(p. B16) James F. Holland, a founding father of chemotherapy who helped pioneer a lifesaving drug treatment for pediatric leukemia patients, died on Thursday [March 22, 2018] at his home in Scarsdale, N.Y.
. . .
“Patients have to be subsidiaries of the trial,” he told The New York Times in 1986. “I’m not interested in holding patients’ hands. I’m interested in curing cancer.”
He acknowledged that some patients become guinea pigs, and that they sometimes suffer discomfort in the effort to eradicate tumors, but he said that even those who die provide lessons for others who will survive.
“If you do no harm,” Dr. Holland said, “then you do no harm to the cancer, either.”
. . .
Dr. Holland acknowledged that while experimenting with drug treatment sometimes amounts to trial and error, the primary killer is typically the disease itself.
“The thing to remember,” he said, “is that the deadliest thing about cancer chemotherapy is not the chemotherapy.” Continue reading ““If You Do No Harm, Then You Do No Harm to the Cancer, Either””
Category: Health
To Be Dangerous with Crispr Takes a Lot of Genetics Knowledge
(p. A11) “I frankly have been flabbergasted at the pace of the field,” says Jennifer Doudna, a Crispr pioneer who runs a lab at the University of California, Berkeley. “We’re barely five years out, and it’s already in early clinical trials for cancer. It’s unbelievable.”
. . .
Scientists have fiddled with genes for decades, but in clumsy ways.
. . .
Crispr is much more precise, as Ms. Doudna explains in her new book, “A Crack in Creation.” It works like this: An enzyme called Cas9 can be programmed to latch onto any 20-letter sequence of DNA. Once there, the enzyme cuts the double helix, splitting the DNA strand in two. Scientists supply a snippet of genetic material they want to insert, making sure its ends match up with the cut strands. When the cell’s repair mechanism kicks in to fix the cut, it pastes in the new DNA.
. . .
A . . . Crispr worry is that it makes DNA editing so easy anybody can do it. Simple hobby kits sell online for $150, and a community biotech lab in Brooklyn offers a class for $400. Jennifer Lopez is reportedly working on a TV drama called “C.R.I.S.P.R.” that, according to the Hollywood Reporter, “explores the next generation of terror: DNA hacking.”
Ms. Doudna provides a bit of assurance. “Genetics is complicated. You have to have quite a bit of knowledge, I think, to be able to do anything that’s truly dangerous,” she says. “There’s been a little bit of hype, in my opinion, about DIY kits and are we going to have rogue scientists—or even nonscientists—randomly doing crazy stuff. I think that’s not too likely.”
For the full interview, see:
(Note: ellipses added.)
(Note: the online version of the interview has the date July 7, 2017, and the same title as the print versio.)
Doudna’s book, mentioned above, is:
Doudna, Jennifer A., and Samuel H. Sternberg. A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution. New York: Houghton Mifflin Harcourt, 2017.
Mandated Long Clinical Trials Favor Trivial Incremental Drugs and Impede Magic Bullet Cures
(p. B1) AstraZeneca PLC’s new cancer research chief, José Baselga, wants the company to prioritize early-stage cancers over advanced disease when developing new cancer drugs. If successful, his unorthodox strategy could reap rewards for both patients—the potential to cure cancer is much greater when it is treated early—and company coffers.
The approach turns the tried-and-tested model of cancer drug development on its head. Typically, drug companies aim their new cancer drugs at patients with advanced forms of the disease who have exhausted other treatment options. Of the more than 30 new drugs for solid tumors approved for sale in the U.S. since the start of 2014, just two targeted early cancer.
That is largely because there is a clear-cut case for testing new drugs on patients with advanced cancer, as they don’t have other options. What’s more, measuring a new medicine’s effect in advanced cancer is straightforward: a meaningful extension in survival can usually be measured in months. Such patients are also often more willing to try experimental drugs, and regulators have smoothed the path for treatments that show they can prolong lives by delaying tumor growth in advanced cancer.
. . .
(p. B5) “One thing with early stage disease, you have to be able to cure patients,” said Daniel Chen, who spent more than a decade running cancer drug development projects at Roche Holding AG. “The majority of cancer drugs delay cancer growth, they don’t cure patients.” Dr. Chen is now chief medical officer at biotech startup IGM Biosciences Inc.
Running clinical trials could also be difficult, as it would involve persuading patients to try experimental drugs when they might already be cured.
Another challenge is measuring the drug’s effectiveness. In patients whose cancer is diagnosed and treated early, it would take years to determine whether a new drug meaningfully extended survival, making for very long clinical trials.
For the full story, see:
(Note: ellipsis added.)
(Note: the online version of the story has the date May 27, 2019, and has the title “Drug Giant Tries New Tactic to Fight Cancer.”)
IBM’s Watson AI Platform Is Not Curing Cancer
(p. B1) Can Watson cure cancer?
That’s what International Business Machines Corp. IBM 0.03% asked soon after its artificial-intelligence system beat humans at the quiz show “Jeopardy!” in 2011. Watson could read documents quickly and find patterns in data. Could it match patient information with the latest in medical studies to deliver personalized treatment recommendations?
“Watson represents a technology breakthrough that can help physicians improve patient outcomes,” said Herbert Chase, a professor of biomedical informatics at Columbia University, in a 2012 IBM press release.
Six years and billions of dollars later, the diagnosis for Watson is gloomy. Continue reading “IBM’s Watson AI Platform Is Not Curing Cancer”
New Opiod Regulations Make Life Harder for Those in Severe Pain
(p. C4) There’s a great deal in “Dopesick” that’s incredibly bleak, but the most chilling moment for me was a quote from one of Macy’s journalist friends. Synthetic opioids had allowed this woman, despite a severe curvature of her spine, to lead an active life without risky surgery. She resented new rules that made it more onerous for her to get the pills. “My life,” she told Macy, “is not less important than that of an addict.”
For the full review, see:
Jennifer Szalai. “BOOKS OF THE TIMES; A Ground-Level Look At the Opioid Epidemic.” The New York Times (Thursday, July 26, 2018): C1 & C4.
(Note: ellipsis added.)
(Note: the online version of the review has the date July 25, 2018, and has the title “BOOKS OF THE TIMES; ‘Dopesick’ Traces the Opioid Crisis, From Beginning to Blow Up.”)
The book under review, is:
Macy, Beth. Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. New York: Little, Brown and Company, 2018.
Obamacare Architect Ezekiel Emanuel “Will Be Satisfied” with 75 Years
(p. A13) Ezekiel Emanuel, a 61-year-old oncologist, bioethicist and vice provost at the University of Pennsylvania, says he will be satisfied to reach 75. By then, he believes, he will have made his most important contributions, seen his kids grown, and his grandkids born. After his 75th birthday, he won’t get flu shots, take antibiotics, get screened for cancer or undergo stress tests. If he lives longer, that’s fine, he says. He just won’t take extra medical steps to prolong life.
“People want to live to 100 but your horizon of what life is becomes much, much narrower,” he says.
For the full story, see:
(Note: the online version of the story has the date May 20, 2019, and has the same title as the print version.)
Fire Marshall Regulations Reduce Use of Hospital Hand Sanitizers, Helping Spread Dangerous Bacteria
(p. A11) With the use of alcohol-based hand sanitizer — often more effective and convenient than soap and water — it’s far easier to keep hands clean than clothing.
But the placement of alcohol-based hand sanitizer for health workers isn’t as convenient as it could be, reducing its use. The reason? In the early 2000s, fire marshals began requiring hospitals to remove or relocate dispensers because hand sanitizers contain at least 60 percent alcohol, making them flammable.
Fire codes now limit where they can be placed — a minimum distance from electrical outlets, for example — or how much can be kept on site.
Hand sanitizers are most often used in hallways, though greater use closer to patients (like immediately before or after touching a patient) could be more effective.
. . .
Although there have been fires in hospitals traced to alcohol-based hand sanitizer, they are rare. Across nearly 800 American health care facilities that used alcohol-based hand sanitizer, one study found, no fires had occurred. The World Health Organization puts the fire risk of hand sanitizers as “very low.”
For the full commentary, see:
(Note: ellipsis added.)
(Note: the online version of the commentary has the date April 29, 2019, and has the title “Why Your Doctor’s White Coat Can Be a Threat to Your Health.” The last two sentences quoted above, occur in the online, but not the print, version of the article.)
The the rarity of hand sanitizer hospital fires was documented in:
Boyce, John M., and Michele L. Pearson. “Low Frequency of Fires from Alcohol-Based Hand Rub Dispensers in Healthcare Facilities.” Infection Control & Hospital Epidemiology 24, no. 8 (Aug. 2003): 618-19.
Fear of Malpractice Suits Increases Useless Medical Care by 5%
(p. B4) Researchers from Duke and M.I.T. . . . offer what is perhaps the most precise estimate of how much defensive medicine matters, at least for care in the hospital. They found that the possibility of a lawsuit increased the intensity of health care that patients received in the hospital by about 5 percent — and that those patients who got the extra care were no better off.
“There is defensive medicine,” said Jonathan Gruber, a health economist at M.I.T. and an author of the paper, which was published in draft form Monday [July 23, 2018] by the National Bureau of Economic Research. “But that defensive medicine is not explaining a large share of what’s driving U.S. health care costs.”
Mr. Gruber and Michael D. Frakes, a Duke economist and lawyer, looked at the health care system for active-duty members of the military. Under longstanding law, such patients get access to a government health care system but are barred from suing government doctors and hospitals for malpractice. Their family members can also use the military hospitals, but they can sue for malpractice if they wish.
Their study looked at what happened to the hospital care that military members received when a base closing forced them to use their benefits in civilian hospitals, where it was possible to sue. Spending on their health care increased, particularly on extra diagnostic tests.
They also found that, even within the military hospitals, family members who could sue tended to get more tests than those who could not.
For the full commentary, see:
(Note: ellipsis added.)
(Note: the online version of the commentary has the date July 23, 2018, and has the title “A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests.”)
The Frakes and Gruber working paper, mentioned above, is:
Frakes, Michael D., and Jonathan Gruber. “Defensive Medicine: Evidence from Military Immunity.” National Bureau of Economic Research, Inc., NBER Working Paper # 24846, July 2018.
Under Chinese Socialized Medicine, Long Waits, Bribes, and Violent Attacks on Physicians Are Common
(p. A1) BEIJING — Well before dawn, nearly a hundred people stood in line outside one of the capital’s top hospitals.
They were hoping to get an appointment with a specialist, a chance for access to the best health care in the country. Scalpers hawked medical visits for a fee, ignoring repeated crackdowns by the government.
. . .
The long lines, a standard feature of hospital visits in China, are a symptom of a health care system in crisis.
. . .
(p. A8) Instead of going to a doctor’s office or a community clinic, people rush to the hospitals to see specialists, even for fevers and headaches. This winter, flu-stricken patients camped out overnight with blankets in the corridors of several Beijing hospitals, according to state media.
Hospitals are understaffed and overwhelmed. Specialists are overworked, seeing as many as 200 patients a day.
And people are frustrated, with some resorting to violence. In China, attacks on doctors are so common that they have a name: “yi nao,” or “medical disturbance.” Continue reading “Under Chinese Socialized Medicine, Long Waits, Bribes, and Violent Attacks on Physicians Are Common”
Due to “Safety” Regulations, Disabled Man Crawls Up Airplane Stairs
(p. B4) The activist, Hideto Kijima, said Vanilla Air staff initially told him he would not be allowed to board the small aircraft, which was flying from a small airport on the southern island of Amami to Mr. Kijima’s home in Osaka, because it lacked wheelchair-accessible boarding ramps or elevators.
Mr. Kijima was paralyzed from the waist down while playing rugby as a teenager and now uses a wheelchair.
. . .
He was visiting the island with a group of friends, and they offered to carry him up the short stairway from the tarmac, he said. But the airline told them that would violate safety regulations.
So he started crawling.
“I sat down on the stairs and started climbing up one at a time,” he wrote. “The staff told me to stop but I ignored them. How else was I supposed to get back to Osaka?”
He was allowed to take a seat once he reached the top, he said.
For the full story, see:
(Note: ellipsis added.)
(Note: the online version of the story has the date June 29, 2017, and has the title “Japanese Airline Apologizes After Disabled Man Crawls Aboard.”)
“You Don’t Venture into the Wilderness Expecting to Find a Paved Road”
(p. 40) I, . . . , always considered the heart a pump, much the way a doctor explained it to Sandeep Jauhar during his cardiology fellowship. “In the end,” the doctor said, “cardiology is mostly a problem of plumbing.”
Jauhar quickly learned otherwise. His gripping new book, “Heart: A History,” had me nearly as enthralled with this pulsating body part as he seems to be. The tone — a physician excited about his specialty — takes a sharp turn from his first two memoirs. The first, “Intern,” was filled with uncertainty; the second, “Doctored,” with disillusionment.
. . .
We go into an operating room where a young girl is having open-heart surgery, tethered to a heart-lung machine. Then we learn that the concept for this machine began with one doctor’s brazen idea of connecting a patient to another person’s blood supply. He was inspired by the way a fetus feeds off its mother. Six of seven cases ended with a death.
Eventually, the heart-lung machine replaced the volunteers. The machine got off to a rough start too: 17 of the first 18 patients died. As one of the mid-20th-century researchers remarked, “You don’t venture into the wilderness expecting to find a paved road.”
Continue reading ““You Don’t Venture into the Wilderness Expecting to Find a Paved Road””