Category: Regulations

High and Growing Financial Burden of Cancer

The story quoted below would lead many to support socialized medicine, euphemistically called a “single-payer system” where the single payer is the taxpayer. But socialized medicine is inefficient and slows innovation. The main reason that cancer therapy has grown so costly is that the new therapies are very expensive to achieve approval. That expense could be slashed if we followed Milton Friedman’s suggestion to stop mandating hyper-expensive Phase 3 randomized clinical trials. (These are the large trials mainly intended to prove efficacy, while the much smaller and cheaper Phase 1 and Phase 2 trials are mainly intended to prove safety.) I am researching Friedman’s suggestion and hope to write more on it soon.

(p. A1) The economic burden of a cancer diagnosis is getting strikingly worse in the U.S., as drug and medical costs soar and more patients live longer with the disease. About 55% of cancer drugs introduced between 2019 and 2023 cost at least $200,000 a year, according to Iqvia’s Institute for Human Data Science. And an increasing number of patients are working-age, a group more likely to report financial hardship after diagnosis compared with older adults.

Nearly 60% of working-age cancer survivors report facing some financial difficulty. Many patients struggle to afford care and end up taking on debt, with some getting payday loans or running up credit cards. Cancer alone accounts for some 40% of medical campaigns seeking financial help on GoFundMe, research shows.

. . .

(p. A2) Among common diseases, cancer creates a uniquely difficult financial strain known as financial toxicity. Treatments with expensive medicines start immediately and come with a string of nonmedical costs. Chemotherapy and other treatments can leave patients too weak to work for weeks or months. This can result in a twofold blow, with patients losing income and their employer-sponsored health insurance.

. . .

The problem starts with costs for medical care and cancer drugs that have either risen above the rate of inflation or have high starting prices. Common cancer drugs have list prices that go well into the six figures: Imbruvica, which treats leukemia, has a list price of more than $213,000 for a full year. The average Medicare patient taking it paid $5,247 out-of-pocket in 2022, federal data show. AbbVie, one of the drug’s co-marketers, declined to comment.

. . .

Many insurers have shifted rising healthcare costs to patients. Some employer-backed plans require patients to pay a percentage of a drug’s cost, which can add up to thousands of dollars. One report found a 15% increase in out-of-pocket costs for privately insured, working-age cancer patients from 2009 to 2016. Patients also foot the bill for transportation, lodging, child care and parking.

. . .

People with cancer are at higher risk of ending up late on credit-card payments, mortgage payments, and experiencing other financial challenges than noncancer patients, according to research co-written by Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Center in Seattle.

Other research shows that patients with more out-of-pocket costs are more likely to delay starting their medications or stop taking them. Ramsey and his co-authors also found that cancer patients who file for bankruptcy had an 80% higher risk of dying than cancer patients who didn’t file.

“There actually was a pretty big detriment for survival,” he said.

For the full story, see:

Brianna Abbott and Peter Loftus. “Cancer Costs Destroy Finances: ‘It Broke Me’.” The Wall Street Journal (Wednesday, May 29, 2024): A1-A2.

(Note: ellipses added.)

(Note: the online version of the story has the date May 28, 2024, and has the title “Cancer Is Capsizing Americans’ Finances. ‘I Was Losing Everything.’.”)

One of the relevant papers co-authored by Ramsey and mentioned above is:

Ramsey, Scott D., Aasthaa Bansal, Catherine R. Fedorenko, David K. Blough, Karen A. Overstreet, Veena Shankaran, and Polly Newcomb. “Financial Insolvency as a Risk Factor for Early Mortality among Patients with Cancer.” Journal of Clinical Oncology 34, no. 9 (March 2016): 980-86.

Neuroscientists Confirm Folk Medicine Claims of Lavender’s Healing Powers

(p. D2) Lavender has purported healing powers for reducing stress and anxiety. But are these effects more than just folk medicine?

Yes, said Hideki Kashiwadani, a physiologist and neuroscientist at Kagoshima University in Japan — at least in mice.

. . .

In a study published Tuesday [Oct. 23, 2018 [sic]] in the journal Frontiers in Behavioral Neuroscience, he and his colleagues found that sniffing linalool, an alcohol component of lavender odor, was kind of like popping a Valium. It worked on the same parts of a mouse’s brain, but without all the dizzying side effects.

. . .

Their findings add to a growing body of research demonstrating anxiety-reducing qualities of lavender odors and suggest a new mechanism for how they work in the body.

For the full story see:

JoAnna Klein. “Purple Reigns: Folk Wisdom Hails Lavender’s Powers. Now Researchers Are Pinning Down Why.” The New York Times (Tuesday, October 30, 2018 [sic]): D2.

(Note: ellipses and bracketed date added.)

(Note: the online version of the story has the date Oct. 23, 2018 [sic], and has the title “Lavender’s Soothing Scent Could Be More Than Just Folk Medicine.” Where there is a small difference in wording between the versions, the passages quoted above follow the online version.)

The article co-authored by Kashiwadani and mentioned above is:

Harada, Hiroki, Hideki Kashiwadani, Yuichi Kanmura, and Tomoyuki Kuwaki. “Linalool Odor-Induced Anxiolytic Effects in Mice.” Frontiers in Behavioral Neuroscience 12 (Oct. 23, 2018).

To Save One Species of Brown Owl, the Feds Want to Shoot Hundreds of Thousands of a More Adaptable Similar-Looking Species of Brown Owl

Isn’t it interesting that many in the Pacific Northwest and in the federal government want to take guns away from self-defending citizens at the same time that they want to use large-bore shotguns to shoot hundreds of thousands of barred owls whose only sin is that, unlike the spotted owls who they resemble, they are not picky eaters?

(p. D1) In the ancient forests of the Pacific Northwest, the northern spotted owl, a rare and fragile subspecies of spotted owl, is being muscled out of its limited habitat by the barred owl, its larger and more ornery northeastern cousin. The opportunistic barred owl has been moving in on spotted owl turf for more than half a century, competing with the locals for food and space, outnumbering, out-reproducing and inevitably chasing them out of their nesting spots. Barred owls have also emerged as a threat to the California spotted owl, a closely related subspecies in the Sierra Nevada and the mountains of coastal and Southern California.

. . .

(p. D5) In a last-ditch effort to rescue the northern spotted owl from oblivion and protect the California spotted owl population, the U.S. Fish and Wildlife Service has proposed culling a staggering number of barred owls across a swath of 11 to 14 million acres in Washington, Oregon and Northern California, where barred owls — which the agency regards as invasive — are encroaching. The lethal management plan calls for eradicating up to half a million barred owls over the next 30 years, or 30 percent of the population over that time frame. The owls would be dispatched using the cheapest and most efficient methods, from large-bore shotguns with night scopes to capture and euthanasia.

. . .

The agency’s plan, outlined last fall in a draft report assessing its environmental impact that is due for final review this summer, has pitted conservationists, who say it will benefit both species, against animal supporters, who consider the proposed scale, scope and timeline unsustainable.

Last month, a coalition of 75 wildlife protection and animal welfare organizations sent a letter to Secretary of the Interior Deb Haaland urging her to scrap what they called a “colossally reckless action” that would necessitate a perpetual killing program to keep the number of barred owls in check. Wayne Pacelle, the president of Animal Wellness Action and an author of the statement, said it was dangerous for the government to start managing competition and social interaction among North American species, including ones that have expanded their range as a partial effect of “human perturbations” of the environment. “I cannot see how this succeeds politically, because of its price tag and its sweeping ambitions,” he said in an email.

Mr. Pacelle questions whether barred owls, which are indigenous to North America, truly meet the criteria for an invasive species. “This ‘invasive’ language rings familiar to me in our current political debates,” he said. “Demonize the migrants, and the harsh policy options become much easier from a moral perspective.”

The signatories argued that the current predicament warranted nonlethal control, and that the agency’s approach would lead to the wrong owls being shot and to the death of thousands of eagles, hawks and other creatures from lead poisoning. “Implementing a decades-long plan to unleash untold numbers of ‘hunters’ in sensitive forest ecosystems is a case of single-species myopia regarding wildlife control,” the letter said.

. . .

At first sight, it’s easy to mistake a spotted for a barred: Both have tuftless rounded heads, teddy bear eyes and bodies mottled brown and white. They can interbreed to produce chicks called sparred owls. But they differ in their habitat requirements. Up to four pairs of barred owls can occupy the three-to-12 square miles that one spotted couple needs, and barred owls aggressively defend their terrain. “The closer spotted owls live to barred owls, the less likely the spotted owls are to have offspring,” Dr. Wiens said. Barred owls also produce four times as many young.

Spotted owls are extremely picky eaters: In California, they eat only flying squirrels and wood rats. “Barred owls devour anything and everything,” Ms. Bloem said, . . .

For the full story see:

Franz Lidz. “The Lethal Cost of a Rescue.” The New York Times (Tuesday, April 30, 2024): D1 & D5.

(Note: ellipses added.)

(Note: the online version of the story has the date April 29, 2024, and has the title “They Shoot Owls in California, Don’t They?” Where there is a difference in wording between the versions, the passages quoted above follow the online version.)

Buy Health Supplements Certified by “a Trusted Third Party” Like U.S. Pharmacopeia (USP)

According to a Consumer Reports article, “USP is a nonprofit organization that sets what CR experts say are the most widely accepted standards for supplements.” Note that with the services of private organizations such as USP, attentive consumers can be safe without the heavy hand of government regulators.

(p. D6) . . . most supplements have not been rigorously tested for safety or effectiveness, said Dr. JoAnn Manson, a professor of medicine at Harvard Medical School.

. . .

But, she said, there are some instances where taking a supplement may improve your health. Here are some of the main ones.

If a blood test reveals that your body is low in a particular vitamin or mineral, such as vitamin D or iron, supplements can be “essential” in correcting that deficiency, said Dr. Pieter Cohen, an internist at Cambridge Health Alliance in Somerville, Mass.

. . .

Most older adults usually get enough nutrition from their food. But as you age, your requirements for some nutrients increase while your ability to absorb them and your appetite can diminish, so your doctor may recommend a supplement. Older adults may have trouble absorbing vitamin B12, for example. And you may need a calcium and vitamin D supplement if you’re at risk for bone loss, Dr. Manson said.

. . .

Several recent trials have also found that multivitamins may improve memory and slow cognitive decline in older adults, though more research is needed, Dr. Manson said.

And there’s some evidence that taking a supplement that contains vitamins C and E, zinc, copper, lutein and zeaxanthin (called an AREDS supplement) can slow vision loss for those with age-related macular degeneration, Dr. Manson said.

. . .

If you do purchase supplements, look for a certification seal from a trusted third party organization such as the U.S. Pharmacopeia or NSF, which confirm that the products contain the ingredients listed on the label.

For the full story see:

Alice Callahan. “Ask Well: Are Any Supplements Proven To Benefit Health?.” The New York Times (Tuesday, November 7, 2023 [sic]): D6.

(Note: ellipses added.)

(Note: the online version of the story has the date Oct. 31, 2023, and has the title “Ask Well: Should I Be Taking Supplements?” Where there is a difference in wording between the versions, the passages quoted above follow the online version.)

Fauci’s Office Rejected Protocol for a Voluntary COVID Human Challenge Trial That Could Have Tested Therapies and Vaccines Faster

(p. 2) . . . the first Covid-19 human challenge study [was] just completed in Britain, where young, healthy and unvaccinated volunteers were infected with the coronavirus that causes Covid while researchers carefully monitored how their bodies responded.

. . ., there were those who decried deliberately infecting or “challenging” healthy volunteers with disease-causing pathogens. It violates the medical principle of “do no harm.” The trade-off is a unique opportunity to discover the causes, transmission and progression of an illness, as well as the ability to more rapidly test the effectiveness of proposed treatments.

. . .

Dr. [Matthew] Memoli [the director of the Laboratory of Infectious Diseases Clinical Studies Unit at the National Institute of Allergy and Infectious Diseases] has conducted numerous influenza challenge studies, and he prepared a protocol for a Covid challenge trial that the National Institute of Allergy and Infectious Diseases rejected last year because it was felt that not enough was known about the virus and that there were no effective rescue therapies, according to a statement from the office of the director, Dr. Anthony Fauci.

The consortium formed to run Britain’s Covid challenge trial, which included scientists who trained at the Common Cold Unit, had access to the British National Health Service’s robust, real-time data on Covid hospitalizations and deaths. The researchers designing the study said they felt confident that there was little risk to the healthy unvaccinated 18-to-30-year-old volunteers they recruited for the trial. There were no severe adverse events in the 36 people who participated, and they will continue to be monitored over the next year.

The aim of the study was to identify the lowest amount of virus to safely and reliably infect someone, so researchers can later easily test the efficacy of vaccines or antivirals on future challenge trial volunteers.

. . .

Dr. Fauci’s office said the institute has no plans to fund Covid-19 human challenge trials in the future. Many bioethicists support that decision. “We don’t ask people to sacrifice themselves for the good of society,” said Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics. “In the U.S., we are very much about protecting individual rights and individual life and health and liberty, while in more communal societies it’s about the greater good.”

But Josh Morrison, a co-founder of 1Day Sooner, which advocates on behalf of more than 40,000 would-be human challenge volunteers, argues it should be his and other people’s right to take risks for the greater good. “Most people aren’t going to want to be in a Covid challenge study, and that’s totally fine, but they shouldn’t project their own choices on other people,” he said.

. . .

As one participant in Britain’s Covid human challenge trial put it: “You know the phrase ‘one interesting fact about yourself’ that strikes terror into everyone? That’s now solved forever. I did something that made a difference.”

For the full commentary, see:

Kate Murphy. “Are Human Challenge Trials Ethical?” The New York Times, SundayReview Section (Sunday, October 17, 2021 [sic]): 2.

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

(Note: the online version of the commentary has the date Oct. 14, 2021 [sic], and has the title “Britain Infected Volunteers With the Coronavirus. Why Won’t the U.S.?”)

Allowing the Sale of Hearing Aids Over-the-Counter (O.T.C.) Results in “Increased Innovation and Lower Prices”

(p. D3) A year ago, the Food and Drug Administration announced new regulations allowing the sale of over-the-counter hearing aids and setting standards for their safety and effectiveness.

. . .

Some background: In 2020, the influential Lancet Commission on Dementia Prevention, Intervention and Care identified hearing loss as the greatest potentially modifiable risk factor for dementia.

Previous studies had demonstrated a link between hearing loss and cognitive decline, said Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins and lead author of the new research.

“What remained unanswered was, If we treat hearing loss, does it actually reduce cognitive loss?” he said. The ACHIEVE study (for Aging and Cognitive Health Evaluation in Elders) showed that, at least for a particular group of older adults, it could.

. . .

A small study recently published in JAMA Otolaryngology found that patients who were given a commercially available, self-fitting hearing aid in a clinical trial could, after six weeks, hear as well as patients fitted with the same device by audiologists.

. . .

The United States is the first country to develop a regulated O.T.C. hearing aid market, and “the tech companies and the retailers are still experimenting,” Dr. Lin pointed out. He predicts increased innovation and lower prices ahead.

For the full commentary, see:

Paula Span. “THE NEW OLD AGE; A Challenging Over-the-Counter Market for Hearing Aids.” The New York Times (Tuesday, October 31, 2023): D3.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Oct. 30, 2023, and has the title “THE NEW OLD AGE; Hearing Aids Are More Affordable, and Perhaps More Needed, Than Ever.”)

The “small study” mentioned above is:

De Sousa, Karina C., Vinaya Manchaiah, David R. Moore, Marien A. Graham, and De Wet Swanepoel. “Effectiveness of an over-the-Counter Self-Fitting Hearing Aid Compared with an Audiologist-Fitted Hearing Aid: A Randomized Clinical Trial.” JAMA Otolaryngology–Head & Neck Surgery 149, no. 6 (2023): 522-30.

“The Economic Mobility That Springs From Property Ownership”

(p. C9) Mr. Husock, a senior fellow at the American Enterprise Institute, traces the progress of a seemingly sensible but ultimately destructive idea: that “low-income neighborhoods built by ordinary builders were exploitative, overcrowded, and dangerous.”

. . .

What these reformers failed to understand, Mr. Husock contends, is that the poor neighborhoods of large cities provided what planned and subsidized neighborhoods never could: tightly knit communities, a sense of belonging and attendant political participation, ethnic character and the economic mobility that springs from property ownership.

. . .

The unreformers, Mr. Husock writes, “understood something fundamental: Community develops when keeping one’s property becomes part of a positive conspiracy of shared self-interest.”

For the full review, see:

Barton Swaim. “The Tragedy of the Progressive City.” The Wall Street Journal (Saturday, Oct. 30, 2021 [sic]): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date October 29, 2021 [sic], and has the title “Politics: When the Lights Go Down in the City.”)

The book under review is:

Husock, Howard A. The Poor Side of Town: And Why We Need It. New York: Encounter Books, 2021.

Mandated Fukushima Evacuations Killed 1,600; Radiation Killed 0

Berkeley scientist Noah Whiteman’s Most Delicious Poison argues that often chemicals that are therapeutic at low doses are poisons at high doses. The commentary quoted below provides evidence that what Whiteman argues is true of many chemicals, is also true of radiation.

(p. D3) This spring [2015], four years after the nuclear accident at Fukushima, a small group of scientists met in Tokyo to evaluate the deadly aftermath.

No one has been killed or sickened by the radiation — a point confirmed last month by the International Atomic Energy Agency. Even among Fukushima workers, the number of additional cancer cases in coming years is expected to be so low as to be undetectable, a blip impossible to discern against the statistical background noise.

But about 1,600 people died from the stress of the evacuation — one that some scientists believe was not justified by the relatively moderate radiation levels at the Japanese nuclear plant.

. . .

“The government basically panicked,” said Dr. Mohan Doss, a medical physicist who spoke at the Tokyo meeting, when I called him at his office at Fox Chase Cancer Center in Philadelphia. “When you evacuate a hospital intensive care unit, you cannot take patients to a high school and expect them to survive.”

Among other victims were residents of nursing homes. And there were the suicides. “It was the fear of radiation that ended up killing people,” he said.

Most of the fallout was swept out to sea by easterly winds, and the rest was dispersed and diluted over the land. Had the evacuees stayed home, their cumulative exposure over four years, in the most intensely radioactive locations, would have been about 70 millisieverts — roughly comparable to receiving a high-resolution whole-body diagnostic scan each year. But those hot spots were anomalies.

By Dr. Doss’s calculations, most residents would have received much less, about 4 millisieverts a year. The average annual exposure from the natural background radiation of the earth is 2.4 millisieverts.

How the added effect of the fallout would have compared with that of the evacuation depends on the validity of the “linear no-threshold model,” which assumes that any amount of radiation, no matter how small, causes some harm.

Dr. Doss is among scientists who question that supposition, one built into the world’s radiation standards. Below a certain threshold, they argue, low doses are harmless and possibly even beneficial — a long-debated phenomenon called radiation hormesis.

. . .

Life evolved in a mildly radioactive environment, and some laboratory experiments and animal studies indicate that low exposures unleash protective antioxidants and stimulate the immune system, conceivably protecting against cancers of all kinds.

. . .

. . ., a study of radon by a Johns Hopkins scientist suggested that people living with higher concentrations of the radioactive gas had correspondingly lower rates of lung cancer. If so, then homeowners investing in radon mitigation to meet federal safety standards may be slightly increasing their cancer risk. These and similar findings have also been disputed.

. . .

There is more here at stake than agonizing over irreversible acts, like the evacuation of Fukushima. Fear of radiation, even when diluted to homeopathic portions, compels people to forgo lifesaving diagnostic tests and radiotherapies.

We’re bad at balancing risks, we humans, and we live in a world of continual uncertainty. Trying to avoid the horrors we imagine, we risk creating ones that are real.

For the full commentary, see:

George Johnson. “RAW DATA; When Radiation Isn’t the Risk.” The New York Times (Tuesday, Sept. 22, 2015 [sic]): D3.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 21, 2015 [sic], and has the title “RAW DATA; When Radiation Isn’t the Real Risk.”)

The recent book by Whiteman mentioned above is:

Whiteman, Noah. Most Delicious Poison: The Story of Nature’s Toxins―from Spices to Vices. New York: Little, Brown Spark, 2023.

The study of radon mentioned above is:

Thompson, Richard E. “Epidemiological Evidence for Possible Radiation Hormesis from Radon Exposure: A Case-Control Study Conducted in Worcester, Ma.” Dose-Response 9, no. 1 (2011): 59-75.

“A Richer World Is Much More Resilient Against Weather Extremes”

(p. A15) A new peer-reviewed study of all the scientific estimates of climate-change effects shows the most likely cost of global warming averaged across the century will be about 1% of global gross domestic product, reaching 2% by the end of the century. This is a very long way from global extinction.

Draconian net-zero climate policies, on the other hand, will be prohibitively costly. The latest peer-reviewed climate-economic research shows the total cost will average $27 trillion each year across the century, reaching $60 trillion a year in 2100. Net zero is more than seven times as costly as the climate problem it tries to address.

. . .  A richer world is much more resilient against weather extremes. In the short term, therefore, policymakers should focus on lifting the billions of people still in poverty out of it, both because it will make them more resilient against extreme weather and because it will do so much good in a myriad of other ways.  . . .

Careful science can inform us about the problem of climate change, but it can’t tell us how to solve it. Sensible public debate requires all the facts, including about the costs of our choices. Some of the most popular climate policies will have costs far greater than climate change itself. When politicians try to shut down discussion with claims that they’re “following the science,” don’t let them.

For the full commentary, see:

Bjorn Lomborg. “‘Follow the Science’ Leads to Ruin.” The Wall Street Journal (Thursday, March 14, 2024): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 13, 2024, and has the same title as the print version.)

The “new peer-reviewed study” mentioned above is:

Tol, Richard S. J. “A Meta-Analysis of the Total Economic Impact of Climate Change.” Energy Policy 185 (Feb. 2024): 113922.

The “latest peer-reviewed climate-economic research” mentioned above is:

Tol, Richard S. J. “Costs and Benefits of the Paris Climate Targets.” Climate Change Economics 14, no. 04 (2023): 2340003.

Federal and State Regulatory Thicket Thwarts “Permitting, Siting, Construction and Operation” of New Energy Infrastructure and Technology

(p. C5) Environmentalists have long argued that tackling climate change will require regulations to discourage fossil-fuel use, such as a carbon tax or a cap-and-trade program. In reality, there is no plausible path to a low-carbon economy without a serious deregulatory program. Today’s thicket of environmental regulation at the federal and state levels thwarts permitting, siting, construction and operation of virtually every class of new infrastructure and technology. There are simply too many veto points and opportunities for obstruction, at too many procedural and jurisdictional levels, to conceivably embark on a rapid mission to remake the nation’s energy economy.

. . .

The U.S. can no longer continue to neglect its compounding infrastructure and clean-energy needs. We aren’t going to regulate our way to a thriving low-carbon economy and a more stable climate. America needs to get back to building again.

For the full commentary, see:

Ted Nordhaus. “For a Clean-Energy Future, We Need Deregulation.” The Wall Street Journal (Saturday, February 19, 2022 [sic]): C5.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date February 17, 2022 [sic], and has the same title as the print version.)

Most Illegal Immigrants to the U.S. Correctly Believe That They Will Be Able to Stay Forever

(p. A1) Today, people from around the globe are streaming across the southern border, most of them just as eager to work. But rather than trying to elude U.S. authorities, the overwhelming majority of migrants seek out border agents, sometimes waiting hours or days in makeshift encampments, to surrender.

. . .

In December [2023] alone, more than 300,000 people crossed the southern border, a record number.

It is not just because they believe they will be able to make it across the 2,000 mile southern frontier. They are also certain that once they make it to the United States they will be able to stay.

Forever.

And by and large, they are not wrong.

For the full commentary, see:

Miriam Jordan. “Most Migrants Arrive Believing They Can Stay.” The New York Times (Thursday, February 1, 2024): A1 & A13.

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

(Note: the online version of the commentary has the date Jan. 31, 2024, and has the title “One Big Reason Migrants Are Coming in Droves: They Believe They Can Stay.”)