid to leave their homes and contract the virus. That hypothesis explains my own behavior. I have not stepped foot on an airplane or inside a restaurant for six months.

. . .

Immunology, meet economics. One of the first principles of economics — perhaps the most important — is that people respond to incentives. Applying this principle to the case at hand, Mr. Litan recommends that the government pay $1,000 to whoever gets the vaccine. With a large enough incentive, most Americans are likely to get vaccinated.

This proposal is textbook economics. (I’ve written some of the textbooks.) As all economics students learn, when an activity has a side effect on bystanders, that effect is called an externality. In the presence of externalities, the famous theorems of economics that justify laissez-faire do not apply. Adam Smith’s vaunted invisible hand can no longer work its magic.

A classic example of a negative externality is pollution, and the simplest and least invasive policy solution is a tax on emissions. In economics-speak, such a tax internalizes the externality: It induces polluters to take the cost of pollution into account by giving them a financial incentive to cut emissions. That’s why I have written here many times that a tax on carbon emissions is the best way to deal with global climate change.

Vaccination confers a positive externality. When you get vaccinated, you benefit not only yourself but also your fellow citizens by helping society take a step toward herd immunity. In this case, internalizing the externality requires not a tax but a subsidy, as Mr. Litan suggests.

For the full commentary, see:

N. Gregory Mankiw. “A Vaccine Subsidy Licks 2 Crises With One Shot.” The New York Times, SundayReview Section (Sunday, September 13, 2020): 5.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 9, 2020, and has the title “Pay People to Get Vaccinated.”)

The Robert Litan op-ed mentioned above is:

Litan, Robert E. “Want Herd Immunity? Pay People to Take the Vaccine.” Brookings Institute Op-Ed. (Tues., Aug. 18, 2020) URL: https://www.brookings.edu/opinions/want-herd-immunity-pay-people-to-take-the-vaccine/.>

The Goolsbee and Syverson NBER working paper mentioned above is:

Goolsbee, Austan, and Chad Syverson. “Fear, Lockdown, and Diversion: Comparing Drivers of Pandemic Economic Decline 2020.” NBER Working Paper #27432, June 2020.