Category: Health

Doctors Lack Incentives to Use Best Ovarian Cancer Treatment

(p. 22) In 2006, the National Cancer Institute took the rare step of issuing a “clinical announcement,” a special alert it holds in reserve for advances so important that they should change medical practice.
In this case, the subject was ovarian cancer. A major study had just proved that pumping chemotherapy directly into the abdomen, along with the usual intravenous method, could add 16 months or more to women’s lives. Cancer experts agreed that medical practice should change — immediately.
Nearly a decade later, doctors report that fewer than half of ovarian cancer patients at American hospitals are receiving the abdominal treatment.
“It’s very unfortunate, but it’s the real world,” said Dr. Maurie Markman, the president of medicine and science at Cancer Treatment Centers of America. He added, “The word ‘tragic’ would be fair.”
Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.

For the full story, see:
DENISE GRADY. “Ovarian Cancer Treatment Is Found Underused.” The New York Times (Tues., AUG. 4, 2015): A1 & A13.
(Note: the online version of the story has the date AUG. 3, 2015, and has the title “Effective Ovarian Cancer Treatment Is Underused, Study Finds.”)

Jewish Medical Inventor Invested in Human Capital Because That “Could Never Be Taken from Me”

Louis Sokoloff’s son Kenneth authored, or co-authored, important papers on how patents aided invention in the 1800s.

(p. A21) Dr. Louis Sokoloff, who pioneered the PET scan technique for measuring human brain function and diagnosing disorders, died on July 30 [2015] in Washington.
. . .
. . . he leapt at the opportunity when he won a scholarship to the University of Pennsylvania, guided by his grandfather’s advice.
“He advised me to choose a profession, any one,” he wrote, “in which all my significant possessions would reside in my mind because, being Jewish, sooner or later I would be persecuted and I would lose all my material possessions; what was contained in my mind, however, could never be taken from me and would accompany me everywhere to be used again.”
. . .
Dr. Sokoloff’s wife, the former Betty Kaiser, died in 2003, and his son, Kenneth, an economic historian, died in 2007.

For the full obituary, see:
SAM ROBERTS. “Louis Sokoloff, Pioneer of PET Scan, Dies at 93.” The New York Times (Thurs., AUG. 6, 2015): A21.
(Note: ellipses added.)
(Note: the online version of the obituary has the date AUG. 5, 2015.)

The Good Old Days Were Grim

(p. A15) In “Progress,” the Swedish author Johan Norberg deploys reams of data to show just how much life has improved–especially over the past few decades but over the past couple of centuries as well. Each chapter is devoted to documenting progress in a single category, including food, sanitation, life expectancy, poverty, violence, the environment, literacy and equality.
In response to people who look fondly on the “good old days,” Mr. Norberg underscores just how grim they could be. Rampant disease, famine and violence routinely killed off millions. In the 14th century, the so-called Black Death wiped out a third of Europe’s population. Five hundred years later, cholera outbreaks throughout the world led to hundreds of thousands of deaths and even killed a U.S. president, James Polk.

For the full review, see:

MATTHEW REES. “BOOKSHELF; Bending the Arc of History.” The Wall Street Journal (Tues., December 13, 2016): A15.
(Note: the online version of the review has the date Dec. 12, 2016,)

The book under review, is:
Norberg, Johan. Progress: Ten Reasons to Look Forward to the Future. London, UK: Oneworld Publications, 2016.

Double-Blind Trials Are Not the Only Source of Sound Knowledge

(p. 1) . . . while all doctors agree about the importance of gauging the quality of evidence, many feel that a hierarchy of methods is simplistic. As the doctor Mark Tonelli has argued, distinct forms of knowledge can’t be judged by the same standards: what a patient prefers on the basis of personal experience; what a doctor thinks on the basis of clinical experience; and what clinical research has discovered — each of these is valuable in its own way. While scientists concur that randomized trials are ideal for evaluating the average effects of treatments, such precision isn’t necessary when the benefits are obvious or clear from other data.
Clinical expertise and rigorous evaluation also differ in their utility at different stages of scientific inquiry. For discovery and explanation, as the clinical epidemiologist Jan Vandenbroucke has argued, practitioners’ instincts, observations and case studies are most useful, whereas randomized controlled trials are least useful. Expertise and systematic evaluation are partners, not rivals.
Distrusting expertise makes it easy to confuse an absence of randomized evaluations with an absence of knowledge. And this leads to the false belief that knowledge of what works in social policy, education or fighting terrorism can come only from randomized evaluations. But by that logic (as a spoof scientific article claimed), we don’t know if parachutes really work because we have no randomized controlled trials of them.

For the full commentary, see:
PAGAN KENNEDY. “The Thin Gene.” The New York Times, SundayReview Section (Sun., NOV. 27, 2016): 1 & 6.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date NOV. 25, 2016.)

The academic article calling for double-blind randomized trials to establish the efficacy of parachutes, is:
Smith, Gordon C. S., and Jill P. Pell. “Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systematic Review of Randomised Controlled Trials.” BMJ 327, no. 7429 (Dec. 18, 2003): 1459-61.

Science Can Learn Much from Outliers “Who Are Naturally Different”

(p. 1) Abby Solomon suffers from a one-in-a-billion genetic syndrome: After just about an hour without food, she begins to starve. She sleeps in snatches. In her dreams she gorges on French fries. But as soon as she wakes up and nibbles a few bites, she feels full, so she ends up consuming very few calories. At 5 feet 10 inches tall, she weighs 99 pounds.
Now 21 years old, she is one of the few people in the world to survive into adulthood with neonatal progeroid syndrome, a condition that results from damage to the FBN1 gene.
. . .
(p. 6) Dr. Chopra told me that, as far as medical science is concerned, Abby Solomon is worth thousands of the rest of us.
. . .
“Nothing comes close to starting with people who are naturally different,” he said. This is why he searches out patients at the extreme ends of the spectrum — those who are wired to weigh 80 pounds or 380 pounds. He said, “We have the opportunity to help a bigger swath of humanity when we learn from these outliers.”
In 2013, after hearing about Ms. Solomon’s unusual condition from another patient, he asked her to visit his clinic. Ms. Solomon warned him that she would be able to carry on a conversation for only 15 minutes before she needed to snack on chips or a cookie. That remark inspired a revelation. Dr. Chopra realized that “she had to eat small, sugary meals all day to stay alive, because her body was constantly running out of glucose,” he said.
The clue led Dr. Chopra and his colleagues to their discovery of the blood-sugar-regulating hormone, which they named asprosin. Ms. Solomon’s natural asprosin deficiency keeps her on the brink of starvation, but Dr. Chopra’s hope is that an artificial compound that blocks asprosin could be used as a treatment for obesity. He and his team have already tested such a compound on mice, and found that it can reverse insulin resistance and weight gain.

For the full commentary, see:
PAGAN KENNEDY. “The Thin Gene.” The New York Times, SundayReview Section (Sun., NOV. 27, 2016): 1 & 6.
(Note: ellipses added.)
(Note: the online version of the commentary has the date NOV. 25, 2016.)

“Patients Should Be the Owners of Their Own Medical Data”

(p. A21) THERE’S quite a paradox when it comes to our health data. Most of us still cannot readily look at it, but there’s been an epidemic of cybercriminals and thieves hacking and stealing this most personal information.
. . .
. . . , giving consumers control of their own medical data would revolutionize who owns medical data and how it is used. Concerns about researchers losing access to this amassed data are overstated. Patients have shown an overwhelming willingness to share their information for altruistic reasons (which far exceeds the track record of doctors and health systems when it comes to sharing data).
. . .
We need to move on from the days of health systems storing and owning all our health data. Patients should be the owners of their own medical data. It’s an entitlement and civil right that should be recognized.

For the full commentary, see:
KATHRYN HAUN and ERIC J. TOPOL. “The Health Data Conundrum.” The New York Times (Tues., January 3, 2017): A21.
(Note: ellipses added.)
(Note: the online version of the commentary has the date January 2, 2017.)

British Government Ignored Scurvy Cure

(p. C14) Scurvy, we know today, has a single and simple cause: lack of vitamin C. But between the years 1500 and 1800, when an estimated two million sailors died from the disease, it seemed to defy all logic.
. . .
The conventional medical narrative holds that the mystery was solved by James Lind’s announcement, in his “Treatise of the Scurvy” (1753), that it could be cured by drinking lemon juice. But in “Scurvy: The Disease of Discovery,” Jonathan Lamb, a professor at Vanderbilt University, shows that the story is nowhere near so simple and that scurvy was a much stranger condition than we imagine, with effects on the mind that neuroscience is only now beginning to elucidate. The result is a book that renders a familiar subject as exotic and uncanny as the tropical shores that confronted sailors in the grip of scurvy’s delirium.
James Lind was not the first person to recommend the lemon-juice cure. Contemporaries of Francis Drake had discovered it 150 years before, but the secret was lost and found again many times over the centuries. Some citrus juices were much more effective than others, and their efficacy was reduced considerably when they were preserved by boiling. The British admiralty ignored Lind’s researches, . . .

For the full review, see:
MIKE JAY. “The Disease of the Enlightenment.” The Wall Street Journal (Sat., December 10, 2016): C14.
(Note: ellipses added.)
(Note: the online version of the review has the date Dec. 9, 2016, and has the title “Scurvy: The Disease of the Enlightenment.”)

The book under review, is:
Lamb, Jonathan. Scurvy: The Disease of Discovery. Princeton, NJ: Princeton University Press, 2017.

Superagers Engage in “Strenuous Mental Effort”

(p. 10) Why do some older people remain mentally nimble while others decline? “Superagers” (a term coined by the neurologist Marsel Mesulam) are those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds.
. . .
Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.
The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.

For the full commentary, see:
LISA FELDMAN BARRETT. “Gray Matter; How to Become a ‘Superager’.” The New York Times, SundayReview Section (Sun., January 1, 2017): 10.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date DEC. 31, 2016.)

The passages quoted above are related to Barrett’s academic paper:
Sun, Felicia W., Michael R. Stepanovic, Joseph Andreano, Lisa Feldman Barrett, Alexandra Touroutoglou, and Bradford C. Dickerson. “Youthful Brains in Older Adults: Preserved Neuroanatomy in the Default Mode and Salience Networks Contributes to Youthful Memory in Superaging.” The Journal of Neuroscience 36, no. 37 (Sept. 14, 2016): 9659-9668.

E.U. Regulations Protect Paris Rats

(p. A4) PARIS — On chilly winter mornings, most Parisians hurry by the now-locked square that is home to the beautiful medieval Tour St. Jacques. Only occasionally do they pause, perhaps hearing a light rustle on the fallen leaves or glimpsing something scampering among the dark green foliage.
A bird? A cat? A puppy?
No. A rat.
No. Three rats.
No. Look closer: Ten or 12 rats with lustrous gray-brown coats are shuffling among the dried autumn leaves.
Paris is facing its worst rat crisis in decades. Nine parks and green spaces have been closed either partly or entirely
. . .
In the 19th century, rats terrified and disgusted Parisians who knew that five centuries earlier, the creatures had brought the bubonic plague across the Mediterranean.
The plague ravaged the city, as it did much of Europe, killing an estimated 100,000 Parisians, between a third and half the population at the time. It recurred periodically for four more centuries. Not surprisingly, the experience left Paris with a millennium-long aversion to rodents.
. . .
. . . why are they proliferating? Could it be everybody’s favorite scapegoat — the European Union and its faceless, unaccountable bureaucrats?
Yes, it could.
New regulations from Brussels, the European Union’s headquarters, have forced countries to change how they use rat poison, said Dr. Jean-Michel Michaux, a veterinarian and head of the Urban Animals Scientific and (p. A14) Technical Institute in Paris.
. . .
While the poison could be a risk to human beings, so are the rats — potentially, although no one is suggesting that the bubonic plague is likely to return.

For the full story, see:

ALISSA J. RUBIN. “PARIS JOURNAL; The Rats Came Back. Blame the E,U.” The New York Times (Fri., DEC. 16, 2016): A4 & A14.
(Note: ellipses added.)
(Note: the online version of the story has the date DEC. 15, 2016, and has the title “PARIS JOURNAL; Rodents Run Wild in Paris. Blame the European Union.”)

Failed “War on Cancer” Gets Repackaged as “Moonshot”

(p. A15) Last Friday [January 8, 2016] a group of 15 cancer researchers cut short a meeting at the Food and Drug Administration. The reason: They had been invited to Vice President Joseph R. Biden’s office to discuss his “moonshot” to cure cancer.
. . .
The idea that a concerted government push can lead to a “cure” for cancer is nearly a half century old, stretching back to President Nixon’s failed “War on Cancer.” The latest, which President Obama formalized in his State of the Union address on Tuesday, has a deeply emotional tinge. Mr. Biden’s son Beau died of brain cancer in May, and the vice president’s very public mourning and call for a “national commitment to end cancer as we know it” as he announced his decision not to run for president has moved and captivated Washington.
. . .
Unlike in 1971, when President Nixon launched his cancer war, researchers now understand that cancer is not one disease but essentially hundreds. The very notion of a single cure — or as Mr. Obama put it, making “America the country that cures cancer once and for all” — is misleading and outdated.
“Cancer is way more complex than anyone had imagined in 1970,” said Dr. Jose Baselga, the president of the American Association for Cancer Research and physician in chief and chief medical officer at Memorial Sloan Kettering Cancer Center.
. . .
Commitments by powerful Washington figures to cure cancer seem to come along about every decade.
Dr. Andrew von Eschenbach, the director of the National Cancer Institute, announced in 2003 that his organization’s goal was to “eliminate suffering and death” caused by cancer by 2015.
During an appropriations hearing, Dr. von Eschenbach got into a public bargaining session with Senator Arlen Specter, then a Republican from Pennsylvania, about how much money Dr. von Eschenbach would need to advance the date of the cure.
“I asked you what it would take to move that date up to 2010,” Mr. Specter asked.
“We have proposed a budget that would support those initiatives that would amount to approximately $600 million a year,” Dr. von Eschenbach answered.
“Six-hundred million a year?” Mr. Specter asked. “And you can move the date from 2015 to 2010?”
“Yes, sir,” Mr. von Eschenbach said.
Mr. Specter died of cancer in 2012.

For the full story, see:
GINA KOLATA and GARDINER HARRIS. “‘Moonshot’ to Cure Cancer, to Be Led by Biden, Relies on Outmoded View of Disease.” The New York Times (Thurs., JAN. 14, 2016): A15.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date JAN. 13, 2016.)

Prehistoric Hunter Suffered from Ulcer-Causing Microbe

(p. A7) Microbes that once troubled the stomach of a prehistoric hunter known as “Otzi the Iceman,” who died on an Alpine glacier 5,300 years ago, are offering researchers a rare insight into the early settlement of Europe.
In findings reported Thursday [January 7, 2016] in Science, an international research group analyzed remnants of ulcer-causing microbes called Helicobacter pylori exhumed from the well-preserved mummy of the Neolithic nomad. With modern DNA sequencing technology, they reconstructed the genetic structure of this ancient microbe–the oldest known pathogen sequenced so far.
. . .
“We know he had a rough lifestyle,” said Frank Maixner at the European Academy Institute for Mummies and the Iceman in Bolzano, Italy, who led the team of 23 scientists. “We found a lot of pathological conditions.”
. . .
The researchers also determined that the bacteria had inflamed his stomach lining, indicating that the prehistoric hunter, fleeing into the icy highlands where he was shot in the back with an arrow and beaten, may have been feeling ill on the day he was murdered.

For the full story, see:
ROBERT LEE HOTZ. “Iceman’s Gut Sheds Light on Human Migration.” The Wall Street Journal (Fri., Jan. 8, 2016): A7.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date Jan. 7, 2016, and has the title “Otzi the Iceman’s Stomach Sheds Light on Copper-Age Migration to Europe.”)

The research summarized in the passages quoted above, was more fully reported in:
Maixner, Frank, Ben Krause-Kyora, Dmitrij Turaev, Alexander Herbig, Michael R. Hoopmann, Janice L. Hallows, Ulrike Kusebauch, Eduard Egarter Vigl, Peter Malfertheiner, Francis Megraud, Niall O’Sullivan, Giovanna Cipollini, Valentina Coia, Marco Samadelli, Lars Engstrand, Bodo Linz, Robert L. Moritz, Rudolf Grimm, Johannes Krause, Almut Nebel, Yoshan Moodley, Thomas Rattei, and Albert Zink. “The 5300-Year-Old Helicobacter pylori Genome of the Iceman.” Science 351, no. 6269 (Jan. 8, 2016): 162-65.