Category: Health

“Two Promising Approaches” for Drugs to Reduce Severe Cases of Covid-19

(p. A19) Americans would have the confidence to return to work, even if the virus is still circulating in the fall, if they knew that a robust screening system is in place to identify and arrest new outbreaks and medication can significantly reduce the chance of becoming severely ill. Kevin Warsh, a former Federal Reserve governor, estimates that such a drug could restore at least $1 trillion in economic activity.

. . .  There are two promising approaches, and both could be available soon if government and private industry do things right.  . . .

One approach involves antiviral drugs that target the virus and block its replication. Think of medicines for treating influenza, HIV or cold sores. The drugs work by blocking the mechanisms that viruses use to replicate.  . . .

The other approach involves antibody drugs, which mimic the function of immune cells. Antibody drugs can be used to fight an infection and to reduce the risk of contracting Covid-19. These medicines may be the best chance for a meaningful near-term success.

Antibody drugs are based on the same scientific principles that make “convalescent plasma” one interim tactic for treating the sickest Covid-19 patients. Doctors are taking blood plasma from patients who have recovered from Covid-19 and infusing it into those who are critically ill. The plasma is laden with antibodies, and the approach shows some promise. The constraint: There isn’t enough plasma from recovered patients to go around.

For the full commentary, see:

Scott Gottlieb. “Bet Big on Treatments for Coronavirus; Antivirals and antibody therapies are showing promise. The FDA needs to step up its pace.” The Wall Street Journal (Monday, April 6, 2020): A19.

(Note: ellipses added.)

(Note: the online version of the commentary has the date April 5, 2020, and has the same title as the print version.)

Seeing Patterns Is Important Knowledge

Collecting, categorizing, and taxonomizing, are early steps toward scientific knowledge, as the example below illustrates. But these activities are often dismissed or ridiculed by members of the scientific establishment.

(p. A23) In the 1970s, Dr. Melzack turned to another problem he had been thinking about for years: pain measurement. At the time, doctors had only very crude instruments, like simply asking people to rate their pain level on a scale from 1 to 10 (a method that is still in use). As a young researcher, Dr. Melzack had worked in a chronic pain clinic and befriended a 70-year-old woman with diabetes.

“She was a highly intelligent person with a good vocabulary, and I began to collect her descriptive words about pain, like ‘burning,’ ‘shooting,’ ‘horrible’ and ‘excruciating,’” he told McGill Reporter in a 2008 interview.

He continued to build his adjective collection by listening to many patients’ descriptions and, working with a statistician, divided them into 20 categories, each describing a particular kind of pain: “tugging,” “pulling” and “wrenching” in one category, for instance, and “pinching,” “pressing” and “gnawing” in another.

This descriptive catalog, published in the journal Pain in 1975, became the McGill Pain Questionnaire. It soon became a standard measure worldwide, deeply enriching the conversations doctors have with their patients, and in many cases helping with diagnosis.

For the full obituary, see:

Benedict Carey. “Ronald Melzack, Cartographer of Pain, Is Dead at 90.” The New York Times (Monday, January 13, 2020): A23.

(Note: the online version of the obituary has the date Jan. 12, 2020, and has the same title as the print version.)

Stop Shaming Those Who Slow Spread of Covid-19 by Wearing Face Masks

The government has been saying that we shouldn’t wear face masks because they won’t do us any good AND we shouldn’t wear face masks because they WILL do good for health professionals. Tucker Carlson slam-dunked this issue at the end of his show on Monday, March 30th. Maybe the widespread voluntary wearing of masks is part of the reason Japan and South Korea have been less affected by covid-19 than the experts expected. It is in our interest to protect our health professionals by sending scarce masks their way. But at the same time, we should allow the incentives (surge-pricing) that will produce a lot more masks for our health professionals and for us too. And we should not shame those in the general population who choose to wear masks.

Those in Their 80s, Ceteris Paribus, Less Likely to Be Offered Bypass Surgery

(p. B6) A U.S. study out Wednesday finds that heart attack patients who turned 80 within the previous two weeks were less likely to get bypass surgery than those who were two weeks shy of that birthday, even though the age difference is less than a month.

Guidelines do not limit the operation after a certain age, but doctors may be mentally classifying people as being “in their 80s” and suddenly much riskier than those “in their 70s,” said the study leader, Dr. Anupam Jena of Harvard Medical School.

. . .

Death rates during the first two months after the heart attack were higher among those over 80, suggesting they might have been harmed by not being offered surgery, Jena said.

For the full story, see:

Marilynn Marchione / The Associated Press. “80 Is Not the New 70: Study Finds That Your Age May Bias Heart Care.” The Omaha World-Herald (Wednesday, February 20, 2020): 3A.

(Note: ellipsis added.)

(Note: the online version of the story has the same date as the print version, and has the title “80 Is Not the New 70: Age May Bias Heart Care, Study Finds.” Where there are slight differences in the wording of the online and print versions, the passages quoted above follow the online version.)

Daylight-Saving Time Is Bad for Brain and for Health

(p. A12) Beth Ann Malow, a professor of neurology at Vanderbilt University Medical Center in Nashville, Tenn., wrote in an opinion piece in JAMA Neurology that switching between daylight-saving time and standard time is bad for the brain. “Going back and forth is ridiculous and disruptive, it makes no sense,” said Dr. Malow, who believes permanent standard time would be healthier for all.

. . .

Muhammad Adeel Rishi, a pulmonologist and sleep physician at the Mayo Clinic Health System in Wisconsin, is the lead author of a daylight-saving time position statement that the American Academy of Sleep Medicine intends to publish this year.

About half-a-dozen studies have found a 5% to 15% increased risk of having a heart attack during the days after shifting to daylight-saving time. “It’s a preventable cause of cardiac injury,” Dr. Rishi said. One study found the opposite effect during the fall, in the days after the transition back to standard time. “So maybe the risk stays high throughout the time when we are on daylight-saving time,” he said.

For the full commentary, see:

Sumathi Reddy. “YOUR HEALTH; Why Daylight-Saving Time Is Bad for You.” The Wall Street Journal (Thursday, March 5, 2020): A12.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date March 4, 2020, and has the title “YOUR HEALTH; Here’s Why Health Experts Want to Stop Daylight-Saving Time.” Where there is a difference in wording in the first quoted paragraph, the online version is used.)

The opinion piece co-authored by Beth Ann Malow, and mentioned above, is:

Malow, Beth A., Olivia J. Veatch, and Kanika Bagai. “Are Daylight Saving Time Changes Bad for the Brain?” JAMA Neurology 77, no. 1 (2020): 9-10.

Open Offices Speed Spread of Covid-19

(p. B6) After years of squeezing ever more workers into tighter office spaces, companies are realizing how efficiently the modern workspace can spread diseases like the coronavirus.

Cubicles and private offices have made way for open floors, where a sneeze or cough can circulate uninterrupted.  . . .

Between 2018 and 2019, the average office space per seat in North America declined by 14.3% to 195.6 square feet, according to brokerage firm JLL’s 2020 Occupancy Benchmarking Report.

Many companies also have abolished assigned seating, rotating workers through the office. That means workers in many offices are now more likely to touch surfaces contaminated by others.

. . .

In a study of more than 1,800 Swedish office workers that was published in 2014, a group of researchers from Stockholm University found that open-plan offices lead to more sick leaves. Among the possible explanations is that these offices can be more stressful, and risk of infection may be greater. The study also found that offices without assigned desks lead to more extended sick leaves, but only among men.

For the full story, see:

Konrad Putzier. “Open Offices Spur Virus Worries.” The Wall Street Journal (Wednesday, MARCH 11, 2020): B6.

(Note: ellipses added.)

(Note: the online version of the story has the date MARCH 10, 2020, and has the title “Your Open-Floor Office Could Help Spread Coronavirus.”)

At Nonprofit Hospitals Revenue Rises and Charity Care Falls

(p. 7) On paper, the average value of community benefits for all nonprofits about equals the value of the tax exemption, but there is tremendous variation among individual hospitals, with many falling short. There is also intense disagreement about how those community benefits are calculated and whether they actually serve the community in question.

Charity medical care is what most people think of when it comes to a community benefit, and before 1969 that was the legal requirement for hospitals to qualify for tax-exempt status. In that year, the tax code was changed to allow for a wide range of expenses to qualify as community benefits. Charitable care became optional and it was left up to the hospitals to decide how to pay back that debt. Hospitals could even declare that accepting Medicaid insurance was a community benefit and write off the difference between the Medicaid payment and their own calculations of cost.

An analysis by Politico found that since the full Affordable Care Act coverage expansion, which brought millions more paying customers into the field, revenue in the top seven nonprofit hospitals (as ranked by U.S. News & World Report) increased by 15 percent, while charity care — the most tangible aspect of community benefit — decreased by 35 percent.

. . .

The average chief executive’s package at nonprofit hospitals is worth $3.5 million annually. (According to I.R.S. regulations, “No part of their net earnings is allowed to inure to the benefit of any private shareholder or individual.”) From 2005 to 2015, average chief executive compensation in nonprofit hospitals increased by 93 percent. Over that same period, pediatricians saw a 15 percent salary increase. Nurses got 3 percent.

For the full commentary, see:

Ofri, Danielle. “Nonprofit Hospitals Are Too Profitable.” The New York Times, SundayReview Section (Sunday, February 23, 2020): 7.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Feb. 20, 2020, and has the title “Why Are Nonprofit Hospitals So Highly Profitable.”)

The Politico article mentioned in the passages quoted above, is:

Diamond, Dan. “Health Care; How Hospitals Got Richer Off Obamacare.” Politico (Posted July 17, 2017). Available from https://www.politico.com/interactives/2017/obamacare-non-profit-hospital-taxes/.

Under Cover of Coronavirus Chaos, Chinese Communists Arrest Hong Kong Defender of Free Speech

(p. A12) HONG KONG — A Hong Kong media tycoon known for his ardent opposition to China was arrested on Friday [Feb. 28, 2020] over his role in a pro-democracy protest last year, the police said, dealing another blow to the city’s independent media.

The tycoon, Jimmy Lai, a rare figure among Hong Kong’s elite for his willingness to take on Beijing, owns Next Media Group, which publishes a popular pro-democracy newspaper and website called Apple Daily. His arrest comes as the city has been dealing with the twin shocks of the protest movement and now the coronavirus outbreak.

His singular status as a prominent businessman in Hong Kong who openly supports the democracy movement and antigovernment protests has made him a frequent target of Beijing-backed elements.

. . .

The arrests were made the same week as a court in China sentenced a Hong Kong bookseller, Gui Minhai, to 10 years in prison. Mr. Gui sold gossipy books about China’s leaders and disappeared mysteriously in Thailand in 2015 and later emerged as a target of China’s effort to quell dissent.

For the full story, see:

Elaine Yu. “Media Baron Is Arrested Over Protests In Hong Kong.” The New York Times (Saturday, February 29, 2020): A12.

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

(Note: the online version of the story has the date Feb. 28, 2020, and has the title “Jimmy Lai, Hong Kong Media Baron, Is Arrested Over Role in Protests.”)

“Good Stress” Causes “a Burst of Energy That Focuses the Mind”

(p. A27) It was a staple of medical thinking dating to the 1910s that stress was the body’s alarm system, switching on only when terrible things happened, often leaving a person with an either-or choice: fight or flight.

The neuroscientist Bruce S. McEwen trailblazed a new way of thinking about stress. Beginning in the 1960s, he redefined it as the body’s way of constantly monitoring daily challenges and adapting to them.

Dr. McEwen, who died on Jan. 2 [2020] at 81, described three forms of stress: good stress — a response to an immediate challenge with a burst of energy that focuses the mind; transient stress — a response to daily frustrations that resolve quickly; and chronic stress — a response to a toxic, unrelenting barrage of challenges that eventually breaks down the body.

For the full obituary, see:

Randi Hutter Epstein. “Bruce McEwen, Who Discovered That Stress Can Alter the Brain, Dies at 81.” The New York Times (Tuesday, February 11, 2020): A27.

(Note: bracketed year added.)

(Note: the online version of the obituary has the date Feb. 10, 2020, and has the title “Bruce McEwen, 81, Is Dead; Found Stress Can Alter the Brain.”)

Chinese Communist “Tradition” of Local Officials Lying to Please Beijing Central Planners

(p. A27) There is a tradition in China (and likely much of the world) for local authorities not to report bad news to their superiors. During the Great Leap Forward, local officials reported exaggerated harvest yields even as millions were starving. More recently, officials in Henan Province denied there was an epidemic of AIDS spread through unsanitary blood collection practices.

For the full commentary, see:

Elisabeth Rosenthal. “Why Is Data on Coronavirus So Limited?” The New York Times (Saturday, February 29, 2020): A27.

(Note: the online version of the commentary has the date Feb. 28, 2020, and has the title “Sanders Is Stirring Cold War Angst. Young Voters Say, So What?.”)