Phage Therapy Renaissance-“Once Derided as an Idea for Cranks and Commies”

(p. C7) As engaging as it is expansive, “The Good Virus” describes the distinctive biology and murky history of bacteriophage (generally shortened to “phage”), a form of life that is remarkably abundant yet obscure enough to have been termed the “dark matter of biology.”

. . .

In a South London research institute in the early 1910s, the meticulous English bacteriologist Frederick Twort set out to grow the smallpox virus in petri dishes, hoping it could be “observed and studied like bacteria.” He succeeded in growing only contaminating bacteria, but within these colonies he noticed the occasional small clearing, as if something invisible was killing the bacteria. With the outbreak of World War I, Twort lost funding, closed his lab and published his results in 1915, cautiously suggesting that a virus could be the cause of the observed phenomenon. Few took notice.

Twort’s unlikely competitor would be Felix d’Herelle, a free-spirited Frenchman . . .

. . .

He found the same glassy spots that Twort had observed and (with noticeably less restraint) announced in 1917 that he had discovered a new form of life, which he called “bacteriophage.” D’Herelle went on to use phage to treat five sick boys successfully. But his “wild and abrasive style” (in Mr. Ireland’s words) antagonized his peers, who conspired to undermine him.

D’Herelle’s discoveries inspired many, including George Eliava, a microbiologist from the Soviet Union’s republic of Georgia. In 1936, he would establish the first institute (and still one of the few) devoted to bacteriophage research. Unfortunately for Eliava, he soon ran afoul of the Soviet secret police, who disappeared him in 1937. The institute continued to pursue the development of phage therapy and scored many victories—phage helped treat soldiers suffering from gangrene, for example. But there were also frustrating failures, in part because the phage weren’t adequately purified and often because they weren’t appropriately matched to the specific strain of infecting bacteria.

. . .

. . ., the “dubious and unreliable nature of commercial American phage products” in the 1930s, we learn, meant that “whether they worked for a particular patient was a complete lottery.”

During World War II, the West turned decisively to newly discovered penicillin, sharing the formula for it with the Soviets but not the methods of mass production. Thus the Soviets continued to rely on phage as the therapy of choice for bacterial infections. When a Soviet researcher tried to obtain production rights to penicillin in 1949, he was arrested by government authorities and died under interrogation, all for the crime of nizkopoklonstvo—adulation of the West.

. . .

Once “derided as an idea for cranks and commies,” Mr. Ireland writes, phage therapy seems to be enjoying a renaissance. Having been sustained for years by an idiosyncratic global community of true believers, phage-based medicines have now attracted the attention of high-powered biotechnologists and investors.

For the full review, see:

David A. Shaywitz. “The Enemy of My Enemy.” The Wall Street Journal (Saturday, Aug. 5, 2023): C7.

(Note: ellipses added. In the original, the Russian word nizkopoklonstvo is in italics.)

(Note: the online version of the review has the date August 4, 2023, and has the title “‘The Good Virus’ Review: An Unlikely Healer.”)

The book under review is:

Ireland, Tom. The Good Virus: The Amazing Story and Forgotten Promise of the Phage. New York: W. W. Norton & Company, 2023.

Fish Would Remember More if Hot Water Could Be Air Conditioned

(p. A4) . . ., a new study suggests for the first time that high water temperatures can cause memory loss in reef fish, and even render them unable to learn at all.

. . .

The researchers designed a maze with a reward in one hallway. For about two weeks before maze training began, three groups of fish were gradually exposed to different temperatures: 28to 28.5 degrees Celsius for the control group, 30to 30.5 Celsius for the second, and 31.5 to32 Celsius for the third.

. . .

The researchers spent five days training the fish to navigate the maze and to associate a blue tag with their reward. Five days after training ended, they tested the fish to see which groups could remember how to find the tag, and their reward, in the maze.

The control group did well, quickly remembering how to reach the reward in the maze. But fish in even the moderately hot group didn’t fare as well. Although they learned to navigate the maze quickly during training, five days later, all evidence of their experience had vanished. In earlier experiments, Dr. Luchiari found that damselfish could remember experiences for at least 15 days, so an inability to remember the maze after only five was striking.

Fish in the hottest group failed to learn the maze at all, taking roughly the same amount of time to navigate it throughout the whole experiment.

For the full story, see:

Rebecca Dzombak. “Fish Get More Forgetful In Higher Temperatures.” The New York Times (Thursday, Aug. 24, 2023): A4.

(Note: ellipses added.)

(Note: the online version of the story has the date Aug. 23, 2023, and has the title “Damselfish in Distress: Warmer Seas Might Be Clouding Their Brains.”)

Caution in Interpreting Alternative Explanations of Ancient Artifacts

A few weeks ago, an article highlighted the finding of female bones in a burial along with a sword. It was interpreted that the sword belonged to a distinguished female warrior and was interpreted as evidence against patriarchal assumptions.

(p. D1) The epitaph on more than one Roman tombstone read: “A gang of doctors killed me.”

Medical remedies have improved since those times — no more smashed snails, salt-cured weasel flesh or ashes of cremated dogs’ heads — but surgical instruments have changed surprisingly little. Scalpels, needles, tweezers, probes, hooks, chisels and drills are as much part of today’s standard medical tool kit as they were during Rome’s imperial era.

Archaeologists in Hungary recently unearthed a rare and perplexing set of such appliances. The items were found in a necropolis near Jászberény, some 35 miles from Budapest, in two wooden chests and included a forceps, for pulling teeth; a curet, for mixing, measuring and applying medicaments, and three copper-alloy scalpels fitted with detachable steel blades and inlaid with silver in a Roman style. Alongside were the remains of a man presumed to have been a Roman citizen.

The site, seemingly undisturbed for 2,000 years, also yielded a pestle that, judging by the abrasion marks and drug residue, was probably used to grind medicinal herbs. Most unusual were a bone lever, for putting fractures back in place, and the handle of what appears to have been a drill, for trepanning the skull and extracting impacted weaponry from bone.

The instrumentarium, suitable for performing complex operations, provides a glimpse into the advanced medical prac-(p. D4)tices of first-century Romans and how far afield doctors may have journeyed to offer care. “In ancient times, these were comparatively sophisticated tools made of the finest materials,” said Tivadar Vida, director of the Institute of Archaeology at Eötvös Loránd University, or ELTE, in Budapest and leader of the excavation.

Two millenniums ago Jászberény and the county around it were part of the Barbaricum, a vast region that lay beyond the frontiers of the Empire and served as a buffer against possible outside threats. “How could such a well-equipped individual die so far from Rome, in the middle of the Barbaricum,” mused Leventu Samu, a research fellow at ELTE and a member of the team on the dig. “Was he there to heal a prestigious local figure, or was he perhaps accompanying a military movement of the Roman legions?”

. . .

The tool-laden grave was discovered last year at a site where relics from the Copper Age (4500 B.C. to 3500 B.C.) and the Avar period (560 to 790 A.D.) had been found on the surface. A subsequent survey with a magnetometer identified a necropolis of the Avars, a nomadic peoples who succeeded Attila’s Huns. Among the rows of tombs, the researchers uncovered the man’s grave, revealing a skull, leg bones and, at the foot of the body, the chests of metal instruments. “The fact that the deceased was buried with his equipment is perhaps a sign of respect,” Dr. Samu said.

That is not the only possibility. Dr. Baker said that she often cautioned her students about interpreting ancient artifacts, and asked them to consider alternative explanations. What if, she proposed, the medical tools were interred with the so-called physician because he was so bad at his practice that his family and friends wanted to get rid of everything associated with his poor medical skills? “This was a joke,” Dr. Baker said. “But it was intended to make students think about how we jump to quick conclusions about objects we find in burials.”

For the full story, see:

Franz Lidz. “Old Roman Medicine Wasn’t So Pleasant.” The New York Times (Tuesday, June 13, 2023): D1 & D4.

(Note: ellipsis added.)

(Note: the online version of the story also has the date June 13, 2023, and has the title “Scalpel, Forceps, Bone Drill: Modern Medicine in Ancient Rome.”)

Allow Us to View the “Artifacts of Human Suffering” That Enable Us to “Appreciate the Epic Achievements of Medicine”

(p. D1) The Mütter Museum, a 19th-century repository of medical oddments and arcana at the College of Physicians of Philadelphia, attracts as many as 160,000 visitors a year. Among the anatomical and pathological specimens exhibited are skulls corroded by syphilis; spines twisted by rickets; skeletons deformed by corsets; microcephalic fetuses; a two-headed baby; a bound foot from China; an ovarian cyst the size of a Jack Russell terrier; Grover Cleveland’s jaw tumor; the liver that joined the original “Siamese twins,” Cheng and Eng Bunker; and the pickled corpse of the Soap Lady, whose fatty tissues decomposed into a congealed asphalt-colored substance called adipocere.

. . .

The celebrity magician Teller, a Philadelphia native, called the Mütter a place of electrifying frankness. “We are permitted to (p. D5) confront real, not simulated, artifacts of human suffering, and are, at a gut level, able to appreciate the epic achievements of medicine,” he said.

But, like museums everywhere, the Mütter is reassessing what it has and why it has it. Recently, the institution enlisted a public-relations consultant with expertise in crisis management to contain criticism from within and without.

The problems began in February [2023] when devoted fans of the Mütter’s website and YouTube channel noticed that all but 12 of the museum’s 450 or so images and videos had been removed.

. . .

Ms. Quinn had tasked 13 unnamed people — medical historians, bioethicists, disability advocates, members of the community — with providing feedback on the digital collection. “Folks from a wide background,” Ms. Quinn said in an interview.

. . .

Blowback to Ms. Quinn’s ethical review was ferocious. An online petition garnered the signatures of nearly 33,000 Mütter enthusiasts who insisted that they loved the museum and its websites as they were. The petition criticized Ms. Quinn and her boss, Dr. Mira Irons, the president and chief executive of the College of Physicians, for decisions predicated on “outright disdain of the museum.” The complaint called for the reinstatement of all web content and urged the college’s board of trustees to fire the two women immediately. (To date, about one-quarter of the videos have been reinstated.)

Moreover, in June [2023], The Wall Street Journal ran an opinion piece entitled “Cancel Culture Comes for Philly’s Weirdest Museum,” in which Stanley Goldfarb, a former director of the college, wrote that the museum’s new “woke leaders” appeared eager to cleanse the institution of anything uncomfortable. Robert Hicks, director of the Mütter from 2008 to 2019, voiced similar sentiments this spring when he quit as a museum consultant. His embittered resignation letter, which he released to the press, stated that Dr. Irons “has said before staff that she ‘can’t stand to walk through the museum,’” and it advised the trustees to investigate her and Ms. Quinn, both of whom Dr. Hicks believed held “elitist and exclusionary” views of the Mütter.

. . .

Dr. Hicks remains unhappy with the new perspective. “Dr. Mütter would have been confused at the dictum that the museum should be about health, not death,” he lamented in his resignation letter. “The principle emblazoned at the entrance of many anatomy theaters, ‘This is where the dead serve the living,’ is readily understood by museum visitors without special guidance by Dr. Irons.”

For the full story, see:

Franz Lidz. “Should a Hall of Human Curiosities Dial It Down?” The New York Times (Tuesday, August 15, 2023): D1 & D5.

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

(Note: the online version of the story has the date Aug. 13, 2023, and has the title “A Museum of ‘Electrifying Frankness’ Weighs Dialing It Down.”)

For more on the innovative surgeon who founded the Mütter Museum, see:

Aptowicz, Cristin O’Keefe. Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. New York: Gotham Books, 2014.

Psychedelics May Return Brains to More “Plastic” Adaptable Form

(p. C4) New studies suggest that psychedelics, carefully administered in controlled settings with trained therapists, can help treat mental illnesses like depression, addiction and PTSD. But just how do psychedelics achieve these therapeutic effects?

A new study in the journal Nature by the neuroscientist Gul Dolen at Johns Hopkins and colleagues tackles this question.

. . .

. . ., Dolen’s team gave mice a variety of psychedelics and observed their effects. Mice, like people, have what are called “critical periods” for various kinds of development—times when the brain is especially open to new experiences and especially likely to learn and change. After a critical period closes, that type of learning is much harder. These specific critical periods reflect a more general phenomenon: Brains start out more “plastic,” easier to change and more sensitive to experience, and get more efficient but more rigid as people—or mice—grow older.

. . .

As expected, the different drugs acted through different chemical mechanisms. But all of them ultimately activated genes that made the brain more “plastic,” more easily changed.

Other research shows that psychedelics may reopen other kinds of critical periods. For example, amblyopia, or “lazy eye,” must be treated early for the visual cortex to rewire properly. But a 2020 study published in Current Biology found that ketamine reopened the visual critical period in mice, allowing older animals to recover from amblyopia.

These results have important implications for psychedelic therapy. We know that the effects of psychedelics depend on “set and setting”—the context and the attitude of the person who takes them—and that psychedelic experiences can feel wonderful or terrible to the user. The new research suggests that psychedelics work by opening up the brain to new possibilities, allowing it to escape from old ruts, change and learn. That might give humans a chance to change addictive habits or destructive thought patterns.

For the full commentary, see:

Alison Gopnik. “MIND & MATTER; The New Promise of Psychedelics.” The Wall Street Journal (Saturday, July 22, 2023): C4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 20, 2023, and has the same title as the print version.)

The academic article discussed in the passages above is:

Nardou, Romain, Edward Sawyer, Young Jun Song, Makenzie Wilkinson, Yasmin Padovan-Hernandez, Júnia Lara de Deus, Noelle Wright, Carine Lama, Sehr Faltin, Loyal A. Goff, Genevieve L. Stein-O’Brien, and Gül Dölen. “Psychedelics Reopen the Social Reward Learning Critical Period.” Nature 618, no. 7966 (June 14, 2023): 790-98.

“An Inalienable Right to Sit In AC”

(p. C4) “Let’s sit in AC.” An American friend of mine, recently living in Mumbai, was wildly amused to hear this said in that steamy megalopolis, as if retreating to the tantalizing cool of an air-conditioned room were an activity in itself.

It took me a moment to see what he found so funny. I had grown up with the deprivations of socialist India in the 1980s. I was hardwired to fetishize air-conditioning. It was not an adjunct to life, sewn seamlessly into our daily routines, as it is in the U.S., where 82.7 million homes have central AC. It was, as the philosopher Immanuel Kant would say, the “thing-in-itself,” and to sit “in” AC was something of a national pastime.

. . .

Our first AC was an unbranded gimcrack contraption, jerry-built by a local electrician, but—my god!—how we loved it.

. . .

India loves to assert the demands of belonging through pacts of mutual suffering, and to be in AC was almost to be a little less Indian, as if you had decamped for the West. Even now that the country is the world’s fastest growing market for air-conditioners—projected by the International Energy Agency to be the biggest by 2050—the first line of attack from your average troll is: “What do you know of the realities of India, sitting in AC?”

. . .

. . . this summer, as newspapers report the hottest temperatures ever recorded on Earth and Amazon blasts me with discounts on their best-selling ACs, I cannot help feeling that our turn has come at a bad time. If nothing is done to make air-conditioning more energy-efficient, India alone is projected to use 30 times more electricity in 2030 than it did in 2010. Globally, air conditioning is projected to account for 40% of the growth in energy consumption in buildings by 2050—the equivalent of all the electricity used today in the U.S. and Germany combined. It’s enough to send a chill down the spine of the most ardent of AC evangelists.

The irony of a world made hotter by our need to be cool strikes some as proof of our rapacity. To me, having grown up in the place where so much of the new demand is coming from, I see it as part of a necessary realignment. As the global south gets richer, it will act as a frontier and laboratory. My hope is that it will achieve a miraculous breakthrough in energy efficiency, even as it asserts an inalienable right to sit in AC.

For the full commentary, see:

Aatish Taseer. “My Love Affair With Air- Conditioning.” The Wall Street Journal (Saturday, July 15, 2023): C4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 14, 2023, and has the same title as the print version.)

Blue Cross of California Seeks to End Drug Rebates and Hidden Fees

(p. A3) A major health insurer says it will jettison the complicated system that Americans use to pay for drugs, and create something that aims to be better, with partners including Amazon.com and the entrepreneur Mark Cuban.

Blue Shield of California said it is dropping CVS Health’s Caremark, the pharmacy-benefit manager it currently uses, which negotiates drug prices and wraps in other services such as a mail-order pharmacy.

. . .

Blue Shield said that, working with its partners, it aims to negotiate prices with pharmaceutical makers in a way that is different from the typical approach—with a simple net price structure that is supposed to eliminate rebates and hidden fees.

Blue Shield executives said that with one company handling many aspects of how drugs are procured through the system, it is often hard to track the flow of payments accurately.

“The current pharmacy supply chain is a forest of opacity and profit,” said Paul Markovich, Blue Shield’s chief executive officer, in an interview with The Wall Street Journal. “It is overwhelmingly complex, it is designed to maximize the earnings of the participants.” His company’s new setup, he said, will be “flipping that on its head.”

For the full story, see:

Anna Wilde Mathews. “Health Insurer Revamps Drug Pricing Model.” The Wall Street Journal (Friday, Aug. 18, 2023): A3.

(Note: ellipsis added.)

(Note: the online version of the story was updated Aug. 17, 2023, and has the title “A Big Health Insurer Is Ripping Up the Playbook on Drug Pricing.”)

Socialist Alexandria Ocasio-Cortez (AOC) Buys Foreign Sunscreens Not Approved by U.S. Government F.D.A.

(p. 2) After months of prompting, I have finally managed to help my husband form a daily sunscreen habit. Whenever I see traces of paper white cream in his dark beard, I think, We’re halfway there.

Hoping to avoid the white cast, heaviness and greasiness common in many sunscreen products available in U.S. drugstores, some Americans, including Representative Alexandria Ocasio-Cortez of New York, have taken matters into their own hands, opting for sunscreens manufactured abroad. In a recent interview, the congresswoman said she toggled between Bioré in the summer and Beauty of Joseon in the winter — two Asian brands that employ active ingredients not approved for use in the United States.

“The technology is very sophisticated,” Ms. Ocasio-Cortez said. “You don’t feel like you have a layer of sunscreen on, and it kind of just feels like you’re putting on a moisturizer in that sense, which makes it easier to use.”

While sunscreen is regulated as a cosmetic in major skin-care hubs like South Korea, Japan and the European Union, in the United States, it falls under the purview of the Food and Drug Administration. Any drug product marketed to American consumers must be approved by the F.D.A., and because sunscreen “makes a drug claim” — namely, that it can prevent sunburn, decrease the risk of skin cancer and mitigate early skin aging — the agency regulates it as an over-the-counter drug.

The last time the Food and Drug Administration approved new active ingredients for use in sunscreens was more than two decades ago, and at times it can feel as if the rest of the world has surpassed the United States in the development of new sunscreen formulations and protocols. Skin-care influencers on TikTok and Instagram are in a near-constant state of frenzy over exciting new products and innovations that are nowhere to be found on American shelves. Currently there are 14 sunscreen filters approved for use by the F.D.A. The European Union employs more than 30.

Frustrated by what seems to be a wealth of more exciting options for sun protection overseas, skin-care-conscious Americans have been quick to point the finger at the F.D.A. for the delay in approving new active ingredients.

For the full story, see:

Sandra E. Garcia. “U.S. Sunscreen Is Stuck in the ’90s.” The New York Times, SundayStyles Section (Sunday, August 13, 2023): 2.

(Note: the online version of the story has the date Aug. 12, 2023, and has the title “U.S. Sunscreen Is Stuck in the ’90s. Is This a Job for Congress?”)

“Best-Funded Startup” in History Seeks Longevity by Rejuvenating Cells

(p. B1) Arch is the largest institutional investor in Altos, which already has $3 billion of committed investments, likely making it the biotech indus-(p. B2)try’s best-funded startup on record.

Nelsen is characteristically unrestrained when discussing Altos’s prospects.

“Epigenetic reprogramming is the biggest thing in healthcare in 100 years. Or ever,” he says. “We will clearly live much healthier and longer lives if this works.”

. . .

A native of Walla Walla, Wa., Nelsen studied biology and economics at the University of Puget Sound before getting an M.B.A. at the University of Chicago.

. . .

His manic energy can lead to confrontations. Nelsen drives his GMC Yukon so aggressively that some friends avoid riding with him. He’s started fights with supermarket customers who resisted using plastic bags.

“I hate plastic bag bans, because the assumption that they are better for the environment than paper is flawed and I am grown up enough to not have government choose my bag for me,” Nelsen says.

. . .

Taking cells back to their youthful, healthier state long captured the imagination of scientists, but seemed unlikely. Then a breakthrough paper published in 2006 by Japanese scientist Shinya Yamanaka and a colleague showed mature skin cells of mice could be reprogrammed into primordial, immature stem cells—called induced pluripotent stem cells—in effect resetting their molecular clocks. Yamanaka, who later shared a Nobel Prize for work in this area, is an adviser to Altos. In 2016, Spanish biochemist Juan Carlos Izpisua Belmonte, Altos’s founding scientist, showed how the age of cells could be reverted without changing their genome and identity. His work demonstrated the potential for toggling between the ‘old’ and ‘young’ states of cells—the basis for Altos’s effort to rejuvenate cells.

For the full story, see:

Gregory Zuckerman. “Fear of Death Drives A Venture Capitalist.” The Wall Street Journal (Monday, Aug. 21, 2023): B1-B2.

(Note: the online version of the story has the date August 20, 2023, and has the title “For This Venture Capitalist, Research on Aging Is Personal; ‘Bob Has a Big Fear of Death’.”)

Well-Intentioned Antislavery Colonists Accidentally Spread Yellow Fever Plague

(p. C9) Hardly anyone noticed the first to die in the sultry August of 1793—a few foreigners, a sailor, an oyster seller. Most Philadelphians brushed off the deaths as the result of air fouled by rotting coffee or fish near the docks. Then the healthy and affluent began to die: public officials, ministers. The plague that was sweeping the young nation’s temporary capital was yellow fever, a contagion little understood at the time. Writes Robert Watson in “America’s First Plague,” the outbreak was “one of the worst epidemics in American history.”

In the course of three horrendous months, between 6,000 and 9,500 people would die, constituting 15% to 20% of Philadelphia’s population.

. . .

The source of the plague is a story in its own right. It apparently derived from infected mosquitoes that had bred on a ship named the Hankey. Earlier in the year, the Hankey had transported an expedition of antislavery Londoners to an island off the coast of present-day Guinea-Bissau, where they hoped to found a model biracial colony. They were instead beset by hostile natives and rampant yellow fever, which the few desperate survivors carried with them across the Atlantic to ports in the Caribbean and eventually to Philadelphia. Mr. Watson, a professor of history at Lynn University in Boca Raton, Fla., notes that “the ship inadvertently unleashed death at every port where it docked.” (A riveting account of this hapless colonial experiment may be found in Billy G. Smith’s “Ship of Death,” published in 2013.)

Fortunately for those who remained in the city, Philadelphia’s capable mayor, a businessman named Matthew Clarkson, aided by a beleaguered committee of brave volunteers, did his best to organize public-health measures and burials.

. . .

Among the doctors who struggled to cope with a disease they couldn’t cure, Mr. Watson rightly emphasizes the polymath Benjamin Rush. A signer of the Declaration of Independence, Rush incarnated both the humanistic best and medical worst of the early republic. Although his treatments were widely accepted, they were disastrous. He believed dogmatically in violent purges, forced heat to blister the limbs and above all bloodletting. He bled his patients of as much as 10 ounces a day, probably killing more of them than he saved. When he himself fell ill, he subjected himself to the same brutal regimen but survived to persist in his malpractice.

For the full review see:

Fergus M. Bordewich. “When Yellow Jack Attacked.” The Wall Street Journal (Saturday, June 10, 2023): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date June 9, 2023, and has the title “‘America’s First Plague’ Review: Attack of the Yellow Jack.”)

The book under review is:

Watson, Robert P. America’s First Plague: The Deadly 1793 Epidemic That Crippled a Young Nation. Lanham, Maryland: Rowman & Littlefield Publishers, 2023.

The “riveting” book mentioned above is:

Smith, Billy G. Ship of Death: A Voyage That Changed the Atlantic World. New Haven, CT: Yale University Press, 2013.

With Repetitions Surgeons Gain Informal Knowledge, Such as “Muscle Memory”

(p. C6) Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?

In a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems.

. . .

. . ., the results suggested if the over-60 doctors took care of 1,000 patients, 13 patients who died in their care would have survived had they been cared for by the under-40 doctors. We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers.

. . .

Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers.

. . .

. . ., a separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age.

. . .

The results showed that unlike hospitalists, surgeons got better with age. Their patient mortality rates had modest but significant declines as they got older: mortality was 6.6% for surgeons under 40, 6.5% for surgeons age 40-49, 6.4% for surgeons age 50-59, and 6.3% for surgeons over age 60.

Clearly something different was happening here. It may be that for hospitalists, the benefit of steadily increasing experience starts to be outweighed by their waning knowledge of the most up-to-date care. It’s different for surgeons, though, who hone many of their skills in the OR. Surgeons build muscle memory through repetition, working in confined spaces with complex anatomy. They learn to anticipate technical problems before they happen and plan around them based on prior experience. Over time, they build greater technical skills across a wider variety of scenarios, learn how to best avoid complications, and choose better surgical strategies.

What does this mean for all of us as patients when we meet a new doctor? Taking studies of hospitalists and surgeons together, it’s clear that a doctor’s age isn’t something that can be dismissed out of hand—age does matter—but nor can it be considered in isolation. If we’re concerned about the quality of care we’re receiving, the questions worth asking aren’t “How old are you?” or even “How many years of experience do you have?” but rather “Do you have a lot of experience caring for patients in my situation?” or “What do you do to stay current with the research?”

For the full essay, see:

Anupam B. Jena and Christopher Worsham. “Do Younger or Older Doctors Get Better Results?” The Wall Street Journal (Saturday, July 8, 2023): C6.

(Note: ellipses added.)

(Note: the online version of the essay was updated July 8, 2023, and has the same title as the print version.)

The essay quoted above is adapted from the book:

Jena, Anupam B., and Christopher M. Worsham. Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health. New York: Doubleday, 2023.