Category: Health

Forssmann’s Courage Rewarded with “Professional Criticism and Scorn”

(p. 197) Forssmann’s report in the leading German medical journal garnered him not hosannas but instead fierce professional criticism and scorn. In response to a senior physician who claimed undocumented priority for the procedure, the twenty-five-year-old Forssmann was forced to provide an addendum to his publication one month later. Rigid dogmatism and an authoritarian hierarchy characterized the German medicine of that day. The human heart, as the center of life, was considered inviolable by instrumentation and surgery.

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

Denied Approval to Catheterize Hearts, Forssmann Catheterized His Own

(p. 195) Forssmann received his medical degree from the University of Berlin in 1929. That year, he interned at a small hospital northwest of Berlin, the Auguste-Viktoria-Heim in Eberswalde. He pleaded with his superiors for approval to try a new procedure–to inject drugs directly into the heart–but was unable to persuade them of his new concept’s validity. Undaunted, Forssmann proceeded on his own. His goal was to improve upon the administration of drugs into the central circulation during emergency operations.
The circumstances of the incident on November 5, 1929, revealed by Forssmann in his autobiography, could hardly have been (p. 196) more dramatic. The account reflects Forssmann’s dogged determination, willpower, and extraordinary courage. He gained the trust of the surgical nurse who provided access to the necessary instruments. So carried away by Forssmann’s vision, she volunteered herself to undergo the experiment. Pretending to go along with her, Forssmann strapped her down to the table in a small operating room while his colleagues took their afternoon naps. When she wasn’t looking, he anesthetized his own left elbow crease. Once the local anesthetic took effect, Forssmann quickly performed a surgical cutdown to expose his vein and boldly manipulated a flexible ureteral catheter 30 cm toward his heart. This thin sterile rubber tubing used by urologists to drain urine from the kidney was 65 cm long (about 26 inches). He then released the angry nurse.
They walked down two flights of stairs to the X-ray department, where he fearlessly advanced the catheter into the upper chamber (atrium) on the right side of his heart, following its course on a fluoroscopic screen with the aid of a mirror held by the nurse. (Fluoroscopy is an X-ray technique whereby movement of a body organ, an introduced dye, or a catheter within the body can be followed in real time.) He documented his experiment with an X-ray film. Forssmann was oblivious to the danger of abnormal, potentially fatal heart rhythms that can be provoked when anything touches the sensitive endocardium, the inside lining of the heart chambers.

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

Major Cancer Drugs Have Come from Unexpected Sources

(p. 182) Starting in the last decades of the twentieth century, last decades of the twentieth century, sophisticated genetics and molecular biology have been aimed toward a more precise understanding of the cell’s mechanisms. Yet, even here, chance has continued to be a big factor. Surprising discoveries led to uncovering cancer-inducing genes (oncogenes) and tumor-suppressing genes, both of which are normal cellular genes that, when mutated, can induce a biological effect that predisposes the cell to cancer development. A search for blood substitutes led to anti-angiogenesis drugs. Veterinary medicine led to oncogenes and vaccine preparations to tumor-suppressor genes. In one of the greatest serendipitous discoveries of (p. 183) modern medicine, stem cells were stumbled upon during research on radiation effects on the blood.
Experience has clearly shown that major cancer drugs have been discovered by independent, thoughtful, and self-motivated researchers–the cancer war’s “guerrillas,” to use the reigning metaphor–from unexpected sources: from chemical warfare (nitrogen mustard), nutritional research (methotrexate), medicinal folklore (the vinca alkaloids), bacteriologic research (cisplatin), biochemistry research (sex hormones), blood storage research (angiogenic inhibitors), clinical observations (COX-2 inhibitors), and embryology (thalidomide).

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

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.)