Category: Health

Progress on Cancer Cures Is Slow and Too Few Benefit

(p. 5) The reason is a new generation of cancer treatments that have become available in recent years. Some, called immunotherapy, harness the patient’s own immune system to battle a tumor. Others, known as targeted therapies, block certain molecules that cancers depend on to grow and spread. The medical literature — usually circumspect when it comes to cancer, in light of many overhyped treatments in the past — now fairly gushes with terms like “revolutionary” and “cure.” In this case, the hype feels mostly justified.
. . .
A recent analysis estimated that about 15 percent of patients with advanced cancer might benefit from immunotherapy — and it’s all but impossible to determine which patients will be the lucky ones. Just last week, a study of lung cancer patients demonstrated the overall benefits of combining immunotherapy with traditional chemotherapy. But here, too, the researchers noted that most patients will not respond to the new treatments, and it is not yet possible to predict who will benefit. In some cases, the side effects are terrible — different from those of chemotherapy but often just as dire.

For the full commentary, see:
Robert M. Wachter. “The Problem With Miracle Cancer Cures.” The New York Times, SundayReview Section (Sunday, April 21, 2018): 5.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date April 19, 2018.)

The claim that only 15% benefit, made above, is based on the following:
Howard, Jacqueline. “Hope and Hype around Cancer Immunotherapy.” CNN, Weds., Sept. 27, 2017.
GAY, NATHAN, and VINAY PRASAD. “First Opinion; Few People Actually Benefit from ‘Breakthrough’ Cancer Immunotherapy.” March 8, 2017.

“Outsider Status” of Surgeons “Permitted Greater Risks and Leaps of Faith”

(p. A19) . . . as Arnold van de Laar reminds us in “Under the Knife: A History of Surgery in 28 Remarkable Operations,” a collection of hypervivid anecdotes and oddities, it was only recently that surgeons were considered the equals of what we would now call internists–doctors who diagnose, prescribe medicine and prognosticate.
. . .
. . . , it has been both the bane and the secret glory of surgery as a vocation that it was relegated for so long to the margins of “decent” intellectual or professional life. Its dodgy, outsider status perhaps permitted greater risks and leaps of faith than were available to nonsurgical physicians, who still found themselves making inchworm progress from the dictates of Hippocrates and Galen. Surgeons worked fast to beat pain and gangrene (so fast that in one case, Scottish surgeon Robert Liston cut off a man’s testicles in a rush to amputate his leg). They used whatever materials seemed to make sense–in some cases gold thread, costly but long-lasting; in other cases branding irons.

For the full review, see:
Laura Kolbe. “The Kindest Cuts.” The Wall Street Journal (Saturday, November 15, 2018): A19.
(Note: ellipses added.)
(Note: the online version of the review has the date Nov. 14, 2018, and has the title “BOOKSHELF; ‘Under the Knife’ Review: The Kindest Cuts.”)

The book under review, is:
van de Laar, Arnold. Under the Knife: A History of Surgery in 28 Remarkable Operations. New York: St. Martin’s Press, 2018.

Health Care Premium Costs Continue to Rise

HealthCoveragePremiumCostsGraph2018-10-29.png

Source of graph: online version of the WSJ article quoted and cited below.

(p. A1) The average cost of employer health coverage offered to workers rose to nearly $20,000 for a family plan this year, according to a new survey, capping years of increases that experts said are chiefly tied to rising prices paid for health services.

For the full story, see:
Anna Wilde Mathews. “‘Health Coverage Costs Firms $20,000 a Family.” The Wall Street Journal (Thursday, Oct. 4, 2018): A1 & A6.
(Note: the online version of the story has the date Oct. 3, 2018, and has the title “Employer-Provided Health Insurance Approaches $20,000 a Year.”)

High-Tech Toilets Could Reduce Feces in Swimming Pools

If the cringeworthy facts reported below were more widely known, demand would greatly increase for the high-tech toilets common in Japan, that shoot water sprays at human rear ends, to quickly, comfortably, and completely remove fecal residue. Why has no one grasped this entrepreneurial opportunity?

(p. A2) Mrs. [Lindsey] Blackstock and several colleagues tested 31 swimming pools and hot tubs in hotels and recreational facilities in Canada for the presence of acesulfame potassium, an artificial sweetener that is largely undigested and almost entirely excreted in urine.
. . .
Using that information, they deduced that a 110,000-gallon pool they studied contained an estimated eight gallons of urine, while a 220,000-gallon pool contained an estimated 20 gallons. The concentrations represented about 0.01% of the total water volume.
“If your eyes are turning red when you’re swimming, or if you’re coughing or have a runny nose, it’s likely there is at least some urine in the pool,” said Michele Hlavsa, chief of the Healthy Swimming Program for the Centers for Disease Control and Prevention.
Urine isn’t a primary source of germs in pools or hot tubs, but feces that clings to the body is. At any time, Dr. Hlavsa said, adults have about 0.14 grams of poop on their bottoms and children have as much as 10 grams.
“When you’re talking about bigger water parks with 1,000 children in a given day, you’re now talking about 10 kilograms or 22 pounds of poop,” she said.
Feces can contain bacteria, viruses and parasites such as E. coli, norovirus and giardia that can lead to outbreaks of diarrhea, vomiting and other illnesses.

For the full commentary, see:
Jo Craven McGinty. “THE NUMBERS; A Sanitary Pool Requires Proper Behavior.” The Wall Street Journal (Saturday, July 21, 2017): A2.
(Note: ellipsis, and bracketed name, added.)
(Note: the online version of the commentary has the date July 21, 2017, and has the title “THE NUMBERS; Is That Pool Really Sanitary? New Chemical Approach Has Answers.”)

Blackstock’s research, described above, was published in:
Jmaiff Blackstock, Lindsay K., Wei Wang, Sai Vemula, Benjamin T. Jaeger, and Xing-Fang Li. “Sweetened Swimming Pools and Hot Tubs.” Environmental Science & Technology Letters 4, no. 4 (April 2017): 149-53.

Buddhist Monks Fear Death

(p. C4) A recent paper in the journal Cognitive Science has an unusual combination of authors. A philosopher, a scholar of Buddhism, a social psychologist and a practicing Tibetan Buddhist tried to find out whether believing in Buddhism really does change how you feel about your self–and about death.
The philosopher Shaun Nichols of the University of Arizona and his fellow authors studied Christian and nonreligious Americans, Hindus and both everyday Tibetan Buddhists and Tibetan Buddhist monks.
. . .
The results were very surprising. Most participants reported about the same degree of fear, whether or not they believed in an afterlife. But the monks said that they were much more afraid of death than any other group did.
Why would this be? The Buddhist scholars themselves say that merely knowing there is no self isn’t enough to get rid of the feeling that the self is there. Neuroscience supports this idea.
. . .
Another factor in explaining why these monks were more afraid of death might be that they were trained to think constantly about mortality. The Buddha, perhaps apocryphally, once said that his followers should think about death with every breath. Maybe just ignoring death is a better strategy.

For the full commentary, see:
Alison Gopnik. “Who’s Most Afraid to Die? A Surprise.” The Wall Street Journal (Saturday, June 9, 2018): C4.
(Note: ellipses added.)
(Note: the online version of the commentary has the date June 6, 2018.)

The print version of the Cognitive Science article discussed above, is:
Nichols, Shaun, Nina Strohminger, Arun Rai, and Jay Garfield. “Death and the Self.” Cognitive Science 42, no. S1 (May 2018): 314-32.

“Entrepreneurs Are Often Driven by Personal Experiences”

(p. B5) Eczema entrepreneurs are often driven by personal experiences that they or their family members have had with the skin condition. Joe Paulo, for example, created Smiling Panda clothing after he had eczema as a teenager.
. . .
Mr. Paulo, 23, has already made some inroads with adults seeking relief with his Smiling Panda brand, which he started after getting eczema on his arms. The eczema appeared after he moved from California to Philadelphia in 2012 to attend college.
His eczema, he said, “got significantly worse” when he had to wear professional clothing during college internships. When even bedsheets began irritating his skin, he started researching the properties of different fibers and how clothing was made. He chose a bamboo-cotton blend for his clothing because bamboo is soft and cotton fibers allow a closer fit, he said. He began cutting and stitching his own shirts, with flat seams and no tags.
When he wore his shirts to bed, he said: “I went from having a really tough time falling asleep to having no trouble at all.”
“I thought there might be other working adults interested in this type of clothing, and that comfortable clothing would help them in the same way it helped me,” he said. He found a small manufacturer willing to make a batch of sizes for women and men. He chose Smiling Panda as the company name and started a website in February 2016.
. . .
Mr. Paulo said he did not know if the company would ever be profitable. “I like doing it because I feel like our products make a difference in our customers’ lives,” he said. “I know from personal experience how miserable clothing can be when you are itching from eczema.”

For the full story, see:
Elizabeth Olson. “Personal Stories Drive Start-Ups In Eczema Products.” The New York Times (Thursday, July 20, 2017): B5.
(Note: ellipses added.)
(Note: the online version of the story has the date July 19, 2017, and has the title “‘The Beginning of a Wave’: A.I. Tiptoes Into the Workplace.”)

Drug Middlemen Create “Perverse Incentive” for Higher List Prices

(p. B1) The Department of Health and Human Services is scrutinizing the system of rebates and discounts paid to middlemen as medicine flows from manufacturers to patients. Those middlemen, such as drug wholesalers, pharmacies, and pharmacy-benefit managers, are often compensated as a percentage of a drug’s list price. That creates a perverse incentive for higher list prices throughout the system.
. . .
Pfizer , which made headlines earlier this month by pausing a slate of planned price increases due to White House criticism, sounds ready for reform. Chief Executive Ian Read on a conference call with analysts last week predicted that rebates are “going away” over the long term. Mr. Read added that the larger gaps between list and net prices amounted to a “subsidy” for companies in the drug supply chain and blamed those subsidies for the relatively weak sales of certain lower-priced versions of blockbuster drugs.

For the full commentary, see:
Charley Grant. ” HEARD ON THE STREET; Skies Darken for Drug Middlemen.” The Wall Street Journal (Wednesday, Aug. 8, 2018): B1.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Aug. 7, 2018.)

Dr. Charles Wilson Had Surgical Intuition, “Sort of an Invisible Hand”

(p. A19) Dr. Wilson sometimes worked in three operating rooms simultaneously: Residents would surgically open and prepare patients for his arrival, and he would then enter to seal an aneurysm or remove a tumor before moving on to the next case.
“He never spent much more than 30 or 60 minutes on each case, and we were left to close the case and make sure everything was O.K.,” Dr. Mitchel Berger, a former resident who is chairman of U.C.S.F.’s neurosurgical department, said in an interview. “It was unorthodox, but it worked. He demanded excellence and we gave him excellence.”
They also gave him silence. He allowed no music, no ringing phones and no idle chatter. Scrub nurses were expected to anticipate his requests.
“He would manage any break of silence with a stern look,” said Dr. Brian Andrews, a neurosurgeon who was one of Dr. Wilson’s residents and also his biographer, with the book “Cherokee Surgeon” (2011). (Dr. Wilson was one-eighth Cherokee.)
Dr. Wilson became world renowned for excising pituitary tumors through the sinus in a surgery called transsphenoidal resection.
. . .
The writer Malcolm Gladwell, in a profile of Dr. Wilson in The New Yorker in 1999, described one of those pituitary cancer surgeries. Looking at a tumor through a surgical microscope, Dr. Wilson used an instrument called a ring curette to peel the tumor from the gland.
“It was, he would say later, like running a squeegee across a windshield,” Mr. Gladwell wrote, “except that in this case, the windshield was a surgical field one centimeter in diameter, flanked on either side by the carotid arteries, the principal sources of blood to the brain.”
A wrong move could nick an artery or damage a nerve, endangering the patient’s vision or his life.
When Dr. Wilson saw bleeding from one side of the gland, he realized that he had not gotten all of the tumor. He found it and removed it. The surgery took only 25 minutes.
Dr. Wilson performed the surgery more than 3,300 times.
He told Mr. Gladwell that he had a special feel for surgery that he could not entirely explain.
“It’s sort of an invisible hand,” he said. “It begins almost to seem mystical. Sometimes a resident asks, ‘Why did you do that?’ ” His response, he told Mr. Gladwell, was to shrug and say, “Well, it just seemed like the right thing.”

For the full obituary, see:
Richard Sandomir. “‘Charles Wilson, 88, Lauded For Excising Brain Tumors, Sometimes Several in a Day.” The New York Times (Monday, March 5, 2018): A19.
(Note: ellipsis, and bracketed year, added.)
(Note: the online version of the obituary has the date March 2, 2018, and has the title “‘Charles Wilson, Top Brain Surgeon and Researcher, Dies at 88.”)

The biography of Wilson, mentioned above, is:
Andrews, Brian T. Cherokee Neurosurgeon: A Biography of Charles Byron Wilson, M.D. Scotts Valley, CA: CreateSpace Independent Publishing Platform, 2011.

When Volunteer Bystanders Save More Lives than So-Called First Responders

(p. A1) In the days after the shootings at the Route 91 Harvest festival in Las Vegas, many stories emerged of bystander courage. Volunteers combed the grounds for survivors and carried out the injured. Strangers used belts as makeshift tourniquets to stanch bleeding, and then others sped the wounded to hospitals in the back seats of cars and the beds of pickup trucks.
These rescue efforts took place before the county’s emergency medical crews, waylaid by fleeing concertgoers, reached the grassy field, an estimated half-hour or more after the shooting began. When they did arrive, the local fire chief said in an interview, only the dead remained.
“Everybody was treating patients and trying to get there,” Chief Gregory Cassell of the Clark County Fire Department, said of his personnel. “They just couldn’t.”
The experiences in Las Vegas have implications for the nation. Emergency medical services have changed how they respond to mass attacks, charging into insecure areas and immediately helping the injured rather than standing back. Still, every minute counts, and bystanders can play a critical role in saving lives, as shown in the aftermath to the shooting on Oct. 1 [2017] outside the Mandalay Bay Resort and Casino.
. . .
(p. A14) In Las Vegas, several factors impeded the arrival of emergency medical workers at the scene of the shooting itself.
Confusion abounded. One fire crew that happened to be passing by during the first few minutes saw people running from the festival and heard what sounded like gunfire. “You got reports of anything?” a member of the fire crew, Capt. Ken O’Shaughnessy of Engine 11, asked a dispatcher over the radio. “That’s a negative, sir,” he was told. Three minutes later, the dispatcher confirmed that there was an active call.
Members of that crew remained nearby, and later assisted injured concertgoers.
“From what it sounds like talking to them, they didn’t identify the hot zone because they didn’t know where it was,” said Mr. Cassell, the fire chief. “They just knew they had dozens and dozens of critical patients.”
More than 10 minutes after the shooting began, a battalion chief advised firefighters to “stage at a distance” and put on protective vests and helmets as he tried to understand the situation and make contact with a police lieutenant on the scene. The battalion chief radioed in seven minutes later that there were reports of gunfire at both the concert grounds and the Mandalay Bay across the street. “We can’t approach it yet,” he said.
The injured were already fleeing and being carried out in several directions. “Those crews making their way to the concert venue were met at every turn by patients in the streets,” Mr. Cassell said. The fire department helped establish several assembly points, and ultimately, about 160 firefighters and emergency medical workers from departments in the region went to the scene.
Inside the nearly empty concert grounds after the shooting stopped, some volunteers remained, roaming among the fallen near the stage, checking pulses and finding some of them unconscious but still breathing.

For the full story, see:
Sheri Fink. “‘First Medics on Scene in Las Vegas: Other Fans.” The New York Times (Monday, Oct. 15, 2017): A1 & A14.
(Note: ellipsis, and bracketed year, added.)
(Note: the online version of the story has the date Oct. 15, 2017, and has the title “‘After the Las Vegas Shooting, Concertgoers Became Medics.”)

The passages quoted above, provide one more example of one of the main messages of:
Ripley, Amanda. The Unthinkable: Who Survives When Disaster Strikes – and Why. New York: Crown Publishers, 2008.

Genetics Entrepreneur Compares FDA to DMV

(p. 1) MOUNTAIN VIEW, Calif. — In 2007, Anne Wojcicki, then 33, lassoed the moon.
She was getting her new company, 23andMe, a mail-order genetics testing firm, off the ground with her “Party ’til you spit” celebrity get-togethers.
She married Sergey Brin, the cute co-founder of Google, also 33 and already one of the richest men in America, at a top-secret Esther Williams extravaganza in the Bahamas. The bride in a white bathing suit and the groom in a black one, they swam to a sandbar in the Bahamas and got hitched in the middle of the sparkling aquamarine ocean.
Soon after the marriage, as Mr. Brin accumulated more power, a yacht, and a fleet of jets, Ms. Wojcicki became pregnant with the first of their two children and Google invested millions in her start-up, named after the 23 paired chromosomes that consist of our DNA.
But six years later, the Silicon Valley fairy tale was shattered by two public humiliations: Mr. Brin got involved with a beautiful young Englishwoman named Amanda Ro-(p. 12)senberg, who provided a public face for Google Glass — an attachment that broke up his marriage. And the Food and Drug Administration shut down the primary function of Ms. Wojcicki’s business, calling her D.N.A. spit vial “an unapproved medical device” and imposing stricter rules for consumer genetic testing. Her business, once so ripe with promise to tackle health issues, was curtailed to its ancestry testing division.
. . .
“In some ways, when you have that many bad things happen, it’s a sense of disbelief,” she says. “This was one of those situations where there’s two aspects. A divorce and the F.D.A. There was no workaround in either. So it was one of the first times in my life where you have to accept, you have to actually change. Like, I need to come up with a different way of approaching both of these relationships.”
. . .
(p. 13) She’s focused for now on her children, her new Bengal cats and her company, which has more than three million customers and its own drug-development program. It started selling kits in CVS and Target, got the F.D.A.’s permission to resume giving consumers health reports on 10 conditions, including Parkinson’s and Alzheimer’s, and the $99 ancestry kit won a spot as one of “Oprah’s favorite things” this year, with Oprah calling it “The Ultimate Selfie.” Fast Company portrayed Ms. Wojcicki as the Comeback Kid of tech.
She realized that she had a treasure trove of DNA data and began teaming with Genentech and Procter & Gamble, which started mining it to make breakthroughs in Parkinson’s, depression and skin care.
In many ways, her struggle with the F.D.A. was a microcosm of the increasingly tense battle between hidebound regulatory agencies and freewheeling tech companies.
Although some people thought Ms. Wojcicki would have to sell her company, she healed the breach with the F.D.A. the same way she healed the breach with Mr. Brin. She did not huff away and seethe and backbite. She “put one foot ahead of the other,” as her mother advises, hired the best regulatory experts and found a respectful new configuration for the relationship.
“We were not communicating in the right way,” she says of the period the F.D.A. felt it was being ignored. “We were not showing Silicon Valley arrogance. We just were running around with our shoes on in a Japanese house. We were not a cultural fit and we weren’t expressing what we were trying to do in the right way.
“Some companies are trying to circumvent the regulators. We weren’t. We just got caught in the cross hairs. We clearly pissed them off. It took us a long time to generate a lot of data to prove that our intentions actually were right. But I feel like we’re doing the right thing in terms of proving that the customer is capable of getting this information on their own.
“I see it from the F.D.A. perspective. It’s a new product. It’s genetics. It’s direct to consumer. It caused anxiety. So, you know, the onus was on us.”
She had to explain to her team: “Listen, when you go to the D.M.V., you don’t argue about the vision test. You don’t say, ‘Oh, I just had a vision test. I don’t need to do the vision test.’ Like, you just do it. The F.D.A. is in charge of public safety, and I have a respect for the job that they have to do. And we’re just going to do the job that they’re asking us to do.”

For the full story, see:
Maureen Dowd. “‘Adapt and Evolve.” The New York Times, SundayStyles Section (Sunday, Nov. 19, 2017): 1 & 12-13.
(Note: ellipses added.)
(Note: the online version of the story has the date Nov. 18, 2017, and has the title “‘The Doyenne of DNA Says: Just Chillax With Your Ex.”)

Dog Research on Muscular Dystrophy Can Lead to Cures for Both Dogs and Humans

(p. A13) Researchers used a gene-editing tool to repair a gene mutation in dogs with Duchenne muscular dystrophy, an important step in efforts to someday use the tool to edit DNA in people with the same fatal disease.
In a study published Thursday [Aug. 30, 2018] in the journal Science, researchers at UT Southwestern Medical Center in Dallas and the Royal Veterinary College in London reported that they used the Crispr gene-editing system in four dogs to restore production of dystrophin, a protein crucial for healthy muscle function.
. . .
“It’s like putting a good spare tire on a car. It’s not as good as the original, but it gets you where you want to go,” said Eric Olson, director of UT Southwestern’s Hamon Center for Regenerative Science and Medicine and senior author of the paper.
Dr. Olson, who is also founder and chief scientific adviser of Exonics Therapeutics Inc., which licensed the technology from UT Southwestern and helped fund the dog studies, said next steps involve testing Crispr in more dogs and observing them for a year or more. If the approach works in the dogs, he said researchers hope to try Crispr in a clinical trial with people with Duchenne.

For the full commentary, see:
Amy Dockser Marcus. “Gene Editing Shows Promise for Muscular Dystrophy.” The Wall Street Journal (Friday, Aug. 31, 2018): A13.
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the commentary has the date Aug. 30, 2018, and has the title “Crispr Used to Repair Gene Mutation in Dogs With Muscular Dystrophy.”)

The study in Science, that is mentioned above, is:
Amoasii, Leonela, John C. W. Hildyard, Hui Li, Efrain Sanchez-Ortiz, Alex Mireault, Daniel Caballero, Rachel Harron, Thaleia-Rengina Stathopoulou, Claire Massey, John M. Shelton, Rhonda Bassel-Duby, Richard J. Piercy, and Eric N. Olson. “Gene Editing Restores Dystrophin Expression in a Canine Model of Duchenne Muscular Dystrophy.” Science (Aug. 30, 2018), DOI: 10.1126/science.aau1549. [Epub ahead of print]