Category: Health

Regulations Reduce Health Care Quality and Increase Health Care Cost

(p. A15) There are two million home health aides in the U.S. They spend more time with the elderly and disabled than anyone else, and their skills are essential to their clients’ quality of life. Yet these aides are poorly trained, and their national median wage is only a smidgen more than $10 an hour.
The reason? State regulations–in particular, Nurse Practice Acts–require registered nurses to perform even routine home-care tasks like administering eyedrops. That duty might not require a nursing degree, but defenders of the current system say aides lack the proper training. “What if they put in the cat’s eyedrops instead?” a health-care consultant asked me. In another conversation, the CEO of a managed-care insurance company wrote off home-care aides as “minimum wage people.”
But aides could do more. With less regulation and better training, they could become as integral to health-care teams as doctors and nurses. That could improve the quality of care while saving buckets of money for everyone involved.
. . .
. . . the potential cost savings are considerable. There are 2.3 million Medicaid patients receiving long-term care at home. Imagine if even half of them replaced one hourlong nurse’s visit a month with a stop by a trained aide. Assuming the nurse makes $35 an hour and the aide $15, that’s an immediate savings of roughly $275 million a year.

For the full commentary, see:
Paul Osterman. “Why Home Care Costs Too Much; Regulations often require that nurses do simple tasks like administer eyedrops.” The Wall Street Journal (Weds., Sept. 13, 2017): A15.
(Note: ellipses added.)
(Note: the online version of the commentary has the date Sept. 12, 2017.)

The commentary, quoted above, is related to the author’s book:
Osterman, Paul. Who Will Care for Us? Long-Term Care and the Long-Term Workforce. New York: Russell Sage Foundation, 2017.

Amateur Inventors Are Crowdsourced to Solve Scientific Problems

(p. A3) At his laboratory console, Rhiju Das is making a game of a pressing public-health problem. He is recruiting thousands of videogamers to develop a better test for tuberculosis, which infects about one-third of the world’s population.
All they have to do is design a single molecule that can diagnose the disease in a patient’s bloodstream quickly, easily and cheaply–a task that so far has eluded public-health experts. To muster a crowd of amateurs to attempt it, Dr. Das, a biochemist at the Stanford University School of Medicine, and his colleagues this week launched the OpenTB challenge on a Web-based videogame called Eterna.
“The players themselves are going to be the inventors,” said Dr. Das. “Any molecule that a top player can make in the game, we will test it in the laboratory.”
. . .
In a game called Phylo, developed at McGill University, 300,000 players have been cross-indexing disease-related DNA sequences from dozens of species. And in Quantum Moves, conceived at Aarhus University in Denmark, 10,000 players are applying the bizarre laws of quantum mechanics to improve computer design.
“The number of projects has exploded,” said McGill computer scientist Jerome Waldispuhl, who co-founded the Phylo project.
Despite initial misgivings about the accuracy of crowdsourced research, players have produced reliable results and a dozen or so peer-reviewed research papers.
Typically, the players drawn to the science games have no special scientific expertise. They usually are intrigued by the chance to make a useful contribution to research in their spare time.
. . .
By harnessing human intuition and visual perception, these crowdsourcing games highlight differences between human and machine intelligence, several game designers said. “All of these citizen-science projects are like a snapshot of what is uniquely human at the moment,” said physicist Jacob Sherson at Aarhus University who helped to design Quantum Moves.

For the full story, see:
Robert Lee Hotz. “Videogamers Wanted: to Fight TB.” The Wall Street Journal (Weds., May 4, 2016): A3.
(Note: ellipses added.)
(Note: the online version of the story has the date May 3, 2016, and has the title “Videogamers Are Recruited to Fight Tuberculosis and Other Ills.” The sentence quoting Jerome Waldispuhl, appeared in the online, but not the print, version of the article.)

“Make School Lunches Great Again”

(p. D1) ATLANTA — On a sweltering morning in July, Sonny Perdue, the newly minted secretary of agriculture, strode across the stage of a convention hall here packed with 7,000 members of the School Nutrition Association, who had gathered for their annual conference.
After reminiscing about the cinnamon rolls baked by the lunchroom ladies of his youth, he delivered a rousing defense of school food-service workers who were unhappy with some of the sweeping changes made by the Obama administration. The amounts of fat, sugar and salt were drastically reduced. Portion sizes shrank. Lunch trays had to hold more fruits and vegetables. Snacks and food sold for fund-raising had to be healthier.
“Your dedication and creativity was being stifled,” Mr. Perdue said. “You were forced to focus your attention on strict, inflexible rules handed down from Washington. Even worse, you experienced firsthand that the rules were failing.”
Mr. Perdue then outlined how his department was loosening some of those rules. He finished with a folksy story about a child who asked whether Mr. Perdue could make school lunches great again.
Some in the audience cheered. Some walked out.

For the full story, see:

KIM SEVERSON. “Will the Trump Era Transform the School Lunch?” The New York Times (Weds., SEPT. 6, 2017): D1 & D6.
(Note: the online version of the story has the date SEPT. 5, 2017, and has the title”Will the Trump Era Transform the School Lunch?”)

Solid Tumor Gene Therapy Studies Plod Along

(p. A1) The approval of gene therapy for leukemia, expected in the next few months, will open the door to a radically new class of cancer treatments.
Companies and universities are racing to develop these new therapies, which re-engineer and turbocharge millions of a patient’s own immune cells, turning them into cancer killers that researchers call a “living drug.” One of the big goals now is to get them to work for many other cancers, including those of the breast, prostate, ovary, lung and pancreas.
“This has been utterly transformative in blood cancers,” said Dr. Stephan Grupp, director of the cancer immunotherapy program at the Children’s Hospital of Philadelphia, a professor of pediatrics at the University of Pennsylvania and a leader of major studies. “If it can start to work in solid tumors, it will be utterly transformative for the whole field.”
But it will take time to find that out, he said, at least five years.

For the full story, see:

DENISE GRADY. “Companies Rush to Develop ‘Utterly Transformative’ Gene Therapies.” The New York Times (Mon., JULY 24, 2017): A1 & A17.
(Note: the online version of the story has the date JULY 23, 2017, and has the title “Racing to Alter Patients’ Cells To Kill Cancer.”)

Gene Editing of Embryos Promises to Cure Inherited Diseases

(p. A13) For the first time in the United States, scientists have edited the genes of human embryos, a controversial step toward someday helping babies avoid inherited diseases.
. . .
The Oregon scientists reportedly used a technique called CRISPR, which allows specific sections of DNA to be altered or replaced. It’s like using a molecular scissors to cut and paste DNA, and is much more precise than some types of gene therapy that cannot ensure that desired changes will take place exactly where and as intended. With gene editing, these so-called “germline” changes are permanent and would be passed down to any offspring.
The approach holds great potential to avoid many genetic diseases, . . .
. . .
One prominent genetics expert, Dr. Eric Topol, director of the Scripps Translational Science Institute in La Jolla, California, said gene editing of embryos is “an unstoppable, inevitable science, and this is more proof it can be done.”
Experiments are in the works now in the U.S. using gene-edited cells to try to treat people with various diseases, but “in order to really have a cure, you want to get this at the embryo stage,” he said.

For the full story, see:
THE ASSOCIATED PRESS. “U.S. Scientists Edit Genes in Human Embryo.” The New York Times (Fri., JULY 28, 2017): A13.
(Note: ellipses added.)
(Note: the online version of the story has the date JULY 27, 2017, and has the title “In U.S. First, Scientists Edit Genes of Human Embryos.”)

Artificial Technology Can Make Food Safer

(p. A11) . . . the wider food-handling community increasingly is calling for a “kill step” in handling raw vegetables and produce.
Cooking (properly) is a kill step that works for food that is cooked.
. . .
After the 2015 disaster, Chipotle hired Prof. James Marsden of Kansas State University’s renowned food safety program. By the details released so far, the company has indeed begun experimenting with kill steps. These include blanching–dipping produce in boiling water–or spritzing with “natural” pathogen-neutralizers like lemon juice. Certain tasks have also been shifted to a central, McDonald’s -style kitchen and away from the local restaurant, though the company says certain steps were reversed when customers complained about the taste or appearance of their meals.
. . . Many in the food-safety camp are already keen on more-energetic kill steps, such as irradiation, chemical treatment with ozone or chlorine compounds, or the use of high-barometric-pressure systems.
. . .
A 2007 KSU study put volunteers in a test kitchen to see if they could follow directions safely to prepare frozen, uncooked, breaded chicken products. Many couldn’t. Among the findings: 100% of adolescents (the kind that work in fast-food restaurants) claimed they washed their hands when video monitoring showed they hadn’t.

For the full commentary, see:
Holman W. Jenkins, Jr. “Chipotle Seeks a ‘Kill Step’; America’s growing taste for fresh greens is a challenge to food-handling practices.” The Wall Street Journal (Sat.., July 29, 2017): A11.
(Note: ellipses added.)
(Note: the online version of the commentary has the date July 28, 2017.)

War and Pandemics Are Greater Threats than Global Warming

(p. A17) To arrive at a wise policy response, we first need to consider how much economic damage climate change will do. Current models struggle to come up with economic costs commensurate with apocalyptic political rhetoric. Typical costs are well below 10% of gross domestic product in the year 2100 and beyond.
That’s a lot of money–but it’s a lot of years, too. Even 10% less GDP in 100 years corresponds to 0.1 percentage point less annual GDP growth. Climate change therefore does not justify policies that cost more than 0.1 percentage point of growth. If the goal is 10% more GDP in 100 years, pro-growth tax, regulatory and entitlement reforms would be far more effective.
. . .
Global warming is not the only risk our society faces. Even if science tells us that climate change is real and man-made, it does not tell us, as President Obama asserted, that climate change is the greatest threat to humanity. Really? Greater than nuclear explosions, a world war, global pandemics, crop failures and civil chaos?
No. Healthy societies do not fall apart over slow, widely predicted, relatively small economic adjustments of the sort painted by climate analysis. Societies do fall apart from war, disease or chaos. Climate policy must compete with other long-term threats for always-scarce resources.

For the full commentary, see:
David R. Henderson and John H. Cochrane. “Climate Change Isn’t the End of the World; Even if world temperatures rise, the appropriate policy response is still an open question.” The Wall Street Journal (Mon., July 31, 2017): A17.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date July 30, 2017.)

Health Innovations Launch Where Regulations Are Few

(p. A15) One type of mobile device that is likely to appear first in the Far East and be widely adopted there is the digital stethoscope. This device is able to detect changes in pitch and soon will be able to detect asthma in children, pneumonia in the elderly, and, in conjunction with low-cost portable electrocardiographs, cardiopulmonary disease.
An additional advantage is that this part of the world–particularly India and Africa–has limited regulation, which makes it much easier to launch these kinds of health-care tools. In India and much of Africa, there are few government drug agencies or big insurance companies to throw up barriers.
Companies that make medical devices and their accompanying smartphone apps could establish themselves almost overnight. Then, once they have built a large, profitable base of users, they could consider jumping through the legal and regulatory hoops to bring the technology to developed countries.

For the full commentary, see:
Michael S. Malone. “Silicon Valley Trails in Medical Tech; With smartphones everywhere and little regulation, India and Africa are set to lead..” The Wall Street Journal (Mon., July 24, 2017): A15.
(Note: the online version of the commentary has the date July 23, 2017.)

U.S. Has 250,000 Less Jobs Due to Obamacare

(p. A15) Democrats loudly complain that people will lose health insurance if the Affordable Care Act is repealed. They never mention those who lose jobs because the ACA remains.
The ACA includes a penalty on employers that fail to provide “adequate” insurance for full-time workers. Thanks to the ACA, hiring the 50th full-time employee effectively costs another $70,000 a year on top of the normal salary and benefits.
. . .
In partnership with the Mercatus Center at George Mason University, in March 2017 I was able to commission Hanover Research to survey small businesses nationwide regarding their hiring and compensation practices. The result was a sample of 745 small businesses, representing every major industry and together employing almost 50,000 people.
. . .
Many businesses, when they do not offer coverage, keep their payrolls just below 50 full-time employees and thereby narrowly escape the ACA’s penalty. This pattern is not visible among businesses that offer coverage.
When we followed up, the businesses employing just fewer than 50 often said the ACA caused them to hire less and cut hours below the full-time threshold. The penalty caused payrolls to shrink or prevented them from growing.
Nationwide, we estimate the ACA-inspired practice of keeping payrolls below 50 has cost roughly 250,000 jobs. This does not count jobs lost when businesses close (we didn’t survey closed businesses) or shrink because of other ACA incentives.

For the full commentary, see:

Casey B. Mulligan. “How Many Jobs Does ObamaCare Kill? We surveyed managers at small businesses and put the count at 250,000.” The Wall Street Journal (Thurs., July 6, 2017): A15.
(Note: ellipses added.)
(Note: the online version of the commentary has the date July 5, 2017.)

“90 Is the New 65”

(p. A15) In this era full of baby boomers caring for frail parents, we’ve seen plenty of documentaries, plays and memoirs about dementia, infirmity, loss. But in the HBO documentary “If You’re Not in the Obit, Eat Breakfast,” Carl Reiner and friends take up another side of the phenomenon of longer life spans: the many people in their later years who are still sharp and vigorous and engaged.
The film, . . . , doesn’t pussyfoot around when setting its bar; no “life after 65” theme here. Mr. Reiner is interested in people 90 and above.
. . .
There is chagrin on occasion; no one likes the condescension that is often showered on people of this age.
“I think the culture stereotypes everything,” Norman Lear says. “Because I’m 93 I’m supposed to behave a certain way. The fact that I can touch my toes shouldn’t be so amazing to people.” (Mr. Lear is now 94.)
. . .
. . . there is plenty of life yet in the population born before the Great Depression. Now the broader culture needs to consider how to change its preconceptions if 90 is the new 65.

For the full review, see:
NEIL GENZLINGER. “Life Goes On (The 90-and-Up Crowd.” The New York Times (Fri., JUNE 5, 2017): C7.
(Note: ellipses added.)
(Note: the online version of the review has the date JUNE 4, 2017, and has the title “Review: ‘If You’re Not in the Obit, Eat Breakfast’ Finds Vigor After 90.”)

Britain’s Socialist National Health Service Failed to Update Old Software

(p. A4) LONDON — Martin Hardy was in his hospital gown, about to be wheeled into the operating room for knee surgery on Saturday morning [May 13, 2017] at Royal London Hospital in East London, when, he said, his operation was abruptly canceled.
Mr. Hardy, 52, a caregiver for his father, said his surgeon told him the operation could not be carried out because the hospital’s computer system was not working and his condition was not life-threatening.
“I was in my hospital robe literally about to go in,” he said, wincing as he stood on crutches outside the hospital, waiting for a taxi home. “How can anyone in their right mind do such a thing?” he added, referring to the people behind the devastating cyberattack that affected organizations in nearly 100 countries and sent tremors across Britain’s National Health Service.
A day after one of the largest “ransomware” attacks on record, which left thousands of computers at companies in Europe, universities in Asia and hospitals in Britain still crippled or shut down on Saturday, Amber Rudd, the British home secretary, told the BBC that the N.H.S. needed to learn from what had happened and upgrade its information technology system.
. . .
Ms. Rudd conceded that the N.H.S., where many computers had outdated software vulnerable to malware and ransomware, had been ill prepared, despite numerous warnings. “I would expect N.H.S. trusts to learn from this and to make sure that they do upgrade,” she said.
. . .
“You can’t blame the hospital, but surely the N.H.S. knew this could happen?” he said, his face reddening with anger. “And I don’t understand why their computers weren’t secure. We all pay into the N.H.S., and this is what we get. What on earth is going on in this country?”
. . .
Dr. Krishna Chinthapalli, a senior resident at the National Hospital for Neurology and Neurosurgery in London, who predicted a cyberattack on the N.H.S. in an article published in the British Medical Journal a few days before the attack, said it was disturbing.
“I had expected an attack,” he said in an interview. “But not on this scale.”
He had warned in the article that hospitals were especially vulnerable to ransomware attacks because they held vital data, and were probably more willing than others to pay a ransom to recover it. He said in the interview that many of the N.H.S. computers still ran Windows XP, an out-of-date software.

For the full story, see:
DAN BILEFSKY. “British Patients Suffer as Hospitals Race to Revive Computer Systems.” The New York Times, First Section (Sun., MAY 14, 2017): 11.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date MAY 13, 2017, and has the title “British Patients Reel as Hospitals Race to Revive Computer Systems.”)