Category: Health

“New Jerseyans Are More Flammable than People in the Other 49 States”

(p. A17) At 12:01 a.m. on Jan. 1, New Jersey became the last state in the nation where drivers are not allowed to pump their own gasoline around the clock.
. . .
It is a distinction that makes Declan J. O’Scanlon Jr., a state lawmaker, spout frustration by the gallon.
“It’s ridiculous,” said Mr. O’Scanlon, a Republican assemblyman from Monmouth County who will soon take a seat in the State Senate. “If I want to pull in, get in and out quickly, I should be able to do so.”
Mr. O’Scanlon said that he frequently pumps his own gas, ignoring the Retail Gasoline Dispensing Safety Act of 1949, the statute that first forbade civilians from putting their grubby hands on the nozzle.
. . .
New Jersey legislators cited safety concerns when they passed the original law that barred residents from pumping gas almost 70 years ago. But when gas station owners challenged the ban in 1951, the state’s Supreme Court ruled that self-serve was indeed “dangerous in use.” And the ban held up, despite attempts to fight it in the 1980s.
In the rest of the country, self-service stations became the norm. Safer unleaded gasoline became more common, thanks to federal regulations, as did pumps that accepted credit cards. In most of the United States, that spelled the end of an era when attendants offered to wipe your windshield and check your oil while the tank filled up and you fumbled for a tip.
Mr. O’Scanlon is undeterred by the dual weights of history and public opinion. He said that he may bring a new proposal this year, just to keep the conversation alive. He said that economic arguments about jobs and safety are absurd, given that drivers in other states have been pumping their own gas for decades and lived to tell the tale.
“The only thing you could argue is that New Jerseyans are more flammable than people in the other 49 states,” he said. “Because we eat so much oily pizza, funnel cake and fries, maybe you could make that argument. Otherwise, it’s simply ridiculous.”

For the full story, see:
JONAH ENGEL BROMWICH. “New Jersey Is Last State to Insist at Gas Stations: Don’t Touch That Pump.” The New York Times (Sat., JAN. 6, 2018): A17.
(Note: ellipses added.)
(Note: the online version of the story has the date JAN. 5, 2018.)

Health Info from Apple Watches Will Allow Patients to “Take More Control”

(p. B1) SAN FRANCISCO — In the last months of Steve Jobs’s life, the Apple co-founder fought cancer while managing diabetes.
Because he hated pricking his finger to draw blood, Mr. Jobs authorized an Apple research team to develop a noninvasive glucose reader with technology that could potentially be incorporated into a wristwatch, according to people familiar with the events, who asked not to be identified because they were not authorized to speak on behalf of the company.
. . .
In September [2017], Apple announced that the Apple Watch would no longer need to be tethered to a smartphone and would become more of a stand-alone device. Since then, a wave of device manufacturers have tapped into the watch’s new features like cellular connectivity to develop medical accessories — such as an electrocardiogram for monitoring heart activity — so people can manage chronic conditions straight from their wrist.
. . .
(p. B4) A digital health revolution has been predicted for years, of course, and so far has been more hype than progress. But the hope is that artificial intelligence systems will sift through the vast amounts of data that medical accessories will collect from the Apple Watch and find patterns that can lead to changes in treatment and detection, enabling people to take more control of how they manage their conditions instead of relying solely on doctors.
Vic Gundotra, chief executive of AliveCor, a start-up that makes portable electrocardiograms, said this would put patients on a more equal footing with doctors because they would have more information on their own conditions.
“It’s changing the nature of the relationship between patient and doctor,” he said, adding that doctors will no longer be “high priests.”
. . .
Apple is also looking at potentially building an electrocardiogram into future models of the Apple Watch, according to a person familiar with the project, who spoke on the condition of anonymity because the details were confidential. It is unclear whether the EKG development, earlier reported by Bloomberg, would be introduced; such a product would most likely require F.D.A. clearance.
Separately, Apple is continuing research on a noninvasive continuous glucose reader, according to two people with knowledge of the project. The technology is still considered to be years away, industry experts said.
The current solution used by many diabetics is also coming to the Apple Watch. Dexcom, a maker of devices measuring blood sugar levels for diabetics, said it was awaiting F.D.A. approval for a continuous glucose monitor to work directly with the Apple Watch. Continuous glucose monitors use small sensors to pierce the skin to track blood sugar levels and relay those readings through a wireless transmitter.

For the full story, see:
DAISUKE WAKABAYASHI. “As Wearable Devices Evolve, The Apple Watch Offers an EKG.” The New York Times (Weds., December 27, 2017): B1 & B4.
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story has the date DEC. 26, 2017, and has the title “Freed From the iPhone, the Apple Watch Finds a Medical Purpose.”)

Enforcing New Blood Pressure Guidelines May Lead to Serious Falls

(p. A23) “Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure.” This is the type of headline that raises my blood pressure to dangerously high levels.
. . .
The new recommendation is principally in response to the results of a large, federally funded study called Sprint that was published in 2015 in The New England Journal of Medicine.
. . .
A blood pressure of 130 in the Sprint study may be equivalent to a blood pressure of 140, even 150, in a busy clinic. A national goal of 130 as measured in actual practice may lead many to be overmedicated — making their blood pressures too low.
. . .
Serious falls are common among older adults. In the real world, will a nationwide target of 130, and the side effects of medication lowering blood pressure, lead to more hip fractures? Ask your doctors. See what they think.
. . .
I suspect many primary-care practitioners will want to ignore this new target. They understand the downsides of the relentless expansion of medical care into the lives of more people. At the same time, I fear many will be coerced into compliance as the health care industry’s middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary — and that usually means more medications.
So focusing on the number 130 not only will involve millions of people but also will involve millions of new prescriptions and millions of dollars. And it will further distract doctors and their patients from activities that aren’t easily measured by numbers, yet are more important to health — real food, regular movement and finding meaning in life. These matter whatever your blood pressure is.

For the full commentary, see:
H. GILBERT WELCH. “Rethinking Blood Pressure Advice.” The New York Times (Thurs., NOV. 16, 2017): A23.
(Note: ellipses added.)
(Note: the online version of the commentary has the date NOV. 15, 2017, and has the title “Don’t Let New Blood Pressure Guidelines Raise Yours.”)

Welch has a book that makes a similar point, though more broadly, to that made in the passages quoted above:
Welch, H. Gilbert. Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care. Boston, MA: Beacon Press, 2015.

Record High Temperatures in London

(p. C6) During London’s long summer of 1858, the sweltering temperatures spawned squalor. With a population of more than 2 million, London had outgrown its medieval waste-removal systems, turning Spenser’s “sweet Thames” into an open sewer. Epidemics such as cholera and diphtheria ravaged the poor and rich alike. The stench, as we now know, was a symptom of a bacterial problem. But at the time it was believed to be, in itself, the cause of disease. The dominant medical notion of miasmas held that “noxious and morbific” contagion was carried through the air.
The heat of 1858 made the problem of London’s effluvia unignorable. At the end of May, Rosemary Ashton notes in “One Hot Summer,” the temperature was 84 degrees in the shade; there followed three months of hot days, with record highs in the 90s for the shade and well over 110 degrees in the sun.
. . .
The Great Stink, as the noisome ordeal came to be called, is a terrific subject for Ms. Ashton, the noted scholar of George Eliot, George Henry Lewes and literary London. She excels at unearthing and explaining the daily distractions of the nose-holding populace over the course of the summer: horse races, art shows, murder and divorce trials, even the breezes that, as Darwin noted, wafted thistle seeds across the English Channel from France. Ms. Ashton also convincingly uses the Great Stink as a backdrop to crisis points in the lives of three great figures of the day whose biographies rarely overlap: Darwin, Disraeli and Charles Dickens.

For the full review, see:

Alexandra Mullen. “The Stink That Sank London; As highs climbed toward 100 degrees, raw sewage roasting on the Thames created the ‘Great Stink’.” The Wall Street Journal (Saturday, Aug. 20, 2017): C6.
(Note: ellipsis added.)
(Note: the online version of the review has the date Aug. 11, 2017.)

The book under review, is:
Ashton, Rosemary. One Hot Summer: Dickens, Darwin, Disraeli, and the Great Stink of 1858. New Haven, CT: Yale University Press, 2017.

Immunotherapy Cocktails, Like Chemotherapy Cocktails, May Benefit from Trial-and-Error Experiments

(p. A16) A new way of genetically altering a patient’s cells to fight cancer has helped desperately ill people with leukemia when every other treatment had failed, researchers reported on Monday [Nov. 20, 2017] in the journal Nature Medicine.
The new approach, still experimental, could eventually be given by itself or, more likely, be used in combination treatments — analogous to antiviral “cocktails” for H.I.V. or multidrug regimens of chemotherapy for cancer — to increase the odds of shutting down the disease.
Researchers say the treatment may be more promising as part of a combination than when given alone because, although some patients in the small study have had long-lasting remissions, many others had relapses.
The research, conducted at the National Cancer Institute, is the latest advance in the fast-growing field of immunotherapy, which fires up the immune system to attack cancer. The new findings build on two similar treatments that were approved by the Food and Drug Administration this year: Kymriah, made by Novartis for leukemia; and Yescarta, by Kite Pharma for lymphoma.
In some cases, those two treatments have brought long and seemingly miraculous remissions to people who were expected to die.
Kymriah and Yescarta require removing millions of each patient’s T-cells — disease-fighting white blood cells — and genetically engineering them to seek and destroy cancer cells. The T-cells are then dripped back into the patient, where they home in on protein molecules called CD19 found on malignant cells in most types of leukemia and lymphoma.
The new treatment differs in a major way: the T-cells are programmed to attack a different target on malignant cells, CD22.

For the full story, see:
DENISE GRADY. “Experimental Gene Treatment Shows Promise in Combating Leukemia.” The New York Times (Tues., NOV. 21, 2017): A16.
(Note: bracketed date added.)
(Note: the online version of the story has the date NOV. 20, 2017, and has the title “New Gene Treatment Effective for Some Leukemia Patients.”)

The Nature Medicine article, mentioned above, is:
Fry, Terry J., Nirali N. Shah, Rimas J. Orentas, Maryalice Stetler-Stevenson, Constance M. Yuan, Sneha Ramakrishna, Pamela Wolters, Staci Martin, Cindy Delbrook, Bonnie Yates, Haneen Shalabi, Thomas J. Fountaine, Jack F. Shern, Robbie G. Majzner, David F. Stroncek, Marianna Sabatino, Yang Feng, Dimiter S. Dimitrov, Ling Zhang, Sang Nguyen, Haiying Qin, Boro Dropulic, Daniel W. Lee, and Crystal L. Mackall. “CD22-Targeted CAR T Cells Induce Remission in B-ALL That Is Naive or Resistant to CD19-Targeted CAR Immunotherapy.” Nature Medicine (published online on Nov. 20, 2017).

Socialized Medicine “Mummifies Its Doctors in Spools of Red Tape”

(p. A17) One of the reasons patients find condescension from doctors especially loathsome is that it diminishes them — if you’re gravely ill, the last thing you need is further diminishment. But the desires of patients, Marsh notes, are often paradoxical. They also pine for supreme confidence in their physicians, surgeons especially, because they’ve left their futures — the very possibility of one at all, in some cases — in their doctors’ custody. “So we quickly learn to deceive,” Marsh writes, “to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face.”
Over time, Marsh writes, many doctors start to internalize the stories they tell themselves about their superior judgment and skill. But the best, he adds, unlearn their self-deceptions, and come to accept their fallibility and learn from their mistakes. “We always learn more from failure than from success,” he writes. “Success teaches us nothing.”
This was a prominent theme in Marsh’s last book, and readers may have a sense of déjà vu while reading this one. Like “Do No Harm,” “Admissions” is wandering and ruminative, an overland trek through the doctor’s anxieties and private shames. Once again, he recounts his miscalculations and surgical catastrophes, citing the French doctor René Leriche’s observation that all surgeons carry cemeteries within themselves of the patients whose lives they’ve lost. Once again, he rails against the constraints of an increasingly depersonalized British health care system, which mummifies its doctors in spools of red tape. Once again, he describes his operating theater in all of its Grand Guignol splendor, with brains swelling beyond their skulls and suction devices “slurping obscenely” as tumors evade his reach.

For the full review, see:
JENNIFER SENIOR. “Books of The Times; Surgical Catastrophes, Private Shames.” The New York Times (Sat., Oct. 7, 2017): A17.
(Note: the online version of the review has the date Oct. 5, 2017, and has the title “Books of The Times; A Surgeon Not Afraid to Face His Mistakes, In and Out of the Operating Room.)

The book under review, is:
Marsh, Henry. Admissions: Life as a Brain Surgeon. New York: Thomas Dunne Books/St. Martin’s Press, 2017.

NIH and FDA Should Allow Gene Editors to Cure Diseases

(p. A15) Should Americans be allowed to edit their DNA to prevent genetic diseases in their children? That question, which once might have sounded like science fiction, is stirring debate as breakthroughs bring the idea closer to reality. Bioethicists and activists, worried about falling down the slippery slope to genetically modified Olympic athletes, are calling for more regulation.
The bigger concern is exactly the opposite–that this kind of excessive introspection will cause patients to suffer and even die needlessly. Anachronistic restrictions at the Food and Drug Administration and the National Institutes of Health effectively ban gene-editing research in human embryos that would lead to implantation and births. These prohibitions are inhibiting critical clinical research and should be lifted immediately.
. . .
What’s holding researchers back, at least in America, is outmoded regulations. The FDA is blocked by law from accepting applications for research involving gene editing of the human germ line–meaning eggs, sperm and embryos. The NIH, whose approval also would be needed, is similarly barred from even considering applications to conduct such experiments in humans. These rules date as far back as the 1970s, when the technology was in its infancy. It’s easy to invoke hypothetical fears when actual lifesaving interventions are decades away.
Today they aren’t–and desperate patients deserve access to whatever cures this technology may be able to provide. The public thinks so, too. A survey this summer found that nearly two-thirds of Americans support therapeutic gene editing–in somatic and germ-line cells alike. Popular opinion is in tune with scientific reality. Legislators and regulators need to catch up.

For the full commentary, see:
Henry I. Miller. “Gene Editing Is Here, and Desperate Patients Want It; Two-thirds of Americans support therapeutic use, but regulators are still stuck in the 1970s.” The Wall Street Journal (Fri., OCT. 13, 2017): A15.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date OCT. 12, 2017.)

After 30 Years, Medical Entrepreneur Rosenberg’s Slow Hunch Pays Off

(p. B3) In the another significant development, the cancer institute’s prominent cancer researcher and chief of surgery, Steven A. Rosenberg, detailed for the first time an immunotherapy success against metastatic breast cancer, in a talk earlier this month.
In the lecture at a Boston meeting of the American Association of Cancer Research, Dr. Rosenberg reported on the first patient with metastatic breast cancer who is disease-free nearly two years after her first immunotherapy treatment. In the therapy, a person’s own cells are multiplied billions of times and reinfused into the patient. Dr. Rosenberg’s lab has already reported successes in treatment of melanoma, lymphoma, colorectal cancer and bile-duct cancer.
That patient is Judy Perkins, a 51-year-old structural engineer from Port St. Lucie, Fla. She was diagnosed with metastatic cancer–cancer that spread beyond the original location–in 2013.
. . .
Ms. Perkins is only one case. But the fact that she had metastatic breast cancer that is no longer detectable makes it very consequential. It follows reports from the Rosenberg lab about other internal-organ cancers, specifically colorectal and bile-duct.
. . .
Dr. Rosenberg’s interest in immunotherapy was piqued three decades ago, when he was struck by a chance encounter with a stomach-cancer patient who improbably recovered despite no treatment. This became a lifelong quest to discover how that patient had in effect cured himself. Scores of recoveries at the cancer institute of melanoma and lymphoma patients followed after immunotherapy treatment from his lab.
Now, his lab is exploring the promise of treating and accomplishing tumor regressions in far-more-common solid-tumor cancers of internal organs, including the breast, colon and bile-duct.

For the full story, see:
Thomas M. Burton. “Immunotherapy Treatments for Cancer Gain Momentum.” The Wall Street Journal (Fri., Oct. 13, 2017): B3.
(Note: ellipses added.)
(Note: the online version of the story has the date Oct. 12, 2017.)

Some Bacteria May Promote Cancer

(p. A15) A mysterious bacterium found in up to half of all colon tumors also travels with the cancer as it spreads, researchers reported on Thursday [Nov. 23, 2017].
Whether the bacterium, called Fusobacterium nucleatum, actually plays a role in causing or spurring the growth of cancer is not known. But the new study, published in the journal Science, also shows that an antibiotic that squelches this organism slows the growth of cancer cells in mice.
Scientists are increasingly suspicious that there may be a link: another type of bacteria has been discovered in pancreatic cancer cells. In both types of cancer, most tumors host bacteria; however, only a small proportion of the cells in any single tumor are infected.
“The whole idea of bacteria in tumors is fascinating and unexpected,” said Dr. Bert Vogelstein, a colon cancer researcher at Johns Hopkins.
The colon cancer story began in 2011, when Dr. Matthew Meyerson of the Dana-Farber Cancer Institute and Dr. Robert A. Holt of Simon Fraser University in British Columbia independently reported finding Fusobacteria, which normally inhabit the mouth, in human colon cancers.
That instigated a rush to confirm. Researchers around the world reported finding Fusobacteria in colon cancers, but their work only raised more questions. The new paper, by Dr. Meyerson and his colleagues, provides some answers.
. . .
Dr. Vogelstein suggests that instead of directly causing cancer, Fusobacteria might be altering patients’ immune response — and perhaps their response to treatments that use the immune system to destroy cancers.
Alternately, perhaps the bacteria are acting more directly by secreting chemicals that spur growth in nearby cancer cells, Dr. Relman said.
“It is not unreasonable to say Fusobacterium is promoting or contributing to colon cancer,” he said.
Are Fusobacteria guilty of causing cancer? If this were a criminal case, where the jury had to be convinced beyond a reasonable doubt, Dr. Meyerson said he would have to acquit.
But if it were a civil case, judged on the preponderance of the evidence, his vote would be different: Fusobacteria are guilty.

For the full story, see:
GINA KOLATA. “Study Suggests Bacteria Have Key Role in Cancer.” The New York Times (Sat., NOV. 25, 2017): A15.
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the story has the date NOV. 23, 2017, and has the title “Why Is This Bacterium Hiding in Human Tumors?”)

The Science article, discussed in the passages quoted above, is:
Bullman, Susan, Chandra S. Pedamallu, Ewa Sicinska, Thomas E. Clancy, Xiaoyang Zhang, Diana Cai, Donna Neuberg, Katherine Huang, Fatima Guevara, Timothy Nelson, Otari Chipashvili, Timothy Hagan, Mark Walker, Aruna Ramachandran, Begoña Diosdado, Garazi Serna, Nuria Mulet, Stefania Landolfi, Santiago Ramon y Cajal, Roberta Fasani, Andrew J. Aguirre, Kimmie Ng, Elena Élez, Shuji Ogino, Josep Tabernero, Charles S. Fuchs, William C. Hahn, Paolo Nuciforo, and Matthew Meyerson. “Analysis of Fusobacterium Persistence and Antibiotic Response in Colorectal Cancer.” Science (posted online (ahead of publication) on Nov. 23, 2017).

More Cures If Local Physicians Can Conduct Clinical Trials

(p. A17) The good news is that technology innovations are moving us toward modern clinical trial designs. Electronic health records, now common in U.S. medical practices, allow physicians to collect timely and detailed data that could be used for exploring ways of bringing clinical research directly to patients. Those records are becoming the technological building blocks of a new research model based on real-world evidence, which aims to provide insights regarding the usage and potential benefits or risks of a drug by analyzing patient data collected as part of routine delivery of care.
Real-world evidence captures the experience of real-world patients, who are generally more diverse than the selective cohorts enrolled in clinical trials. Additionally, real-world data from electronic health records may be used after a drug’s approval to answer important questions about its use. Researchers can, for example, search through anonymized data from patients taking a specific cancer drug to see whether those with a certain tumor mutation respond better or worse than other patients. Such information could help doctors personalize therapies based on the patient’s genomic makeup.
Moving clinical research to a doctor’s office, the point of routine care, may also address the difficulties patients and doctors face with off-label drugs. If local physicians can participate in conducting real-world randomized clinical trials in their own practices, new uses of approved drugs could be carefully studied, potentially generating evidence supporting approval of a new use. Real-world clinical trials could also limit disruptions to patients’ lives by reducing the need for long-distance travel.

For the full commentary, see:
Amy Abernethy and Sean Khozin. “Clinical Drug Trials May Be Coming to Your Doctor’s Office; Electronic medical records make possible a new research model based on real-world evidence.” The Wall Street Journal (Weds., Sept. 13, 2017): A17.
(Note: the online version of the commentary has the date Sept. 12, 2017.)

Nursing Unions “Keep Aides from Encroaching on Their Turf”

(p. B2) There are a few reasons long-term care is such a bad job. “Most people see it as glorified babysitting,” said Robert Espinoza, vice president for policy at PHI, an advocacy group for personal care workers that also develops advanced training curriculums to improve the quality of the work force.
The fact that most workers are immigrant women does not help the occupation’s status. Occupational rules that reserve even simple tasks for nurses, like delivering an insulin shot or even putting drops into a patient’s eye, also act as a barrier against providing care workers with better training.
. . .
. . . there are the powerful nursing unions, ready to fight tooth and nail to keep aides from encroaching on their turf. Carol Raphael, former chief executive of the Visiting Nurse Service of New York, the largest home health agency in the United States, told Professor Osterman that when the association tried to expand the role of home-care aides, the “nurses went bonkers.”

For the full commentary, see:
Porter, Eduardo. “ECONOMIC SCENE; Rethinking Home Health Care as a Path to the Middle Class.” The New York Times (Weds., AUG. 30, 2017): B1-B2.
(Note: ellipses added.)
(Note: the online version of the commentary has the date AUG. 29, 2017, and has the title “ECONOMIC SCENE; Home Health Care: Shouldn’t It Be Work Worth Doing?”)