Category: Health

Knowledge from Self-Experimentation Should Be Publishable

(p. D4) When Bob Hariri developed a product he thought could be useful as a human-skin replacement for burn victims, he had no trouble finding a subject willing to test it–himself.
An entrepreneur and a neurosurgeon with both a medical degree and a doctorate, Dr. Hariri is one of a number of scientists who have experimented on themselves with new or yet-to-be approved medical products or technologies, and who say such practice can be indispensable in the development of innovative biomedical treatments.
Some scientists are pushing for self-experimentation data to be reported publicly and more systematically to aid scientific progress. Alex Zhavoronkov, chief executive of an aging-research company called InSilico Medicine Inc., and others hope to start a peer-reviewed journal on self-experimentation, where scientists and other qualified individuals would publish high-quality case studies of tests performed on themselves. He plans to launch a crowdfunding operation in the next few months to fund it.
The idea is “to unlock the knowledge [of self-experimentation] that resides there anyway,” says Dr. Zhavrononkov, who takes an old diabetes drug called metformin that is supposed to have antiaging properties, even though it hasn’t been approved for that purpose.
. . .
Advocates say self-experimentation can yield information that is hard to get from a clinical trial. The experimenter feels what it’s like to be the patient and gets insight into how to improve testing procedures. Also, a number of individual reports, when cobbled together, can start to yield a picture of whether a new treatment is likely to work or not, though one wouldn’t rely on those reports alone to conclude safety or effectiveness.

For the full story, see:
Wang, Shirley S. “Why Medical Researchers Experiment on Themselves.”The Wall Street Journal (Tues., January 26, 2016): D4.
(Note: ellipsis added.)
(Note: the online version of the story has the date Jan. 25, 2016, and has the title “IN THE LAB; More Medical Researchers Engage In Self-Experimentation.”)

Tinkerers Create Cheap Prosthetic Hands with 3-D Printers

(p. D1) The proliferation of 3-D printers has had an unexpected benefit: The devices, it turns out, are perfect for creating cheap prosthetics. Surprising numbers of children need them: One in 1,000 infants is born with missing fingers, and others lose fingers and hands to injury. Each year, about 450 children receive amputations as a result of lawn mower accidents, according to a study in Pedatrics..
State-of-the-art prosthetic replacements are complicated medical devices, powered by batteries and electronic motors, and they can cost thousands of dollars. Even if children are able to manage the equipment, they grow too quickly to make the investment practical. So most do without, fighting to do with one hand what most of us do with two.
E-nable, an online volunteer organization, aims to change that. Founded in 2013 by Jon Schull, the group matches children like Dawson in need of prosthetic hands and fingers with volunteers able to make them on 3-D printers. Designs may be downloaded into the machines at no charge, and members who create new models share their software plans freely with others.
The materials for a 3-D-printed prosthetic hand can cost as little as $20 to $50, and some experts say they work just as well, if not better, than much costlier devices. Best of all, boys and girls usually love their D.I.Y. prosthetics.

For the full story, see:
Mroz, Jacqueline. “Hand of a Superhero.” The New York Times (Tues., Feb. 17, 2015): D1 & D6..
(Note: the online version of the story has the date FEB. 16, 2015. I do not have the print version, so I cannot confirm if there are differences between the online and print versions, and am not sure if the whole passage quoted above appears on p. D1, or if some or all of it is from p. D6.)

“The Establishment Drew Its Knives” Against Lister’s Handwashing

(p. C5) Lindsey Fitzharris’s slim, atmospheric “The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine” has its share of resplendent gore. . . . The book is an imperfect first effort, stronger at the beginning than at the end, and a bit workaday when it isn’t freaky — it floats less on narrative momentum than on an armada of curious details. But the story it tells is one of abiding fascination, in part because it involves a paradigm shift so basic, so seemingly obvious, that one can scarcely believe the paradigm needed shifting in the first place.
. . .
The real drama in Lister’s story comes from the resistance he faced to his theories. After he published the last article in a five-part series in the medical journal The Lancet, carefully outlining his system for killing “septic germs,” the establishment drew its knives. The inventor of chloroform wrote under a pseudonym to complain that Lister was taking credit for having discovered the miracles of carbolic acid. (He wasn’t.) Others accused him of fearmongering, dismissing Pasteur’s germ theory as pure hooey. The editor of The Lancet himself refused to use the word “germ.”
“It was difficult for many surgeons at the height of their careers,” Fitzharris writes, “to face the fact that for the past 15 or 20 years they might have been inadvertently killing patients by allowing wounds to become infected with tiny, invisible creatures.”
. . .
There were, after all, others — most famously the Hungarian doctor Ignaz Semmelweis. In 1847, he hypothesized that puerperal fever was spread by doctors carrying “cadaverous particles” from the deadhouse to the obstetrics ward at Vienna’s General Hospital. When he set up a basin filled with chlorinated water and enjoined his colleagues to do something radical after autopsies — wash their hands — mortality rates plummeted.
The establishment still rejected Semmelweis’s hypothesis when he published it. Over the years, Fitzharris writes, his behavior grew increasingly erratic. He was eventually committed to an asylum.
Lister, meanwhile, lived to a ripe old age and got a mouthwash named after him. Timing, personality and geopolitics always help determine who earns the garlands for innovation. But it’s sad to think that Semmelweis never lived to see the vindication of his theory. He died in that asylum, possibly from an infection, believing that his contribution had been bleached from the record.

For the full review, see:
JENNIFER SENIOR . “Books of The Times; Wash Up, Doc: How Hospitals Became Clean.” The New York Times (Thursday, November 30, 2017): C5.
(Note: ellipses added.)
(Note: the online version of the review has the date November 29, 2017, and has the title “Books of The Times; The Story of How Surgeons Cleaned Up Their Act.”)

The book under review, is:
Fitzharris, Lindsey. The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine. New York: Farrar, Straus and Giroux, 2017.

World War I Spread the Deadly Flu of 1918

(p. A17) The Spanish flu began in the spring of 1918, infected 500 million people, and killed between 50 million and 100 million of them–more than both world wars and the Holocaust combined. Not since the bubonic plague of the mid-14th century–the Black Death–had such a fearsome pestilence devastated mankind.
Spanish-flu patients “would soon be having trouble breathing,” writes Laura Spinney in “Pale Rider,” her gripping account of the pandemic.
. . .
Ms. Spinney is at her best in trying to tease out the real origin of the pandemic. The first suspect was China, where pneumonic plague had erupted on the Manchurian border in 1910. The government, trying to curry favor with the Allies in World War I, had then sent tens of thousands of laborers, many infected, to dig trenches on the Western Front. Another theory put the initial outbreak at the British army’s mobilization base in Étaples in northern France. A third candidate was in the American heartland, at a U.S. Army staging base, Camp Funston in Kansas. The question is unsettled, but plainly the movement of troops in the Great War accelerated the flu’s spread.
. . .
The frantic search for the cause of the pandemic was nightmarish, too. A respected researcher persuaded himself and others that he had found the bacillus, and he persisted even though autopsies rarely turned up his pet suspect in the tissues of the dead. The microbe hunters couldn’t find their quarry because it slipped through the ultrafine strainers they tried to catch it with, and it was invisible to their microscopes. It was what the French bacteriologist Émile Roux called an “être de raison,” an organism whose existence could be deduced only from its effects. Eventually a virus–1/20th the size of a bacillus–was identified as the culprit. It was not actually seen until decades later with the invention of the electron microscope.

For the full review, see:
Edward Kosner. “BOOKSHELF; A World Of Sickness; The Spanish flu of 1918-19 infected 500 million people, killing between 50 and 100 million. Its cause was discovered only decades later.” The Wall Street Journal (Monday, Dec. 11, 2017): A17.
(Note: ellipses added.)
(Note: the online version of the review has the date Dec. 10, 2017, and has the title “BOOKSHELF; Review: A World of Sickness; The Spanish flu of 1918-19 infected 500 million people, killing between 50 and 100 million. Its cause was discovered only decades later.”)

The book under review, is:
Spinney, Laura. Pale Rider: The Spanish Flu of 1918 and How It Changed the World. New York: PublicAffairs, 2017.

Automation Is “About Doing More with the People We’ve Got”

(p. A1) Mr. Persson, 35, sits in front of four computer screens, one displaying the loader he steers as it lifts freshly blasted rock containing silver, zinc and lead. If he were down in the mine shaft operating the loader manually, he would be inhaling dust and exhaust fumes. Instead, he reclines in an office chair while using a joystick to control the machine.
He is cognizant that robots are evolving by the day. Boliden is testing self-driving vehicles to replace truck drivers. But Mr. Persson assumes people will always be needed to keep the machines running. He has faith in the Swedish economic model and its protections against the torment of joblessness.
“I’m not really worried,” he says. “There are so many jobs in this mine that even if this job disappears, they will have another one. The company will take care of us.”
. . .
(p. A8) The Garpenberg mine has been in operation more or less since 1257. More than a decade ago, Boliden teamed up with Ericsson, the Swedish telecommunications company, to put in wireless internet. That has allowed miners to talk to one another to fix problems as they emerge. Miners now carry tablet computers that allow them to keep tabs on production all along the 60 miles of roads running through the mine.
“For us, automation is something good,” says Fredrik Hases, 41, who heads the local union chapter representing technicians. “No one feels like they are taking jobs away. It’s about doing more with the people we’ve got.”

For the full story, see:
PETER S. GOODMAN. “Sweden Adds Human Touch to a Robotic Future.” The New York Times (Thurs., December 28, 2017): A1 & A8.
(Note: ellipsis added.)
(Note: the online version of the story has the date DEC. 27, 2017, and has the title “The Robots Are Coming, and Sweden Is Fine.”)

“New Jerseyans Are More Flammable than People in the Other 49 States”

(p. A17) At 12:01 a.m. on Jan. 1, New Jersey became the last state in the nation where drivers are not allowed to pump their own gasoline around the clock.
. . .
It is a distinction that makes Declan J. O’Scanlon Jr., a state lawmaker, spout frustration by the gallon.
“It’s ridiculous,” said Mr. O’Scanlon, a Republican assemblyman from Monmouth County who will soon take a seat in the State Senate. “If I want to pull in, get in and out quickly, I should be able to do so.”
Mr. O’Scanlon said that he frequently pumps his own gas, ignoring the Retail Gasoline Dispensing Safety Act of 1949, the statute that first forbade civilians from putting their grubby hands on the nozzle.
. . .
New Jersey legislators cited safety concerns when they passed the original law that barred residents from pumping gas almost 70 years ago. But when gas station owners challenged the ban in 1951, the state’s Supreme Court ruled that self-serve was indeed “dangerous in use.” And the ban held up, despite attempts to fight it in the 1980s.
In the rest of the country, self-service stations became the norm. Safer unleaded gasoline became more common, thanks to federal regulations, as did pumps that accepted credit cards. In most of the United States, that spelled the end of an era when attendants offered to wipe your windshield and check your oil while the tank filled up and you fumbled for a tip.
Mr. O’Scanlon is undeterred by the dual weights of history and public opinion. He said that he may bring a new proposal this year, just to keep the conversation alive. He said that economic arguments about jobs and safety are absurd, given that drivers in other states have been pumping their own gas for decades and lived to tell the tale.
“The only thing you could argue is that New Jerseyans are more flammable than people in the other 49 states,” he said. “Because we eat so much oily pizza, funnel cake and fries, maybe you could make that argument. Otherwise, it’s simply ridiculous.”

For the full story, see:
JONAH ENGEL BROMWICH. “New Jersey Is Last State to Insist at Gas Stations: Don’t Touch That Pump.” The New York Times (Sat., JAN. 6, 2018): A17.
(Note: ellipses added.)
(Note: the online version of the story has the date JAN. 5, 2018.)

Health Info from Apple Watches Will Allow Patients to “Take More Control”

(p. B1) SAN FRANCISCO — In the last months of Steve Jobs’s life, the Apple co-founder fought cancer while managing diabetes.
Because he hated pricking his finger to draw blood, Mr. Jobs authorized an Apple research team to develop a noninvasive glucose reader with technology that could potentially be incorporated into a wristwatch, according to people familiar with the events, who asked not to be identified because they were not authorized to speak on behalf of the company.
. . .
In September [2017], Apple announced that the Apple Watch would no longer need to be tethered to a smartphone and would become more of a stand-alone device. Since then, a wave of device manufacturers have tapped into the watch’s new features like cellular connectivity to develop medical accessories — such as an electrocardiogram for monitoring heart activity — so people can manage chronic conditions straight from their wrist.
. . .
(p. B4) A digital health revolution has been predicted for years, of course, and so far has been more hype than progress. But the hope is that artificial intelligence systems will sift through the vast amounts of data that medical accessories will collect from the Apple Watch and find patterns that can lead to changes in treatment and detection, enabling people to take more control of how they manage their conditions instead of relying solely on doctors.
Vic Gundotra, chief executive of AliveCor, a start-up that makes portable electrocardiograms, said this would put patients on a more equal footing with doctors because they would have more information on their own conditions.
“It’s changing the nature of the relationship between patient and doctor,” he said, adding that doctors will no longer be “high priests.”
. . .
Apple is also looking at potentially building an electrocardiogram into future models of the Apple Watch, according to a person familiar with the project, who spoke on the condition of anonymity because the details were confidential. It is unclear whether the EKG development, earlier reported by Bloomberg, would be introduced; such a product would most likely require F.D.A. clearance.
Separately, Apple is continuing research on a noninvasive continuous glucose reader, according to two people with knowledge of the project. The technology is still considered to be years away, industry experts said.
The current solution used by many diabetics is also coming to the Apple Watch. Dexcom, a maker of devices measuring blood sugar levels for diabetics, said it was awaiting F.D.A. approval for a continuous glucose monitor to work directly with the Apple Watch. Continuous glucose monitors use small sensors to pierce the skin to track blood sugar levels and relay those readings through a wireless transmitter.

For the full story, see:
DAISUKE WAKABAYASHI. “As Wearable Devices Evolve, The Apple Watch Offers an EKG.” The New York Times (Weds., December 27, 2017): B1 & B4.
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story has the date DEC. 26, 2017, and has the title “Freed From the iPhone, the Apple Watch Finds a Medical Purpose.”)

Enforcing New Blood Pressure Guidelines May Lead to Serious Falls

(p. A23) “Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure.” This is the type of headline that raises my blood pressure to dangerously high levels.
. . .
The new recommendation is principally in response to the results of a large, federally funded study called Sprint that was published in 2015 in The New England Journal of Medicine.
. . .
A blood pressure of 130 in the Sprint study may be equivalent to a blood pressure of 140, even 150, in a busy clinic. A national goal of 130 as measured in actual practice may lead many to be overmedicated — making their blood pressures too low.
. . .
Serious falls are common among older adults. In the real world, will a nationwide target of 130, and the side effects of medication lowering blood pressure, lead to more hip fractures? Ask your doctors. See what they think.
. . .
I suspect many primary-care practitioners will want to ignore this new target. They understand the downsides of the relentless expansion of medical care into the lives of more people. At the same time, I fear many will be coerced into compliance as the health care industry’s middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary — and that usually means more medications.
So focusing on the number 130 not only will involve millions of people but also will involve millions of new prescriptions and millions of dollars. And it will further distract doctors and their patients from activities that aren’t easily measured by numbers, yet are more important to health — real food, regular movement and finding meaning in life. These matter whatever your blood pressure is.

For the full commentary, see:
H. GILBERT WELCH. “Rethinking Blood Pressure Advice.” The New York Times (Thurs., NOV. 16, 2017): A23.
(Note: ellipses added.)
(Note: the online version of the commentary has the date NOV. 15, 2017, and has the title “Don’t Let New Blood Pressure Guidelines Raise Yours.”)

Welch has a book that makes a similar point, though more broadly, to that made in the passages quoted above:
Welch, H. Gilbert. Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care. Boston, MA: Beacon Press, 2015.

Record High Temperatures in London

(p. C6) During London’s long summer of 1858, the sweltering temperatures spawned squalor. With a population of more than 2 million, London had outgrown its medieval waste-removal systems, turning Spenser’s “sweet Thames” into an open sewer. Epidemics such as cholera and diphtheria ravaged the poor and rich alike. The stench, as we now know, was a symptom of a bacterial problem. But at the time it was believed to be, in itself, the cause of disease. The dominant medical notion of miasmas held that “noxious and morbific” contagion was carried through the air.
The heat of 1858 made the problem of London’s effluvia unignorable. At the end of May, Rosemary Ashton notes in “One Hot Summer,” the temperature was 84 degrees in the shade; there followed three months of hot days, with record highs in the 90s for the shade and well over 110 degrees in the sun.
. . .
The Great Stink, as the noisome ordeal came to be called, is a terrific subject for Ms. Ashton, the noted scholar of George Eliot, George Henry Lewes and literary London. She excels at unearthing and explaining the daily distractions of the nose-holding populace over the course of the summer: horse races, art shows, murder and divorce trials, even the breezes that, as Darwin noted, wafted thistle seeds across the English Channel from France. Ms. Ashton also convincingly uses the Great Stink as a backdrop to crisis points in the lives of three great figures of the day whose biographies rarely overlap: Darwin, Disraeli and Charles Dickens.

For the full review, see:

Alexandra Mullen. “The Stink That Sank London; As highs climbed toward 100 degrees, raw sewage roasting on the Thames created the ‘Great Stink’.” The Wall Street Journal (Saturday, Aug. 20, 2017): C6.
(Note: ellipsis added.)
(Note: the online version of the review has the date Aug. 11, 2017.)

The book under review, is:
Ashton, Rosemary. One Hot Summer: Dickens, Darwin, Disraeli, and the Great Stink of 1858. New Haven, CT: Yale University Press, 2017.

Immunotherapy Cocktails, Like Chemotherapy Cocktails, May Benefit from Trial-and-Error Experiments

(p. A16) A new way of genetically altering a patient’s cells to fight cancer has helped desperately ill people with leukemia when every other treatment had failed, researchers reported on Monday [Nov. 20, 2017] in the journal Nature Medicine.
The new approach, still experimental, could eventually be given by itself or, more likely, be used in combination treatments — analogous to antiviral “cocktails” for H.I.V. or multidrug regimens of chemotherapy for cancer — to increase the odds of shutting down the disease.
Researchers say the treatment may be more promising as part of a combination than when given alone because, although some patients in the small study have had long-lasting remissions, many others had relapses.
The research, conducted at the National Cancer Institute, is the latest advance in the fast-growing field of immunotherapy, which fires up the immune system to attack cancer. The new findings build on two similar treatments that were approved by the Food and Drug Administration this year: Kymriah, made by Novartis for leukemia; and Yescarta, by Kite Pharma for lymphoma.
In some cases, those two treatments have brought long and seemingly miraculous remissions to people who were expected to die.
Kymriah and Yescarta require removing millions of each patient’s T-cells — disease-fighting white blood cells — and genetically engineering them to seek and destroy cancer cells. The T-cells are then dripped back into the patient, where they home in on protein molecules called CD19 found on malignant cells in most types of leukemia and lymphoma.
The new treatment differs in a major way: the T-cells are programmed to attack a different target on malignant cells, CD22.

For the full story, see:
DENISE GRADY. “Experimental Gene Treatment Shows Promise in Combating Leukemia.” The New York Times (Tues., NOV. 21, 2017): A16.
(Note: bracketed date added.)
(Note: the online version of the story has the date NOV. 20, 2017, and has the title “New Gene Treatment Effective for Some Leukemia Patients.”)

The Nature Medicine article, mentioned above, is:
Fry, Terry J., Nirali N. Shah, Rimas J. Orentas, Maryalice Stetler-Stevenson, Constance M. Yuan, Sneha Ramakrishna, Pamela Wolters, Staci Martin, Cindy Delbrook, Bonnie Yates, Haneen Shalabi, Thomas J. Fountaine, Jack F. Shern, Robbie G. Majzner, David F. Stroncek, Marianna Sabatino, Yang Feng, Dimiter S. Dimitrov, Ling Zhang, Sang Nguyen, Haiying Qin, Boro Dropulic, Daniel W. Lee, and Crystal L. Mackall. “CD22-Targeted CAR T Cells Induce Remission in B-ALL That Is Naive or Resistant to CD19-Targeted CAR Immunotherapy.” Nature Medicine (published online on Nov. 20, 2017).

Socialized Medicine “Mummifies Its Doctors in Spools of Red Tape”

(p. A17) One of the reasons patients find condescension from doctors especially loathsome is that it diminishes them — if you’re gravely ill, the last thing you need is further diminishment. But the desires of patients, Marsh notes, are often paradoxical. They also pine for supreme confidence in their physicians, surgeons especially, because they’ve left their futures — the very possibility of one at all, in some cases — in their doctors’ custody. “So we quickly learn to deceive,” Marsh writes, “to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face.”
Over time, Marsh writes, many doctors start to internalize the stories they tell themselves about their superior judgment and skill. But the best, he adds, unlearn their self-deceptions, and come to accept their fallibility and learn from their mistakes. “We always learn more from failure than from success,” he writes. “Success teaches us nothing.”
This was a prominent theme in Marsh’s last book, and readers may have a sense of déjà vu while reading this one. Like “Do No Harm,” “Admissions” is wandering and ruminative, an overland trek through the doctor’s anxieties and private shames. Once again, he recounts his miscalculations and surgical catastrophes, citing the French doctor René Leriche’s observation that all surgeons carry cemeteries within themselves of the patients whose lives they’ve lost. Once again, he rails against the constraints of an increasingly depersonalized British health care system, which mummifies its doctors in spools of red tape. Once again, he describes his operating theater in all of its Grand Guignol splendor, with brains swelling beyond their skulls and suction devices “slurping obscenely” as tumors evade his reach.

For the full review, see:
JENNIFER SENIOR. “Books of The Times; Surgical Catastrophes, Private Shames.” The New York Times (Sat., Oct. 7, 2017): A17.
(Note: the online version of the review has the date Oct. 5, 2017, and has the title “Books of The Times; A Surgeon Not Afraid to Face His Mistakes, In and Out of the Operating Room.)

The book under review, is:
Marsh, Henry. Admissions: Life as a Brain Surgeon. New York: Thomas Dunne Books/St. Martin’s Press, 2017.