Category: Health

Technology Can Restore Hand Control to Quadriplegic

(p. A1) Five years ago, a college freshman named Ian Burkhart dived into a wave at a beach off the Outer Banks in North Carolina and, in a freakish accident, broke his neck on the sandy floor, permanently losing the feeling in his hands and legs.
On Wednesday [April 13, 2016], doctors reported that Mr. Burkhart, 24, had regained control over his right hand and fingers, using technology that transmits his thoughts directly to his hand muscles and bypasses his spinal injury. The doctors’ study, published by the journal Nature, is the first account of limb reanimation, as it is known, in a person with quadriplegia.
Doctors implanted a chip in Mr. Burkhart’s brain two years ago. Seated in a lab with the implant connected through a computer to a sleeve on his arm, he was able to learn by repetition and arduous practice to focus his thoughts to make his hand pour from a bottle, and to pick up a straw and stir. He was even able to play a guitar video game.
. . .
“Watching him close his hand for the first time — I mean, it was a surreal moment,” Dr. Rezai said. “We all just looked at each other and thought, ‘O.K., the work is just starting.'”
After a year of training, Mr. Burkhart was able to pick up a bottle and pour the contents into a jar, and to pick up a straw and stir. The doctors, though delighted, said that more advances would be necessary to make the bypass system practical, affordable and less invasive, most likely through wireless technology. But the improvement was significant enough, at least in the lab, that rehabilitation specialists could reclassify Mr. Burkhart’s disability from a severe C5 function to a less severe C7 designation.
For now, the funding for the project, which includes money from Ohio State, Battelle and private donors, is set to run out this year — and with it, Mr. Burkhart’s experience of restored movement.
“That’s going to be difficult, because I’ve enjoyed it so much,” Mr. Burkhart said. “If I could take the thing home, it would give me so much more independence. Now, I’ve got to rely on someone else for so many things, like getting dressed, brushing my teeth — all that. I just want other people to hear about this and know that there’s hope. Something will come around that makes living with this injury better.”

For the full story, see:
BENEDICT CAREY. “Quadriplegic Gets Use of Hand from Chip Placed in His Brain.” The New York Times (Thurs., APRIL 14, 2016): A1 & A16.
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the story has the date APRIL 13, 2016, and has the title “Chip, Implanted in Brain, Helps Paralyzed Man Regain Control of Hand.”)

The scientific article in Nature reporting the advance, is:
Bouton, Chad E., Ammar Shaikhouni, Nicholas V. Annetta, Marcia A. Bockbrader, David A. Friedenberg, Dylan M. Nielson, Gaurav Sharma, Per B. Sederberg, Bradley C. Glenn, W. Jerry Mysiw, Austin G. Morgan, Milind Deogaonkar, and Ali R. Rezai. “Restoring Cortical Control of Functional Movement in a Human with Quadriplegia.” Nature 533, no. 7602 (May 12, 2016): 247-50.

Neurosurgical Establishment Waited Decade to Adopt Jannetta’s Cure

(p. C6) Dr. Peter J. Jannetta, a neurosurgeon who as a medical resident half a century ago developed an innovative procedure to relieve an especially devastating type of facial pain, died on Monday [April 1?, 2016] in Pittsburgh.
. . .
“This was a condition that had been documented for a thousand years: There are references in the ancient literature to what was originally called ‘tic douloureux,’ ” Mark L. Shelton, the author of “Working in a Very Small Place: The Making of a Neurosurgeon,” a 1989 book about Dr. Jannetta, said in a telephone interview on Thursday. “People knew of this unexplained, very intense, episodic facial pain but didn’t know the cause of it.”
. . .
In the mid-1960s, Dr. Jannetta made a striking discovery while he was a neurosurgical resident at the University of California, Los Angeles. Dissecting a set of cranial nerves for a class presentation, he noticed something amiss: a tiny blood vessel pressing on the trigeminal nerve.
“It came to him as something of a flash of insight,” Mr. Shelton said. “He saw this blood vessel literally impinging on the nerve so that there was actually a groove in the nerve where the vessel pressed.”
What if, Dr. Jannetta wondered, this were the source of the nerve damage? Though his insight is universally accepted today, it was novel to the point of subversion in the 1960s.
“The idea that a very small blood vessel, the diameter of a mechanical pencil lead, could cause such outsize pain didn’t resonate with people at the time,” Mr. Shelton said.
. . .
If the vessel was a vein, it could simply be cauterized and excised. If it was an artery, however — a more essential structure — it would, Dr. Jannetta realized, have to be gently nudged out of the way.
He created a means of doing so that involved slipping a tiny pad of soft Teflon, about the size of a pencil eraser, between the artery and the nerve.
Dr. Jannetta performed the first microvascular decompression operation in 1966. The patient, a 41-year-old man, was relieved of his pain.
It took about a decade for the procedure to win acceptance from the neurosurgical establishment, owing partly to Dr. Jannetta’s youth and partly to the novelty of his idea.
“He convinced many, many skeptics — and there were a lot of skeptics in the early years — because it seemed so counterintuitive as to what caused neurological disease,” Mr. Shelton said.
. . .
His many laurels include the medal of honor from the World Federation of Neurological Societies; the Olivecrona Award, presented by the Karolinska Institute in Sweden; and the Horatio Alger Award, which honors perseverance in the face of adversity or opposition.

For the full obituary, see:
MARGALIT FOX. “Dr. Peter J. Jannetta, Neurosurgeon and Pioneer on Facial Pain, Dies at 84.” The New York Times (Fri., APRIL 15, 2016): A22.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the obituary has the date APRIL 14, 2016, and has the title “Dr. Peter J. Jannetta, Pioneering Neurosurgeon on Facial Pain, Dies at 84.”)

The book about Jannetta, mentioned above, is:
Shelton, Mark. Working in a Very Small Place: The Making of a Neurosurgeon. New York: Vintage Books, 1990.

Many Empirical Research Results Are False

(p. B7) Research on 100 studies in psychology found in 2015 that more than 60% couldn’t be replicated. Similar results have been found in medicine and economics. Campbell Harvey, a professor at Duke University and president of the American Finance Association, estimates that at least half of all “discoveries” in investment research, and financial products based on them, are false.
. . .
Brian Nosek, a psychology professor at the University of Virginia and executive director of the Center for Open Science, a nonprofit seeking to improve research practices, has spent much of the last decade analyzing why so many studies don’t stand up over time.
Because researchers have an incentive to come up with results that are “positive and clean and novel,” he says, they often test a plethora of ideas, throwing out those that don’t appear to work and pursuing those that confirm their own hunches.
If the researchers test enough possibilities, they may find positive results by chance alone — and may fool themselves into believing that luck didn’t determine the outcomes.

For the full commentary, see:
JASON ZWEIG. “Chasing Hot Returns in ‘Smart-Beta’ Can Be Dumb.” The Wall Street Journal (Sat., Feb 13, 2016): B1 & B7.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Feb 12, 2016, and has the title “Chasing Hot Returns in ‘Smart-Beta’ Funds Can Be a Dumb Idea.”)

Retail Clinics Provide Convenient Care

(p. A3) My wife and I both work. When one of our children wakes up complaining of a sore throat, we could begin a ritual stare-down to determine which of us is going to have to wait for the doctor’s office to open, make the phone call, wait on hold, schedule an appointment (which will inevitably be in the middle of the day), take off work, pick up the child from school, sit in the waiting room (surrounded by other sick children), get the rapid strep test, find out if the child is infected and then go to the pharmacy or back to school, before returning to work.
Or, one of us could just take the child to a retail clinic on the way to work and be done in 30 minutes. Strep throat is incredibly easy to treat (Penicillin still works great!). There’s a simple and very fast test for it. Moreover, physicians are really bad at diagnosing some of these common illnesses clinically; a study found that a doctor’s guess as to whether a respiratory infection is bacterial or viral is right about 50 percent of the time — no better than flipping a coin. The point is, you need to get the rapid strep test every time regardless, whether at your doctor’s office or at a clinic.
Aimee and I choose the retail clinic every time.
Why? Convenience is the biggest reason. Many doctors’ offices are open only on weekdays and during business hours. This also happens to be when most adults work and when children attend school. A 2010 survey of 11 countries found that Americans seek out after-hours care or care in a hospital’s emergency room more often than citizens of almost any other industrialized nation. More than two-thirds of Americans with a below-average income did so. But this isn’t just a problem for the poor. About 55 percent of those with an above-average income did so as well.
We complain all the time that people use the emergency room for primary care. But that’s not always about lack of insurance. It’s about access. The emergency room is open when people can actually go. Emergency room use has gone up, not down, since the passage of the Affordable Care Act. More people have insurance, and now can afford care when they need it.
That care is also coming from retail clinics, usually found either in stand-alone storefronts or inside pharmacies. Between 2007 and 2009, retail clinic use increased 10-fold. It turns out that my wife and I represent America pretty well. About 35 percent of retail visits for children are for pharyngitis — sore throats. Add in ear infections and upper respiratory infections, and you’ve accounted for more than three-quarters of visits for children. Parents bring their children to retail clinics to take care of quick, acute problems. Swap ear infections for immunizations, and you’ve got the main reasons adults use retail clinics, too.
Researchers for a study published in the American Journal of Medical Quality talked to patients who sought out care at retail clinics. Patients who had a primary care physician, but still went to a retail clinic, did so because their primary care doctors were not available in a timely manner. A quarter of them said that if the retail clinic weren’t available, they’d go to the emergency room.

For the full commentary, see:
Aaron E. Carroll. “The Hidden Cost of Retail Health Clinics.” The New York Times (Thurs., APRIL 14, 2016): A3.
(Note: the online version of the commentary has the date APRIL 12, 2016, and has the title “The Undeniable Convenience and Reliability of Retail Health Clinics.” Where the two versions differ, the quoted passages above follow the online version.)

The research on patient motivation for using retail clinics, is:
Wang, Margaret C., Gery Ryan, Elizabeth A. McGlynn, and Ateev Mehrotra. “Why Do Patients Seek Care at Retail Clinics, and What Alternatives Did They Consider?” American Journal of Medical Quality 25, no. 2 (March/April 2010): 128-34.

“Lifespan Research Really Should Be the Future of Medicine”

(p. D1) A research lab at a University of California campus has a big ambition–to extend the number of years people live disease-free. The animal model it uses for its experiments is decidedly smaller: the tiny fruit fly.
The Jafari Lab, located at UC Irvine, has run tests on substances as diverse as green tea, cinnamon and an Arctic plant called Rhodiola rosea, looking for an elixir of life. To pass muster, each experimental compound must help the fruit flies live longer and not have adverse effects.
The researchers are currently investigating the effects of cinnamon on lifespan. The spice passed the first test: A dose of 25 milligrams of cinnamon per milliliter of food resulted in fruit flies living up to 37% longer. But to be declared a success, the lab is putting cinnamon through three additional tests–does it harm reproductive ability and locomotion and what impact does it have on cognitive capacities such as memory.
“When you look at how we think about aging, we don’t really consider it a disease–it’s just considered a ‘natural’ thing. But I think aging and lifespan research really should be the future of medicine,” says Mahtab Jafari, an associate professor of pharmaceutical sciences at UC Irvine for whom the lab is named.

For the full story, see:
ANGELA CHEN. “HEALTH & WELLNESS; In Search of Elixir of Life, Scientist Studies Fruit Flies.” The Wall Street Journal (Tues., MARCH 8, 2016): D3.
(Note: italics in original.)
(Note: the online version of the story has the date MARCH 7, 2016, and has the title “HEALTH & WELLNESS; Seeking Elixir of Life, a Scientist Studies Fruit Flies.”)

A relevant academic article discussing possible metabolic pathways to increased lifespan, is:
Barzilai, Nir, Derek M. Huffman, Radhika H. Muzumdar, and Andrzej Bartke. “The Critical Role of Metabolic Pathways in Aging.” Diabetes 61, no. 6 (June 2012): 1315-22.

Those Who Suffer from a Problem, Can Invent to Solve It

(p. 1) Is it possible to extract blood from people without causing pain? For decades, this problem has stumped the medical industry. In an effort to replace the old-fashioned needle, companies are trying to deploy laser beams and tiny vacuums to draw blood.
In 2014, an engineer at Harvard named Ridhi Tariyal hit on a far simpler workaround. “I was trying to develop a way for women to monitor their own fertility at home,” she told me, and “those kinds of diagnostic tests require a lot of blood. So I was thinking about women and blood. When you put those words together, it becomes obvious. We have an opportunity every single month to collect blood from women, without needles.”
Together with her business partner, Stephen Gire, she has patented a method for capturing menstrual flow and transforming it into medical samples. “There’s lots of information in there,” Ms. Tariyal said, “but right now, it’s all going in the trash.”
Why did Ms. Tariyal see a possibility that had eluded so many engineers before her? You might say she has an unfair advantage: her gender.
. . .
(p. 4) Eric von Hippel, a scholar of innovation at M.I.T., has spent decades studying what seems like a truism: People who suffer from a problem are uniquely equipped to solve it. “What we find is that functionally novel innovations — those for which a market is not yet defined — tend to come from users,” he said. He pointed out that young Californians pioneered skateboards so that they could “surf” the streets. And surgeons built the first heart-and-lung machines to keep patients alive during long operations. “The reason users are so inventive is twofold. One is that they know the needs firsthand,” he said. The other is that they have skin in the game.

For the full commentary, see:
PAGAN KENNEDY. “The Tampon of the Future.” The New York Times, SundayReview Section (Sun., APRIL 3, 2016): 1 & 4-5.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date APRIL 1, 2016.)

Pagan Kennedy’s book, that is related to her commentary quoted above, is:
Kennedy, Pagan. Inventology: How We Dream up Things That Change the World. New York: Houghton Mifflin Harcourt Publishing Co., 2016.

How Health Insurance Slows Medical Innovation

(p. A8) A recent study led by Wendell Evans at the University of Sydney supports growing evidence that early tooth decay, before a cavity forms, can often be arrested and reversed with simple treatments that restore minerals in the teeth, rather than the more typical drill-and-fill approach.
The randomized, controlled trial followed 19 dental practices in Australia for three years, then researchers checked up on the patients again four years later. The result: After seven years, patients receiving remineralization treatment needed on average 30% fewer fillings.
. . .
There is a substantial body of research supporting remineralization as a treatment for early tooth decay, and little opposition in the dental profession, says Margherita Fontana, a professor of cariology at the University of Michigan School of Dentistry. Tradition, however, has been an obstacle to widespread use of the treatment. “For older generations [of dentists], it just feels wrong to leave decay and not remove it,” Dr. Fontana says. “That’s how they were trained.”
Reimbursement is another obstacle. Insurance typically covers application of fluoride varnish in children, but not adults. The cost ranges from $25 to $55, according to the American Dental Association’s Health Policy Institute. Other preventive treatments also generally aren’t covered.

For the full story, see:
DANA WECHSLER LINDEN. “Simple Dental Treatments Can Help Reverse Decay.” The Wall Street Journal (Tues., APRIL 12, 2016): D3.
(Note: ellipsis added.)
(Note: the online version of the story has the date April 11, 2016, and has the title “Simple Dental Treatments May Reverse Decay.”)

Government Regulations Protect Health-Care Incumbents Against Innovation

(p. A15) As people age, the main valve controlling the flow of blood out of the heart can narrow, causing heart failure, and sometimes death. In the past the only way to repair the damage was risky open-heart surgery. But an ingenious medical device now allows the heart to be repaired using a catheter that introduces a replacement valve through a main artery in the leg–another miracle of modern medicine.
In 2011, more than four years after they hit the European market, the Food and Drug Administration finally approved aortic heart valves for use in the U.S. The total cost of the new procedure is about the same as open-heart surgery. But government bureaucrats feared that the new replacement valve’s lower risks and easier administration would mean that many more elderly patients would seek to fix their failing heart valves, pushing up Medicare’s total spending. To limit their use, regulators created coverage rules based on a set of strained medical criteria. It was a budget prerogative masquerading as clinical reasoning.
This episode is a vivid example of the government’s increasing practice to regulate medicine and ration care. A series of landmark studies published earlier this month in the Lancet and the New England Journal of Medicine, and presented at the annual meeting of the American College of Cardiology in Chicago, makes clear how contrived the original Medicare guidelines were.
For a patient to be qualified for the aortic valve device, Medicare required two cardiac surgeons to certify first that a patient wasn’t a candidate for the open-heart repair. Also mandated was the presence of a cardiothoracic surgeon and an interventional cardiologist in the operating room during the procedure.

For the full commentary, see:
SCOTT GOTTLIEB. “Warning: Medicare May Be Bad for Your Heart; Aortic valve replacements are superior to open-heart surgery and less risky. So why are they hard to get?” The Wall Street Journal (Tues., April 12, 2016): A15.
(Note: the online version of the commentary has the date April 11, 2016.)

The Lancet article mentioned above, is:
Thourani, Vinod H., Susheel Kodali, Raj R. Makkar, Howard C. Herrmann, Mathew Williams, Vasilis Babaliaros, Richard Smalling, Scott Lim, S. Chris Malaisrie, Samir Kapadia, Wilson Y. Szeto, Kevin L. Greason, Dean Kereiakes, Gorav Ailawadi, Brian K. Whisenant, Chandan Devireddy, Jonathon Leipsic, Rebecca T. Hahn, Philippe Pibarot, Neil J. Weissman, Wael A. Jaber, David J. Cohen, Rakesh Suri, E. Murat Tuzcu, Lars G. Svensson, John G. Webb, Jeffrey W. Moses, Michael J. Mack, D. Craig Miller, Craig R. Smith, Maria C. Alu, Rupa Parvataneni, Ralph B. D’Agostino, Jr., and Martin B. Leon. “Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement in Intermediate-Risk Patients: A Propensity Score Analysis.” The Lancet (April 3, 2016), DOI: 10.1016/S0140-6736(16)30073-3.

The New England Journal of Medicine article mentioned above, is:
Leon, Martin B., Craig R. Smith, Michael J. Mack, Raj R. Makkar, Lars G. Svensson, Susheel K. Kodali, Vinod H. Thourani, E. Murat Tuzcu, D. Craig Miller, Howard C. Herrmann, Darshan Doshi, David J. Cohen, Augusto D. Pichard, Samir Kapadia, Todd Dewey, Vasilis Babaliaros, Wilson Y. Szeto, Mathew R. Williams, Dean Kereiakes, Alan Zajarias, Kevin L. Greason, Brian K. Whisenant, Robert W. Hodson, Jeffrey W. Moses, Alfredo Trento, David L. Brown, William F. Fearon, Philippe Pibarot, Rebecca T. Hahn, Wael A. Jaber, William N. Anderson, Maria C. Alu, and John G. Webb. “Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.” New England Journal of Medicine (April 2, 2016), DOI: 10.1056/NEJMoa1514616.

Government Limits Hospital Competition

(p. A9) When the 124-bed StoneSprings Hospital Center opened in December, it became the first new hospital in Loudoun County, Va., in more than a century. That’s more remarkable than it might at first seem: In the past two decades, Loudoun County, which abuts the Potomac River and includes growing Washington suburbs, has tripled in population. Yet not a single new hospital had opened. Why? One big reason is that StoneSprings had to fight through years of regulatory reviews and court challenges before laying the first brick.
County officials and the Hospital Corporation of America, or HCA, began talking about building a new hospital in 2001. But Virginia is one of the 36 states with a “certificate of need” law, which requires health-care providers to obtain a state license before opening a new facility. Getting a license is supposed to take about nine months, according to the state Health Department. HCA first submitted an application in July 2002 but didn’t win approval for a new facility until early 2004.
Then the plan faced a series of legal challenges from the Inova Health System, an entrenched, multibillion-dollar competitor. Over decades Inova has become the dominant player in the Virginia suburbs.
. . .
It’s not hard to understand why Inova might fight so hard to keep out challengers: There’s a direct correlation between prices and competition. In a paper released in December, economists with Yale, Carnegie Mellon and the London School of Economics evaluated claims data from Aetna, Humana and UnitedHealth. They found that rates were 15.3% higher, on average, in areas with one hospital, compared with those serviced by four or more. In markets with a two-hospital duopoly, prices were 6.4% higher. Where only three hospitals compete they were 4.8% higher.
Research by Chris Koopman of the free-market Mercatus Center suggests that Virginia could have 10,000 more hospital beds and 40 more hospitals offering MRIs if the certificate of need restrictions did not exist. “In many instances, they create a quasi-monopoly,” he says. “In essence, it’s a government guarantee that no one will compete with you, until you get notice and an opportunity to challenge that person’s entry into that market.”

For the full commentary, see:
ERIC BOEHM. “CROSS COUNTRY; For Hospital Chains, Competition Is a Bitter Pill; Building a new medical center in Virginia can take a decade, because state laws favor entrenched players.” The Wall Street Journal (Sat., Jan. 30, 2016): A9.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Jan. 29, 2016.)

The academic paper mentioned above that relates hospital charges to the number of hospitals in the area, is:
Cooper, Zack, Stuart V. Craig, Martin Gaynor, and John Van Reenen. “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured.” NBER Working Paper # 21815. National Bureau of Economic Research, Inc., 2015.

Chris Koopman’s research, mentioned above, can be found in:
Koopman, Christopher, and Thomas Stratmann. “Certificate-of-Need Laws: Implications for Virginia.” In Mercatus on Policy: Mercatus Center, George Mason University, 2015.

After Wife’s Cancer, F.D.A. Regulator Cuts Decision Time from Six to Five Months (Beyond Years Spent Testing)

(p. 1) BETHESDA, Md. — Mary Pazdur had exhausted the usual drugs for ovarian cancer, and with her tumors growing and her condition deteriorating, her last hope seemed to be an experimental compound that had yet to be approved by federal regulators.
So she appealed to the Food and Drug Administration, whose oncology chief for the last 16 years, Dr. Richard Pazdur, has been a man denounced by many cancer patient advocates as a slow, obstructionist bureaucrat.
He was also Mary’s husband.
In her struggle with cancer and ultimately her death in November, Ms. Pazdur had a part, her husband and a number of cancer specialists now say, in a profound change at the F.D.A.: a speeding up of the drug approval process. Ms. Pazdur’s three-year battle with cancer was a factor, they say, in Dr. Pazdur’s willingness to swiftly approve risky new treatments and passion to fight the disease that patient advocates thought he lacked.
. . .
(p. 13) Certainly there has been a change at the powerful agency. Since Ms. Pazdur learned she had ovarian cancer in 2012, approvals for drugs have been faster than at any time in the F.D.A.’s modern history. Although companies go through a yearslong discovery and testing process with new drugs before filing a formal application with the F.D.A., the average decision time on drugs by Dr. Pazdur’s oncology group has come down to five months from six months. That is a major acceleration in a pharmaceutical industry where every month’s delay can mean thousands of lives lost and sometimes hundreds of millions of dollars in sales that, given limited patent times, can never be recovered.
When asked specifically how his wife’s illness had changed his work at the F.D.A., Dr. Pazdur said he was intent on making decisions more quickly.
“I have a much greater sense of urgency these days,” Dr. Pazdur, 63, said in an interview. “I have been on a jihad to streamline the review process and get things out the door faster. I have evolved from regulator to regulator-advocate.”

For the full story, see:
GARDINER HARRIS. “A Wife’s Cancer Prods the F.D.A.” The New York Times, First Section (Sun., JAN. 3, 2016): 1 & 13.
(Note: ellipsis added.)
(Note: the online version of the story has the date JAN. 2, 2016, and has the title “F.D.A. Regulator, Widowed by Cancer, Helps Speed Drug Approval.”)

The Value of Longer Life

(p. C6) With the seeker’s restlessness that seems not to have left him until his last breath, . . . [Dr. Paul Kalanthi accrued] two B.A.s and an M.A. in literature at Stanford, then a Master of Philosophy at Cambridge, before graduating cum laude from the Yale School of Medicine. He returned to Stanford for a residency in neurological surgery and a postdoctoral fellowship in neuroscience. His training was almost complete when the bad diagnosis hit.
. . .
And then everything changes. In a single moment of recognition, everything Dr. Kalanithi has imagined for himself and his wife evaporates, and a new future has to be imagined.
. . . A job at Stanford for which he was the prime candidate? Not happening. Another good job that would require the Kalanithis to move to Wisconsin? Too far from his oncologist. Long-term plans of any kind? Well, what does long-term mean now? Does he have a day, a month, a year, six years, what? He’s heard the advice about living one day at a time, but what’s he supposed to do with that day when he doesn’t know how many others remain?

For the full review, see:
JANET MASLIN. “Books of The Times; Singularly Striving Until Life Steps In.”The New York Times (Tues., July 7, 2015): C1 & C6.
(Note: ellipses, and bracketed words, added.)
(Note: the online version of the review has the date July 6, 2015, and has the title “Books of The Times; Review: In ‘When Breath Becomes Air,’ Dr. Paul Kalanithi Confronts an Early Death.”)

The book under review, is:
Kalanithi, Paul. When Breath Becomes Air. New York: Random House, 2016.