Category: Health

Affordable Care Act Reduces GDP, Employment and Labor Income

(p. A17) Whether the Affordable Care Act lives up to its name depends on how, or whether, you consider its consequences for the wider economy.
. . .
I estimate that the ACA’s long-term impact will include about 3% less weekly employment, 3% fewer aggregate work hours, 2% less GDP and 2% less labor income. These effects will be visible and obvious by 2017, if not before. The employment and hours estimates are based on the combined amount of the law’s new taxes and disincentives and on historical research on the aggregate effects of each dollar of taxation. The GDP and income estimates reflect lower amounts of labor as well as the law’s effects on the productivity of each hour of labor.
. . .
The Affordable Care Act is weakening the economy. And for the large number of families and individuals who continue to pay for their own health care, health care is now less affordable.

For the full commentary, see:
CASEY B. MULLIGAN. “OPINION; The Myth of ObamaCare’s Affordability; The law’s perverse incentives will have the nation working fewer hours, and working those hours less productively.” The Wall Street Journal (Tues., SEPTEMBER 9, 2014): A17.
(Note: ellipses added.)
(Note: the online version of the commentary has the date SEPTEMBER 8, 2014.)

Mulligan’s research on the effects of Obamacare is detailed in his Kindle e-book:
Mulligan, Casey B. Side Effects: The Economic Consequences of the Health Reform. Flossmoor, IL: JMJ Economics, 2014.

Cancer Gains Have Not Come from “Centralized Direction”

(p. 180) The truth remains that over the course of the twentieth century, the greatest gains in the battle against cancer came from independent research that was not under any sort of centralized direction and that did not have vast resources at its disposal. As we have seen, such research led to momentous chance discoveries in cancer chemotherapy and a greater understanding of the mechanisms of the disease that have resulted in exciting new therapeutic approaches.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

War on Cancer Was “Profoundly Misconceived”

(p. 179) Following the testing of nearly half a million drugs, the number of useful anticancer agents remains disappointingly small. Expressions of discontent with the methodology of research and of research and the appalling paucity of results were, over the years, largely restricted to the professional literature. However, in 2001 they broke through to the popular media. In an impassioned article in the New Yorker magazine entitled “The Thirty Years’ War: Have We Been Fighting Cancer the Wrong Way?” Jerome Groopman, a respected clinical oncologist and cancer researcher at Harvard Medical School in Boston, fired a devastating broadside. “The war on cancer,” he wrote, “turned out to be profoundly misconceived–both in its rhetoric and in its execution. The high expectations of the early seventies seem almost willfully naïve.” Regarding many of the three-phased clinical trials, with their toxic effects, he marveled at “how little scientific basis there was and how much sensationalism surrounded them.” Groopman concluded that hope for progress resided in the “uncertainty inherent in scientific discovery.”

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: italics in original.)

In 1971 Nixon “Launched an All-Out War on Cancer”

(p. 173) In 1971 the U.S. government finally launched an all-out “war on cancer.” In his State of the Union address in January 1971, President Richard Nixon declared: “The time has come in America when the same kind of concerted effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal.”
As the country debated a bill known as the National Cancer Act, the air was filled with feverish excitement and heady optimism. Popular magazines again trumpeted the imminent conquest of cancer. However, some members of the committee of the Institute of Medicine, a part of the National Academy of Sciences, which was asked by the NCI to review the cancer plan envisioned by the act, expressed concern regarding the centralization of planning of research and that “the lines of research… could turn out to be the wrong leads.” The plan fails, the reviewers said in their confidential report, because

It leaves the impression that all shots can be called from a national headquarters; that all, or nearly all, of the really important ideas are already in hand, and that given the right kind of administration and organization, the hard problems can be solved. It fails to allow for the surprises which must surely lie ahead if we are really going to gain an understanding of cancer.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: ellipsis in original.)

“Discovery Cannot Be Achieved by Directive”

(p. 170) As early as 1945 the medical advisory committee reporting to the committee reporting to the federal government on a postwar program for scientific research emphasized the frequently unexpected nature of discoveries:

Discoveries in medicine have often come from the most remote and unexpected fields of science in the past; and it is probable that this will be equally true in the future. It is not unlikely that significant progress in the treatment of cardiovascular disease, kidney disease, cancer, and other refractory conditions will be made, perhaps unexpectedly, as the result of fundamental discoveries in fields unrelated to these diseases…. Discovery cannot be achieved by directive. Further progress requires that the entire field of medicine and the underlying sciences of biochemistry, physiology, pharmacology, bacteriology, pathology, parasitology, etc., be developed impartially.

Their statement “discovery cannot be achieved by directive” would prove to be sadly prophetic.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: italics in original.)

“Folkman Persisted in His Genuinely Original Thinking”

(p. 141) As detailed by Robert Cooke in his 2001 book Dr. Folkman’s War, the successful answers to these basic questions took Folkman through diligent investigations punctuated by an astonishing series of chance observations and circumstances. Over decades, Folkman persisted in his genuinely original thinking. His concept was far in advance of technological and other scientific advances that would provide the methodology and basic knowledge essential to its proof, forcing him to await verification and to withstand ridicule, scorn, and vicious competition for grants. Looking back three decades later, Folkman would ruefully reflect: “I was too young to realize how much trouble was in store for a theory that could not be tested immediately.”

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: italics in original.)

Centrally Planned War on Cancer “Fails to Allow for Surprises”

(p. 115) It leaves the impression that all shots can be called from a national headquarters; that all, or nearly all, of the really important ideas are already in hand…. It fails to allow for the surprises which must surely lie ahead if we are really going to gain an understanding of cancer. –A COMMITTEE OF THE INSTITUTE OF MEDICINE, NATIONAL ACADEMY OF SCIENCES, ON THE NATIONAL CANCER ACT AND THE “WAR ON CANCER”

Source:
As quoted in Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: ellipsis in original.)

British Parents Jailed by Nationalized Health Service for Trying to Sell Home to Pay for Son’s Cancer Treatment

(p. A4) . . . , no Briton is ever entirely happy with the taxpayer-funded service, and now the case of a 5-year-old boy with a brain tumor has thrown a harsh light on the $170 billion-a-year system.
Critics are asking whether the service was justified in refusing a cancer treatment for the boy, Ashya King, sought by his desperate parents in an effort to save his life, and whether it overstepped in trying to impose its decision on his family.
The refusal set off a chain of events that enthralled and horrified the British public, as Ashya’s parents removed their son from University Hospital Southampton in England on Aug. 28 without the consent of British doctors, setting off a highly publicized international hunt. Concern for the child, however, turned into public outrage when the parents, Brett and Naghemeh King, were arrested and jailed in Madrid, where they had traveled to sell their holiday home so they could pay for the treatment, called proton beam therapy.
. . .
“They treated us like terrorists,” Mr. King, 51, said during an emotional news conference in Spain, where he and his wife were held for three days, separated from their critically ill son, as British authorities pursued University Hospital Southampton’s recommendation that Ashya be made a ward of the court.
. . .
(p. A10) Professor Hunter . . . said that, because the health service is publicly accountable, doctors tend to be reluctant to recommend innovative solutions for fear of lawsuits if things go wrong.
Mrs. Anderton, too, said that, despite the excellent care her son received, the N.H.S. is not always at the cutting edge. “The only downside is that we don’t have advanced types of treatments that could be lifesaving,” she said.

For the full story, see:
KIMIKO DE FREYTAS-TAMURA. “Health Care for Britain in Harsh Light.” The New York Times (Weds., SEPT. 17, 2014): A4 & A10.
(Note: ellipses added.)
(Note: the online version of the story has the date SEPT. 16, 2014.)

In Finding Cure for Ulcers, Marshall Was Not Constrained by the Need to Obtain Approval or Funding

(p. 113) Marshall was a youthful maverick, not bound by traditional theory and not professionally invested in a widely held set of beliefs. There is such a thing as being too much of an insider. Marshall viewed the problem with fresh eyes and was not constrained by the requirement to obtain approval or funding for his pursuits. It is also noteworthy that his work was accomplished not at a high-powered academic ivory tower with teams of investigators but instead far from the prestigious research centers in the Western Hemisphere.
The delay in acceptance of Marshall’s revolutionary hypothesis reflects the tenacity with which long-held concepts are maintained. Vested interests–intellectual, financial, commercial, status–keep these entrenched. Dogmatic believers find themselves under siege by a new set of explanations.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

Ideas Should Not Be Rejected Just Because They Disagree with Reigning Theory

(p. 107) . . . Claude Bernard, the nineteenth-century founder of experimental medicine, . . . famously said, “If an idea presents itself to us, we must not reject it simply because it does not agree with the logical deductions of a reigning theory.”

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.
(Note: ellipses added.)

Fleck Made Two Versions of His Typhus Vaccine: A Worthless Version for the SS Troops and an Effective Version for His Fellow Buchenwald Inmates

(p. C7) Ludwik Fleck (1896-1961), who earned a doctorate at Lwów University while studying under Weigl, also became interested in typhus during World War I, when he too was drafted by Austria-Hungary. Fleck’s specialty was immunology, and in 1919 he joined Weigl’s institute. Somewhere between 1921 and 1923 he crafted a way to diagnose typhus, but despite this achievement, Polish anti-Semitism denied him the academic recognition that his talent merited. During this period, he would occupy government posts (until 1935, when anti-Semitic policies made it impossible for Jews to hold such positions) and, with his wife’s dowry, opened his own laboratory.
By August 1942, Fleck, though confined to Lwów’s Jewish ghetto, managed to create a vaccine from the urine of typhus patients. (Fleck’s vaccine may have been easier to produce than Weigl’s.) Six months later, he was sent to Auschwitz, where he worked in a bacteriological research unit and where he was treated somewhat better than most camp inmates. In December 1943, Fleck was dispatched to the Buchenwald concentration camp to work on a typhus vaccine.
The Germans wanted the Buchenwald typhus-vaccine prisoner unit–some were physicians and scientists, some weren’t–to follow instructions for making a vaccine that had originated at the Pasteur Institute in Paris. It was a convoluted process that involved rabbit lungs and the organs of other animals. The unit’s inmates, including Fleck, who understood immunology better than anyone else at Buchenwald, conspired to produce two kinds of vaccine: large quantities of worthless serum that were shipped to SS troops at the front; and much smaller doses of effective vaccine that were used to secretly immunize prisoners. Their daring sabotage could have led to their execution, of course, but their Nazi overseers in the camp were too medically ignorant to understand what was transpiring. If senior SS officials elsewhere became suspicious, the prisoners would supply the real vaccine for testing by the skeptical parties.

For the full review, see:
HOWARD SCHNEIDER. “The Fever that Gripped Europe.” The Wall Street Journal (Sat., July 19, 2014): C7.
(Note: the online version of the review has the date July 18, 2014, and has the title “Book Review: ‘The Fantastic Laboratory of Dr. Weigl’ by Arthur Allen; Two scientists who worked to beat typhus and sabotage the Nazis.”)

The book being reviewed:
Allen, Arthur. The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis. New York: W. W. Norton & Company, 2014.

My dissertation adviser, Stephen Toulmin, recommended a philosophy of science book by Ludwig Fleck that I have owned for several decades, but never gotten around to reading. It is said to anticipate some of the issues discussed by Thomas Kuhn in his classic The Structure of Scientific Revolutions. The Fleck book is:
Fleck, Ludwik. Genesis and Development of a Scientific Fact. pb ed. Chicago, IL: University of Chicago Press, 1981 [first published in German in 1935].