Category: Health

Paul Marks Purged Old Guard in Order to Recruit New Talent for His Vision of Cancer Research

One important question, not addressed in the obituary quoted below, is the extent to which Marks’s vision for cancer research was farsighted and the extent to which it was misguided. Another important related issue is Marks’s role in support of Nixon’s centrally planned war on cancer.

(p. B11) Paul A. Marks, who transformed Memorial Sloan Kettering Cancer Center into one of the world’s leading institutions for research and treatment of cancer, died on April 28 at his home in Manhattan. He was 93.

. . .

Memorial Sloan Kettering today is very different from the institution Dr. Marks joined in 1980 as president and chief executive. It was still reeling from a scientific scandal in the 1970s involving crudely falsified data. It was also behind the times, focused more on surgical interventions than on the developing frontiers of biological science.

“Frankly, it was an institution that really needed surgery from top to bottom, and Marks was the right guy,” James Rothman, chairman of the Yale School of Medicine’s department of cell biology, said in a phone interview.

. . .

The timing was ideal, said Richard Axel, a neuroscientist and molecular biologist in the department of neuroscience at Columbia University Medical Center. Dr. Marks, he said, energized the institution to pursue the alterations in DNA that cause tumors, doing so at the very moment that it was becoming possible “to truly study DNA, to pet it, to clone it, to determine its sequence.”

What followed was a purge of much of the institution’s old guard, with attendant turmoil and alienation for many of those involved. Dr. Marks instituted a tenure system with a tough review process, and dozens of scientists left between 1982 and 1986. A 1987 article about Dr. Marks in The New York Times Magazine noted that “there are researchers who call Marks ‘Caligula,’ ‘Attila the Hun’ or simply ‘the monster.’”

The article described a scene in his laboratory during his Columbia days when Dr. Marks “grabbed a man by the throat and dragged him across a table.” His wife, Joan Marks, then head of graduate programs at Sarah Lawrence College in Bronxville, N.Y., said in the article, “He can be brutal,” adding, “He really doesn’t understand why people don’t work 97 hours a day, and why they don’t care as much as he cares.”

In his memoir, “On the Cancer Frontier: One Man, One Disease, and a Medical Revolution” (2014, with the former Times reporter James Sterngold), Dr. Marks said he had been embarrassed to see the incident recounted in the article. While he didn’t deny that it had happened, he said that he had actually grabbed the man by both arms, not the throat, and shaken him.

For all of the sharpness of his elbows, Dr. Rothman of Yale said, there was also charm. Dr. Marks, he said, “projected at once a kind of a deep warmth and, at the same time, a formidable aspect.”

Dr. Marks was known for a sharp eye in recruiting talent. “He had an uncanny ability to attract these great scientists from all over the nation,” said Joan Massagué, the director of the Sloan Kettering Institute, the institution’s experimental research arm.

For the full obituary, see:

John Schwartz. “Paul Marks, 93, Administrator Who Pushed Memorial Sloan Kettering to Top-Tier Status.” The Wall Street Journal (Thursday, May 7, 2020): B11.

(Note: ellipses added.)

(Note: the online version of the obituary was updated May 6, 2019 and has the title “Paul Marks, Who Pushed Sloan Kettering to Greatness, Dies at 93.”)

Marks’s memoir, mentioned above, is:

Marks, Paul, and James Sterngold. On the Cancer Frontier: One Man, One Disease, and a Medical Revolution. New York, NY: PublicAffairs, 2014.

Physicians Fighting Covid-19 Use Social Media “to Share Improvised Solutions”

(p. A9) In mid-March [2020], as U.S. hospitals scrambled for ventilators to treat a surge of coronavirus cases, a Vermont pulmonologist proposed a different treatment on a blog popular with emergency-medicine doctors.

Joshua Farkas observed in the post on the EMCrit blog that many Covid-19 patients seemed to benefit from less-invasive alternatives to help their breathing, including pressure therapy used to treat sleep apnea—sometimes referred to as CPAP, for continuous positive airway pressure.

. . .

The post helped galvanize an emerging theory about the treatment of Covid-19 patients, which in recent weeks has taken hold in U.S. hospitals. In New York City, where ventilators are in perilously short supply, doctors say they have since embraced CPAP and other treatments to improve breathing in Covid-19 patients.

The shift is one example of how health-care workers are writing the playbook for treating coronavirus patients on the fly, knowing they can’t wait for peer-reviewed articles or studies in established medical journals. Instead they are tapping into social media, podcasts, inside-baseball medical blogs and text-message groups to share improvised solutions to supply shortages and patient care, forcing hospitals to quickly re-evaluate their practices.

“This has been a rapidly evolving process,” said Dr. Farkas, who has treated Covid-19 patients in the intensive-care unit at the University of Vermont in Burlington. “As we struggle with how to treat a disease that so recently was totally unknown, this rapid exchange and updating of information is crucial.”

. . .

Last week, Michelle Romeo, a chief emergency-medicine resident at NYU Langone and Bellevue hospital in Manhattan, tweeted photos of a jury-rigged breathing device involving a mask used for BiPAP—an airway pressure therapy similar to CPAP.

At Mount Sinai Hospital in Manhattan, pulmonologists worked with the hospital’s sleep lab to figure out a way to use BiPAP machines like a ventilator. The result was posted on Reddit, and got “all kinds of different responses,” said Valerie Burgos-Kneeland, a registered nurse in the hospital’s Medical Intensive Care Unit. “It’s kind of been an opportunity for people to get creative.”

For the full story, see:

Rebecca Davis O’Brien. “Doctors Improvise, Share Treatments.” The Wall Street Journal (Friday, April 10, 2020): A9.

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

(Note: the online version of the story has the date April 9, 2020, and has the title “Doctors Are Improvising Coronavirus Treatments, Then Quickly Sharing Them.”)

Drugs Targeting Cytokines Tried Against Covid-19

(p. A9) Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.

As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients, doctors say. Genetics may be a factor.

. . .

Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.

Drugs targeting specific cytokines rather than the entire immune system may be more effective, doctors say.

Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.

For the full story, see:

Jared S. Hopkins, Joseph Walker. “Haywire Immune Reaction Linked to Most Severe Cases.” The Wall Street Journal (Friday, April 10, 2020): A1 & A9.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 9, 2020, and has the title “Haywire Immune Response Eyed in Coronavirus Deaths, Treatment.”)

“Real World Evidence” on Effectiveness of Experimental Drugs Can Be Extracted From Electronic Health Records

(p. A7) . . . analysis of compassionate-use data, about the experimental drug remdesivir from Gilead Sciences Inc. published in the New England Journal of Medicine, came under criticism. Scientists pointed out that the Covid-19 patients received the drug in centers around the world where care may have differed, data on some patients was incomplete and there was no comparison group.

That study’s first author, Jonathan Grein, of Cedars-Sinai Medical Center in Los Angeles, said given how little is known about the coronavirus and how to treat it, “I think at this point any information is potentially helpful.” He said the study, funded by Gilead Sciences, noted the findings were limited and preliminary. “It is a starting point, an opportunity to aggregate our initial experiences,” he said.

. . .

The FDA . . . has worked closely with companies trying to extract “real world evidence” about patients’ experiences with new or experimental drugs from sources such as electronic health records.

For the full story, see:

Amy Dockser Marcus. “Hundreds Get Plasma in National Study.” The Wall Street Journal (Wednesday, April 22, 2020): A7.

(Note: ellipses added.)

(Note: the online version of the story has the date April 21, 2020, and has the title “Hundreds Receive Plasma From Recovered Coronavirus Patients in National Study.”)

Blacks Deficient in Vitamin D Are at Greater Risk of Cytokine Storm from Covid-19

(p. A15) Black Americans are dying of Covid-19 at a higher rate than whites. Socioeconomic factors such as gaps in access to health care no doubt play a role. But another possible factor has been largely overlooked: vitamin D deficiency that weakens the immune system.

Researchers last month released the first data supporting this link. Based on a link between levels of the inflammatory marker C-reactive protein and severe cases of Covid-19, they estimate that tens of thousands of lives could be saved world-wide by normalizing vitamin D levels, through its modulation of the inflammatory cascade.

Vitamin D is produced by a reaction in the skin to the ultraviolet rays in sunlight. Many Americans are low in vitamin D, but those with darker skin are at a particular disadvantage because melanin inhibits the vitamin’s production.

For the full commentary, see:

Vatsal G. Thakkar. “Vitamin D and Coronavirus Disparities.” The Wall Street Journal (Friday, April 17, 2020): A15.

(Note: the online version of the commentary has the date April 16, 2020, and has the same title as the print version. Where the wording of the online and print versions differs, the passages quoted above follow the online version.)

The research working paper mentioned above, is:

Daneshkhah, Ali, Vasundhara Agrawal, Adam Eshein, Hariharan Subramanian, Hemant Kumar Roy, and Vadim Backman. “The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in Covid-19 Patients.” (April 30, 2020).

Art Diamond Interviewed on Curing Covid-19

On Monday, May 4, Jim Blasingame, the host of his nationally syndicated “The Small Business Advocate” radio show, interviewed me on issues related to my book Openness to Creative Destruction, and “Free to Choose a Possible Cure,” my April 17 op-ed piece on the web site of the American Institute for Economic Research. You can click on the links below to listen to each segment of the interview.

Early Promising Results from Gilead-Sponsored Study on Remdesivir

(p. B3) A doctor in Chicago told colleagues that Gilead’s drug remdesivir appeared to help many patients enrolled in a clinical trial site at the University of Chicago Medicine hospital, according to a news report in online health publication STAT, which cited a video of the remarks. The doctor said that the hospital had enrolled 125 patients in two remdesivir studies sponsored by Gilead, and that most had been discharged from the hospital, and two had died.

. . .

“Partial data from an ongoing clinical trial is by definition incomplete and should never be used to draw conclusions about the safety or efficacy of a potential treatment that is under investigation,” a University of Chicago spokeswoman said in an email. “Drawing any conclusions at this point is premature and scientifically unsound.”

. . .

Last week, Gilead reported in the New England Journal of Medicine that remdesivir showed encouraging results in treating 53 patients with severe Covid-19 symptoms. The patients were given the drug under so-called compassionate use, which allows for doctors to request unapproved drugs for patients in emergency situations.

Of the 53 compassionate use patients who received remdesivir, nearly half were discharged from the hospital and seven patients died, or 13% of the total, according to the New England Journal paper. Of 30 patients using breathing tubes connected to ventilators, 17 had their tubes disconnected after remdesivir treatment.

For the full story, see:

Joseph Walker. “Gilead Shares Up 9.7% On Encouraging Signs In Covid-19 Drug Trial.” The Wall Street Journal (Saturday, April 18, 2020): B3.

(Note: ellipses added.)

(Note: the online version of the story has the date April 17, 2020, and has the title “Coronavirus Drug Report, Though Inconclusive, Sends Gilead Higher.” Where the versions differ, the passages quoted above follow the somewhat longer online version.)

An Informed Public Can Protect Themselves Better than Central Planners Can Protect Them

(p. A15) China teaches one thing: When a novel respiratory virus emerges, a free press is on balance an indispensable medical asset. The steps an informed public can take to protect itself are far more potent than any top-down action. Unknown is whether the new disease really originated in a meat market in Wuhan, as was first reported. But suppressing news of its outbreak once it was discovered was China’s most fatal mistake.

For the full commentary, see:

Holman W. Jenkins, Jr. “BUSINESS WORLD; Coronavirus Needs a Free Press.” The Wall Street Journal (Wednesday, February 12, 2020): A15.

(Note: the online version of the commentary has the date Feb. 11, 2020, and has the same title as the print version.)

A Map as Large as the Territory It Represents

(p. A4) As more reliable data comes in, said Dr. Spiegelhalter, “the Covid-19 pandemic is rapidly becoming a constrained problem.”

. . .

Statistical science, he said, “is a machine, in a sense, to turn the variability that we see in the world — the unpredictability, the enormous amount of scatter and randomness that we see around us — into a tool that can quantify our uncertainty about facts and numbers and science.”

But as he acknowledged in his book, “The Art of Statistics,” models “are simplifications of the real world — they are the maps not the territory.” (This is reminiscent of Jorge Luis Borges’s story, “On Exactitude in Science,” about a map growing as large as the territory it was meant to represent.)

For the full review, see:

Siobhan Roberts. “Embracing the Uncertainties of the Pandemic.” The New York Times (Wednesday, April 8, 2020): A4.

(Note: ellipsis added.)

(Note: the online version of the review has the date April 7, and has the title “Embracing the Uncertainties.”)

The Spiegelhalter book mentioned above, is:

Spiegelhalter, David. The Art of Statistics: How to Learn from Data. New York: Basic Books, 2019.

Since SARS, Japanese Protect One Another by Wearing Masks

(p. A4) PARIS — Until a few weeks ago, Asian tourists were the only mask-wearers in Paris, eliciting puzzlement or suspicion from French locals, or even hostility as the coronavirus began sweeping across Europe.

. . .

This taboo is falling fast, not only in France but across Western countries, after mounting cries from experts who say the practice is effective in curbing the coronavirus pandemic.

The shift for Western nations is profound and has had to overcome not merely the logistical challenges of securing enough masks, which are significant enough, but also a deep cultural resistance and even stigma associated with mask-wearing, which some Western leaders described flatly as “alien.”

Seemingly, it won’t be for much longer. After discouraging people from wearing face masks, France, like the United States, has begun urging its citizens to wear basic or homemade ones outside. And some parts of Europe are moving faster than the United States by requiring masks instead of simply recommending their use.

. . .

. . . masks were . . . alien to Asia until it was struck by the SARS pandemic in 2003.

In Japan, after people got used to masks, they continued to wear them against seasonal allergies or to protect one another from germs. Unlike in other Asian nations, where many wear masks against air pollution, mask-wearing became widespread despite the absence of immediate threats.

Mask-wearing has become such a part of daily life that it now plays a role in maintaining an overall feeling of being “reassured” in Japanese society, said Yukiko Iida, an expert on masks at the Environmental Control Center, an environmental consulting company based in Tokyo.

“When you put on a mask, you’re not inconveniencing others when you cough,” Ms. Iida said. “You’re showing others that you’re abiding by social etiquette, and so people feel reassured.”

. . .

Daniel Illouz, a pharmacist in eastern Paris, said that he had been skeptical of the government’s repeated message that widespread mask-wearing was not helpful in fighting the epidemic.

“I don’t see why in all the Asian countries, where they have masks, it would work, but it wouldn’t work for us,” he said.

For the full story, see:

Norimitsu Onishi and Constant Méheut. “Wearing Masks, Common in Asia, Rises in the West.” The New York Times (Friday, April 10, 2020): A4.

(Note: ellipses added.)

(Note: the online version of the story has the date April 9, 2020, and has the title “Mask-Wearing Is a Very New Fashion in Paris (and a Lot of Other Places).”)

Low Quality Parts from Corrupt Contractors Endanger Russian Sailors in Deep-Diving Subs

(p. A22) OFF THE COAST OF NORWAY — There could hardly have been a more terrifying place to fight a fire than in the belly of the Losharik, a mysterious deep-diving Russian submarine.

. . .

A fire on any submarine may be a mariner’s worst nightmare, but a fire on the Losharik was a threat of another order altogether. The vessel is able to dive far deeper than almost any other sub, but the feats of engineering that allow it do so may have helped seal the fate of the 14 sailors killed in the disaster.

. . .

(p. A23) As for the accident itself, few expressed surprise that a jewel of the Russian submarine fleet might catch fire not very far from its home base — probably in water no more than 1,000 feet deep — leaving most of its crew dead. The Russians, some experts said, seem to have a greater tolerance for risk than the West.

. . .

Mr. Lobner, the former American submarine officer, said “we have nothing except unmanned vehicles” operating at such depths.

Still, while some see an engineering marvel, others see evidence that Russia may be unable to build the kind of sophisticated, autonomous underwater drones the United States appears to rely on.

“They would rather adapt existing systems, modernize them, and try to muddle through,” Mr. Boulègue said. “So, no wonder these things keep exploding,” he said. Mr. Boulègue believes accidents have been far more common than publicly known.

John Pike, director of the think tank GlobalSecurity.org, said the Losharik fire suggested that the Russian military was still contending with some longstanding issues: corrupt contractors, and problems with quality control in manufacturing, spare parts supply chains and maintenance.

“I assume that every other sub in the Russian fleet has similar problems,” Mr. Pike said. “I just think the whole thing is held together with a lot of baling wire and spit.”

For the full story, see:

James Glanz and Thomas Nilsen. “A Deep-Diving Sub, a Deadly Fire And Russia’s Secret Undersea Agenda.” The New York Times (Tuesday, April 21, 2020): A22-A23.

(Note: ellipses added.)

(Note: the online version of the story was updated April 21, 2020, and has the title “A Deep-Diving Sub. A Deadly Fire. And Russia’s Secret Undersea Agenda.”)