Category: Regulations

Covid Policy Should Have Taken Account of Costs of Lockdowns and Mandates

(p. A17) Reducing the incidence of disease isn’t necessarily desirable if excessive prevention, in the form of lockdowns or school closures, is more costly to society than the damage done by an illness. We don’t close highways to minimize accidental deaths, despite the existence of dangerous drivers. Yet this is exactly what we’re doing when the government intervenes to limit the spread of communicable diseases by, for instance, mandating vaccines that don’t prevent transmission.

. . .

In early 2020, University of Chicago economists estimated that about 80% of the total damage from Covid came from prevention efforts that hindered economic activity, and only 20% from the direct effects of the disease itself. This analysis motivated me and others to recommend that initial efforts to stop the spread should focus on older people, who are at higher risk of severe illness and not as active in the economy as younger people. This would allow younger people to keep the economy going while limiting the spread of the disease among those most at risk from it. Some in the public-health community, like the signers of the Great Barrington Declaration, eventually saw the light.

My Chicago colleague Casey B. Mulligan has found that total monthly Covid-related harms fell from 2020 to 2021, even as the number of deaths rose. In tax terms, this is an effect not unlike that of the Laffer curve—a lower rate may increase revenue because of growth in the tax base. Similarly, vaccines and treatments reduced the costs associated with getting sick—call it the “disease tax”—but also increased social and economic activity, allowing the infection to spread. Even if the disease tax is paid by more people, the costs are outpaced by the overall benefit derived from the subsequent tsunami of economic activity.

For the full commentary, see:

Tomas J. Philipson. “An Economic Evaluation Of Covid Lockdowns.” The Wall Street Journal (Saturday, January 20, 2022): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date January 19, 2022, and has the same title as the print version.)

During Pandemic, Delayed Medical Procedures Rose from 4.6 to 6 Million in England’s Socialized Healthcare System

(p. A8) LONDON — Lara Wahab had been waiting for more than two years for a kidney and pancreas transplant, but months had passed without any word. So last month she called the hospital, and got crushing news.

There had been a good match for her in October [2021], the transplant coordinator told her, which the hospital normally would have accepted. But with Covid-19 patients filling beds, the transplant team could not find her a place in the intensive care unit for postoperative care. They had to decline the organs.

“I was just in shock. I knew that the N.H.S. was under a lot of strain, but you don’t really know until you’re waiting for something like that,” she said, referring to the National Health Service. “It was there, but it sort of slipped through my fingers,” she added of the transplant opportunity.

Ms. Wahab, 34, from North London, is part of an enormous and growing backlog of patients in Britain’s free health service who have seen planned care delayed or diverted, in part because of the pandemic — a largely unseen crisis within a crisis. The problems are likely to have profound consequences that will be felt for years.

The numbers are stark: In England, nearly 6 million procedures are currently delayed, a rise from the backlog of 4.6 million before the pandemic, according to the N.H.S. The current delays most likely impact more than five million people — a single patient can have multiple cases pending for different ailments — which represents almost one-tenth of the population. Hundreds of thousands more haven’t been referred yet for treatment, and many ailments have simply gone undiagnosed.

For the full story, see:

Megan Specia. “In Britain, an Ever-Growing Backlog of Non-Covid Care.” The New York Times (Thursday, January 27, 2022): A8.

(Note: bracketed year added.)

(Note: the online version of the story was updated January 27, 2022, and has the title “‘I Feel Really Hopeless’: In U.K., Millions See Non-Covid Health Care Delayed.”)

Natural Immunity Is Stronger and Lasts Longer Than Immunity from Covid Vaccines

(p. A17) Public-health officials ruined many lives by insisting that workers with natural immunity to Covid-19 be fired if they weren’t fully vaccinated. But after two years of accruing data, the superiority of natural immunity over vaccinated immunity is clear. By firing staff with natural immunity, employers got rid of those least likely to infect others. It’s time to reinstate those employees with an apology.

For most of last year, many of us called for the Centers for Disease Control and Prevention to release its data on reinfection rates, but the agency refused. Finally last week, the CDC released data from New York and California, which demonstrated natural immunity was 2.8 times as effective in preventing hospitalization and 3.3 to 4.7 times as effective in preventing Covid infection compared with vaccination.

Yet the CDC spun the report to fit its narrative, bannering the conclusion “vaccination remains the safest strategy.” It based this conclusion on the finding that hybrid immunity—the combination of prior infection and vaccination—was associated with a slightly lower risk of testing positive for Covid. But those with hybrid immunity had a similar low rate of hospitalization (3 per 10,000) to those with natural immunity alone. In other words, vaccinating people who had already had Covid didn’t significantly reduce the risk of hospitalization.

Similarly, the National Institutes of Health repeatedly has dismissed natural immunity by arguing that its duration is unknown—then failing to conduct studies to answer the question. Because of the NIH’s inaction, my Johns Hopkins colleagues and I conducted the study. We found that among 295 unvaccinated people who previously had Covid, antibodies were present in 99% of them up to nearly two years after infection. We also found that natural immunity developed from prior variants reduced the risk of infection with the Omicron variant. Meanwhile, the effectiveness of the two-dose Moderna vaccine against infection (not severe disease) declines to 61% against Delta and 16% against Omicron at six months, according to a recent Kaiser Southern California study. In general, Pfizer’s Covid vaccines have been less effective than Moderna’s.

The CDC study and ours confirm what more than 100 other studies on natural immunity have found: The immune system works. The largest of these studies, from Israel, found that natural immunity was 27 times as effective as vaccinated immunity in preventing symptomatic illness.

None of this should surprise us. For years, studies have shown that infection with the other coronaviruses that cause severe illness, SARS and MERS, confers lasting immunity.

For the full commentary, see:

Marty Makary. “The High Cost of Disparaging Natural Immunity.” The Wall Street Journal (Thursday, January 27, 2022): A17.

(Note: the online version of the commentary has the date January 26, 2022, and has the title “The High Cost of Disparaging Natural Immunity to Covid.”)

The Israeli preprint study mentioned above is:

Gazit, Sivan, Roei Shlezinger, Galit Perez, Roni Lotan, Asaf Peretz, Amir Ben-Tov, Dani Cohen, Khitam Muhsen, Gabriel Chodick, and Tal Patalon. “Comparing Sars-Cov-2 Natural Immunity to Vaccine-Induced Immunity: Reinfections Versus Breakthrough Infections.” medRxiv (2021): doi: https://doi.org/10.1101/2021.08.24.21262415.

Middle Class Hurt by California Mandate for New Home Batteries and Solar Panels

(p. B1) This month, state regulators updated California’s building code to require some new homes and commercial buildings to have solar panels and batteries and the wiring needed to switch from heaters that burn natural gas to heat pumps that run on electricity. Energy experts say it is one of the most sweeping single environmental updates to building codes ever attempted by a government agency.

But some energy and building experts warn that California may be taking on too much, too quickly and focusing on the wrong target — new buildings, rather than the much larger universe of existing structures. Their biggest fear is that these new requirements will drive up the state’s already high construction costs, putting new homes out of reach of middle- and lower-income families that cannot as easily afford the higher upfront costs of cleaner energy and heating equipment, which typically pays for itself over years through (p. B3) savings on monthly utility bills.

. . .

Adding solar panels and a battery to a new home can raise its cost by $20,000 or more. While that might not matter to somebody buying a million-dollar property, it could be a burden on a family borrowing a few hundred thousand dollars to buy a home.

“You’re going to see the impact in office rents. You’re going to see it in the cost of the milk in your grocery store,” said Donald J. Ruthroff, a principal at Dahlin Group Architecture Planning in Pleasanton, Calif. “There’s no question this is going to impact prices across the board.”

. . .

The Sycamore Square townhouses were the last ones developed in San Bernardino before the solar mandate took effect last year. Glenn Elssmann, a partner in the project who hired Mr. Marini’s company as the contractor, said the added cost of the solar requirement would have made construction of the development impossible. Homes in Sycamore Square started at $340,000 for the four-bedroom, three-bath units and reached as high as $370,000.

Jimmie Joyce, 44, who works in payroll at the Los Angeles County Department of Public Health, will soon close on the purchase of a house in Sycamore Square after trying for almost a year to buy closer to Inglewood, a city near the Los Angeles International Airport where he lives now. His commute will likely increase from about 40 minutes to an hour and a half.

“I, for one, didn’t even plan on moving out that far,” Mr. Joyce said. “The way the market is, people are just overbidding to just try to get in things.” He said he made an offer $10,000 to $15,000 higher than the asking price on a home that ended up with more than 70 bids, including one that was $60,000 more than his.

His new home is already expensive for him, he said, and adding $10,000 to $20,000 more for solar, a battery and other amenities “would make that much more challenging.”

The changes regulators adopted this month will also require most new commercial buildings, including schools, hotels, hospitals, office buildings, retailers and grocery stores, and apartment buildings and condos above three stories to include solar and batteries. And regulators will require single-family homes to have wiring that will allow them to use electric heat pumps and water heaters, rather than ones that burn natural gas. About 55 percent of California’s homes use electric heat and 45 percent use natural gas.

For the full story, see:

Ivan Penn. “Greener Buildings, for a Lot of Green.” The New York Times (Monday, August 30, 2021): B1 & B3.

(Note: ellipses added.)

(Note: the online version of the story was updated Sept. 9, 2021, and has the title “California’s Plan to Make New Buildings Greener Will Also Raise Costs.”)

Democrat-Praised “Whistleblower” Rick Bright, Not Trump Admin, Delayed Molnupiravir by Months at Peak of Pandemic

(p. A17) When Merck and Ridgeback Biotherapeutics announced on Oct. 1 [2021]that their new antiviral pill reduced Covid hospitalizations by roughly half, some in the media blamed Donald Trump. An Axios headline: “Before Merck backed COVID antiviral, Trump admin turned it down.” In fact, Trump officials pushed for government funding to accelerate the development of the drug, molnupiravir. They were opposed by a career official, Rick Bright, whom Democrats praised as a “whistleblower.”

Mr. Bright joined the Biomedical Advanced Research and Development Authority in 2010 and became Barda’s director in 2016.

. . .

Emory had licensed molnupiravir to Ridgeback, which in April 2020 requested $100 million from the government to fast-track studies in humans. Mr. Bright says Trump officials ordered Barda officials “to fund the Ridgeback proposal as quickly as possible, and preferably within 24 hours.” But he said “Ridgeback had not followed the proper procedure for receiving BARDA funding.” Barda declined the request, and Ridgeback collaborated with Merck, which put its own capital at risk.

After Mr. Bright’s reassignment, Barda funding for trials, manufacturing and advance purchases of monoclonal antibodies proved critical in accelerating their development. Molnupiravir would likely have been available much sooner had Barda provided funding as Trump officials urged last spring.

For the full commentary, see:

Allysia Finley. “Who Slowed Merck’s Covid Remedy?” The Wall Street Journal (Monday, October 11, 2021): A17.

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

(Note: the online version of the commentary has the date October 10, 2021, and has the same title as the print version.)

The Elite Experts Who Have Failed, Tend to Censor the Heterodox Outsiders Who They Fear

(p. 8) When you have a chronic illness and struggle to get better, you try to maintain a certain equilibrium by distinguishing yourself from all those other sick people, the ones who are trying truly crazy things while you are proceeding sensibly and moderately along the path to health.

. . .

These exotic treatments, from acupuncture to IV vitamin C to magnet therapy and more, weren’t the core of what helped me eventually gain ground and improve — strong and various doses of antibiotics played the central role. But they were the most educational part of my slow, still-continuing recovery, in the sense of what they revealed about the complexity and strangeness of the world.

The strangest of them all was the Rife machine.

. . .

Naturally, it worked.

What does “worked” mean, you may reasonably ask? Just this: By this point in my treatment, there was a familiar feeling whenever I was symptomatic and took a strong dose of antibiotics — a temporary flare of pain and discomfort, a desire to move or rub the symptomatic areas of my body, a sweating or itching feeling, followed by a wave of exhaustion and then a mild relief. I didn’t get this kind of reaction with every alternative treatment I tried. But with the Rife machine I got it instantly: It was like having a high dose of antibiotics hit the body all at once.

Of course, this was obviously insane, so to the extent that I was able I conducted experiments, trying frequencies for random illnesses to see if they elicited the same effect (they did not), setting up blind experiments where I ran frequencies without knowing if they were for Lyme disease or not (I could always tell).

. . .

When I set out to write about the entire chronic-illness experience, I hesitated over whether to tell this kind of story. After all, if you’re trying to convince skeptical readers to take chronic sickness seriously, and to make the case for the medical-outsider view of how to treat Lyme disease, reporting that you’ve been dabbling in pseudoscience and that it works is a good way to confirm every stereotype about chronic ailments and their treatment: It’s psychosomatic … it’s all the power of suggestion … it’s a classic placebo effect … poor Ross, taken in by the quacks … he’ll be ‘doing his own research’ on vaccination next

    .

    But there are two good reasons to share this sort of story. The first is that it’s true, it really happened, and any testimony about what it’s like to fight for your health for years would be dishonest if it left the weird stuff out.

    The second is that this kind of experience — not the Rife machine specifically, but the experience of falling through the solid floor of establishment consensus and discovering something bizarre and surprising underneath — is extremely commonplace. And the interaction between the beliefs instilled by these experiences and the skepticism they generate (understandably) from people who haven’t had them, for whom the floor has been solid all their lives, is crucial to understanding cultural polarization in our time.

    On both sides of our national divides, insider and outsider, establishment and populist, something in human psychology makes us seek coherence and simplicity in our understanding of the world. So people who have a terrible experience with official consensus, and discover that some weird idea that the establishment derides actually seems to work, tend to embrace a new rule to replace the old one: that official knowledge is always wrong, that outsiders are always more trustworthy than insiders, that if Dr. Anthony Fauci or the Food and Drug Administration get some critical things wrong, you can’t trust them to get anything right.

    This impulse explains why fringe theories tend to cluster together, the world of outsider knowledge creating its own form of consensus and self-reinforcement. But it also explains the groupthink that the establishment often embraces in response, its fear that pure craziness automatically abounds wherever official knowledge fails, and its commitment to its own authority as the only thing standing between society and the abyss.

    This is a key dynamic in political as well as biomedical debates. The conspicuous elite failures in the last 20 years have driven many voters to outsider narratives, which blend plausible critiques of the system with outlandish paranoia. But the insiders only see the paranoia, the QAnon shaman and his allies at the gates. So instead of reckoning with their own failures, they pull up the epistemic drawbridge and assign fact checkers to patrol the walls. Which in turn confirms for outsiders their belief that the establishment has essentially blinded itself and only they have eyes to see.

    What we need, I’m convinced, are more people and institutions that sustain a position somewhere in between.

For the full commentary, see:

Ross Douthat. “How I Became Extremely Open-Minded.” The New York Times, SundayReview Section (Sunday, November 7, 2021): 8.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 6, 2021, and has the same title as the print version. The passages that are underlined above, were in italics in the original. In the underlined passages I use a hyphen were the original had ellipses.)

The passages quoted above are from a commentary adapted from Douthat’s book:

Douthat, Ross. The Deep Places: A Memoir of Illness and Discovery. New York: Convergent Books, 2021.

To Get “Free” Covid Pills from 60 Miles Away You Pay Private Uber to Deliver

(p. 1) Just after 1 p.m. on Tuesday last week, my phone buzzed with a text message from my mother: “Well, came down with cold, aches, cough etc over wknd.” She had taken an at-home coronavirus test. It was positive.

Having spent the past year writing about Covid-19 vaccines and treatments for The New York Times, I knew a lot about the options available to people like my mother. Yet I was about to go on a seven-hour odyssey that would show me there was a lot I didn’t grasp.

. . .

(p. 3) In the end, my scramble to find a prescriber turned out to be unnecessary. In the early evening, my mother got an unexpected call from a doctor with her primary care provider. She told the doctor about her symptoms and about the Rite Aid I had found with Paxlovid in stock.

The doctor told her that he was surprised that we had been able to track down Paxlovid. He phoned in a prescription to the Rite Aid.

Now we just needed to pick up the pills before the pharmacy closed in about an hour.

Uber came to the rescue. I requested a pickup at the Rite Aid and listed the destination as my mother’s home, some 60 miles away.

Once a driver accepted the ride, I called him and explained my unusual request: He’d need to get the prescription at the pharmacy window and then drive it to my mother’s. I told him I’d give him a 100 percent tip.

The driver, who asked me not to use his name in this article, was game. He delivered the precious cargo just after 8 p.m. My mother swallowed the first three pills — the beginning of a five-day, 30-pill regimen — within minutes of the driver’s arrival.

. . .

. . . the fact that the process was so hard for a journalist whose job it is to understand how Paxlovid gets delivered is not encouraging. I worry that many patients or their family would give up when told “no” as many times as I was.

I was also reminded that even a “free” treatment can come with significant costs.

The federal government has bought enough Paxlovid for 20 million Americans, at a cost of about $530 per person, to be distributed free of charge. But I spent $256.54 getting the pills for my mother. I paid $39 for the telemedicine visit with the provider who told my mother that she would need to visit in person. The rest was the Uber fare and tip. Many patients and their families can’t afford that.

President Biden recently called the Pfizer pills a “game changer.” My experience suggests it won’t be quite so simple.

For the full story, see:

Rebecca Robbins. “A 7-Hour Odyssey to Get My Mom Covid Pills.” The New York Times, SundayBusiness Section (Sunday, January 23, 2022): 1 & 3.

(Note: ellipses added.)

(Note: the online version of the story has the date Jan. 19, 2022, and has the title “When My Mom Got Covid, I Went Searching for Pfizer’s Pills.”)

“People Are Now Coming to Their Own Conclusions About Covid”

(p. 3) Lauren Terry, 23, thought she would know what to do if she contracted Covid-19. After all, she manages a lab in Tucson that processes Covid tests.

But when she developed symptoms on Christmas Eve, she quickly realized she had no inside information.

“I first tried to take whatever rapid tests I could get my hands on,” Ms. Terry said. “I bought some over the counter. I got a free kit from my county library. A friend gave me a box. I think I tried five different brands.” When they all turned up negative, she took a P.C.R. test, but that too, was negative.

With clear symptoms, she didn’t believe the results. So she turned to Twitter. “I was searching for the Omicron rapid test efficacy and trying to figure out what brand works on this variant and what doesn’t and how long they take to produce results,” she said. (The Food and Drug Administration has said that rapid antigen tests may be less sensitive to the Omicron variant but has not identified any specific tests that outright fail to detect it.) “I started seeing people on Twitter say they were having symptoms and only testing positive days later. I decided not to see anybody for the holidays when I read that.”

She kept testing, and a few days after Christmas she received the result she had expected all along.

Though it’s been almost two years since the onset of the pandemic, this phase can feel more confusing than its start, in March 2020. Even P.C.R. tests, the gold standard, don’t always detect every case, especially early in the course of infection, and there is some doubt among scientists about whether rapid antigen tests perform as well with Omicron. And, the need for a 10-day isolation period was thrown into question after the Centers for Disease Control and Prevention announced that some people could leave their homes after only five days.

“The information is more confusing because the threat itself is more confusing,” said David Abramson, who directs the Center for Public Health Disaster Science at the N.Y.U. School of Global Public Health. “We used to know there was a hurricane coming at us from 50 miles away. Now we have this storm that is not well defined that could maybe create flood or some wind damage, but there are so many uncertainties, and we just aren’t sure.”

Many people are now coming to their own conclusions about Covid and how they should behave. After not contracting the virus after multiple exposures, they may conclude they can take more risks. Or if they have Covid they may choose to stay in isolation longer than the C.D.C. recommends.

And they aren’t necessarily embracing conspiracy theories. People are forming opinions after reading mainstream news articles and tweets from epidemiologists; they are looking at real-life experiences of people in their networks.

For the full story, see:

Alyson Krueger. “Covid Experts, the Self-Made Kind.” The New York Times, SundayStyles Section (Sunday, January 23, 2022): 3.

(Note: the online version of the story has the date January 21, 2022, and has the title “So You Think You’re a Covid Expert (but Are You?).”)

When Humans Control Animals, Their Wily Resilience Can Cause “Unforeseen Consequences”

(p. A15) For the past three years, a gray squirrel has set out to ruin my life, chewing leaves off my beloved exotic hibiscus and geraniums.

. . .

. . . , Mary Roach’s “Fuzz: When Nature Breaks the Law” makes me feel grateful that my nemesis is only a rodent, and that I live in Ohio, not Colorado or India. My refrigerator will not be emptied by a bear; I will not be throttled by a leopard while taking out the compost.

. . .

There’s something demonic at work in India’s leopards and macaques, but the dilemma finds its root in human behavior. For centuries, feeding monkeys has been considered a religious offering, but this ritual has fueled a certain conviction on the monkeys’ part that humans are in service to them. Ms. Roach’s attempts to pin down government officials on how they might tackle the problem (including hiring more monkey catchers and staffing more monkey sterilization centers) are hilariously convoluted and laced with bizarre anecdotes. She’s passed from one office to the next and back again, never getting an answer. Before redirecting her, one official “veered off into a story about a macaque that got inside the All India Institute of Medical Sciences and took to pulling IV needles out of patients’ arms and sucking the glucose like a child with a straw in a pop bottle.”

During World War II, the U.S. military established a naval air station on Midway Atoll, the strategically significant string of islets halfway between North America and Asia. But the islands turned out to be also a significant nesting ground for thousands of albatrosses, and the result was hundreds of collisions between the airplanes and the huge soaring birds. It is heartbreaking to read of sailors being made to club the long-living albatrosses—80,000 in one assault, 21,000 in another—to reduce the population. Still, nature prevailed. “For a brief time the hazard to aircraft was reduced,” read one report. “The following season there appeared to be as many albatrosses as before.” After every possible deterrent and lethal attack on the gentle birds failed, the air base was closed and in 1993 converted into a refuge. The contrast between this midcentury horror and the reverence shown earlier this year for Wisdom, the 70-year-old Laysan albatross still nesting on Midway, could hardly be more stark.

. . .

This book is largely about the unspooling of unforeseen consequences, and our feeble attempts to put the animal genies we’ve freed back into their bottles.

For the full review, see:

Julie Zickefoose. “BOOKSHELF; Rebellious Nature.” The Wall Street Journal (Tuesday, Nov. 2, 2021): A15.

(Note: ellipses added.)

(Note: the online version of the review has the date November 1, 2021, and has the title “BOOKSHELF; ‘Fuzz’ Review: Rebellious Nature.”)

The book under review is:

Roach, Mary. Fuzz: When Nature Breaks the Law. NY: W. W. Norton & Company, 2021.

Biden’s Cancer “Moonshot Is 100 Percent Hype”

(p. A17) WASHINGTON — President Biden unveiled a plan on Wednesday to reduce the death rate from cancer by at least 50 percent over the next 25 years — an ambitious new goal, he said, to “supercharge” the cancer “moonshot” program he initiated and presided over five years ago as vice president.

Mr. Biden, joined by his wife, Jill Biden, and Vice President Kamala Harris, also announced a campaign to urge Americans to undergo screenings that were missed during the coronavirus pandemic.

. . .

More screenings are not the answer — the only cancers for which screening has indisputably lowered the death rate are colon and cervical. Death rates for other cancers, like breast, have fallen, but a large part of the drop, if not all of it, is because of improved treatment, said Donald A. Berry, a biostatistician at the University of Texas M.D. Anderson Cancer Center who has spent decades studying these issues.

“Everybody loves early detection, but it comes with harms,” he said — principally, the harm of finding and treating tumors that do not need to be treated because they are innocuous. “The harms we know, but the benefits of screening are very uncertain,” he said.

If the age-adjusted cancer death rate were to plunge by 50 percent, it would have to be because cancers were being cured. Some treatments, like a drug that treats chronic myelogenous leukemia, have slashed death rates for that disease, but such marked effects in cancer are few and far between.

. . .

The White House billed the event as a fresh push by the president to “reignite” the moonshot program and “end cancer as we know it.”

. . .

Yet one Wall Street analyst who specializes in biotechnology and pharmaceuticals said that the time, money and effort might be better spent on initiatives to prevent cancer, like reducing smoking and rates of obesity. The Centers for Disease Control and Prevention says being obese increases a person’s risk of cancer. And reducing smoking is a proven way to cut the cancer death rate.

“This moonshot is 100 percent hype; this is the absolute wrong way to do this,” said the analyst, Stephen Brozak, the president of WBB Securities.

Presidents since Richard M. Nixon have sought to tackle cancer, of which there are more than 100 types of disease that can vary in how they grow, spread and respond to treatment. The cancer institute estimates that nearly 40 percent of men and women will be diagnosed with some type of cancer at some point during their lifetimes. The American Cancer Society estimates there will be 1.9 million new cases of cancer in the United States this year, and more than 609,000 cancer deaths.

For the full story, see:

Sheryl Gay Stolberg and Gina Kolata. “President Aims to Cut The Cancer Death Rate In Half Over 25 Years.” The New York Times (Thursday, February 3, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the story has the date Feb. 2, 2022, and has the title “Biden Presents Ambitious Plan to Cut Cancer Death Rate in Half.”)

Expert Medical Advice Often Flip-Flops

(p. D6) A History of Medical Flip-Flops

Shifting medical advice is surprisingly common, and it tends to fall into three categories: emerging guidance, replacement advice and reversals.

Emerging guidance comes during times of crisis — like pandemics — and is destined to change quickly. In the past several months, guidance about the best way to treat Covid patients, masks to prevent transmission and the limits of vaccine protection have all shifted as knowledge of the coronavirus and its variants has evolved.

Sometimes it’s hard to tell the difference between replacement advice, which is issued when research improves on advice that came before it, and a full reversal, which comes about because a common medical practice got ahead of the science and never actually worked or even caused harm. Here are some examples of true medical flip-flops in recent years.

MENOPAUSE HORMONES TO PROTECT THE HEART: In 2002, decades of advice about the heart benefits of menopause hormones seemed to change overnight when a major study called the Women’s Health Initiative was halted after researchers detected more heart attacks in the women taking hormones. In hindsight, doctors had misinterpreted data from observational research. The current advice: Hormones can relieve menopause symptoms but shouldn’t be used for chronic disease prevention.

VIOXX AS A LOWER-RISK ARTHRITIS TREATMENT: In 1999, the Food and Drug Administration approved Vioxx as a breakthrough pain reliever because it lowered the risk of gastrointestinal problems. But by 2004, Merck had withdrawn the drug because studies showed it significantly raised the risk of heart attack.

ARTHROSCOPIC SURGERY ON AGING KNEES: For years, the partial removal of torn meniscus tissue was the most common orthopedic procedure in the United States, with about 700,000 performed a year. In 2013, a researcher in Finland compared the operation to a “sham” procedure and found there was no benefit. Most doctors now recommend physical therapy instead.

VITAMIN MEGADOSES TO LOWER CANCER AND HEART RISK: For years, doctors believed various vitamins could lower risk for cancer and heart disease, but a number of studies showed just the opposite. A study of beta carotene and vitamin A found that the supplements actually increased the risk of lung cancer in male smokers. A study of vitamin E and selenium, thought to protect against prostate cancer, increased risk for the disease.

STENTS FOR STABLE HEART DISEASE: Doctors used to insert stents — tiny wire mesh tubes that prop open arteries — in millions of otherwise stable patients with heart disease. A study found that the surgical procedure was no better than drug therapy for preventing heart attacks.

Dr. Vinay Prasad, associate professor at the University of California San Francisco, and Dr. Adam S. Cifu, a professor of medicine at the University of Chicago Department of Medicine, coined the term “medical reversal” and concluded that about 40 percent of common medical practices that they reviewed turned out to be useless or harmful. In their book, “Ending Medical Reversal: Improving Outcomes, Saving Lives,” they noted that most of these failed treatments were initially embraced because they were based on logical reasoning.

“The thing that’s often behind reversal: All of these things have a good story, they have good pathophysiological rationale,” Dr. Cifu said. “They should work. But things only work if they’ve been shown in people to work, and people are so complicated.”

For the full story, see:

Tara Parker-Pope. “Shifting Medical Advice Is a Feature, Not a Bug.” The New York Times (Tuesday, November 2, 2021): D6.

(Note: the online version of the story was updated Oct. 24, 2021, and has the title “Is the New Aspirin Advice a Medical Flip-Flop, or Just Science?” The paragraphs on menopause hormones to protect the heart and on vitamin megadoses to lower cancer and heart risk appear in the online version, but not in the print version.)

The book co-authored by Prasad and mentioned above is:

Prasad, Vinayak K., and Adam S. Cifu. Ending Medical Reversal: Improving Outcomes, Saving Lives. Baltimore: Johns Hopkins University Press, 2015.