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We Need Market-Tested Innovation to Cure the Sadly Chaotic, Inefficient, Dishonest, and Unfair Organ Transplant System

The government contracts with, and ‘supervises,’ a network of nonprofits in a sadly chaotic, inefficient, dishonest, and unfair system to allocate scarce transplant organs. The government has set up perverse incentives, with unintended consequences, by telling the nonprofits that they will be evaluated on the basis of not wasting organs; those evaluated badly will not have their contracts renewed. So they have an incentive to get the organs out the door quickly, even if they do not go to patients higher on the waiting list. Hospitals know they will be evaluated on the basis of how many transplanted patients survive at least a year. So they have an incentive to reject below average organs, and, when they get above average organs, to ignore the waiting list, in order to transplant them into the most healthy patients.

The result is that the sickest and those who have waited the longest are frequently skipped over, instead of receiving the organ when it is their turn.

Why don’t we try something bold–allow for-profit entrepreneurs to engage in medical institutional innovation? For instance, if we allow it, one medical entrepreneurs might purchase from willing donors the right to allocate their organs if and when they become available. Another medical entrepreneur might set up an institution appealing to donors who do not want to be paid, but do want a guarantee that their organs will go to the poor at no charge.

In retailing Walmart and Amazon have different models, but both made major logistical innovations. We need a Walmart and an Amazon of organ transplantation. We need market-tested innovation (as Deirdre McCloskey might say).

Allowing some donors to be paid will reduce the scarcity of organs, which is the most basic constraint on this issue. Innovative medical entrepreneurs may find other ways to loosen this most basic constraint, such as mechanical organs, regrowing human organs from stem cells, and growing transplantable organs in pigs.

(p. A1) For decades, fairness has been the guiding principle of the American organ transplant system. Its bedrock, a national registry, operates under strict federal rules meant to ensure that donated organs are offered to the patients who need them most, in careful order of priority.

But today, officials regularly ignore the rankings, leapfrogging over hundreds or even thousands of people when they give out kidneys, livers, lungs and hearts. These organs often go to recipients who are not as sick, have not been waiting nearly as long and, in some cases, are not on the list at all, a New York Times investigation found.

Last year, officials skipped patients on the (p. A10) waiting lists for nearly 20 percent of transplants from deceased donors, six times as often as a few years earlier. It is a profound shift in the transplant system, whose promise of equality has become increasingly warped by expediency and favoritism.

Under government pressure to place more organs, the nonprofit organizations that manage donations are routinely prioritizing ease over fairness. They use shortcuts to steer organs to selected hospitals, which jockey to get better access than their competitors.

. . .

The Times analyzed more than 500,000 transplants performed since 2004 and found that procurement organizations regularly ignore waiting lists even when distributing higher-quality organs. Last year, 37 percent of the kidneys allocated outside the normal process were scored as above-average. Other organs are not scored in the same way, but donor age is often used as a proxy for quality, and data shows there is little difference in the age of organs allocated normally compared with those that are not.

And while many people in the transplant community believe ignoring lists is reducing organ wastage, there is no evidence that is true, according to an unreleased report by a group of doctors and researchers asked by the transplant system last year to study the practice.

. . .

In 2020, procurement organizations felt under attack. Congress was criticizing them for letting too many organs go to waste. Regulators moved to give each organization a grade and, starting in 2026, fire the lowest performers.

They scrambled to respond. They assigned more staff to hospitals to identify donors, grew more aggressive with families and recovered more organs from older or sicker donors.

Those steps increased donations and transplants, dozens of employees said. Both hit record highs last year, when there were 41,115 transplants.

At the same time, the organizations increasingly used a shortcut known as an open offer. Open offers are remarkably efficient — officials choose a hospital and allow it to put the organ into any patient.

. . .

Some procurement organizations sidestep the list because they believe it helps them place more organs. But it can also help their bottom lines.

In 2021, the South Carolina procurement organization phased out its allocation team and handed the task to workers who were already managing donors, testing organs and helping with surgeries. As a workaround, three former employees said, executives created a spreadsheet with preferred doctors’ phone numbers.

If the employees were too busy to do allocation, they said, they were told to give open offers to those doctors.

“They’d tell me to get rid of the organs quickly, so I could be done,” said Aron Knorr, one of the former workers, who said the directive made him uncomfortable.

. . .

Dr. Alghidak Salama, who led South Florida’s organization until August [2024], said open offers were financially beneficial: When organizations distribute organs, they are paid a set fee by receiving hospitals, regardless of what costs they incur. Speeding up allocation (p. A11) saves money on staffing.

. . .

When hospitals get open offers, they often give organs to patients who are healthier than others needing transplants, The Times found. For example, 80 percent of all donated hearts in recent years went to patients sick enough to be hospitalized, records show. But when lists were skipped, it was less than 40 percent.

Healthier patients are likelier to help transplant centers perform well on one of their most important benchmarks: the percentage of patients who survive a year after surgery. The government monitors that rate, as do insurers, which can decline to pay low-performing hospitals.

. . .

Federal regulators have known since 2022 that more people were being skipped, according to meeting notes obtained by The Times. But until last week, they had done little to address it.

The U.S. Centers for Medicare & Medicaid Services monitors hospitals and procurement organizations. The Health Resources and Services Administration tracks the system overall. But for years, they deferred to UNOS.

Records show that when the system’s oversight committee reviews instances of bypassed patients, it closes more than 99.5 percent of cases without action, usually concluding that the organ was at risk of going to waste. In the last five years, the committee has never gone further than sending “notices of noncompliance,” the mildest action it can take.

“The oversight is almost nonexistent, and that’s been true basically forever,” said Dr. Seth Karp, a Vanderbilt University surgeon who served on the committee, which he noted is largely made up of transplant doctors and procurement officials policing themselves.

For the full story see:

Brian M. Rosenthal, Mark Hansen and Jeremy White. “Organ Transplant System ‘in Chaos’ As Waiting Lists Are Ignored.” The New York Times (Monday, March 10, 2025): A1 & A10-A11.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date Feb. 26, 2025, and has the same title as the print version.)

A Rare Antibody in James Harrison’s Blood Protected the Lives of 2.4 Million Australian Babies

I recently purchased from Amazon, but have not read, Good Blood, which describes the discovery of a cure, and the struggle for acceptance of the cure, for the RH disease sketched in the passages quoted below. The disease affected my family, but I am not sure I remember exactly how. I am Rh positive and I think my mother was Rh negative. I think with each child after me, there was increasing risk and worry of possible bad health effects.

According to the Amazon summary for Good Blood, the book also describes the devotion of master blood donor James Harrison, whose recent obituary is quoted below.

Starting at least in the 1960s medical experts were often optimistic that future medical advances would come from designer chemicals enabled by scientific advances in our knowledge of chemistry and biological processes. Taxpayer funding was devoted to that approach in Nixon’s War on Cancer. But fewer medical advances have come from that approach than hoped, and more advances than expected have continued to come from the evolved usable chemicals (sometimes poisons, sometimes antibodies) of plants, animals, and exceptional human beings like Mr. Harrison.

Mao is often misquoted as saying ‘Let a thousand flowers bloom,’ but someone should say it (at least if the cost of planting the flowers is not too high).

(p. A25) James Harrison did not much care for needles. Whenever he donated plasma, he would look away as the tip went into his arm.

But Mr. Harrison was one of the most prolific donors in history, extending his arm 1,173 times. He may have also been one of the most important: Scientists used a rare antibody in his plasma to make a medication that helped protect an estimated 2.4 million babies in Australia from possible disease or death, medical experts say.

“He just kept going and going and going,” his grandson Jarrod Mellowship said in an interview on Monday [March 3, 2025]. “He didn’t feel like he had to do it. He just wanted to do it.”

. . .

Mr. Harrison’s plasma contained the rare antibody anti-D. Scientists used it to make a medication for pregnant mothers whose immune systems could attack their fetuses’ red blood cells, according to Australian Red Cross Lifeblood.

Anti-D helps protect against problems that can occur when babies and mothers have different blood types, most often if the fetus is “positive” and the mother is “negative,” according to the Cleveland Clinic. (The positive and negative signs are called the Rhesus factor, or Rh factor.)

In such cases, a mother’s immune system might react to the fetus as if it were a foreign threat. That can lead babies to develop a dangerous and potentially fatal condition, hemolytic disease of the fetus and newborn, which can cause anemia and jaundice.

. . .

In Australia, scientists from the Walter and Eliza Hall Institute of Medical Research in Melbourne are working to create a synthetic version of the drug using what some have called “James in a Jar,” an antibody that can be made in a lab.

But for now, human donors are essential: The anti-D shots are made with donated plasma, and Mr. Harrison was one of about 200 donors among the 27 million people in Australia, Lifeblood said.

. . .

Mr. Harrison knew the importance of his work firsthand. At 14, he needed a lot of blood transfusions during a major lung surgery. The experience inspired him to donate and encourage others to donate, too.

For the full obituary, see:

Amelia Nierenberg. “James Harrison, Whose Rare Antibodies Helped Millions, Is Dead at 88.” The New York Times (Saturday, March 8, 2025): A25.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the obituary was updated March 7, 2025, and has the title “James Harrison, Whose Antibodies Helped Millions, Dies at 88.”)

The Good Blood book, mentioned above, is:

Guthrie, Julian. Good Blood: A Doctor, a Donor, and the Incredible Breakthrough That Saved Millions of Babies. New York: Harry N. Abrams Press, 2020.

Vindication is Sweet, Even 60 Years Too Late

When I was a child my mother would stick an oral thermometer in my mouth. When she returned she would always be annoyed with me, saying that I didn’t have it in right, because my temperature was too low. She would say with irritation: ‘Now this time do it right!’ So I would feel discouraged and would give the thermometer a hard jab into my mouth until it hurt. But my temperature would still be too low.

The story below suggests, decades too late for me, that maybe it wasn’t my fault. Maybe the official mandated “normal” temperature of 98.6 was wrong!

(p. D6) We seem to be getting cooler. Since 1851, when the standard was set at 37 degrees centigrade, or 98.6 Fahrenheit, the average human body temperature has steadily declined.

. . . . The analysis is in eLife.

. . .

. . . improvements in sanitation and improved dental and medical care have reduced chronic inflammation, and the constant temperatures maintained by modern heating and air conditioning have helped lower resting metabolic rates. Today, a temperature of 97.5 may be closer to “normal” than the traditional 98.6.

For the full story see:

Nicholas Bakalar. “Is 98.6 No Longer ‘Normal’?” The New York Times (Tuesday, January 21, 2020): D6.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story was updated Jan. 21, 2020 [sic], and has the title “Body Temperature 2.0: Do We Need to Rethink What’s Normal?”)

The academic paper in eLife, mentioned above, is:

Protsiv, Myroslava, Catherine Ley, Joanna Lankester, Trevor Hastie, and Julie Parsonnet. “Decreasing Human Body Temperature in the United States since the Industrial Revolution.” eLife 9 (2020): e49555.

Rickets Is Now Rare Because Vitamin D Is Easy to Get

(p. A15) Rickets is one of those diseases that seem incredibly old-fashioned. It’s difficult to comprehend, now, how widespread this bone ailment once was: In some cities less than a century ago, 90% of children showed symptoms of rickets during wintertime. But ubiquity has its benefits. In “Starved for Light,” Christian Warren convincingly argues that modern medicine would be unrecognizable without the many advances in treatment that trace their roots to this once-widespread disease.

Rickets results from a lack of vitamin D, which we need to help shuttle calcium and phosphorus into our bones. Our bodies manufacture vitamin D whenever ultraviolet sunlight hits our skin; we can also get it through food. A deficiency in vitamin D causes the softening and bending of bones characteristic of rickets; victims are often left bowlegged or knock-kneed, or with curved spines or misshapen pelvises. The worst cases leave babies unable to crawl or even sit up straight.

. . .

Given how disgusting cod-liver oil tastes, some countries began combating rickets by adding vitamin D to milk in the 1930s—an odd choice, since milk contains no vitamin D naturally. (Amusingly, Mr. Warren calls the practice an “in uddero” health intervention.) The choice seems even odder, the author wryly notes, when there’s a much simpler solution to preventing rickets: going outside for a few minutes. Instead, we’ve effectively turned “a dairy product into a drug-delivery device,” severing the ancient interplay between “sun, skin, and bone.”

For the full review see:

Sam Kean. “Bookshelf; A Disease Of Deficiency.” The Wall Street Journal (Monday, Dec. 9, 2024): A15.

(Note: ellipsis added.)

(Note: the online version of the review has the date December 8, 2024, and has the title “Bookshelf; ‘Starved for Light’: A Disease of Deficiency.”)

The book under review is:

Warren, Christian. Starved for Light: The Long Shadow of Rickets and Vitamin D Deficiency. Chicago: University of Chicago Press, 2024.

W.H.O. Ignored Those Who Knew Covid Was Airborne

The article quoted below provides more evidence that the World Health Organization (W.H.O.) failed to protect world health during the Covid pandemic. Its funding and decision-making processes made failure highly likely.

In the absence of W.H.O, how can we learn quickly of potential pandemic threats from around the world? The Covid book co-authored by Ridley documents quick and effective Twitter (now X) networks that spread and evaluated Covid information. Maybe a proof of concept?

(p. D3) In early February 2020, China locked down more than 50 million people, hoping to hinder the spread of a new coronavirus. No one knew at the time exactly how it was spreading, but Lidia Morawska, an expert on air quality at Queensland University of Technology in Australia, did not like the clues she managed to find.

It looked to her as if the coronavirus was spreading through the air, ferried by wafting droplets exhaled by the infected. If that were true, then standard measures such as disinfecting surfaces and staying a few feet away from people with symptoms would not be enough to avoid infection.

Dr. Morawska and her colleague, Junji Cao at the Chinese Academy of Sciences in Beijing, drafted a dire warning. Ignoring the airborne spread of the virus, they wrote, would lead to many more infections. But when the scientists sent their commentary to medical journals, they were rejected over and over again.

“No one would listen,” Dr. Morawska said.

It took more than two years for the World Health Organization to officially acknowledge that Covid spread through the air.

For the full story see:

Carl Zimmer. “Covid Proved Airborne. Could Bird Flu Be, Too?” The New York Times (Tuesday, February 4, 2025): D3.

(Note: the online version of the story has the date February 3, 2025, and has the title “Could the Bird Flu Become Airborne?”)

The book co-authored by Ridley that I praise in my initial comments is:

Chan, Alina, and Matt Ridley. Viral: The Search for the Origin of Covid-19. New York: Harper, 2021.

Those Who Criticize the Powerful “Are Seldom Seen Distinctly by the Age in Which They Live”

Founding Father Benjamin Rush was apparently willing to take the ill-will that comes to those who challenge the lazy, incompetent, or corrupt.

The importance of being willing to be the target of ill-will was well-described by Charlie Munger.

(p. C7) During the spring of 1813, former presidents John Adams and Thomas Jefferson were united in grief at the death of a mutual friend who had recently persuaded them to forget their bitter rivalries. Like the two celebrated statesmen, the eminent physician and social reformer Benjamin Rush had been a Founding Father, one of 56 men who signed the Declaration of Independence in 1776.

. . .

. . ., after George Washington’s beaten army was pushed back across the Delaware River and Philadelphia’s militia marched to his assistance, Rush volunteered his medical skills. He helped tend the wounded from the Second Battle of Trenton, on Jan. 2, 1777, and the next day witnessed the bloody aftermath of Washington’s victory at Princeton.

Months later, Rush was appointed surgeon-general of the Continental Army’s so-called Middle Department—a key geographical sector that included Pennsylvania. He had ambitious plans for reform and outlined them in a pamphlet titled “Directions for Preserving the Health of Soldiers.” In a statement true for future American wars, he observed: “A greater proportion of men have perished with sickness in our armies than have fallen by the sword.” To curb that toll, Rush urged radical changes in food, clothing and hygiene. In his improving zeal, he unleashed a barrage of unrestrained letters to his friends in Congress that swiftly kindled a feud with his superior, Dr. William Shippen.

Rush accused Shippen of neglect, incompetence and corruption but underestimated his antagonist’s political clout.

. . .

(p. C8) . . ., Rush himself had always suspected that his outspoken views would affect his reputation, observing: “The most acceptable men in practical society, have been those who have never shocked their contemporaries, by opposing popular or common opinions.” He added, with considerable prescience: “Men of opposite characters, like objects placed too near the eye, are seldom seen distinctly by the age in which they live.” Through the efforts of Mr. Fried and Mr. Unger, what Benjamin Rush characterized as “the distant and more enlightened generations” are now better placed to judge him.

For the full review see:

Stephen Brumwell. “American Hippocrates.” The Wall Street Journal (Saturday, May 20, 2017 [sic]): C7-C8.

(Note: ellipses added.)

(Note: the online version of the review has the date Sept. 20, 2018 [sic], and has the title “‘Rush’ and ‘Dr. Benjamin Rush’ Review: American Hippocrates.”)

The books under review are:

Fried, Stephen. Rush: Revolution, Madness, and Benjamin Rush, the Visionary Doctor Who Became a Founding Father. New York: Crown, 2018.

Unger, Harlow Giles. Dr. Benjamin Rush: The Founding Father Who Healed a Wounded Nation. New York: Da Capo Press, 2018.

F.D.R.’s Wage Controls Created a Wedge Between Patients and Doctors, With Awful Unintended Consequences

Under F.D.R.’s wage controls, firms competed for workers through perks, like healthcare benefits, since they could not legally compete by offering higher wages. That resulted in the first middlemen (in this case firms) between the customers (patients) and the suppliers (doctors). The result of adding the middlemen, and also adding a variety of regulations, is a “market” that is opaque, inefficient, and slow to innovate. Rather than drain the swamp, the response has been to add more middlemen (Medicare, Medicaid, Obamacare, and Pharmacy Benefit Managers, aka PBMs), that have only thickened the mire.

(p. B11) The roots of today’s fragmented system can be traced back to a quirk in U.S. history. Unlike most high-income countries, which created centralized government systems to ration care in the 20th century, the U.S. followed a different path shaped by historical circumstances. During World War II, wage controls prompted employers to offer health insurance as a tax-free benefit to attract workers.

Medicare and Medicaid, followed decades later by Affordable Care Act exchanges, were added over time to cover those who couldn’t get insurance through their job, creating a highly decentralized and convoluted system. . . .

. . . the pressure to increase their earnings means insurers have looked for ways to overbill the government and skimp on patient care, always staying a step ahead of regulators. In recent years, they have become vertically integrated conglomerates, controlling doctors, pharmacies and payment-processing systems.

. . .

One of the most frustrating aspects of the system is a tactic called prior authorization, a process requiring providers to obtain insurer approval before delivering certain services. While that might be disagreeable, there is little public data on how often insurers deny care. This lack of transparency allows insurers to wield prior authorization aggressively, particularly when expensive treatments are recommended.

For the full commentary see:

David Wainer. “How to Fix Health Insurance.” The Wall Street Journal (Saturday, Dec. 21, 2024): B11.

(Note: ellipses added.)

(Note: the online version of the commentary has the date December 20, 2024, and has the title “How American Health Insurance Got So Infuriating.”)

In Europe Citizens Self-Medicated with Coca Plant Before Official Use in Hospital

Bones from the 1600s in a hospital crypt reveal the use of coca leaves, even though the records from the hospital do not record any use of coca leaves. The records do indicate the early use of derivatives of the opium poppy plant, so if coca leaves were being officially used, you would expect that would also be in the records. One of the researchers, Cristina Cattaneo, concludes that the coca plant was not an official medicine but was “something lurking among the population” (as quoted in Nazaryan 2024, p. D3).

The findings of Giordano are summarized in:

Alexander Nazaryan. “Cocaine Use in Europe Is Dated to the 1600s.” The New York Times (Tues., September 17, 2024): D3.

(Note: the online version of the Steve Lohr article was updated Sept. 13, 2024, and has the title “Europeans Used Cocaine Much Earlier Than Previously Thought, Study Finds.”)

The academic paper co-authored by Cattaneo is:

Giordano, Gaia, Mirko Mattia, Lucie Biehler‐Gomez, Michele Boracchi, Alessandro Porro, Francesco Sardanelli, Fabrizio Slavazzi, Paolo Maria Galimberti, Domenico Di Candia, and Cristina Cattaneo. “Forensic Toxicology Backdates the Use of Coca Plant (Erythroxylum Spp.) in Europe to the Early 1600s.” Journal of Archaeological Science 170 (Oct. 2024): 106040.

An earlier related academic paper, on evidence of early official use of derivatives of the opium poppy, is:

Giordano, Gaia, Mirko Mattia, Lucie Biehler-Gomez, Michele Boracchi, Stefania Tritella, Emanuela Maderna, Alessandro Porro, Massimiliano Marco Corsi Romanelli, Antonia Francesca Franchini, Paolo Maria Galimberti, Fabrizio Slavazzi, Francesco Sardanelli, Domenico Di Candia, and Cristina Cattaneo. “Papaver Somniferum in Seventeenth Century (Italy): Archaeotoxicological Study on Brain and Bone Samples in Patients from a Hospital in Milan.” Scientific Reports 13, no. 1 (2023): 3390.

For Quicker Cures, Do Not Cancel Those Who See What We Do Not See

Dogs smell odors that we do not smell. They say Eskimos can distinguish 40 or more kinds of snow. Physical differences in biology and differences in past experiences allow some people to perceive what other people miss. We should encourage, not cancel, those who see differently. They can communicate and act on what they see, giving us more cures more quickly.

In the passages quoted below, a case is made that Pasteur’s artistic experiences allowed him to see a structural difference (chirality) in crystals; a difference that turns out to matter for medical drug molecules.

(p. D5) In a paper published last month in Nature Chemistry, Dr. Gal explains how a young Pasteur fought against the odds to articulate the existence of chirality, or the way that some molecules exist in mirror-image forms capable of producing very different effects. Today we see chirality’s effects in light, in chemistry and in the body — even in the drugs we take.

And we might not know a thing about them if it weren’t for the little-known artistic experience of Louis Pasteur, says Dr. Gal.

. . .

As a teenager, Pasteur made portraits of his friends, family and dignitaries. But after his father urged him to pursue a more serious profession — one that would feed him — he became a scientist. At the age of 24 he discovered chirality.

To understand chirality, consider two objects held up before a mirror: a white cue ball from a pool table and your hand. The reflection of the ball is exactly like the original. If you could reach into that mirror, pull out the reflection and cram it inside the original, they’d match up point for point. But if you tried the same thing with your hand, no matter how much you tried, the mirror image would never fit into the original.

At the molecular level some objects are like cue balls, and they are always superimposable. But other things are like hands, and they can never be combined.

. . .

During winemaking, a chemical called tartaric acid builds up on vat walls. In the 18th and 19th centuries, makers of medicine and dyes used this acid.

In 1819, factory workers boiled wine too long and accidentally produced paratartaric acid, which had unique properties that intrigued scientists like Pasteur.

. . .

When studying the paratartaric acid, Pasteur found that it produced two kinds of crystals — one like those found in tartaric acid and another that was the mirror opposite. The crystals were handed, or what the Greeks call chiral (kheir) for hand.

. . .

“Several famous or much more accomplished scientists, some well along their illustrious careers, studied the same molecules, the same substances,” said Dr. Gal. “Realistically you would think they’d have beaten him to the punch, and yet they missed it.”

So why did this young, inexperienced chemist get it right?

Dr. Gal thinks the answer might lie in the artistic passions of Pasteur’s youth. Even as a scientist, Pasteur remained closely connected to art. He taught classes on how chemistry could be used in fine art and attended salons. He even carried around a notebook, jotting down 1-4 ratings of artwork he visited.

And then Dr. Gal stumbled upon a letter Pasteur had written to his parents about a lithographic portrait he had made of a friend.

Lithography back then involved etching a drawing onto a limestone slab with wax or oil and acid, and pressing a white piece of paper on top of it. The resulting picture was transposed, like a mirror image of the drawing left on the slab.

In his letter, Pasteur wrote:

“I think I have not previously produced anything as well drawn and having as good a resemblance. All who have seen it find it striking. But I greatly fear one thing, that is, that on the paper the portrait will not be as good as on the stone; this is what always happens.”

Eureka. “Isn’t this the explanation of how he saw the handedness on the crystals — because he was sensitized to that as an artist?” Dr. Gal proposed.

. . .

We now know that many drugs contain molecules that exist in two chiral forms, and that the two forms can react differently in the body. The most tragic example occurred in the 1950s and ’60s, when doctors prescribed Thalidomide, a drug for morning sickness and other ailments, to pregnant women. The drug also contained a chiral molecule that caused disastrous side effects in many babies.

For the full story see:

Joanna Klein. “How Pasteur’s Artistic Insight Changed Chemistry.” The New York Times (Tuesday, June 20, 2017 [sic]): D5.

(Note: ellipses added.)

(Note: the online version of the story has the date June 14, 2017 [sic], and has the same title as the print version.)

The academic article in Nature Chemistry authored by Gal and mentioned above is:

Gal, Joseph. “Pasteur and the Art of Chirality.” Nature Chemistry 9, no. 7 (2017): 604-05.

Peppermint at One Time Required a Prescription, While Strychnine Was Sold Over-the-Counter

I suspect I would not much like the Remaking the American Patient book–it seems to blame capitalism for all of the ills of the healthcare system. But it does include one compelling example of the limitations of government regulation of drugs: allowing strychnine while restricting peppermint.

(p. D3) Medical historians who focus on the conquest of dire diseases serve up narratives of progress and triumph. Not Ms. Tomes, a professor of history at Stony Brook University, who has chosen to examine instead the health care experience of average healthy citizens, the great silent majority whose lives are punctuated by a variety of minor ills and only the occasional major calamity.

. . .

Are you perplexed by our regulatory chaos, with layer upon layer of well-meaning but persistently ineffective efforts to guarantee the safety of medical services? It turns out we come from a long tradition of such inadequacy: Patient safety has been the holy grail for everyone, long sought, never achieved.

Drug regulatory efforts have been inconsistent and confusing. (At one point in the 1940s, peppermint drops were available by prescription, while strychnine could be freely purchased by anyone).

For the full review see:

Abigail Zuger, M.D. “When Patients Became Purchasers.” The New York Times (Tuesday, January 26, 2016 [sic]): D3.

(Note: ellipsis added.)

(Note: the online version of the review has the date Jan. 23, 2016 [sic], and has the title “Review: ‘Remaking the American Patient’.”)

The book under review above is:

Tomes, Nancy. Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers, Studies in Social Medicine. Chapel Hill: The University of North Carolina Press, 2016.

In Middle Ages the Less Credentialed Offered “Daily Care,” While “Experts” Theorized

(p. 12) A new book about medieval views on medicine helps explain the Oby nuns’ contentment with the cheapness of their lives. In “Medieval Bodies: Life and Death in the Middle Ages,” the British art historian Jack Hartnell tackles a difficult phenomenon: the medieval embrace of medical “theories that have since been totally disproven to the point of absurdity but which nevertheless could not have seemed more vivid or logical in the Middle Ages.”

The doctors of Europe and the Mediterranean were not practical specialists but rather scholars of Greek and Roman natural philosophy, which taught a theory of nature composed of four basic elements (fire, water, earth, air). Each was associated with differing levels of moisture and heat. The human body contained four viscous liquids or “humors”: phlegm, blood, yellow bile and black bile. A doctor’s job was to correct an uneven humoral balance, drying up perceived wetness with spices or relieving an excess of heat with cooling herbs.

While experts promulgated theory, daily care was mostly administered by midwives, apothecaries, dentists and the odd entrepreneurial carpenter. A local barber might puncture your neck to drain three pints of blood if you complained of a headache.

For the full review see:

Josephine Livingstone. “Death by a Thousand Cuts.” The New York Times Book Review (Sunday, January 5, 2020 [sic]): 12.

(Note: the online version of the review has the date Nov. 19, 2019 [sic], and has the title “Bad Bishops, Bloodletting and a Plague of Caterpillars.”)

The book under review is:

Hartnell, Jack. Medieval Bodies: Life and Death in the Middle Ages. New York: W. W. Norton & Company, 2019.