Category: Health

Traveling Health Volunteers Often Do Harm

(p. D3) Tens of thousands of religious and secular institutions now send hundreds of thousands of health volunteers from the United States out into the world, generating close to an estimated $1 billion worth of unpaid labor. Volunteers include experienced medical professionals and individuals who can provide only elbow grease; between these extremes of competence are the hordes of students in the health professions, among whom global volunteering has become immensely popular.
. . .
Students may take advantage of the circumstances to attempt tasks well beyond their expertise. Seasoned professionals may cling to standards of practice that are irrelevant or impossible to sustain in poor countries. Unskilled volunteers who do not speak the language may monopolize local personnel with their interpreting needs without providing much of value in return.
Problems may lie with the structure of a program rather than the personnel. Volunteer projects may be choppy and discontinuous, one set of volunteers not knowing what the previous group was up to, and not able to leave suggestions for the next group. Medications may run out. Surgery may be performed with insufficient provisions for postoperative care.
Even well-organized programs may undermine hosting communities in unanticipated ways: For instance, a good volunteer-based clinic may sap confidence in local medical care and, providing free services, threaten to put local physicians out of business.
. . .
A few studies on the long-term effects of short-term good works are ongoing. In the meantime, “there is little evidence that short-term volunteer trips produce the kinds of transformational changes that are often promised,” Dr. Lasker finds.

For the full review, see:
ABIGAIL ZUGER, M.D. “The Folly of the Well-Meaning Traveling Volunteer.” The New York Times (Tues., APRIL 26, 2016): D3.
(Note: ellipses added.)
(Note: the online version of the review has the date APRIL 25, 2016, and has the title “Books; Book Review: ‘Hoping to Help’ Questions Value of Volunteers.”)

The book under review, is:
Lasker, Judith N. Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, The Culture and Politics of Health Care Work. Ithaca, NY: Cornell University Press, 2016.

FDA Blocking Stem-Cell Therapies from Those With No Other Hope

(p. D2) Research is exploding into ways stem cells might be harnessed to cure diseases, mend damaged tissue, even grow replacement organs.
. . .
Jeffrey Weiss, a retinal surgeon in Margate, Fla., has treated about 570 patients with retinal and optic nerve diseases with stem cells taken from patients’ bone marrow as part of a study, and says that about 60% have had meaningful improvement. Patients pay $19,000 to $21,000 to receive the injections.
Shawn Rockafellow, a 31-year old truck dispatcher in Chandler, Ariz., started rapidly losing his vision in 2014 to a genetic disease and says he was told to accept that he was going blind. His mother read about Dr. Weiss’s work. Mr. Rockafellow raised the $20,000 fee on GoFundMe, a personal charity website, and had the treatment in both eyes in January.
After three months, the vision in his right eye went from roughly 20/1,000 to 20/400. After six months, it was 20/300. His left eye hasn’t improved as much, so he wants to try the treatment again. His regular ophthalmologist, Scott Markham, says “the fact that he’s not worsening is fantastic.”
. . .
Mark Berman, a Beverly Hills, Calif., cosmetic surgeon who co-founded a network of stem-cell clinics, says “fundamentally, all we are doing is a simple, surgical procedure. This is not witch-doctor stuff. We are repairing cell damage with people’s own stem cells.” He says the member clinics in 25 states have treated about 5,000 patients to date, with no significant adverse events.
SammyJo Wilkinson, a former dot-com executive, developed multiple sclerosis in 1995 and was confined to a wheelchair by 2011. She says her symptoms started to improve almost immediately after receiving a high-dose stem cell treatment at a Houston clinic in 2012. When the FDA blocked access to that form of therapy, Ms. Wilkinson went to Cancún, Mexico, for follow-ups. After a total of five treatments for $90,000, she says she has far less pain, can exercise and walk short distances with the help of a walker.
At the FDA hearing, Ms. Wilkinson, who founded a patient group called Patients for Stem Cells, plans to appeal for a faster approval process for stem-cell therapies and a registry to monitor patient outcomes. “Patients will never get these treatments if they have to go the traditional double-blind placebo-controlled trial route. That takes 10 years and $1 billion,” she says. “There’s got to be a middle ground, where you don’t shut off treatment, you just keep track of it.”

For the full story, see:
Beck, Melinda. “Stem-Cell Treatments Become More Available, and Face More Scrutiny.” The Wall Street Journal (Tues., Aug. 30, 2016): D2.
(Note: ellipses added.)
(Note: the online version of the story has the date Aug. 29, 2016, and has the title “Stem-Cell Treatments Become More Available, and Face More Scrutiny.” There are minor differences in wording between the online and print versions. The sentences quoted above, follow the online version.)

Precautionary Principle Slows Cloning Innovation

(p. A8) Dolly the Sheep started her life in a test tube in 1996 and died just six years later. When she was only a year old, there was evidence that she might have been physically older. At five, she was diagnosed with osteoarthritis. And at six, a CT scan revealed tumors growing in her lungs, likely the result of an incurable infectious disease. Rather than let Dolly suffer, the vets put her to rest.
Poor Dolly never stood a chance. Or did she?
Meet Daisy, Diana, Debbie and Denise. “They’re old ladies. They’re very healthy for their age,” said Kevin Sinclair, a developmental biologist who, with his colleagues at the University of Nottingham in Britain, has answered a longstanding question about whether cloned animals like Dolly age prematurely.
In a study published Tuesday in Nature Communications, the scientists tested these four sheep, created from the same cell line as Dolly, and nine other cloned sheep, finding that, contrary to popular belief, cloned animals appear to age normally.
. . .
Not only did many countries, including Canada and Australia, ban reproductive cloning in animals, but the United Nations banned all kinds of cloning in humans in 2005. Last year the European Union made importing food from cloned animals or their offspring illegal.
. . .
Now, based on results of this new study, researchers have confirmed what most scientists believed years ago: Cloning does not lead to premature aging.
. . .
Many scientists hope that changes in perception will lead to advances in reproductive technology that will enable us to provide food for a growing global population, save endangered species and develop advanced therapies.

For the full story, see:
JOANNA KLEIN. “Dolly’s Fellow Clones, Enjoying the Golden Years.” The New York Times (Weds., JULY 27, 2016): A8.
(Note: ellipses added.)
(Note: the online version of the commentary has the date JULY 26, 2016, and has the title “Dolly the Sheep’s Fellow Clones, Enjoying Their Golden Years.”)

Mather and Boylston Risked Much to Fight Smallpox

I enjoyed reading the book reviewed below. From the title, and from reviews, I had the impression that it would mostly be about the smallpox epidemic and the innoculation conflict. I was surprised that of equal, or greater, importance in the book is the role of James Franklin’s newspaper in laying the intellectual groundwork for the American Revolution. I learned from that part of the book too, but some might feel misled from the title about what the book was mainly about. (I think “fever” in the title is intended as a double entendre, referring both to a fever from smallpox, and a fever from the ideas of liberty.)

(p. A11) Inoculation was proposed by Cotton Mather, a figure much diminished in the 30 years since Salem. He had suffered a terrible sequence of tragedies, losing his wife and 10 of his children to accidents and epidemic disease. He had also been marginalized within the religious community by quarrels and scandals. But he had become an assiduous student of science, corresponding with the Royal Society in London and learning from its “Transactions” that inoculation against smallpox had long been practiced in Constantinople. Mr. Coss shows how Mather’s investigations led him to consult a source closer to home. His slave Onesimus, when asked whether he had ever had smallpox, replied “both Yes, and No”: He had been inoculated as a child in Africa, receiving a mild infection and subsequent immunity.

Inoculation was commonplace across swaths of Africa, the Middle East and Asia, Mr. Coss explains, but this inclined the doctors of Enlightenment-era Europe to regard it as a primitive superstition. Such was the view of William Douglass, the only man in Boston with the letters “M.D.” after his name, who was convinced that “infusing such malignant filth” in a healthy subject was lethal folly. The only person Mather could persuade to perform the operation was a surgeon, Zabdiel Boylston, whose frontier upbringing made him sympathetic to native medicine and who was already pockmarked from a near-fatal case of the disease.
“Given that attempting inoculation constituted an almost complete leap of faith for Boylston,” Mr. Coss writes, “he spent surprisingly little time agonizing over it.” He knew personally just how savage the toll could be. On June 26, 1721, just as the epidemic began to rage in earnest, Boyston filled a quill with the fluid from an infected blister and scratched it into the skin of two family slaves and his own young son.
News of the experiment was greeted with public fury and terror that it would spread the contagion. A town-hall meeting was convened, at Dr. Douglass’s instigation, at which inoculation was condemned and banned. Mather’s house was firebombed with an incendiary device to which a note was attached: “I will inoculate you with this.”

For the full review, see:
MIKE JAY. “‘BOOKSHELF; An Ounce of Prevention; When Cotton Mather advocated inoculation during a smallpox outbreak, young Benjamin Franklin helped foment outrage against him.” The Wall Street Journal (Thurs., March 3, 2016): A11.
(Note: the online version of the review has the date March 2, 2016, and has the title “‘BOOKSHELF; When Ben Franklin Was Against Vaccines; When Cotton Mather advocated inoculation during a smallpox outbreak, young Benjamin Franklin helped foment outrage against him.”)

The book under review, is:
Coss, Stephen. The Fever of 1721: The Epidemic That Revolutionized Medicine and American Politics. New York: Simon & Schuster, 2016.

Fragmented Health Care Causes Polypharmacy Harms

(p. D5) Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.
“A cardiologist puts someone on good, evidence-based medications for his heart,” said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “An endocrinologist does the same for his bones.”
. . .
“Pretty soon, you have an 82-year-old man who’s on 14 medications,” Dr. Alexander said, barely exaggerating.
Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.
. . .
Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to health care. “The system is not geared to look at a person as a whole, to see how the patterns fit together,” Dr. Steinman said.

For the full commentary, see:
Span, Paula. “THE NEW OLD AGE; An Ever-Mounting Pile of Pills.” The New York Times (Tues., APRIL 26, 2016): D5.
(Note: ellipses added.)
(Note: the online version of the commentary has the date APRIL 22, 2016, and has the title “THE NEW OLD AGE; The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills.”)

Cancer Is Not Due to Modernity

(p. 1A) Scientists’ conventional opinion about cancer was that it’s a relatively recent phenomenon caused by the stresses of modern life.

Dietary changes, behavioral changes and man-made changes to our environment have subjected humans to toxins that contribute to cancers, they say.

But new findings from researchers at South Africa’s University of the Witwatersrand published in the South African Journal of Science challenge that assumption.

Paleontologists found a benign tumor in a 12 or 13-year-old boy specimen that dates back almost 2 million years.

More significantly, they also found a malignant tumor that’s 1.7 million years old on the little toe bone of a left foot.

Previously the oldest discovered human cancer was between 780,000 and 120,000 years old.

. . .

(p. 2A) “The evidence is out there that these conditions have been with us a long time and we’ve been kind of hoodwinked that cancer is a modernity,” said Patrick Randolph-Quinney, one of the study’s authors. “These things are ancient.”

The greatest predictor of cancer, the study argues, even in our ancestors, is longevity. The longer we live, the more chances something in our bodies goes wrong, the more chances that something is a tumor.

For the full story, see:
The Washington Post. “Ancient tumor upends notion of cancer as modern affliction; 1.7-million-year-old malignant growth is causing scientists to rethink diseases and human history.” Omaha World-Herald (Sat., JUNE 20, 2016): 1A & 2A.
(Note: ellipsis added.)

The scientific article mentioned above, is:
Patrick, S. Randolph-Quinney, A. Williams Scott, Steyn Maryna, R. Meyer Marc, S. Smilg Jacqueline, E. Churchill Steven, J. Odes Edward, Augustine Tanya, Tafforeau Paul, and R. Berger Lee. “Osteogenic Tumour in Australopithecus Sediba: Earliest Hominin Evidence for Neoplastic Disease.” South African Journal of Science (July/Aug. 2016), DOI: http://dx.doi.org/10.17159/sajs.2016/20150470.

“Doctors Often Do Not ‘Know’ What They Are Doing”

(p. A11) Into the “swift currents and roiling waters of modern medicine” plunges Dr. Steven Hatch, whose informative “Snowball in a Blizzard” adds an important perspective. Dr. Hatch believes that our health-care system can “champion patient autonomy” and facilitate “more humane treatment, less anxiety, and better care” by revealing to patients the “great unspoken secret of medicine.” What’s the secret? Simply stated, “doctors often do not ‘know’ what they are doing.” In Dr. Hatch’s view, despite spectacular advances in biomedical science, modern “doctors simply cannot provide the kind of confident predictions that are often expected of them.”
. . .
He begins where Donald Rumsfeld ended: There will always be “known knowns, known unknowns, and unknown unknowns” in medicine. Dr. Hatch illustrates this spectrum of uncertainty with engaging exposés of popular screening tests like mammograms (attempting to detect breast cancer is like “finding a snowball in a blizzard”); common drug treatments, like those used to lower serum cholesterol or blood-pressure levels (about which expert national guidelines seem to change almost yearly); and health-care coverage in the lay media (whose “breaking news” too often ignores the uncertainty of the news being broken). Throughout his book, Dr. Hatch’s message is “caveat emptor,” warning his readers to beware not only the pseudoscientists, flim-flammers, anti-vacciners and celebrity doctors but also the all-too-certain pronouncements of the medical establishment.

For the full review, see:
BRENDAN REILLY. “BOOKSHELF; Give It To Me Straight, Doc; Doctors can’t really be certain if any treatment will help a particular person. But patients are looking for prescriptions, not probabilities.” The Wall Street Journal (Tues., March 15, 2016): A11.
(Note: the ellipsis between paragraphs, and the first two in the final quoted paragraph, are added; the third ellipsis in the final paragraph is in the original.)
(Note: ellipsis added.)
(Note: the online version of the review has the date March 14, 2016.)

The book under review, is:
Hatch, Steven. Snowball in a Blizzard: A Physician’s Notes on Uncertainty in Medicine. New York: Basic Books, 2016.

Iowa State Students Go Bananas to Save (or Harm?) African Children

(p. A11) Student activists at Iowa State University are up in arms after researchers offered to pay them almost a thousand bucks to eat some genetically modified banana. The bananas, created by an Australian scientist, contain high levels of beta carotene, which converts to vitamin A when eaten.
. . .
“Those students are acting out of ignorance,” Jerome Kubiriba, the head of the National Banana Research Program in Uganda, tells me. “It’s one thing to read about malnutrition; it’s another to have a child who is constantly falling sick yet, due to limited resources, the child cannot get immediate and constant medical care. If they knew the truth about the need for vitamin A and other nutrients for children in Uganda and Africa, they’d get a change of heart.”

For the full commentary, see:
JULIE KELLY. “Anti-GMO Students Bruise a Superbanana.” The Wall Street Journal (Tues., March 15, 2016): A11.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date March 14, 2016.)

Androgen Lengthens Telomeres

(p. A3) Androgens, a kind of sex hormone, have been used to treat certain genetic blood disorders for decades. But doctors haven’t been able to pinpoint exactly why they seem to help some patients. A small study puts forth a theory behind androgens’ disease-fighting mechanism: They help stabilize and even rebuild telomeres, which increasingly diminish in certain conditions and aging.
. . .
The authors of the study, published Wednesday [May 18, 2016] in the New England Journal of Medicine, treated telomere-disease patients who had a variety of conditions with a high dose of a synthetic androgen called danazol. The goal was to test whether the treatment would help keep telomeres intact longer. Instead, they saw them lengthen.
. . .
Experts, including the study’s authors, . . . warned against concluding danazol is a fountain of youth for the healthy, based on research that suggests that shrinking telomeres may be involved in aging.
“That,” said Dr. Agarwal, “would be purely in the realm of speculation.”

For the full story, see:
DANIELA HERNANDEZ. “How Sex Hormones Might Treat Some Diseases.” The Wall Street Journal (Thurs., May 19, 2016): A3.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date May 18, 2016, and has the title “How Sex Hormones Might Treat Certain Diseases.” The print version starts with a one-sentence summary paragraph that is absent in the online version. The second paragraph in the print version differs slightly from the first paragraph in the online version. The version quoted as the first paragraph above, is the first paragraph of the online version.)

The academic article mentioned above (though the date given by the NYT above appears to be a day too early), is:
Townsley, Danielle M., Bogdan Dumitriu, Delong Liu, Angélique Biancotto, Barbara Weinstein, Christina Chen, Nathan Hardy, Andrew D. Mihalek, Shilpa Lingala, Yun Ju Kim, Jianhua Yao, Elizabeth Jones, Bernadette R. Gochuico, Theo Heller, Colin O. Wu, Rodrigo T. Calado, Phillip Scheinberg, and Neal S. Young. “Danazol Treatment for Telomere Diseases.” New England Journal of Medicine 374, no. 20 (May 19, 2016): 1922-31.

Certificate-of-Need Regulations Protect Incumbents and Hurt Consumers

(p. A11) An important but overlooked debate is unfolding in several states: When governments restrict market forces in health care, who benefits? Legislative majorities in 36 states believe that consumers benefit, because restrictions help control health-care costs. But new research confirms what should be common sense: Preventing qualified health-care providers from freely plying their trade results in less access to care.
Most states enforce market restrictions through certificate-of-need programs, which mandate a lengthy, expensive application process before a health-care provider can open or expand a facility. The story goes: If hospitals or physicians could choose what services to provide, competition for patients would force providers to overinvest in equipment such as MRI machines–and the cost could be passed on to patients through higher medical bills.
. . .
These restrictions have largely failed to reduce costs, but they certainly reduce services. A 2011 study in the Journal of Health Care Finance found that certificate-of-need laws resulted in 48% fewer hospitals and 12% fewer hospital beds.

For the full commentary, see:
THOMAS STRATMANN and MATTHEW BAKER. “Certifiably Needless Health-Care Meddling.” The Wall Street Journal (Tues., Jan. 12, 2016): A11.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Jan. 11, 2016.)

The “new research” mentioned by Stratman in the passage quoted above, is:
Stratmann, Thomas, and Matthew C. Baker. “Are Certificate-of-Need Laws Barriers to Entry?: How They Affect Access to MRI, CT, and Pet Scans.” Mercatus Working Paper, Jan. 2016.

Denmark Drones Saving Lives

(p. B1) Mr. McLinden is a member of a group of middle-aged emergency workers taking part in a trial to jump-start the use of unmanned aircraft by Europe’s emergency services. The goal is to give the region a head start over the United States and elsewhere in using drones to tackle real-world emergencies.
The “drone school” builds on Europe’s worldwide lead in giving public groups and companies relatively free rein to experiment with unmanned aircraft. If everything goes as planned, the project’s backers hope government agencies in Europe and farther afield can piggyback on the experiences, helping to transform drones from recreational toys to lifesaving tools.
“For us, this technology is a game-changer,” said Mr. McLinden, who traveled to Copenhagen (p. B4) for a three-day training course with two colleagues from the Mid and West Wales Fire and Rescue Service. They will start offering 24/7 drone support — allowing colleagues, for example, to monitor accidents from 300 feet above — across central Wales later this month.
“Drones aren’t going to replace what we do,” Mr. McLinden added. “But anything that we can do to give our crews an advantage, that’s great.”
. . .
In a somewhat stuffy classroom at a disused fire station in Copenhagen, Thomas Sylvest gave advice to Mr. McLinden and others from his two years of flying. As Denmark’s first, and so far only, emergency service drone pilot, Mr. Sylvest has responded to things as varied as missing person cases and fires, often receiving calls late at night.
Mr. Sylvest, a fast-talking 50-year-old, offered tips on how best to share videos streamed directly from drones to commanders on the ground. During a recent fire in downtown Copenhagen, Mr. Sylvest said, he was able to beam high-definition images from high above, allowing his bosses to judge if a building’s walls would collapse (they did not). And when the police called him out last year after a man was reported missing, he flew his drone along a stretch of train tracks to guide colleagues on where best to look. (The man was found.)

For the full story, see:
MARK SCOTT. “Emergency Workers Turn to Drones to Save Lives.” The New York Times (Mon., JUNE 20, 2016): B1 & B4.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date JUNE 19, 2016, and has the title “Europe’s Emergency Workers Turn to Drones to Save Lives.”)