Category: Health

Fragmented Health Care Causes Polypharmacy Harms

(p. D5) Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.
“A cardiologist puts someone on good, evidence-based medications for his heart,” said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “An endocrinologist does the same for his bones.”
. . .
“Pretty soon, you have an 82-year-old man who’s on 14 medications,” Dr. Alexander said, barely exaggerating.
Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.
. . .
Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to health care. “The system is not geared to look at a person as a whole, to see how the patterns fit together,” Dr. Steinman said.

For the full commentary, see:
Span, Paula. “THE NEW OLD AGE; An Ever-Mounting Pile of Pills.” The New York Times (Tues., APRIL 26, 2016): D5.
(Note: ellipses added.)
(Note: the online version of the commentary has the date APRIL 22, 2016, and has the title “THE NEW OLD AGE; The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills.”)

Cancer Is Not Due to Modernity

(p. 1A) Scientists’ conventional opinion about cancer was that it’s a relatively recent phenomenon caused by the stresses of modern life.

Dietary changes, behavioral changes and man-made changes to our environment have subjected humans to toxins that contribute to cancers, they say.

But new findings from researchers at South Africa’s University of the Witwatersrand published in the South African Journal of Science challenge that assumption.

Paleontologists found a benign tumor in a 12 or 13-year-old boy specimen that dates back almost 2 million years.

More significantly, they also found a malignant tumor that’s 1.7 million years old on the little toe bone of a left foot.

Previously the oldest discovered human cancer was between 780,000 and 120,000 years old.

. . .

(p. 2A) “The evidence is out there that these conditions have been with us a long time and we’ve been kind of hoodwinked that cancer is a modernity,” said Patrick Randolph-Quinney, one of the study’s authors. “These things are ancient.”

The greatest predictor of cancer, the study argues, even in our ancestors, is longevity. The longer we live, the more chances something in our bodies goes wrong, the more chances that something is a tumor.

For the full story, see:
The Washington Post. “Ancient tumor upends notion of cancer as modern affliction; 1.7-million-year-old malignant growth is causing scientists to rethink diseases and human history.” Omaha World-Herald (Sat., JUNE 20, 2016): 1A & 2A.
(Note: ellipsis added.)

The scientific article mentioned above, is:
Patrick, S. Randolph-Quinney, A. Williams Scott, Steyn Maryna, R. Meyer Marc, S. Smilg Jacqueline, E. Churchill Steven, J. Odes Edward, Augustine Tanya, Tafforeau Paul, and R. Berger Lee. “Osteogenic Tumour in Australopithecus Sediba: Earliest Hominin Evidence for Neoplastic Disease.” South African Journal of Science (July/Aug. 2016), DOI: http://dx.doi.org/10.17159/sajs.2016/20150470.

“Doctors Often Do Not ‘Know’ What They Are Doing”

(p. A11) Into the “swift currents and roiling waters of modern medicine” plunges Dr. Steven Hatch, whose informative “Snowball in a Blizzard” adds an important perspective. Dr. Hatch believes that our health-care system can “champion patient autonomy” and facilitate “more humane treatment, less anxiety, and better care” by revealing to patients the “great unspoken secret of medicine.” What’s the secret? Simply stated, “doctors often do not ‘know’ what they are doing.” In Dr. Hatch’s view, despite spectacular advances in biomedical science, modern “doctors simply cannot provide the kind of confident predictions that are often expected of them.”
. . .
He begins where Donald Rumsfeld ended: There will always be “known knowns, known unknowns, and unknown unknowns” in medicine. Dr. Hatch illustrates this spectrum of uncertainty with engaging exposés of popular screening tests like mammograms (attempting to detect breast cancer is like “finding a snowball in a blizzard”); common drug treatments, like those used to lower serum cholesterol or blood-pressure levels (about which expert national guidelines seem to change almost yearly); and health-care coverage in the lay media (whose “breaking news” too often ignores the uncertainty of the news being broken). Throughout his book, Dr. Hatch’s message is “caveat emptor,” warning his readers to beware not only the pseudoscientists, flim-flammers, anti-vacciners and celebrity doctors but also the all-too-certain pronouncements of the medical establishment.

For the full review, see:
BRENDAN REILLY. “BOOKSHELF; Give It To Me Straight, Doc; Doctors can’t really be certain if any treatment will help a particular person. But patients are looking for prescriptions, not probabilities.” The Wall Street Journal (Tues., March 15, 2016): A11.
(Note: the ellipsis between paragraphs, and the first two in the final quoted paragraph, are added; the third ellipsis in the final paragraph is in the original.)
(Note: ellipsis added.)
(Note: the online version of the review has the date March 14, 2016.)

The book under review, is:
Hatch, Steven. Snowball in a Blizzard: A Physician’s Notes on Uncertainty in Medicine. New York: Basic Books, 2016.

Iowa State Students Go Bananas to Save (or Harm?) African Children

(p. A11) Student activists at Iowa State University are up in arms after researchers offered to pay them almost a thousand bucks to eat some genetically modified banana. The bananas, created by an Australian scientist, contain high levels of beta carotene, which converts to vitamin A when eaten.
. . .
“Those students are acting out of ignorance,” Jerome Kubiriba, the head of the National Banana Research Program in Uganda, tells me. “It’s one thing to read about malnutrition; it’s another to have a child who is constantly falling sick yet, due to limited resources, the child cannot get immediate and constant medical care. If they knew the truth about the need for vitamin A and other nutrients for children in Uganda and Africa, they’d get a change of heart.”

For the full commentary, see:
JULIE KELLY. “Anti-GMO Students Bruise a Superbanana.” The Wall Street Journal (Tues., March 15, 2016): A11.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date March 14, 2016.)

Androgen Lengthens Telomeres

(p. A3) Androgens, a kind of sex hormone, have been used to treat certain genetic blood disorders for decades. But doctors haven’t been able to pinpoint exactly why they seem to help some patients. A small study puts forth a theory behind androgens’ disease-fighting mechanism: They help stabilize and even rebuild telomeres, which increasingly diminish in certain conditions and aging.
. . .
The authors of the study, published Wednesday [May 18, 2016] in the New England Journal of Medicine, treated telomere-disease patients who had a variety of conditions with a high dose of a synthetic androgen called danazol. The goal was to test whether the treatment would help keep telomeres intact longer. Instead, they saw them lengthen.
. . .
Experts, including the study’s authors, . . . warned against concluding danazol is a fountain of youth for the healthy, based on research that suggests that shrinking telomeres may be involved in aging.
“That,” said Dr. Agarwal, “would be purely in the realm of speculation.”

For the full story, see:
DANIELA HERNANDEZ. “How Sex Hormones Might Treat Some Diseases.” The Wall Street Journal (Thurs., May 19, 2016): A3.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date May 18, 2016, and has the title “How Sex Hormones Might Treat Certain Diseases.” The print version starts with a one-sentence summary paragraph that is absent in the online version. The second paragraph in the print version differs slightly from the first paragraph in the online version. The version quoted as the first paragraph above, is the first paragraph of the online version.)

The academic article mentioned above (though the date given by the NYT above appears to be a day too early), is:
Townsley, Danielle M., Bogdan Dumitriu, Delong Liu, Angélique Biancotto, Barbara Weinstein, Christina Chen, Nathan Hardy, Andrew D. Mihalek, Shilpa Lingala, Yun Ju Kim, Jianhua Yao, Elizabeth Jones, Bernadette R. Gochuico, Theo Heller, Colin O. Wu, Rodrigo T. Calado, Phillip Scheinberg, and Neal S. Young. “Danazol Treatment for Telomere Diseases.” New England Journal of Medicine 374, no. 20 (May 19, 2016): 1922-31.

Certificate-of-Need Regulations Protect Incumbents and Hurt Consumers

(p. A11) An important but overlooked debate is unfolding in several states: When governments restrict market forces in health care, who benefits? Legislative majorities in 36 states believe that consumers benefit, because restrictions help control health-care costs. But new research confirms what should be common sense: Preventing qualified health-care providers from freely plying their trade results in less access to care.
Most states enforce market restrictions through certificate-of-need programs, which mandate a lengthy, expensive application process before a health-care provider can open or expand a facility. The story goes: If hospitals or physicians could choose what services to provide, competition for patients would force providers to overinvest in equipment such as MRI machines–and the cost could be passed on to patients through higher medical bills.
. . .
These restrictions have largely failed to reduce costs, but they certainly reduce services. A 2011 study in the Journal of Health Care Finance found that certificate-of-need laws resulted in 48% fewer hospitals and 12% fewer hospital beds.

For the full commentary, see:
THOMAS STRATMANN and MATTHEW BAKER. “Certifiably Needless Health-Care Meddling.” The Wall Street Journal (Tues., Jan. 12, 2016): A11.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Jan. 11, 2016.)

The “new research” mentioned by Stratman in the passage quoted above, is:
Stratmann, Thomas, and Matthew C. Baker. “Are Certificate-of-Need Laws Barriers to Entry?: How They Affect Access to MRI, CT, and Pet Scans.” Mercatus Working Paper, Jan. 2016.

Denmark Drones Saving Lives

(p. B1) Mr. McLinden is a member of a group of middle-aged emergency workers taking part in a trial to jump-start the use of unmanned aircraft by Europe’s emergency services. The goal is to give the region a head start over the United States and elsewhere in using drones to tackle real-world emergencies.
The “drone school” builds on Europe’s worldwide lead in giving public groups and companies relatively free rein to experiment with unmanned aircraft. If everything goes as planned, the project’s backers hope government agencies in Europe and farther afield can piggyback on the experiences, helping to transform drones from recreational toys to lifesaving tools.
“For us, this technology is a game-changer,” said Mr. McLinden, who traveled to Copenhagen (p. B4) for a three-day training course with two colleagues from the Mid and West Wales Fire and Rescue Service. They will start offering 24/7 drone support — allowing colleagues, for example, to monitor accidents from 300 feet above — across central Wales later this month.
“Drones aren’t going to replace what we do,” Mr. McLinden added. “But anything that we can do to give our crews an advantage, that’s great.”
. . .
In a somewhat stuffy classroom at a disused fire station in Copenhagen, Thomas Sylvest gave advice to Mr. McLinden and others from his two years of flying. As Denmark’s first, and so far only, emergency service drone pilot, Mr. Sylvest has responded to things as varied as missing person cases and fires, often receiving calls late at night.
Mr. Sylvest, a fast-talking 50-year-old, offered tips on how best to share videos streamed directly from drones to commanders on the ground. During a recent fire in downtown Copenhagen, Mr. Sylvest said, he was able to beam high-definition images from high above, allowing his bosses to judge if a building’s walls would collapse (they did not). And when the police called him out last year after a man was reported missing, he flew his drone along a stretch of train tracks to guide colleagues on where best to look. (The man was found.)

For the full story, see:
MARK SCOTT. “Emergency Workers Turn to Drones to Save Lives.” The New York Times (Mon., JUNE 20, 2016): B1 & B4.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date JUNE 19, 2016, and has the title “Europe’s Emergency Workers Turn to Drones to Save Lives.”)

Crony Credentialism Is Regulatory Barrier to Telemedicine

(p. A11) Telemedicine has made exciting advances in recent years. Remote access to experts lets patients in stroke, neonatal and intensive-care units get better treatment at a lower cost than ever before. In rural communities, the technology improves timely access to care and reduces expensive medevac trips. Remote-monitoring technology lets patients with chronic conditions live at home rather than in an assisted-living facility.
Yet while telemedicine can connect a patient in rural Idaho with top specialists in New York, it often runs into a brick wall at state lines. Instead of welcoming the benefits of telemedicine, state governments and entrenched interests use licensing laws to make it difficult for out-of-state experts to offer remote care.
. . .
Using its power under the Commerce Clause of the Constitution, Congress could pass legislation to define where a physician practices medicine to be the location of the physician, rather than the location of the patient, as states currently do. Physicians would need only one license, that of their home state, and would work under its particular rules and regulations.
This would allow licensed physicians to treat patients in all 50 states. It would greatly expand access to quality medical care by freeing millions of patients to seek services from specialists around the country without the immense travel costs involved.

For the full commentary, see:

SHIRLEY SVORNY. “Telemedicine Runs Into Crony Doctoring; State medical-licensing barriers protect local MDs and deny patients access to remote-care physicians.” The Wall Street Journal (Sat., July 23, 2016): A11.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date JUNE 22, 2016.)

World Health Organization Praises Coffee, Reversing 1991 Warning

(p. A9) An influential panel of experts convened by the World Health Organization concluded on Wednesday [JUNE 15, 2016] that regularly drinking coffee could protect against at least two types of cancer, a decision that followed decades of research pointing to the beverage’s many health benefits. The panel also said there was a lack of evidence that it might cause other types of cancer.
The announcement marked a rare reversal for the panel, which had previously described coffee as “possibly carcinogenic” in 1991 and linked it to bladder cancer. But since then a large body of research has portrayed coffee as a surprising elixir, finding lower rates of heart disease, Type 2 diabetes, neurological disorders and several cancers in those who drink it regularly.

For the full story, see:
ANAHAD O’CONNOR. “Coffee May Protect Against Cancer, W.H.O. Concludes, in Reversal of a 1991 Study.” The New York Times (Thurs., JUNE 16, 2016): A9.
(Note: bracketed date added.)
(Note: the online version of the commentary has the date JUNE 15, 2016, and has the title “Coffee May Protect Against Cancer, W.H.O. Concludes.”)

“Entrepreneurs Can Appear in the Most Unpromising Environments”

(p. A11) Adam Fifield’s entertaining biography of the little-recognized Grant shows that entrepreneurs can appear in the most unpromising environments–such as within the dysfunctional bureaucracy of the United Nations.
. . .
While top-down planning is usually misguided in aid (and most everywhere else), it turned out to be suitable for the particular challenge of vaccinations. Unfortunately, the aid establishment learned the wrong lessons from Grant’s career. Instead of seeing him as an entrepreneur who saw a very specific unrealized opportunity to spread vaccination and oral rehydration salts, they viewed his success as vindicating top-down planning in general.
. . .
Those who came after Grant . . . seem to have developed even more of the paternalistic savior complex than he had–his counterparts today are the likes of Bono, Jeffrey Sachs and Bill Gates. But the condescending image of a powerful white male as the savior of helpless nonwhite children is thankfully a lot less acceptable today than it was in Grant’s time. Since 2000 we have witnessed the mainly homegrown economic growth of low- and middle-income countries surpassing that of rich countries–plus many other positive long-term trends from democratization to the explosion of cellphones. Aid alone cannot explain these large triumphs in poor countries. There is still room for humanitarian entrepreneurs like Grant to find new breakthroughs, but we can appreciate much more today that the poor are their own best saviors.​

For the full review, see:
WILLIAM EASTERLY. “BOOKSHELF; The Father of Millions; The Unicef breakthrough on vaccinations and oral rehydration salts is still cited today as one of the few successes in foreign aid.” The Wall Street Journal (Fri., Oct. 16, 2015): A11.
(Note: ellipses added.)
(Note: the online version of the review has the date Oct. 15, 2015.)

The book under review, is:
Fifield, Adam. A Mighty Purpose: How Jim Grant Sold the World on Saving Its Children. New York: Other Press, 2015.

Majerus Did Not Need a Randomized Trial to Know that Aspirin Prevents Heart Attacks

(p. A21) Philip W. Majerus, a biochemist who was credited as being the first to theorize that taking small doses of aspirin regularly can prevent heart attacks and strokes in vulnerable patients, died last Wednesday [June 8, 2016] at his home in St. Louis. . . .
. . .
Even before his findings were confirmed in a study by other researchers a decade later, Dr. Majerus was taking aspirin daily.
“I was already convinced that aspirin prevented heart attacks,” he recalled in the journal Advances in Biological Regulation in 2014. “I was unwilling to be randomized into a trial where I might end up with the placebo. I refused to participate.”
Dr. Majerus recommended that “all adults should take an aspirin daily unless they are among the few percent of the population that cannot tolerate the drug.” The cardiovascular benefit of aspirin was fully achieved by 50 to 75 milligrams daily, he said, and “there is no evidence that branded aspirin, which is much more expensive, is in any way superior to the generic version.”
Later studies found that for people in their 50s who are vulnerable to heart disease, taking daily doses of aspirin reduces the risk of heart disease.
. . .
Investigating how aspirin inhibited clotting, Dr. Majerus concluded that the medicine modified an enzyme that leads to the formation of a platelet-made molecule that constricts blood vessels and aggregates platelets. The pills’ effect lasts for the platelets’ life span, typically about two weeks.
“Phil Majerus, more than any other individual, has produced the most original body of work on biochemistry of platelets as it relates to thrombosis,” Prof. Joseph L. Goldstein, a Nobel laureate at the University of Texas Southwestern Medical Center in Dallas, said when the Bristol-Myers Squibb Award was announced.

For the full obituary, see:
SAM ROBERTS. “Dr. Philip Majerus, Who Recognized Heart Benefits of Aspirin, Is Dead at 79.” The New York Times (Weds., JUNE 15, 2016): A23.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the obituary has the date JUNE 14, 2016, and has the title “Dr. Philip Majerus, Who Discerned Aspirin’s Heart Benefits, Dies at 79.”)