Category: Regulations

CDC’s “Rigid Checklist” Leads Doctors to Misdiagnose Atypical Cases

(p. A17) In his “memoir of illness and discovery,” Mr. Douthat tells us of his descent into a netherworld of consternation, paranoia and despair after contracting a chronic form of Lyme disease six years ago. Although he experienced physical pain that was often unbearable, he was stonewalled and scoffed at by skeptical doctors who refused to accept the existence of a long-lingering form of Lyme.

. . .

Lyme—a debilitating bacterial disease acquired from deer-tick bites—was ruled out because many of his symptoms didn’t match a rigid checklist drawn up for the ailment by the Centers for Disease Control and Prevention. This “diagnostic standardization,” Mr. Douthat writes, was “supposed to establish a consistent baseline for national case reporting, not rule out the possibility of atypical cases or constrain doctors from diagnosing them.” As a result of such inflexibility, he tells us, doctors miss “anywhere from a third to half of early Lyme cases.”

For the full review, see:

Tunku Varadarajan. “BOOKSHELF; Patient, Heal Thyself.” The Wall Street Journal (Saturday, Oct. 14, 2021): A17.

(Note: ellipsis added.)

(Note: the online version of the review has the date October 13, 2021, and has the title “BOOKSHELF; ‘The Deep Places’ Review: Patient, Heal Thyself.”)

The book under review is:

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

Sri Lankan Ban on Synthetic Fertilizer Causes Soaring Food Prices and Hunger

(p. A17) The Green Revolution of Norman Borlaug, the American agronomist who did more to feed the world than any man before or since, set Sri Lanka on the path to agricultural abundance in 1970. It was built around chemical fertilizers and crops bred to be disease-resistant. Fifty-two years later, Sri Lanka has pulled off a revolution that is “antigreen” in the modern sense, toppling its president, Gotabaya Rajapaksa. In an uprising that has its roots in Mr. Rajapaksa’s imperious decision to impose organic farming on the entire country—which led to widespread hunger after the agricultural economy collapsed—Sri Lanka’s people have wrought the first contra-organic national uprising in history.

. . .

. . ., Mr. Rajapaksa was driven from office in part because he was an overzealous green warrior, who imposed on his countrymen a policy that the American environmental left holds sacred.

. . .

. . ., Mr. Rajapaksa took a step that poleaxed Sri Lanka. On April 27, 2021—with no warning, and with no attempt to teach farmers how to cope with the change—he announced a ban on all synthetic fertilizers and pesticides. Henceforth, he decreed, Sri Lankan agriculture would be 100% organic. Agronomists and other scientists warned loudly of the catastrophe that would ensue, but they were ignored. This Sri Lankan Nero listened to no one.

. . .

What happened next? Rice production fell by 20% in the first 180 days of the ban on synthetic fertilizer. Tea, Sri Lanka’s main cash crop, has been hit hard, with exports at their lowest level in nearly a quarter-century. Whether from indignation over the new laws or an inability to go organic, farmers left a third of all farmland fallow. Food prices soared as a result of scarcity and Sri Lanka’s people, their pockets already hit by the pandemic, began to go hungry. To add to the stench of failure, a shipload of manure from China had to be turned back after samples revealed dangerous levels of bacteria. The farmers had no synthetic fertilizer, and hardly any of the organic kind.

For the full commentary see:

Tunku Varadarajan. “Sri Lanka’s Green New Deal Was a Human Disaster.” The Wall Street Journal (Friday, July 15, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 14, 2022, and has the same title as the print version.

Insurers Claim Curing Obesity Is “Vanity”

(p. A17) Maya Cohen’s entree into the world of obesity medicine came as a shock.

In despair over her weight, she saw Dr. Caroline Apovian, an obesity specialist at Brigham and Women’s Hospital, who prescribed Saxenda, a recently approved weight-loss drug. Ms. Cohen, who is 55 and lives in Cape Elizabeth, Maine, hastened to get it filled.

Then she saw the price her pharmacy was charging: $1,500 a month. Her insurer classified it as a “vanity drug” and would not cover it.

“I’m being treated for obesity,” she complained to her insurer, but to no avail.

. . .

More than 40 percent of Americans have obesity, and most have tried repeatedly to lose weight and keep it off, only to fail. Many suffer from medical conditions that are linked to obesity, including diabetes, joint and back pain and heart disease, and those conditions often improve with weight loss.

“The evidence is now overwhelming that there are physical changes in weight regulating pathways that make it difficult for people to lose weight and maintain their weight loss,” said Dr. Louis Aronne, an obesity medicine specialist who directs the comprehensive weight control center at Weill Cornell Medicine. “It’s not that they don’t have willpower. Something physical is holding them back.”

. . .

“Access to medicines for the treatment of obesity is dismal in this country,” said Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School.

. . .

Douglas Langa, an executive vice president at Novo Nordisk, . . . said that diabetes and obesity were “separate categories, separate marketplaces” to explain the difference in price between the companies’ two drugs that were based on the same medicine, semaglutide. He said Wegovy’s price “reflects efficacy and clinical value in this area of unmet need.”

Dr. Stanford was appalled.

“It’s unbelievable,” she said, adding that it was a gross inequity to charge people more for the same drug because of their obesity. She finds herself in an untenable situation: getting excited when her patients with obesity also have diabetes because their insurers pay for the drug.

For the full story, see:

Gina Kolata. “Many Insurers Won’t Cover New Weight Loss Drugs.” The New York Times (Wednesday, June 1, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the story has the date May 31, 2022, and has the title “The Doctor Prescribed an Obesity Drug. Her Insurer Called It ‘Vanity.’.”)

U.S. Forest Service Started the Most Destructive Fire in New Mexico History

(p. A10) MORA, N.M. — It started small, with a team of federal employees using drip torches to ignite a prescribed burn in the Santa Fe National Forest, aimed at thinning out dense pine woodlands.

But as April [2022] winds howled across the mountains of brittle-dry northern New Mexico, driving the fire over its boundaries and soon into the path of another out-of-control prescribed burn, it grew to become one of the U.S. Forest Service’s most destructive mistakes in decades.

The resulting merger of those two burns, called the Calf Canyon/Hermit’s Peak blaze, now ranks as the largest wildfire in New Mexico’s recorded history. Still burning in a zone of more than 341,000 acres — larger than the city of Los Angeles — the fire has destroyed hundreds of homes and displaced thousands in a region where Hispanic villagers settled centuries ago.

The painful losses have created a backlash against the Forest Service and provided a pivotal test case for how the authorities react when a prescribed burn goes badly wrong.

“I hope those responsible for this catastrophic failure are not sleeping at night,” said Meg Sandoval, 65, whose family settled in the region in the 1840s. She is now living out of a pickup camper shell after her home in Tierra Monte was destroyed by the fire.

“They ruined the lives of thousands of people,” she said.

. . .

. . . like many of her constituents, Ms. Leger Fernández said she was furious to learn that the Forest Service had started both blazes. “How could you make the same mistake twice in the same neighborhood?” she asked.

. . .

Patrick Dearen wrote a book about the Pecos River, whose headwaters are threatened by the Calf Canyon/Hermit’s Peak fire. He noted that in the 1890s, the forest around the river that is now designated as national forest was made up mostly of “old burns,” as well as meadows, open parks and barren peaks.

An inventory in 1911 showed that a typical acre of ponderosa pine habitat had 50 to 60 trees. By the end of the 20th century, Mr. Dearen said, after a long national policy of suppressing natural fires, that had skyrocketed to 1,089 trees per acre.

“Nature had done its job well, but no one recognized it,” Mr. Dearen said. Still, if the government is going to assume nature’s role of thinning out forests, it needs to own up to its mistakes, he said.

“If an individual goes out and starts a fire on purpose and it gets away, he’s probably going to go to jail,” he said. “The federal government needs to assume responsibility to the people.”

For the full story, see:

Simon Romero. “Thousands Lost Everything In Fire Set by Forest Service.” The New York Times (Thursday, June 23, 2022): A10.

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

(Note: the online version of the story was updated June 24, 2022, and has the title “The Government Set a Colossal Wildfire. What Are Victims Owed?”)

The book by Dearen mentioned above is:

Dearen, Patrick. Bitter Waters: The Struggles of the Pecos River. Norman, OK: University of Oklahoma Press, 2016.

New York City Hurt as Wealthy Residents Move to Miami

(p. A1) When roughly 300,000 New York City residents left during the early part of the pandemic, officials described the exodus as a once-in-a-century shock to the city’s population.

Now, new data from the Internal Revenue Service shows that the residents who moved to other states by the time they filed their 2019 taxes collectively reported $21 billion in total income, substantially more than those who departed in any prior year on record. The IRS said the data captured filings received in 2020 and as late as July 2021.

Many new or returning residents have since moved in. But the total income of those who had initially left was double the average amount of those who had departed over the previous decade, a potential loss that could have long-term effects on a city that relies heavily on its wealthiest residents to support schools, law enforcement and other public services.

The sheer number of people who left in such a short period raises uncertainty about New York City’s competitiveness and economic stability. The top 1 percent of earners, who make more than $804,000 a year, contributed 41 percent of the city’s personal income taxes in 2019.

About one-third of the people who left moved from Manhattan, and had an average income of $214,300. No other large American county had a similar exodus of wealth.

Early in the pandemic, Sam Williamson, 51, a white-collar defense lawyer living on the Upper West Side of Manhattan, first relocated to Utah, then to Long Island. After a return to the city, he and (p. A19) his family permanently moved to Miami last year when his law firm opened an office there.

“I love New York City, but it’s been a challenging time,” Mr. Williamson said. “I didn’t feel like the city handled the pandemic very well.”

. . .

Gergana Ivanova, 28, a clothing designer and social media influencer, said her decision to move to Miami was less about taxes. The pandemic made the downsides of living in New York City more noticeable, she said, including the lack of space in her tiny Queens apartment and the trash piling up on the sidewalks. She felt less safe walking around when the streets were emptier.

“It didn’t feel happy and positive like it used to,” she said.

. . .

The exodus to Florida was especially robust, and not just for the retiree crowd. In 2020, New York City had a net loss of nearly 21,000 residents to Florida, IRS data showed, almost double the average annual net loss from before the pandemic.

. . .

Zak Jacoby was the general manager of a bar on the Lower East Side when the pandemic hit. Throughout 2020, his employment status fluctuated with the city’s changing indoor dining rules, a stressful period that put him on and off unemployment benefits.

Mr. Jacoby, 37, flew to Miami in January 2021 to see a friend — and decided to stay permanently after getting a job offer at a local restaurant group. If there was another virus surge, he said, the state would be less likely to shut down businesses, giving him more job security.

“My mind-set was, Florida’s more lenient on Covid, and there’s going to be less regulation,” he said.

For the full story see:

Nicole Hong and Matthew Haag. “Exodus of New York’s Wealthy Leaves Lasting Costs in Wake.” The New York Times (Tuesday, June 28, 2022): A1 & A19.

(Note: ellipses added.)

(Note: the online version of the story has the same date as the print version, and has the title “The Flight of New York City’s Wealthy Was a Once-in-a-Century Shock.” The online version of the story says that the print version has the title “An Exodus of New York’s Wealthy Has Left Lasting Costs,” but my National print version has the somewhat different title “Exodus of New York’s Wealthy Leaves Lasting Costs in Wake.”)

Lacking Government Approval During Pandemic, “State-of-the-Art Testing Machines . . . Weren’t Turned On”

(p. 12) The ethics manual of the American College of Physicians states that “the ethical imperative for physicians to provide care” overrides “the risk to the treating physician, even during epidemics.” Nevertheless, for most of human history, doctors often ran away in the face of widespread contagious disease.

. . .

When health workers stick around to treat patients, even at risk to their own lives, it is something to be celebrated, and the journalist Marie Brenner does just that in “The Desperate Hours,” an account of how workers at New York-Presbyterian, an academic health system, coped with the Covid surge in New York City beginning in the spring of 2020. The book details both medical heroism and corporate cowardice, prescient decisions and howling missteps, all against the backdrop of a swirling and mysterious pandemic that claimed the lives of more than 30,000 residents, not to mention 35 New York-Presbyterian employees.

Along the way we encounter some eye-opening anecdotes. Early on, New York City hospitals were faced with an alarming dearth of masks and a near rebellion by workers on the front lines. In response, New York-Presbyterian’s chief operating officer, Dr. Laura Forese, a pediatric orthopedic surgeon, assured staff members that “masks would not be necessary” unless workers were in direct contact with infected patients. Though she was working off mistaken C.D.C. guidelines, it was “advice and regulation that countermanded every bit of common sense understood by public health officials since the Black Plague,” Brenner writes.

. . .

Yet state-of-the-art testing machines at New York-Presbyterian weren’t turned on because the leadership was waiting for the government to approve their use. When doctors and nurses complained, the communications office attempted to throttle them and even threatened them with demotions or dismissal. It is part of what Dr. Steve Corwin, New York-Presbyterian’s chief executive, calls “a failure of imagination on our part.”

The book has its share of heroes who buck the strictures of the system to speak the truth about what was coming (or had already arrived). No one was more heroic than Dr. Nathaniel Hupert, an infectious-disease modeler at New York-Presbyterian who raised the alarm about the pandemic in February 2020 but was largely ignored.

“This is going to be historically bad, rivaling the medical consequences of 1918, but far exceeding it in terms of global financial impact,” he warned his colleagues. “If we get through this, it will be the sort of thing that we will tell our grandchildren about.” Yet when Hupert showed his projections at a planning meeting, the medical school dean told him, “I think we will be all right.”

. . .

Compounding the disaster was that little guidance was coming from executives on how to navigate the crisis, including how to potentially ration beds and ventilators (which fortunately did not come to pass). “The amount of moral damage they did to a lot of people while they get paid millions of dollars is disgusting,” a critical-care physician says bitterly.

For the full review, see:

Sandeep Jauhar. “Plagued.” The New York Times Book Review (Sunday, July 3, 2022): 12.

(Note: ellipses added.)

(Note: the online version of the review has the date June 19, 2022, and has the title “Facing Death During the Pandemic.”)

The book under review is:

Brenner, Marie. The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines. New York: Flatiron Books, 2022.

Organic Strawberries Blamed for Hepatitis A Outbreak

(p. A21) Public health officials said they were investigating an outbreak of hepatitis A in the United States and Canada that is potentially linked to organic strawberries.

American health officials said the outbreak most likely came from fresh organic strawberries branded as FreshKampo and H-E-B that were bought between March 5 and April 25.

The strawberries were sold at stores including Aldi, H-E-B, Kroger, Safeway, Sprouts Farmers Market, Trader Joe’s, Walmart and Weis Markets, the Food and Drug Administration said.

. . .

In the United States, the F.D.A. said it had identified 17 cases of hepatitis A linked to the strawberries — 15 in California and one each in Minnesota and North Dakota. Twelve people have been hospitalized, the agency said.

. . .

Hepatitis A is a contagious virus that may cause liver disease.

. . .

Symptoms usually develop 15 to 20 days after eating the contaminated food and can include fatigue, nausea, vomiting, abdominal pain, jaundice, dark urine and pale stool, the F.D.A. said.

For the full story see:

Michael Levenson. “Strawberries Linked to Hepatitis A Outbreak, F.D.A. Says.” The New York Times (Wednesday, June 1, 2022): A21.

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

(Note: the online version of the story has the date May 31, 2022 and has the title “Hepatitis A Outbreak in U.S. and Canada Linked to Strawberries.”)

Dr. Zelenko’s pre-Covid-19 memoir is:

Zelenko, Vladmir. Metamorphosis. Lakewood, NJ: Israel Bookshop Publications, 2019.

A highly credentialed Yale academic presented evidence of the promise of hydroxychloroquine for early outpatient treatment in:

Risch, Harvey A. “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients That Should Be Ramped-up Immediately as Key to the Pandemic Crisis.” American Journal of Epidemiology 189, no. 11 (Nov. 2020): 1218–26.

“Quiet, Unassuming” Dr. Zelenko Got Twitter Suspension and Death Threats for Speaking on Hydroxychloroquine

Dr. Zelenko was stricken with a rare form of lung cancer in 2018, shortly before the Covid-19 pandemic. I wonder if that increased his personal sense of urgency to find a cure for Covid-19?

(p. A21) Vladimir Zelenko, a self-described “simple country doctor” from upstate New York who rocketed to prominence in the early days of the Covid-19 pandemic when his controversial treatment for the coronavirus gained White House support, died on Thursday in Dallas. He was 48.

. . .

Like many health care providers, he scrambled when the coronavirus began to appear in his community. Within weeks he had landed on what he insisted was an effective cure: a three-drug cocktail of the antimalarial drug hydroxychloroquine, the antibiotic azithromycin and zinc sulfate.

. . .

“At the time, it was a brand-new finding, and I viewed it like a commander in the battlefield,” Dr. Zelenko told The New York Times. “I realized I needed to speak to the five-star general.”

On March 28, [2020] the Food and Drug Administration granted emergency authorization to doctors to prescribe hydroxychloroquine and another antimalarial drug, chloroquine, to treat Covid. Mr. Trump called the treatment “very effective” and possibly “the biggest game changer in the history of medicine.”

But, as fellow medical professionals began to point out, Dr. Zelenko had only his own anecdotal evidence to support his case, and what little research had been done painted a mixed picture.

Still, he became something of a folk hero on the right, someone who offered not just hope amid the pandemic but also an alternative to the medical establishment and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who insisted that months of research would be needed to find an effective treatment.

. . .

A quiet, unassuming man, Dr. Zelenko seemed unprepared for the attention he received, which included harassing phone calls and even death threats. In May 2020, a federal prosecutor opened an investigation into whether he had falsely claimed F.D.A. approval for his research.

. . .

After the F.D.A. rescinded its approval of hydroxychloroquine as a Covid treatment, he founded a company, Zelenko Labs, to promote other nonconventional treatments for the disease, including vitamins and quercetin, an anti-inflammatory drug.

And while he claimed to be apolitical, he embraced the image of a victim of the establishment. He founded a nonprofit, the Zelenko Freedom Foundation, to press his case. In December 2020, Twitter suspended his account, stating that it had violated standards prohibiting “platform manipulation and spam.”

. . .

In a memoir, “Metamorphosis” (2018), Dr. Zelenko wrote that he grew up nonreligious and entered Hofstra University as an avowed atheist.

“I enjoyed debating with people and proving to them that G-d did not exist,” he wrote. “I studied philosophy and was drawn to nihilistic thinkers such as Sartre and Nietzsche.”

But after a trip to Israel, he began to change his mind. He gravitated toward Orthodox Judaism, and in particular the Chabad-Lubavitch movement.

He graduated from Hofstra in 1995 with a degree in chemistry, and he received his medical degree from the State University of New York at Buffalo in 2000.

. . .

In 2018, doctors found a rare form of cancer in his chest and, in hopes of treating it, removed his right lung.

For the full obituary see:

Clay Risen. “Vladimir Zelenko, 48, ‘Country Doctor’ Who Pushed Unfounded Covid Remedy.” The New York Times (Saturday, July 2, 2022): A21.

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

(Note: the online version of the obituary has the date July 1, 2022 and has the title “Vladimir Zelenko, 48, Dies; Promoted an Unfounded Covid Treatment.”)

Dr. Zelenko’s pre-Covid-19 memoir is:

Zelenko, Vladmir. Metamorphosis. Lakewood, NJ: Israel Bookshop Publications, 2019.

A highly credentialed Yale academic presented evidence of the promise of hydroxychloroquine for early outpatient treatment in:

Risch, Harvey A. “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients That Should Be Ramped-up Immediately as Key to the Pandemic Crisis.” American Journal of Epidemiology 189, no. 11 (Nov. 2020): 1218–26.

California Should Go Nuclear

(p. C1) A recent study sponsored by the Environmental Defense Fund and the Clean Air Task Force concluded that to meet its net-zero pledge by 2045, the state of California will need power that is not only “clean” but “firm”—that is, “electricity sources that don’t depend on the weather.” The same is true around the world, and nuclear offers a relatively stable source of power.

Nuclear plants don’t depend on a steady supply of coal or gas, where disruptions in commodity markets can lead to spikes in electricity prices, as has happened this winter in Europe. Nor do nuclear plants depend on the weather. Solar and wind have a great deal of potential, but to be reliable energy sources on their own, they require advanced batteries and high-tech grid management to balance varying levels of power generation with anticipated spikes in demand. That balancing act is easier and cheaper with the kind of firm power that nuclear can provide.

. . .

(p. C2) In France, as part of a massive push to “reindustrialize,” the government will spend $1.13 billion on nuclear power R&D by 2030. The focus is on developing a new generation of small modular reactors (SMRs) to replace parts of the existing fleet that supplies around 70% of the country’s electricity.

. . .

. . . it’s , , , important to recognize that regulatory oversight and safety provisions are usually effective. Even the Fukushima accident, or the Three Mile Island accident in Pennsylvania in 1979, could be considered a success on the safety front: Some safety features failed but others worked, containing the fallout.

. . .

SMRs and other new technologies are the nuclear industry’s big hope. One focus of research is using new fissile materials such as thorium, which is more abundant, produces less waste and has no direct military applications. Other technologies look to using existing nuclear waste as a fuel source. Turning away from massive reactors toward SMRs might, at first, increase costs per unit of energy produced. But it would open financing models unavailable to large reactors, allowing costs to come down, with reactors following a uniform design instead of being designed one by one. Building many small reactors also allows for learning-by-doing, a model actively pursued by China at home and as part of its Belt and Road Initiative abroad.

None of these new technologies is sure to be economically competitive. Some of the more experimental technologies, like China’s thorium reactors, might yet pay off. TerraPower, a venture founded by Bill Gates, has been working on natrium reactors for over a decade and recently added a molten-salt design to the mix, which could make a real difference if it works out. The point is to try. Like solar and wind, nuclear energy could climb the learning curve and slide down the cost curve with the right financial backing.

For the full commentary, see:

Gernot Wagner. “Is Nuclear Power Part of the Climate Solution?” The Wall Street Journal (Saturday, Jan. 8, 2022): C1-C2.

(Note: ellipses added.)

(Note: the online version of the commentary has the date January 7, 2022, and has the same title as the print version.)

The commentary quoted above is related to the author’s book:

Wagner, Gernot. Geoengineering: The Gamble. Cambridge, UK: Polity, 2021.

Regulations Hurt Immigrant Home Cooks in Gig Labor Market

“In the kitchen of her apartment in Green point, Brooklyn, Juliet Achan stirs up dishes from her Surinamese background.” Source of photo: online version of the NYT article cited below. Source of caption: print version of the NYT article cited below.

(p. B1) Several days a week, Jullet Achan moves around the kitchen of her apartment in Greenpoint, Brooklyn, stirring up dishes from her Surinamese background: fragrant batches of goat curry, root vegetable soup and her own take on chicken chow mein.

She packages the meals, and they are picked up for delivery to customers who order through an app called WoodSpoon.

“Joining WoodSpoon has made a huge difference during the pandemic, giving me the flexibility to work safely from home and supplement my income,” Ms. Achan said in a news release from the company in February.

However, in the state of New York, there are no permits or licenses that allow individuals to sell hot meals cooked in their home kitchens. And WoodSpoon, a three-year-old start-up that says it has about 300 chefs preparing foods on its platform and has raised millions of dollars from investors, including the parent company of Burger King, knows it.

“It’s not legally allowed,” said Oren Saar, a founder and the chief executive of WoodSpoon, which facilitated the interviews with Ms. Achan and other cooks. “If someone is on our platform and they’re selling food they cooked in their own kitchens, that’s against our platform policy. But, to be completely honest, we think that those rules are outdated.”

Ms. Achan said she had become aware from her own research that cooks were not allowed to sell foods cooked in their homes, but said she continued to do so. “The food needs to be prepared in a clean kitchen, and it needs to be done correctly,” she said. “I’ve been cooking for my family for years, and that’s how I prepare meals for my customers.”

. . .

(p. B4) Legislation was introduced last year that would allow individuals to sell hot meals from their own kitchens, but it is still pending.

Mr. Saar said WoodSpoon, which started in 2019, couldn’t wait for the laws to catch up when the pandemic hit. “With Covid and all of the people who were reaching out to us to work on the platform, all of the people we thought we could work with, it was not right for us to wait to launch,” he said.

He estimates that 20 to 30 percent of the chefs on the platform are using licensed commercial kitchens, meaning the bulk are not. He said WoodSpoon helped home cooks obtain the proper permits and licenses, provided safety training and inspected the kitchens, but ultimately the onus is on the individuals selling on the platform to follow the proper rules. A spokesman later added in an email that the company was working to make commercial kitchens available to its chefs.

“We are ahead of the regulators, but as long as I keep my customers safe and everything is healthy, there are no issues,” Mr. Saar said. “We believe our home kitchens are safer than any restaurants.”

When asked if WoodSpoon would remove any chefs it knew were cooking from kitchens in their homes, Mr. Saar demurred, saying, “It was a good question.” He noted that many of WoodSpoon’s cooks prepared and sold foods on social media and competing food platforms, like Shef.

For the full story, see:

Julie Creswell. “Illegally Delicious. Probably.” The New York Times (Monday, April 18, 2022): B1 & B4.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 10, 2022, and has the title “The Home Cooks (and Start-Ups) Betting on Prepared Meals.”)

Key Healthcare Issue Is Not How to Divvy Up a Fixed Pie, But How to Grow the Pie Through New Cures

(p. A23) . . . in the second phase of my illness, once I knew roughly what was wrong with me and the problem was how to treat it, I very quickly entered a world where the official medical consensus had little to offer me. It was only outside that consensus, among Lyme disease doctors whose approach to treatment lacked any C.D.C. or F.D.A. imprimatur, that I found real help and real hope.

And this experience made me more libertarian in various ways, more skeptical not just of our own medical bureaucracy, but of any centralized approach to health care policy and medical treatment.

This was true even though the help I found was often expensive and it generally wasn’t covered by insurance; like many patients with chronic Lyme, I had to pay in cash. But if I couldn’t trust the C.D.C. to recognize the effectiveness of these treatments, why would I trust a more socialized system to cover them? After all, in socialized systems cost control often depends on some centralized authority — like Britain’s National Institute for Health and Care Excellence or the controversial, stillborn Independent Payment Advisory Board envisioned by Obamacare — setting rules or guidelines for the system as a whole. And if you’re seeking a treatment that official expertise does not endorse, I wouldn’t expect such an authority to be particularly flexible and open-minded about paying for it.

Quite the reverse, in fact, given the trade-off that often shows up in health policy, where more free-market systems yield more inequalities but also more experiments, while more socialist systems tend to achieve their egalitarian advantages at some cost to innovation. Thus many European countries have cheaper prescription drugs than we do, but at a meaningful cost to drug development. Americans spend obscene, unnecessary-seeming amounts of money on our system; America also produces an outsize share of medical innovations.

And if being mysteriously sick made me more appreciative of the value of an equalizing floor of health-insurance coverage, it also made me aware of the incredible value of those breakthroughs and discoveries, the importance of having incentives that lead researchers down unexpected paths, even the value of the unusual personality types that become doctors in the first place. (Are American doctors overpaid relative to their developed-world peers? Maybe. Am I glad that American medicine is remunerative enough to attract weird Type A egomaniacs who like to buck consensus? Definitely.)

Whatever everyday health insurance coverage is worth to the sick person, a cure for a heretofore-incurable disease is worth more. The cancer patient has more to gain from a single drug that sends the disease into remission than a single-payer plan that covers a hundred drugs that don’t.

. . .

. . ., the weakness of the liberal focus on equalizing cost and coverage is the implicit sense that medical care is a fixed pie in need of careful divvying, rather than a zone where vast benefits await outside the realm of what’s already available.

. . .

. . . once you’ve become part of the American pattern of trying anything, absolutely anything in order to feel better — and found that spirit essential to your own recovery — the idea of medical cost control as a primary policy goal inevitably loses some of its allure, and the American way of medical spending looks a little more defensible. To just try things without counting the cost can absolutely run to excess. But sometimes what seems like waste on the technocrat’s ledger is the lifeline that a desperate patient needs.

For the full commentary, see:

Ross Douthat. “Being Sick Changed My Views on Health Care.” The New York Times (Thursday, January 20, 2022): A23.

(Note: ellipses added.)

(Note: the online version of the commentary has the date January 19, 2022, and has the title “How Being Sick Changed My Health Care Views.”)

The commentary quoted above is related to the author’s book:

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