Category: Health

“Long, Lonely Odyssey “from Heresy to Orthodoxy””

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Source of book image: online version of the NYT review quoted and cited below.

(p. D5) As the Nobel committee put it in the 1997 citation for Dr. Prusiner’s prize in physiology or medicine, he had established “a novel principle of infection” — one so controversial that a few experts in the field still continue to search for that elusive virus. But as far as Dr. Prusiner is concerned, the Nobel confirmed that his long, lonely odyssey “from heresy to orthodoxy” was over.

The journey he details was full of hurdles. Some were of the kind likely to befall any researcher: insufficient laboratory space, poor correlation between needs and resources. (At one point, Dr. Prusiner calculated that for a single year’s worth of experiments he would have to house and feed 72,000 mice, an impossible multimillion-dollar proposition.) He submitted a grant application that was not just rejected for funding but actually “disapproved,” often the kiss of death for a train of scientific thought.
Some of his problems were a little darker but still universal — graduate students captured by competing labs, data appropriated and misrepresented by erstwhile colleagues, bitter authorship battles.
Some of Dr. Prusiner’s shoals, however, seem more particular to his personal operating style. As a teenager he was blessed with what he describes as indefatigable self-confidence, and this trait apparently endures, to the considerable irritation of others.

For the full review, see:
ABIGAIL ZUGER, M.D. “Books; A Victory Lap for a Heretical Neurologist.” The New York Times (Sat., May 20, 2014): D5.
(Note: the online version of the review has the date May 19, 2014.)

The book under review is:
Prusiner, Stanley B. Madness and Memory: The Discovery of Prions–a New Biological Principle of Disease. New Haven, CT: Yale University Press, 2014.

The Opportunity Cost of Surgeons Dictating and Documenting Health Records

(p. A13) Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

For the full commentary, see:
DANIEL F. CRAVIOTTO JR. “A Doctor’s Declaration of Independence; It’s time to defy health-care mandates issued by bureaucrats not in the healing profession.” The Wall Street Journal (Tues., April 29, 2014): A13.
(Note: the online version of the commentary has the date April 28, 2014.)

How Medicaid Rewards Doctors Who Mistreat Patients

(p. A13) I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT, code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled.
During the surgery, I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes.
However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment. Ironically, the code-listed payment for the procedure I ultimately performed was an amount 40% less than the amount approved for the initially authorized surgery. For over a year, I challenged Medicaid about its decision to deny payment. I wrote numerous letters and spoke to many Medicaid employees explaining the predicament. Eventually I gave up fighting what had obviously become a losing battle.

For the full commentary, see:
ZANE F. POLLARD. “The Bureaucrat Sitting on Your Doctor’s Shoulder; When I’m operating on a child, I shouldn’t have to wonder if Medicaid will OK a change in the surgical plan..” The Wall Street Journal (Thurs., May 22, 2014): A13.
(Note: the online version of the commentary has the date May 21, 2014.)

Government Regulations Favor Health Care Incumbents

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Source of book image: online version of the WSJ review quoted and cited below.

(p. A11) The rise in U.S. health-care costs, to nearly 18% of GDP today from around 6% of GDP in 1965, has alarmed journalists, inspired policy wonks and left patients struggling to find empathy in a system that tends to view them as “a vessel for billing codes,” as the technologist Dave Chase has put it.

Enter Jonathan Bush, dyslexic entrepreneur, . . .
. . .
. . . , Mr. Bush touts technology as a driver of change. It has revolutionized the way we shop for books and select hotels, but health-care delivery has been stubbornly resistant. Mr. Bush notes that the number of people supporting each doctor has climbed to 16 today from 10 in 1990–half of whom, currently, are administrators handling the mounting paperwork. Astonishingly, as Mr. Bush observes, the government had to pay doctors billions of dollars, via the 2009 HITECH Act, to incentivize them to upgrade from paper to computers. Meanwhile, fast-food chains discovered computers on their own, because the market demanded it.
. . .
Let entrepreneurs loose on these challenges, Mr. Bush believes, and they will come up with solutions.
Mr. Bush identifies three major obstacles to the kinds of change he has in mind. First, large hospital systems leverage their market position to charge hefty premiums for basic services, then use the proceeds to buy more regional hospitals and local practices. “As big ones take over the small,” Mr. Bush laments, “prices shoot up. Choices vanish.” Second, government regulations, especially state laws, favor powerful incumbents, shielding “imaging centers and hospitals from competition.” Third, heath care suffers from a risk-avoidant culture. The maxim “do no harm,” Mr. Bush says, should not be an excuse for clinging to a flawed status quo.

For the full review, see:
David A. Shaywitz. “BOOKSHELF; A System Still in Need of Repair; Routine medical services can be done for less cost–one of many obvious realities that current health-care practices studiously ignore.” The Wall Street Journal (Mon., May 19, 2014): A11.
(Note: ellipses added.)
(Note: the online version of the review has the date May 18, 2014, and has the title “BOOKSHELF; Book Review: ‘Where Does It Hurt?’ by Jonathan Bush; Routine medical services can be done for less cost–one of many obvious realities that current health-care practices studiously ignore.”)

The book under review is:
Bush, Jonathan, and Stephen Baker. Where Does It Hurt?: An Entrepreneur’s Guide to Fixing Health Care. New York: Portfolio, 2014.

Young Inca Woman Was Probably Murdered

MurderedIncanYoungWoman2014-04-28.jpg “The Incan mummy.” Source of caption and photo: online version of the NYT article quoted and cited below.

Hobbes famously wrote that for most of human existence, life has been “poor, nasty, brutish, and short.” Further evidence:

(p. D4) Scientists who have examined the mummy of a young Inca say that her death was most likely a homicide and that it was not because of Chagas disease, the tropical parasitic infection that she had.

For the full story, see:
“Observatory; A Verdict of Murder.” The New York Times (Tues., MARCH 4, 2014): D4.
(Note: the online version of the story has the date MARCH 3, 2014.)

The famous Hobbes quote can be found on p. 70 of:
Hobbes, Thomas. Leviathan, Dover Philosophical Classics. Mineola, New York: Dover Publications, Inc., 2006 [first published 1651].

Crispr Molecular System Allows Scientists to Edit Genes

CrisprEditsGenes2014-04-28.jpgSource of graph: online version of the NYT article quoted and cited below.

(p. D1) In the late 1980s, scientists at Osaka University in Japan noticed unusual repeated DNA sequences next to a gene they were studying in a common bacterium. They mentioned them in the final paragraph of a paper: “The biological significance of these sequences is not known.”
Now their significance is known, and it has set off a scientific frenzy.
The sequences, it turns out, are part of a sophisticated immune system that bacteria use to fight viruses. And that system, whose very existence was unknown until about seven years ago, may provide scientists with unprecedented power to rewrite the code of life.
In the past year or so, researchers have discovered that the bacterial system can be harnessed to make precise changes to the DNA of humans, as well as other animals and plants.
This means a genome can be edited, much as a writer might change words or fix spelling errors. It allows “customizing the genome of any cell or any species at will,” said Charles Gersbach, an assistant professor of biomedical engineering at Duke University.

For the full story, see:
ANDREW POLLACK. “A Powerful New Way to Edit DNA.” The New York Times (Tues., MARCH 4, 2014): D1 & D5.
(Note: the online version of the story has the date MARCH 3, 2014.)

30,000 Year Old Virus Revived from Permafrost

(p. D5) From Siberian permafrost more than 30,000 years old, [French and Russian researchers] have revived a virus that’s new to science.
“To pull out a virus that’s 30,000 years old and actually grow it, that’s pretty impressive,” said Scott O. Rogers of Bowling Green State University who was not involved in the research. “This goes well beyond what anyone else has done.”
. . .
Measuring 1.5 micrometers long, the viruses are 25 percent bigger than any virus previously found.
. . .
“Sixty percent of its gene content doesn’t resemble anything on earth,” Dr. Abergel said. She and her colleagues suspect that pithoviruses may be parasitic survivors of life forms that were very common early in the history of life.
. . .
“Its potential implications for evolutionary theory and health are quite astonishing,” said Eske Willerslev, an evolutionary biologist at the University of Copenhagen.

For the full story, see:
Carl Zimmer. “Out of Siberian Ice, a Virus Revived.” The New York Times (Tues., MARCH 4, 2014): D5.
(Note: ellipses, and bracketed words, added.)
(Note: the online version of the story has the date MARCH 3, 2014.)

In France “‘Liberté, Égalité, Fraternité’ Means that What’s Yours Should Be Mine”

SantacruzGuillaumeFrenchEntrepreneurInLondon2014-04-27.jpgGuillaume Santacruz is among many French entrepreneurs now using London as their base. He said of his native France, “The economy is not going well, and if you want to get ahead or run your own business, the environment is not good.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. 1) Guillaume Santacruz, an aspiring French entrepreneur, brushed the rain from his black sweater and skinny jeans and headed down to a cavernous basement inside Campus London, a seven-story hive run by Google in the city’s East End.
. . .
A year earlier, Mr. Santacruz, who has two degrees in finance, was living in Paris near the Place de la Madeleine, working in a boutique finance firm. He had taken that job after his attempt to start a business in Marseille foundered under a pile of government regulations and a seemingly endless parade of taxes. The episode left him wary of starting any new projects in France. Yet he still hungered to be his own boss.
He decided that he would try again. Just not in his own country.
“A lot of people are like, ‘Why would you ever leave France?’ ” Mr. Santacruz said. “I’ll tell you. France has a lot of problems. There’s a feeling of gloom that seems to be growing deeper. The economy is not going well, and if you want to get ahead or run your own business, the environment is not good.”
. . .
(p. 5) “Making it” is almost never easy, but Mr. Santacruz found the French bureaucracy to be an unbridgeable moat around his ambitions. Having received his master’s in finance at the University of Nottingham in England, he returned to France to work with a friend’s father to open dental clinics in Marseille. “But the French administration turned it into a herculean effort,” he said.
A one-month wait for a license turned into three months, then six. They tried simplifying the corporate structure but were stymied by regulatory hurdles. Hiring was delayed, partly because of social taxes that companies pay on salaries. In France, the share of nonwage costs for employers to fund unemployment benefits, education, health care and pensions is more than 33 percent. In Britain, it is around 20 percent.
“Every week, more tax letters would come,” Mr. Santacruz recalled.
. . .
Diane Segalen, an executive recruiter for many of France’s biggest companies who recently moved most of her practice, Segalen & Associés, to London from Paris, says the competitiveness gap is easy to see just by reading the newspapers. “In Britain, you read about all the deals going on here,” Ms. Segalen said. “In the French papers, you read about taxes, more taxes, economic problems and the state’s involvement in everything.”
. . .
“It is a French cultural characteristic that goes back to almost the revolution and Robespierre, where there’s a deep-rooted feeling that you don’t show that you make money,” Ms. Segalen, the recruiter, said. “There is this sense that ‘liberté, égalité, fraternité’ means that what’s yours should be mine. It’s more like, if someone has something I can’t have, I’d rather deprive this person from having it than trying to work hard to get it myself. That’s a very French state of mind. But it’s a race to the bottom.”

For the full story, see:
LIZ ALDERMAN. “Au Revoir, Entrepreneurs.” The New York Times, SundayBusiness Section (Sun., MARCH 23, 2014): 1 & 5.
(Note: ellipses added.)
(Note: the online version of the story has the date MARCH 22, 2014.)

SegalenDianeFrenchEntrepreneurInLondon2014-04-27.jpg ‘Diane Segalen moved most of her executive recruiting practice to London from Paris. In France, she says, “there is this sense that ‘liberté, égalité, fraternité’ means that what’s yours should be mine.”” Source of caption and photo: online version of the NYT article quoted and cited above.

Heart Pioneer Bailey Kept Moving from Hospital to Hospital Due to His Failures

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Source of book image:
http://media.npr.org/assets/bakertaylor/covers/e/extreme-medicine/9781594204708_custom-14713d8588e54f066a6abf7b5a13e4c9de832ea1-s6-c30.jpg

(p. C8) In “Extreme Medicine,” physician Kevin Fong reminds us that virtually everything we take for granted in lifesaving medical intervention was once unthinkable. Over the past century, as technology has allowed man to conquer hostile environments and modernize warfare, medical pioneers have been on a parallel journey, confronting what had once been fatal in man’s boldest pursuits and making it survivable.
. . .
As Dr. Fong notes, many of today’s commonplace treatments were once dangerously experimental. One pioneer in the early postwar years, a Philadelphia surgeon named Charles Bailey, killed several patients while trying to repair problems of the mitral valve, which if damaged can cause blood to flow backward into the hear chamber, decreasing flow to the rest of the body. Bailey moved from hospital to hospital to avoid scrutiny of his successive failures.

For the full review, see:
LAURA LANDRO. “BOOKS; They Died So We Might Live; Hypothermia, which killed explorers like Scott, is now induced in heart patients to allow time for surgery.” The Wall Street Journal (Sat., Feb. 15, 2014): C8.
(Note: ellipsis added.)
(Note: the online version of the review has the date Feb. 14, 2014, and has the title “BOOKSHELF; Book Review: ‘Extreme Medicine’ by Kevin Fong; Explorers, astronauts and soldiers all pushed the limits of doctors’ abilities to heal and repair.”)

The book under review is:
Swidey, Neil. Trapped under the Sea: One Engineering Marvel, Five Men, and a Disaster Ten Miles into the Darkness. New York: Crown Publishers, 2014.

Sweden Shows ObamaCare Will Cause Health Care Delays and Rationing

(p. A11) President Obama has declared the Affordable Care Act a success–a reform that is “here to stay.” The question remains, however: What should we expect to come out of it, and do we want the effects to stay? If the experiences of Sweden and other countries with universal health care are any indication, patients will soon start to see very long wait times and difficulty getting access to care.
. . .
Rationing is an obvious effect of economic planning in place of free-market competition. Free markets allow companies and entrepreneurs to respond to demand by offering people what they want and need at a better price. Effective and affordable health care comes from decentralized innovation and risk-taking as well as freedom in pricing and product development. The Affordable Care Act does the opposite by centralizing health care, minimizing or prohibiting differentiation in pricing and offerings, and mandating consumers to purchase insurance. It effectively overrides the market and the signals it sends about supply and demand.
Stories of people in Sweden suffering stroke, heart failure and other serious medical conditions who were denied or unable to receive urgent care are frequently reported in Swedish media. Recent examples include a one-month-old infant with cerebral hemorrhage for whom no ambulance was made available, and an 80-year-old woman with suspected stroke who had to wait four hours for an ambulance.
Other stories include people waiting many hours before a nurse or anyone talked to them after they arrived in emergency rooms and then suffering for long periods of time before receiving needed care. A 42-year-old woman in Karlstad seeking care for meningitis died in the ER after a three-hour wait. A woman with colon cancer spent 12 years contesting a money-saving decision to deny an abdominal scan that would have found the cancer earlier. The denial-of-care decision was not made by an insurance company, but by the government health-care system and its policies.

For the full commentary, see:
PER BYLUND. “OPINION; What Sweden Can Teach Us About ObamaCare; Universal public health care means the average Swede with ‘high risk’ prostate cancer waits 220 days for treatment.” The Wall Street Journal (Fri., April 18, 2014): A11.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date April 17, 2014.)

Research on Dogs that Benefits Both Humans and Dogs

MooreEricaExaminesAkyra2014-04-24.jpg “Erica Moore examined Akyra, a shih tzu, in August before the dog was enrolled in Penn Vet’s canine mammary tumor program. She had surgery there.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. D6) Akyra’s mammary glands were riddled with tumors, including one the size of a golf ball. She would be hard to place in a home, and the medical care she needed would be expensive. The tumors could be cancerous.

“When my husband called and said they were going to leave one of the dogs behind because she had mammary tumors, I said, ‘No, you’re not!’ ” said Bekye Eckert, 49, a dog lover who lives outside Baltimore and has cared for several animals with mammary cancer.
Ms. Eckert arranged for Akyra to be enrolled in an innovative program at the University of Pennsylvania, where veterinary oncologists are learning about the progression of human breast cancer by treating mammary tumors in shelter dogs.
. . .
Generally, two sets of tumor samples are taken from each dog, one for the pathology lab and one for Dr. Troyanskaya to use for molecular analysis. Astrid, for example, had tumors in seven mammary glands that were mostly benign. The largest proved to be malignant.
Such a large set of samples is a gold mine for Dr. Troyanskaya, who is looking for changes in the expression of a specific gene or group of genes, or pathways linking groups of genes as the tumor becomes malignant.
. . .
In the meantime, stray dogs are getting free cancer treatment that makes it easier to find them permanent homes, and they are promised care for any recurrence. More than 100 dogs have been through the program; several have been adopted by women who also survived breast cancer.
For Akyra, there was good news. She had surgery in August, and veterinarians removed the large tumor and three smaller lesions. The pathology report gave her a clean bill of health: None were cancerous. She was adopted by Beth Gardner, a relocation consultant in Devon, Pa.

For the full story, see:
RONI CARYN RABIN. “By Treating Dogs, Answers About Breast Cancer.” The New York Times (Tues., April 1, 2014): D6.
(Note: ellipses added.)
(Note: the online version of the commentary has the date MARCH 31, 2014, and has the title “From Dogs, Answers About Breast Cancer.”)