Health – Page 97 – artdiamondblog.com

“Don’t Kill the Goose”

(p. A11) I think there are two major but not fully formed or fully articulated fears among thinking Americans right now, and the deliberate obscurity of official language only intensifies those fears.

The first is that Mr. Obama’s government, in all its flurry of activism, may kill the goose that laid the golden egg. This is as dreadful and obvious a cliché as they come, but too bad, it’s what people fear. They see the spending plans and tax plans, the regulation and reform hunger, the energy proposals and health-care ambitions, and they–we–wonder if the men and women doing all this, working in their separate and discrete areas, are being overseen by anyone saying, “By the way, don’t kill the goose.”
The goose of course is the big, messy, spirited, inspiring, and sometimes in some respects damaging but on the whole brilliant and productive wealth-generator known as the free-market capitalist system. People do want things cleaned up and needed regulations instituted, and they don’t mind at all if the very wealthy are more heavily taxed, but they greatly fear a goose killing. Economic freedom in all its chaos and disorder has kept us rich for 200 years, and allowed us as a nation to be generous and strong at home and in the world. But the goose can be killed–by carelessness, hostility, incrementalism, paralysis, and by no one saying, “Don’t kill the goose.”

For the full commentary, see:
PEGGY NOONAN. “What’s Elevated, Health-Care Provider? Economy of language would be good for the economy.” Wall Street Journal (Sat., MAY 15, 2009): A11.

Medical Care is Much Advanced Since Victorian Era of Mid-1800s

In the final sentences quoted below, note the under-appreciated role of air conditioning, and electric light, in advancing medical education.

(p. W6) “Gray’s Anatomy” is one of the most famous medical books of all time, but if a picture is worth a thousand words, then the man most responsible for the success of the book was its long-forgotten illustrator, Henry Vandyke Carter. In “The Making of Mr. Gray’s Anatomy,” Ruth Richardson shows how Carter and Henry Gray came together to produce a classic that originally bore neither of their names — it was published as “Anatomy Descriptive and Surgical” — but she also affords us a remarkable glimpse of science in the 19th century.
. . .
Not much of a paper record exists regarding Henry Gray’s life. Ms. Richardson speculates that his possessions were burned in the “Victorian terror” stirred by smallpox, the disease that would kill him at age 34. Henry Carter kept a diary, but its contents are not exactly a trove of detail about his life and times. . . .
. . .
Describing their methods, Ms. Richardson reminds us of what we now take for granted in medicine by relating what wasn’t feasible back then. The “dissecting season” was the colder months, January-March, to make the most of the cadavers’ preservation. And the work day had to begin soon after dawn because sunlight was so much better for close observation than any other light source.

For the full review, see:
MARK F. TEAFORD. “Dissecting an Unheralded Alliance; A classic medical text bears one man’s name, but it was the product of a true collaboration.” Wall Street Journal (Fri., MARCH 27, 2009): W6.
(Note: ellipses added.)

The reference to the reviewed book is:
Richardson, Ruth. The Making of Mr. Gray’s Anatomy. Oxford, UK: Oxford University Press.

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

Greenmarket Rules Are “Cumbersome, Confusing and Contradictory”

“Dante Hesse, . . . , of Milk Thistle Farm, thinks Greenmarket rules are too hard on dairies.” Source of caption and photo: online version of the NYT article quoted and cited below. (Note: ellipsis in caption added.)

(p. D4) The basic aim of the producer-only rules is to ensure that all foods sold at market originate entirely or mostly on family farms within a half day’s drive from New York City. The 10-page document detailing these rules, however, is anything but clear.

“Cumbersome, confusing and contradictory,” was the assessment of Michael Hurwitz, the director of Greenmarket, which operates 45 markets in the five boroughs.
Pickle makers can sell preserved foods such as peppers in vinegar, but not processed foods such as hot sauce. Farmers, on the other hand, can sell processed hot sauce if it is made with their peppers. Dairies may purchase a higher percentage of their milk for cheese if the cheese is made from one type of milk rather than two milks, such as cow and sheep. Cider makers can buy 40 percent of the apples they press from local farmers, whereas wheatgrass juice sellers must grow all their wheatgrass.

For the full story, see:
INDRANI SEN. “Greenmarket Sellers Debate Maze of Producer-Only Rules.” The New York Times (Weds., August 6, 2008): D4.

Charles Wolf’s Main Cancer Regret: “I’m Not There for the Market Open”

“Charles Wolf with laptop and Archie, in his house near Denver last spring.” Source of the caption and the photo: online version of the WSJ article quoted and cited below.

(p. C5) He was irked when a cancer recurrence last year required him to resume morning radiation treatments, partly because that took him away from the market. “What kills me more than anything else is that I’m not there for the market open,” he said.

For the full obituary, see:
E.S. BROWNING. “Wolf Loses Battle With Cancer; Disease Didn’t Affect His Investing Success; Model Patient.” The Wall Street Journal (Thurs., JANUARY 29, 2009): C5.

Unintended Consequences in Medicine

“Jonas Salk, right, inoculates his son against polio as his wife, left, looks on.” Source of caption and photo: online version of the WSJ quoted and cited below.

(p. W9C) “The Polio Crusade” will stir many memories with its account of successful efforts to eradicate the disease whose fear factor, we’re told, was second only to that of the atom bomb. (Monday 9-10 p.m. ET on PBS’s “American Experience” series, but check local listings.) The documentary also tells less-familiar, and sometimes disturbing, stories about the birth of modern fund-raising techniques, and old testing techniques.
. . .
Since the virus is spread most effectively by mouth, or through contact with byproducts of the intestinal tract, the improved hygiene of the 20th century should have led to a decrease in polio infections. The opposite happened. First in Europe and then in America, a disease which had barely registered on the medical radar began to strike more and more people, culminating in a U.S. record of nearly 58,000 cases in 1952.
The explanation for this seemingly counterintuitive symbiosis between cleanliness and disease is astonishing, yet simple. In a germier age, newborns were likely to be exposed to the polio virus very early in life, when they still had immunity conferred by their mother in the womb. When improved hygiene pushed back the time of exposure to a later age, or even to adulthood, many people were by then defenseless.

For the full review, see:
NANCY DEWOLF SMITH. “TELEVISION; In a Time of Plague.” The Wall Street Journal (Tues., JANUARY 30, 2009): W9C.
(Note: ellipsis added.)

Experiments on Animal Genes Enthuses Longevity Researchers

“Charles Yogi, 89, a track & field athlete, is part of the Hawaii Lifespan Study.” Source of caption and photo: online version of the WSJ story quoted and cited below.

(p. A18) Based on animal experiments, gerontologists believe that one key to a healthy, longer lifespan may be found in a few master genes that affect cellular responses to famine, drought and other survival stresses. The more active these genes are, the longer an organism seems to survive — at least in the laboratory. Moreover, researchers are convinced that some genes may protect us against the risks of heart disease, diabetes, cancer and dementia.
. . .
Recent insights into the genetics of aging among simple organisms are stoking their enthusiasm. In January, for example, gerontologist Valter Longo at the University of Southern California reported that by altering two genes he made yeast that lived 10 times longer than normal. “We can really reprogram the lifespan of these organisms,” he said. In March, scientists at the University of Washington identified 15 genes regulating lifespan in yeast and worms that resemble genes found in humans. At least three companies are working independently on potential therapies based on the discovery that life span in mammals may be regulated partly by genetically controlled enzymes called sirtuins.

For the full story, see:
ROBERT LEE HOTZ. “Secrets of the ‘Wellderly’; Scientists Hope to Crack the Genetic Code of Those Who Live the Longest.” The Wall Street Journal (Fri., SEPTEMBER 19, 2008): A18.
(Note: ellipsis added.)

Patients “Stuck on Waiting Lists” in Canadian Universal Healthcare

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

(p. A17) In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.
Ontario’s government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He’s challenging Ontario’s government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.
Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.
On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a “Birmingham” hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was “too old” to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He’s heading to court claiming a violation of Charter rights as well.
. . .
Canada’s system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.

For the full commentary, see:
NADEEM ESMAIL. “‘Too Old’ for Hip Surgery.” Wall Street Journal (Mon., February 9, 2009): A17.
(Note: ellipsis added.)

Christensen Book Re-Thinks Basic Assumptions About Health Care Innovation

Source of book image: http://images.barnesandnoble.com/images/34000000/34009038.jpg

Christensen’s new book hit the shelves in December 2008. His ideas on health care are promising, if the special interests don’t get in the way. (I have not yet read the new book, but have read earlier versions of his proposals on how disruptive innovations can improve health care.)

(p. R2) BUSINESS INSIGHT: Your coming book, “The Innovator’s Prescription,” takes a look at health care. How likely do you think it is we’ll see substantial innovation in the structure of the U.S. health-care system?
DR. CHRISTENSEN: Well, one great benefit of the current economic crisis is that it will create pressure to find a real solution to the health-care problem. Right now, emergencies exist at companies like General Motors, which has got to drive the cost of its health care down. Every city and town in America would be bankrupt if they kept their books the way private-sector companies keep their books — because of the obligation cities and towns have taken upon themselves to provide health care for their retirees.
And so we really are in an emergency where it’s likely that employers and health-care providers are open to completely rethinking some of the basic assumptions that made innovation seem impossible. What we’re hoping with this book is that we can just bring a way to frame the problem that can help people reach consensus around a course of action that otherwise, at another time, would have seemed quite counterintuitive.

For the full interview, see:
Martha E. Mangelsdorf, interviewer. “Executive Briefing; How Hard Times Can Drive Innovation.” Wall Street Journal (Mon., DECEMBER 15, 2008): R2.
(Note: ellipses added.)

Leeuwenhoek’s Great Discovery Was at First Rejected by the “Experts”

In the passage quoted below, Hager discusses the reception that Leeuwenhoeck received to his first report of the “animalcules” seen under his microscope:

(p. 42) He hired a local artist to draw what he saw and sent his findings to the greatest scientific body of the day, the Royal Society of London.

(p. 43) Van Leeuwenhoek’s raising of the curtain on a new world was greeted with what might kindly be called a degree of skepticism. Three centuries later a twentieth-century wit wrote a lampoon of what the Royal Society’s secretary might well have responded:

Dear Mr. Anthony van Leeuwenhoek,
Your letter of October 10th has been received here with amusement. Your account of myriad “little animals” seen swimming in rainwater, with the aid of your so-called “microscope,” caused the members of the society considerable merriment when read at our most recent meeting. Your novel descriptions of the sundry anatomies and occupations of these invisible creatures led one member to imagine that your “rainwater” might have contained an ample portion of distilled spirits—imbibed by the investigator. Another member raised a glass of clear water and exclaimed, “Behold, the Africk of Leeuwenhoek.” For myself, I withhold judgement as to the sobriety of your observations and the veracity of your instrument. However, a vote having been taken among the members—accompanied, I regret to inform you, by considerable giggling—it has been decided not to publish your communication in the Proceedings of this esteemed society. However, all here wish your “little animals” health, prodigality and good husbandry by their ingenious “discoverer.”

The satire was not far from the truth. Although very interested in the Dutchman’s discoveries, so many English scientists were doubtful about his reports that van Leeuwenhoek had to enlist an English vicar and several jurists to attest to his findings. Then Hooke himself confirmed them. All doubt was dispelled.

Source:
Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor’s Heroic Search for the World’s First Miracle Drug. New York: Three Rivers Press, 2007.

A Salute to the Sudanese Medicine Men

One might expect that the Sudanese medicine men mentioned below, might have undermined the British physicians, as potential competition. So either there is more to the story than is sketched below, or else these Sudanese medicine men in 1939 placed the mission of saving lives, above their own narrow short-run self-interest. If it was the later, then they deserve our belated salute.

(p. 236) Meningitis was a vicious disease. The death rate had always been high, and nothing they did had much effect. The British physicians concentrated on nursing the sick and trying to limit the spread of the disease. The only thing different this year came in the form of three small sample bottles of sulfa that had been sent to their clinic for the treatment of strep diseases and pneumonia. Strep diseases were not the problem of the moment in Wau. This meningitis was caused not by strep but by the more common cause, a related germ called meningococcus. Still, they had the new medicine, they had nothing else, and they had nothing to lose. Someone decided to try it on a meningitis patient.
. . .
(p. 237) . . . There were twenty-one patients in the first group. The doctors hoped to save at least a few of them.
A few days later, all but one were still alive. The physicians immediately wired for more sulfa. Once it arrived, one of the British doctors stayed at the hospital while the other two went village to village, administering sulfa to every meningitis patient they could find. They asked the help of local “medicine men,” as they called them, tribal healers whose dispensation was needed before the natives would accept treatment. The Sudanese healers knew how deadly the disease was. They told their people that the physicians had “magic in a bottle.” They told them to take the shots. The physicians traveled day and night, injecting patients in grass huts, under trees, and along roadsides, The results, they wrote, were “spectacular.” Within a few weeks, they treated more than four hundred patients. They saved more than 90 percent of them. They knocked out the epidemic before it could get started.

Inability to Patent Sulfa, Delayed Its Marketing

When new uses of old, unpatentable drugs are discovered, there seems to be inadequate incentive to publicize them, and bring them to market. (For example, I think I have seen research suggesting that aspirin and fish oil capsules, are as effective in fighting heart disease as some newer drugs, but are nonoptimally utilized because of perverse incentives.) Maybe a revision of the patent law should be considered that permits some patenting of new uses of old drugs and substances?

(p. 172) It was wonderful that this powerful, inexpensive medicine was now available, but for a year after the Pasteur Institute announcement, no one marketed it seriously in its pure form as a medicine. Because it was not patentable, it was difficult for major chemical or drug firms to see a way to make much of a profit from it. It was not until months after the Pasteur group’s first publication on sulfa that the president of Rhône-Poulenc, an industrial supporter of Fourneau’s laboratory, visited the Pasteur Institute to hear about it. After talking with the researchers he decided to launch Septazine, a variation on pure sulfa that he felt was different enough to allow patenting—and hence profits. Septazine reached the marketplace in May 1936.