Health – Page 79 – artdiamondblog.com

Curing Cancer Requires Enabling Serendipity, Not a Centrally Planned War

Happy Accidents is a wonderful book on serendipitous discovery that I ran across serendipitously. I had never heard of the author, but was interested in serendipity, so I started to collect books that Amazon says have something to do with serendipity. I let Happy Accidents sit on my shelf for about four years before starting to read.
The author is a retired, distinguished physician. The book is mainly a compendium of cases where major medical advances resulted from chance discoveries. Of course, the discoveries usually required more than just good luck. They usually required that someone was alert to the unexpected, and was willing to work in order to turn the unexpected into a cure. Their efforts are often made all the harder because of resistance from powerful incumbent “experts” and institutions. Often the discoveries go against the current theory, and are discovered by underfunded marginal outsiders.
Meyers points out that the centrally planned War on Cancer has cost the taxpayer a lot of money, and has largely failed to achieve its intended and predicted results. The reason is that you cannot centrally plan serendipity.
During the next several weeks, I will be quoting some of Meyers’ more revealing examples or thought-provoking comments.

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

Drugs May Rebuild Muscle in Frail Elderly

(p. B1) In 1997, scientist Se-Jin Lee genetically engineered “Mighty Mice” with twice as much muscle as regular rodents. Now, pharmaceutical companies are using his discovery to make drugs that could help elderly patients walk again and rebuild muscle in a range of diseases.
. . .
“I am very optimistic about these new drugs,” says Dr. Lee, a professor of molecular biology at Johns Hopkins University in Baltimore, who isn’t involved in any of the drug trials. “The fact that they’re so far along means to me they must have seen effects.”
Myostatin is a naturally occurring protein that curbs muscle growth. The drugs act by blocking it, or blocking the sites where it is detected in the body, potentially rebuilding muscle.

For the full story, see:
HESTER PLUMRIDGE and MARTA FALCONI. “Drugs Aim to Treat Frailty in Aging.” The Wall Street Journal (Mon., April 28, 2014): B1-B2.
(Note: ellipsis added.)
(Note: the second paragraph quoted above is divided into two mini-paragraphs in the online, but not in the print, version.)
(Note: the online version of the story has the date April 27, 2014, and has the title “Drugs Aim to Help Elderly Rebuild Muscle.”)

3.2 Million Waiting for Care Under England’s Single-Payer Socialized Medicine

(p. A13) . . . even as the single-payer system remains the ideal for many on the left, it’s worth examining how Britain’s NHS, established in 1948, is faring. The answer: badly. NHS England–a government body that receives about £100 billion a year from the Department of Health to run England’s health-care system–reported this month that its hospital waiting lists soared to their highest point since 2006, with 3.2 million patients waiting for treatment after diagnosis. NHS England figures for July 2013 show that 508,555 people in London alone were waiting for operations or other treatments–the highest total for at least five years.
Even cancer patients have to wait: According to a June report by NHS England, more than 15% of patients referred by their general practitioner for “urgent” treatment after being diagnosed with suspected cancer waited more than 62 days–two full months–to begin their first definitive treatment.
. . .
The socialized-medicine model is struggling elsewhere in Europe as well. Even in Sweden, often heralded as the paradigm of a successful welfare state, months-long wait times for treatment routinely available in the U.S. have been widely documented.
To fix the problem, the Swedish government has aggressively introduced private-market forces into health care to improve access, quality and choices. Municipal governments have increased spending on private-care contracts by 50% in the past decade, according to Näringslivets Ekonomifakta, part of the Confederation of Swedish Enterprise, a Swedish employers’ association.

For the commentary, see:
SCOTT W. ATLAS. “OPINION; Where ObamaCare Is Going; The government single-payer model that liberals aspire to for the U.S. is increasingly in trouble around the world.” The Wall Street Journal (Thur., Aug. 14, 2014): A13.
(Note: the online version of the commentary has the date Aug. 13, 2014.)

The Health Hazards of Government Guidelines on Salt

Source of graphic: online version of the WSJ article quoted and cited below.

(p. A1) A long-running debate over the merits of eating less salt escalated Wednesday when one of the most comprehensive studies yet suggested cutting back on sodium too much actually poses health hazards.

Current guidelines from U.S. government agencies, the World Health Organization, the American Heart Association and other groups set daily dietary sodium targets between 1,500 and 2,300 milligrams or lower, well below the average U.S. daily consumption of about 3,400 milligrams.
The new study, which tracked more than 100,000 people from 17 countries over an average of more than three years, found that those who consumed fewer than 3,000 milligrams of sodium a day had a 27% higher risk of death or a serious event such as a heart attack or stroke in that period than those whose intake was estimated at 3,000 to 6,000 milligrams. Risk of death or other major events increased with intake above 6,000 milligrams.
The findings, published in the (p. A2) New England Journal of Medicine, are the latest to challenge the benefit of aggressively low sodium targets–especially for generally healthy people. Last year, a report from the Institute of Medicine, which advises Congress on health issues, didn’t find evidence that cutting sodium intake below 2,300 milligrams reduced risk of cardiovascular disease.

For the story, see:
RON WINSLOW. “Low-Salt Diets May Pose Health Risks, Study Finds.” The Wall Street Journal (Thur., Aug. 14, 2014): A1-A2.
(Note: the online version of the story has the date Aug. 13, 2014, an has the title “Low-Salt Diets May Pose Health Risks, Study Finds.”)

Butter Is Back

(p. B1) Changing views of nutrition are turning butter into one of the great comeback stories in U.S. food history.
. . .
The revival flows in part from new legions of home gourmets inspired by celebrity chefs and cooking shows with butter-rich recipes. Butter makers have encouraged the trend, using food channels and websites to promote what they say is their products’ natural simplicity.
Butter’s shifting fortunes also reflect the vicissitudes of thinking on healthy eating that rattle the national diet. Families for decades opted for vegetable spreads because of concerns about butter’s high concentration of saturated fat, only to be told more recently that the trans fats traditionally contained in margarine are just as unhealthy. Many Americans also have altered their thinking on how important reducing all fat is for controlling weight.

For the full story, see:
KELSEY GEE. “Butter Makes Comeback as Margarine Loses Favor.” The Wall Street Journal (Thurs., June 26, 2014): B1-B2.
(Note: ellipsis added.)
(Note: the last quoted sentence was in the online, but not the print, version.)
(Note: the online version of the review has the date June 25, 2014, and has the title “Butter Makes Comeback as Margarine Loses Favor.”)

“The Lone Commando Who Answers to No One and Breaks Rules to Save Patients Is No Longer a Viable Job Description”

(p. D5) A keen sense of loss permeates “Code Black,” an affecting love letter from a young doctor to his hospital. Over the years, plenty of similar romances have been immortalized in book form, but this may be the first to play out as a documentary, and is surely the first to emerge from our newly reformed health care climate. You’d think you’d be in for some celebration.
But not in the least. In fact, among all its familiar themes, the film’s most striking is the profound sense of estrangement between the young doctors on the screen and all the recent efforts at improving the health care system. The spirit that brought them to medicine and keeps them there, they say over and over, was never even part of the national discussion.
. . .
. . . , as their department chairman points out, the day of the cowboy doctor is over; the lone commando who answers to no one and breaks rules to save patients is no longer a viable job description. Newly smothered in paperwork and quality control, many of these young doctors grieve for a self-image that has ridden off into the sunset.

For the full review, see:
ABIGAIL ZUGER, M.D.. “Saving Lives and Pushing Paper.” The New York Times (Tues., July 1, 2014): D5.
(Note: ellipses added.)
(Note: the online version of the review has the date JUNE 30, 2014.)

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

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

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

“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].