Category: Health

Industrial Giants Succeeded in Philanthropy in the Same Way They Succeeded in Business

(p. 3) . . . the Gateses were not the first to see that money could sometimes move mountains in public health. They are following in the footsteps of the industrial giants of the late-19th century, said Dr. Howard Markel, director of the University of Michigan’s Center for the History of Medicine.

These men also brought their fortunes to bear on social problems, and believed that they could succeed in philanthropy in much the way they had succeeded in business.
The donors of the robber-baron years started their philanthropy while still alive – a novel idea then. Andrew Carnegie, for example, gave away hundreds of millions of dollars to build libraries long before his death.
The largest bequest in American history prior to Carnegie’s time was from Johns Hopkins, a Baltimore merchant, who left $7 million to found the eponymous university and hospital in 1873 – after he died.
But the closest parallel to the Gates approach to philanthropy is that of John D. Rockefeller, said Dr. Markel and Robert E. Kohler, a medical historian from the University of Pennsylvania.
Rockefeller built Standard Oil. Like Mr. Gates, he was the richest man of his time, and like him he was reviled as a greedy monopolist.
Rockefeller, like Mr. Gates, hired a professional to run his charities. And he, like Mr. Gates, used his money systematically to identify and attack important public health problems.
Rockefeller hired Frederick T. Gates, a former minister (and no relation to the Microsoft co-founder) as his philanthropic executive. Mr. Gates read an 1892 medical textbook that convinced him that diseases had causes, like germs and worms, that could be fought by science – not a universally accepted idea at the time.
The most famous health campaign he started with Rockefeller money was the drive, begun in 1907, to rid the rural American South of hookworm. Called “the germ of laziness” because it caused anemia and made victims lethargic and dull-witted, hookworm afflicted up to a third of Southerners.
The foundation set up clinics that administered purgatives and – because the worm is shed in feces and picked up by bare feet – taught people to dig deep privies and wear shoes. More Rockefeller money underwrote some of the 20th century’s great public health drives, many using research done at Rockefeller University. Clinics were built in 50 other countries to eliminate hookworm worldwide. The effort failed because the worm can survive in soil and reinfect people; but the problem diminished, especially in parts of Asia.
In 1915, the foundation declared war on yellow fever; by 1932, scientists had realized that monkeys were also a reservoir for the virus, making eradication impossible, but by then Rockefeller scientists had invented the vaccine still used today.
Patty Stonesifer, chief executive of the Gates foundation, said she and William H. Gates Sr., the father of the software pioneer and co-chair of the foundation, consider the Rockefeller campaigns especially instructive. “We stood on their shoulders,” she said.
. . .
As Ms. Stonesifer said admiringly of the Rockefeller campaign against hookworm: “A lot of people would say, ‘you’ve got to reduce poverty to get rid of hookworm.’ But the Rockefellers said, ‘You don’t need a 20-year intervention. You can use shoes.’ “

For the full article, see:

DONALD G. McNEIL Jr. “The Rich, Sometimes, Are the Best Medicine.” The New York Times, Section 4 (Sun., December 11, 2005): 3.
(Note: ellipses added.)

Dear Feds: Stop Bugging US!

15bugs.1842.jpg Asian lady beetles (Photo source: online version of article cited below, downloaded from: http://www.nytimes.com/2005/11/15/national/15bugs.html?pagewanted=1)

(p. A18) This Asian cousin of the benign, beloved ladybug has transformed domestic life in rural and suburban regions from Louisiana to Canada, intruding on the peace – and the attics, curtains and nostrils – of a significant swath of the nation.

Some years, the beetle problem is terrible. Some years, like this one, there are fewer beetles. But even so, in the 12 years that the beetle has spread from the South through the East and Midwest, irritation has given way to fury in its favorite wooded haunts.
“Please help us get rid of these bugs!” one Kentuckian commented on an anonymous survey by the University of Kentucky’s entomology department. “It’s so bad you can’t eat safely. They are falling into the food and drinks.”
A second person wrote, “A huge swarm enveloped my house last fall, causing me to fall off the porch and break my shoulder.” From a third came a cri de coeur: “Get rid of these pests. They are making me crazy. They have ruined my life.”
Unlike domestic ladybugs, the multicolored Asian variety likes to keep its polka dots indoors in the winter. In older rural neighborhoods, where houses are not knit tight, only insecticide can hope to keep them out. They swarm by the tens of thousands. Unlike the domestic ladybug, the Asian variety leaves a yellow stain. It can bite. Worst of all, it stinks.
. . .
It was for the benefit of farmers like the pecan growers that the Department of Agriculture released Asian lady beetles in the 1980’s in Georgia and elsewhere. The promise of aphid-free fruit trees and crops had prompted the department to try to import the bugs repeatedly, from 1916 on. But they never seemed to survive, until the early 1990’s.
A 1995 article in the journal Agricultural Research quoted William H. Day, a federal entomologist with the Agricultural Research Service, saying, “U.S.D.A. scientists have gone overseas for more than 100 years to search for, test, import, rear, release and evaluate exotic beneficial lady beetles, parasitic wasps, other insects and microorganisms.”

FELICITY BARRINGER. “Asian Cousin of Ladybug Is a Most Unwelcome Guest.” The New York Times (Tuesday, November 15, 2005): A18.
(Note: ellipsis added.)

Even Medical Experts Can’t Understand Their Medical Bills

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out — known as E.O.B.’s — are filled with unintelligible codes.
The system is so impenetrable that it mystifies even the most knowledgeable.
”I’m the president’s senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old’s care, I can’t figure out what happened, or what I’m supposed to do,” said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. ”I can’t figure out what care it was related to or who did what.”
Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer.
”I understand the words of diagnoses and procedures,” he said. ”But codes? No. Or how things are paid or not paid? I don’t understand that.”
Dr. Brailer said he often used an analogy to describe the current state of medical billing.
”Suppose you walk into a restaurant,” he said, ”and you don’t get a menu, you don’t get any choice of what food you’ll eat, they don’t tell you what it is when they’re serving it to you, they don’t tell you what it’s going to cost.”
”Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don’t, and although you get the bill, you still can’t figure out what you really owe,” Dr. Brailer said.
Some people make valiant efforts to sort through bills and claims, but end up throwing up their hands; others ignore them, until they are pursued by collection agencies; still others, basically healthy but weary at the prospect of a paperwork fusillade, stop going to the doctor altogether.

KATIE HAFNER. “Treated for Illness, Then Lost in Labyrinth of Bills.” The New York Times (October 13, 2005): A1.

Early Detection Does Not Always Lengthen Life

Unfortunately some cancer tests do a lot more good for doctors’ revenues than they do for patients’ longevity:

“The improvement in long-term mortality may be due to the higher proportion of small or slow-growing tumors being detected, which means you start counting earlier,” says Dr. Jaffe. That’s why longer survival, measured from the time of diagnosis, is a misleading measure of progress against cancer, and no substitute for reductions in mortality.
The more scientists study cancers, the more indolent ones they discover. Researchers in Japan, for instance, find that CT scans detect almost as many lung lesions in nonsmokers as in smokers. But since nonsmokers have a mortality rate from lung cancer less than 10% that of smokers, the vast majority of what CT scans picked up would never have progressed to anything life-threatening. And a Mayo Clinic study found that although X-rays detect lung cancers at earlier stages, and lead to more five-year survivors, early detection does not lower death rates.
For colon cancer, the fecal occult blood test “does decrease your risk of dying of this cancer,” says Dr. Kramer. “But for colonoscopy and sigmoidoscopy, which appeal to our intuition [about early detection], the evidence is not great.” They pick up polyps earlier, but not all polyps become cancers, “and we don’t know what proportion would lead to death.”
The Pap test for cervical cancer has saved lives, but many of the abnormal cells it finds wouldn’t go on to become cancer. Most women with low-grade or even high-grade lesions would have been fine anyway. Similarly, the PSA test for prostate cancer picks up tumors that are biologically nonaggressive.
The discovery that many tumors are innocuous casts doubt on the value of new screening tests. “You may fool yourself into thinking a test is twice as sensitive,” says Dr. Kramer, “but the only extra cancers it picks up are those that wouldn’t have harmed the patient.

SHARON BEGLEY. “Early Cancer Detection Doesn’t Always Give Patient an Advantage.” The Wall Street Journal (August 26, 2005): B1.

Medical Studies Frequently Not Confirmed

According to a study published in the July 13, 2005 Journal of the American Medical Association (JAMA) by Dr. John Ioannidis, almost a third of the medical studies included in his sample, were eventually either contradicted by subsequent studies (16%) or else required significant modification. (One media report summarizing the study appears at: http://www.newsday.com/news/health/ny-hsdrug4348592jul19,0,2629446.story?coll=ny-health-headlines)
This is only surprising in the face of the certainty with which the media and parts of the medical establishment, totally embrace each new study as it appears. Perhaps the tentativenss, and revisability of medical research argues for allowing patients more choice in their treatment?