Category: Regulations

“New Jerseyans Are More Flammable than People in the Other 49 States”

(p. A17) At 12:01 a.m. on Jan. 1, New Jersey became the last state in the nation where drivers are not allowed to pump their own gasoline around the clock.
. . .
It is a distinction that makes Declan J. O’Scanlon Jr., a state lawmaker, spout frustration by the gallon.
“It’s ridiculous,” said Mr. O’Scanlon, a Republican assemblyman from Monmouth County who will soon take a seat in the State Senate. “If I want to pull in, get in and out quickly, I should be able to do so.”
Mr. O’Scanlon said that he frequently pumps his own gas, ignoring the Retail Gasoline Dispensing Safety Act of 1949, the statute that first forbade civilians from putting their grubby hands on the nozzle.
. . .
New Jersey legislators cited safety concerns when they passed the original law that barred residents from pumping gas almost 70 years ago. But when gas station owners challenged the ban in 1951, the state’s Supreme Court ruled that self-serve was indeed “dangerous in use.” And the ban held up, despite attempts to fight it in the 1980s.
In the rest of the country, self-service stations became the norm. Safer unleaded gasoline became more common, thanks to federal regulations, as did pumps that accepted credit cards. In most of the United States, that spelled the end of an era when attendants offered to wipe your windshield and check your oil while the tank filled up and you fumbled for a tip.
Mr. O’Scanlon is undeterred by the dual weights of history and public opinion. He said that he may bring a new proposal this year, just to keep the conversation alive. He said that economic arguments about jobs and safety are absurd, given that drivers in other states have been pumping their own gas for decades and lived to tell the tale.
“The only thing you could argue is that New Jerseyans are more flammable than people in the other 49 states,” he said. “Because we eat so much oily pizza, funnel cake and fries, maybe you could make that argument. Otherwise, it’s simply ridiculous.”

For the full story, see:
JONAH ENGEL BROMWICH. “New Jersey Is Last State to Insist at Gas Stations: Don’t Touch That Pump.” The New York Times (Sat., JAN. 6, 2018): A17.
(Note: ellipses added.)
(Note: the online version of the story has the date JAN. 5, 2018.)

Health Info from Apple Watches Will Allow Patients to “Take More Control”

(p. B1) SAN FRANCISCO — In the last months of Steve Jobs’s life, the Apple co-founder fought cancer while managing diabetes.
Because he hated pricking his finger to draw blood, Mr. Jobs authorized an Apple research team to develop a noninvasive glucose reader with technology that could potentially be incorporated into a wristwatch, according to people familiar with the events, who asked not to be identified because they were not authorized to speak on behalf of the company.
. . .
In September [2017], Apple announced that the Apple Watch would no longer need to be tethered to a smartphone and would become more of a stand-alone device. Since then, a wave of device manufacturers have tapped into the watch’s new features like cellular connectivity to develop medical accessories — such as an electrocardiogram for monitoring heart activity — so people can manage chronic conditions straight from their wrist.
. . .
(p. B4) A digital health revolution has been predicted for years, of course, and so far has been more hype than progress. But the hope is that artificial intelligence systems will sift through the vast amounts of data that medical accessories will collect from the Apple Watch and find patterns that can lead to changes in treatment and detection, enabling people to take more control of how they manage their conditions instead of relying solely on doctors.
Vic Gundotra, chief executive of AliveCor, a start-up that makes portable electrocardiograms, said this would put patients on a more equal footing with doctors because they would have more information on their own conditions.
“It’s changing the nature of the relationship between patient and doctor,” he said, adding that doctors will no longer be “high priests.”
. . .
Apple is also looking at potentially building an electrocardiogram into future models of the Apple Watch, according to a person familiar with the project, who spoke on the condition of anonymity because the details were confidential. It is unclear whether the EKG development, earlier reported by Bloomberg, would be introduced; such a product would most likely require F.D.A. clearance.
Separately, Apple is continuing research on a noninvasive continuous glucose reader, according to two people with knowledge of the project. The technology is still considered to be years away, industry experts said.
The current solution used by many diabetics is also coming to the Apple Watch. Dexcom, a maker of devices measuring blood sugar levels for diabetics, said it was awaiting F.D.A. approval for a continuous glucose monitor to work directly with the Apple Watch. Continuous glucose monitors use small sensors to pierce the skin to track blood sugar levels and relay those readings through a wireless transmitter.

For the full story, see:
DAISUKE WAKABAYASHI. “As Wearable Devices Evolve, The Apple Watch Offers an EKG.” The New York Times (Weds., December 27, 2017): B1 & B4.
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story has the date DEC. 26, 2017, and has the title “Freed From the iPhone, the Apple Watch Finds a Medical Purpose.”)

Supersonic Technology Constrained by Regulators

(p. B5) Japan Airlines Co. 9201 -0.09% has become the first carrier to invest in Boom Technology Inc., a U.S. startup seeking to build a faster-than-sound airliner capable of flying more than four dozen premium passengers to Tokyo from the West Coast in roughly five hours.
. . .
With a one-third scale version now scheduled to start flight tests in late 2018–nearly a year later than initially planned–JAL’s involvement is expected to influence cabin design and various operational issues. Blake Scholl, Boom’s founder and chief executive, said such cooperation is intended “to determine whether airlines will really be happy to have this airliner in their fleets,” including from a maintenance perspective.
. . .
Boom’s project has initial support from several venture funds and is taking an unusual approach by adopting various technologies already certified by regulators.

For the full story, see:
Andy Pasztor. “Supersonic Jet Gets Boost.” The Wall Street Journal (Weds., Dec. 6, 2017): B5.
(Note: ellipses added.)
(Note: the online version of the story has the date Dec. 5, 2017, and has the title “Japan Airlines Invests in Fledgling Supersonic Aircraft Company.” The online version differs significantly in wording from the print version. Where different, the passages quoted above, follow the online wording.)

Hundreds of Thousands of Californians Moving to Texas, Arizona and Nevada

(p. A18) For more than three decades, California has seen a net outflow of residents to other states, as less expensive southern cities like Phoenix, Houston and Raleigh supplant those of the Golden State as beacons of opportunity.
. . .
. . . , for many Californians, the question is always sitting there: Is this worth it? Natural disasters are a moment to take stock and rethink the dream. But in the end, the calculation almost always comes down to cost.
. . .
California was once a migration magnet, but since 2010 the state has lost more than two million residents 25 and older, including 220,000 who moved to Texas, according to census data. Arizona and Nevada have each welcomed about 180,000 California expatriates since the start of the decade.

For the full story, see:
CONOR DOUGHERTY. “Californians Brave Fires, but Flee Cost of Living.” The New York Times (Weds., DEC. 13, 2017): A1 & A18.
(Note: ellipses added.)
(Note: the online version of the story has the date DEC. 12, 2017, and has the title “Quakes and Fires? It’s the Cost of Living That Californians Can’t Stomach.”)

Enforcing New Blood Pressure Guidelines May Lead to Serious Falls

(p. A23) “Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure.” This is the type of headline that raises my blood pressure to dangerously high levels.
. . .
The new recommendation is principally in response to the results of a large, federally funded study called Sprint that was published in 2015 in The New England Journal of Medicine.
. . .
A blood pressure of 130 in the Sprint study may be equivalent to a blood pressure of 140, even 150, in a busy clinic. A national goal of 130 as measured in actual practice may lead many to be overmedicated — making their blood pressures too low.
. . .
Serious falls are common among older adults. In the real world, will a nationwide target of 130, and the side effects of medication lowering blood pressure, lead to more hip fractures? Ask your doctors. See what they think.
. . .
I suspect many primary-care practitioners will want to ignore this new target. They understand the downsides of the relentless expansion of medical care into the lives of more people. At the same time, I fear many will be coerced into compliance as the health care industry’s middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary — and that usually means more medications.
So focusing on the number 130 not only will involve millions of people but also will involve millions of new prescriptions and millions of dollars. And it will further distract doctors and their patients from activities that aren’t easily measured by numbers, yet are more important to health — real food, regular movement and finding meaning in life. These matter whatever your blood pressure is.

For the full commentary, see:
H. GILBERT WELCH. “Rethinking Blood Pressure Advice.” The New York Times (Thurs., NOV. 16, 2017): A23.
(Note: ellipses added.)
(Note: the online version of the commentary has the date NOV. 15, 2017, and has the title “Don’t Let New Blood Pressure Guidelines Raise Yours.”)

Welch has a book that makes a similar point, though more broadly, to that made in the passages quoted above:
Welch, H. Gilbert. Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care. Boston, MA: Beacon Press, 2015.

France’s “Mille-Feuille” Regulations

(p. A1) France has long been known for its open hostility to corporations and its suspicion of personal wealth. Taxes were high, regulations were baffling and “It’s not possible” was the default answer to any question — if a company could even find the right person to ask.
Now, the country is in the midst of a sweeping attempt at national rebranding. Labor laws are being changed to make hiring and firing easier. New legislation has slashed a “wealth tax” that was said to drive millionaires out of the country.
. . .
(p. A5) “When you grow up in France, none of the heroes you learn about are entrepreneurs,” said Brigitte Granville, a professor of economics at Queen Mary University of London, who was raised in France. “When someone gets rich in France, people immediately ask, ‘What did he do to make this money? He must be a nasty person.'”
. . .
Now, a new crop of French leaders, most notably the free market-supporting president, Emmanuel Macron, are vigorously trying to shed this anticapitalist reputation. During his campaign, he visited London, home to as many as 400,000 French expatriates, urging them to return to France and “innovate.”
. . .
France’s economic makeover has inspired some derision outside of the country, too. It has the faint smell of desperation to people like Nicolas Mackel, the chief executive of Luxembourg for Finance, a public-private partnership that promotes the country as a business hub.
. . .
“You’ll accuse me of bashing the French,” he said over tea recently, “but earlier this year, they announced that they would have regulators who speak English. We didn’t need to do that because our regulators already speak English and always have.”
For France, English-speaking government officials would be little more than a promising start. The country has so many bewildering layers of regulations that its system is known, unaffectionately, as mille-feuille, a reference to a densely layered pastry.

For the full story, see:
DAVID SEGAL. “Paris Tries On A Fresh Look: Less Red Tape.” The New York Times (Mon., DEC. 11, 2017): A1 & A5.
(Note: ellipses added.)
(Note: the online version of the story has the date DEC. 10, 2017, and has the title “As Brexit Looms, Paris Tries a Business Makeover.”)

Socialized Medicine “Mummifies Its Doctors in Spools of Red Tape”

(p. A17) One of the reasons patients find condescension from doctors especially loathsome is that it diminishes them — if you’re gravely ill, the last thing you need is further diminishment. But the desires of patients, Marsh notes, are often paradoxical. They also pine for supreme confidence in their physicians, surgeons especially, because they’ve left their futures — the very possibility of one at all, in some cases — in their doctors’ custody. “So we quickly learn to deceive,” Marsh writes, “to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face.”
Over time, Marsh writes, many doctors start to internalize the stories they tell themselves about their superior judgment and skill. But the best, he adds, unlearn their self-deceptions, and come to accept their fallibility and learn from their mistakes. “We always learn more from failure than from success,” he writes. “Success teaches us nothing.”
This was a prominent theme in Marsh’s last book, and readers may have a sense of déjà vu while reading this one. Like “Do No Harm,” “Admissions” is wandering and ruminative, an overland trek through the doctor’s anxieties and private shames. Once again, he recounts his miscalculations and surgical catastrophes, citing the French doctor René Leriche’s observation that all surgeons carry cemeteries within themselves of the patients whose lives they’ve lost. Once again, he rails against the constraints of an increasingly depersonalized British health care system, which mummifies its doctors in spools of red tape. Once again, he describes his operating theater in all of its Grand Guignol splendor, with brains swelling beyond their skulls and suction devices “slurping obscenely” as tumors evade his reach.

For the full review, see:
JENNIFER SENIOR. “Books of The Times; Surgical Catastrophes, Private Shames.” The New York Times (Sat., Oct. 7, 2017): A17.
(Note: the online version of the review has the date Oct. 5, 2017, and has the title “Books of The Times; A Surgeon Not Afraid to Face His Mistakes, In and Out of the Operating Room.)

The book under review, is:
Marsh, Henry. Admissions: Life as a Brain Surgeon. New York: Thomas Dunne Books/St. Martin’s Press, 2017.

NIH and FDA Should Allow Gene Editors to Cure Diseases

(p. A15) Should Americans be allowed to edit their DNA to prevent genetic diseases in their children? That question, which once might have sounded like science fiction, is stirring debate as breakthroughs bring the idea closer to reality. Bioethicists and activists, worried about falling down the slippery slope to genetically modified Olympic athletes, are calling for more regulation.
The bigger concern is exactly the opposite–that this kind of excessive introspection will cause patients to suffer and even die needlessly. Anachronistic restrictions at the Food and Drug Administration and the National Institutes of Health effectively ban gene-editing research in human embryos that would lead to implantation and births. These prohibitions are inhibiting critical clinical research and should be lifted immediately.
. . .
What’s holding researchers back, at least in America, is outmoded regulations. The FDA is blocked by law from accepting applications for research involving gene editing of the human germ line–meaning eggs, sperm and embryos. The NIH, whose approval also would be needed, is similarly barred from even considering applications to conduct such experiments in humans. These rules date as far back as the 1970s, when the technology was in its infancy. It’s easy to invoke hypothetical fears when actual lifesaving interventions are decades away.
Today they aren’t–and desperate patients deserve access to whatever cures this technology may be able to provide. The public thinks so, too. A survey this summer found that nearly two-thirds of Americans support therapeutic gene editing–in somatic and germ-line cells alike. Popular opinion is in tune with scientific reality. Legislators and regulators need to catch up.

For the full commentary, see:
Henry I. Miller. “Gene Editing Is Here, and Desperate Patients Want It; Two-thirds of Americans support therapeutic use, but regulators are still stuck in the 1970s.” The Wall Street Journal (Fri., OCT. 13, 2017): A15.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date OCT. 12, 2017.)

After 30 Years, Medical Entrepreneur Rosenberg’s Slow Hunch Pays Off

(p. B3) In the another significant development, the cancer institute’s prominent cancer researcher and chief of surgery, Steven A. Rosenberg, detailed for the first time an immunotherapy success against metastatic breast cancer, in a talk earlier this month.
In the lecture at a Boston meeting of the American Association of Cancer Research, Dr. Rosenberg reported on the first patient with metastatic breast cancer who is disease-free nearly two years after her first immunotherapy treatment. In the therapy, a person’s own cells are multiplied billions of times and reinfused into the patient. Dr. Rosenberg’s lab has already reported successes in treatment of melanoma, lymphoma, colorectal cancer and bile-duct cancer.
That patient is Judy Perkins, a 51-year-old structural engineer from Port St. Lucie, Fla. She was diagnosed with metastatic cancer–cancer that spread beyond the original location–in 2013.
. . .
Ms. Perkins is only one case. But the fact that she had metastatic breast cancer that is no longer detectable makes it very consequential. It follows reports from the Rosenberg lab about other internal-organ cancers, specifically colorectal and bile-duct.
. . .
Dr. Rosenberg’s interest in immunotherapy was piqued three decades ago, when he was struck by a chance encounter with a stomach-cancer patient who improbably recovered despite no treatment. This became a lifelong quest to discover how that patient had in effect cured himself. Scores of recoveries at the cancer institute of melanoma and lymphoma patients followed after immunotherapy treatment from his lab.
Now, his lab is exploring the promise of treating and accomplishing tumor regressions in far-more-common solid-tumor cancers of internal organs, including the breast, colon and bile-duct.

For the full story, see:
Thomas M. Burton. “Immunotherapy Treatments for Cancer Gain Momentum.” The Wall Street Journal (Fri., Oct. 13, 2017): B3.
(Note: ellipses added.)
(Note: the online version of the story has the date Oct. 12, 2017.)

FCC Spectrum Regulations Drive Innovators to Bankruptcy

(p. A17) In 2004 the FCC moved to relax L-Band rules, permitting deployment of a terrestrial mobile network. Satellite calls would continue, but few were being made, and sharing frequencies with cellular devices made eminent sense. By 2010, L-Band licensee LightSquared was ready to build a state-of-the-art 4G network, and the FCC announced that the 40 MHz bandwidth would become available. LightSquared quickly spent about $4 billion of its planned $14 billion infrastructure rollout. Americans would soon enjoy a fifth nationwide wireless choice.
But in 2012 the FCC yanked LightSquared’s licenses. Various interests, from commercial airlines to the Pentagon, complained that freeing up the L Band could cause interference with Global Positioning System devices, since they are tuned to adjacent frequencies. Yet cheap remedies–such as a gradual roll-out of new services while existing networks improved reception with better radio chips–were available. In reality, the costliest spectrum conflicts emanate from overprotecting old services at the expense of the new. With its licenses snatched away, LightSquared instantly plunged into bankruptcy.
. . .
. . . regulatory impediments continue to block progress. Years after the L-Band spectrum was slated for productive use in 4G, it lies fallow–now delaying upgrades to 5G.

For the full commentary, see:
Thomas W. Hazlett. “How Politics Stalls Wireless Innovation; The FCC unveiled its National Broadband Plan in 2010–but couldn’t stick to it.” The Wall Street Journal (Mon., Oct. 2, 2017): A17.
(Note: ellipses added.)
(Note: the online version of the commentary has the date Oct. 1, 2017.)

The commentary, quoted above, is related to the author’s book:
Hazlett, Thomas W. The Political Spectrum: The Tumultuous Liberation of Wireless Technology, from Herbert Hoover to the Smartphone. New Haven, CT: Yale University Press, 2017.

Federal and State Mandates Constrain “Creativity in the Classroom”

(p. A11) Mrs. DeVos sees choice as a means to the end of promoting educational innovation–including within traditional public schools. “Instead of focusing on systems and buildings, we should be focused on individual students,” she says. That means encouraging young people “to pursue their curiosity and their interests, and being OK with wherever that takes them–not trying to conform them into a path that everybody has to take.”
What stands in the way? “I think a real robust defense of the status quo is the biggest impediment,” Mrs. DeVos says. She doesn’t mention teachers unions until I raise the subject, whereupon she observes: “I think that they have done a good job in continuing to advocate for their members, but I think it’s a focus more around the needs of adults” rather than students.
Many of the adults are frustrated, too. Recently I met a veteran middle-school teacher who said his creativity in the classroom has been increasingly constrained by federal and state mandates on curriculum and testing. Another teacher I know, who wants to start a charter, complains that “it is getting harder and harder to work for the idiots in traditional schools.”
That sounds familiar to Mrs. DeVos. “I do hear sentiments from many teachers like that,” she says, “and particularly from many teachers that are really effective and creative themselves. I’ve also heard from many teachers who have stopped teaching because they feel like they can’t really be free to do their best, because they’re either subtly or not subtly criticized by peers who might not be as effective as they are–or by administrators who don’t want to see them sort of excelling and upsetting the apple cart within whatever system they’re in.”
She continues: “I talked to a bunch of teachers that had left teaching that had been Teachers of the Year in their states or their counties or whatever. I recall one of the teachers said he just felt so beaten down after being told repeatedly to have his class keep it down–that they were having too much fun, and the kids were too engaged. Well, what kind of a message is that?”

For the full interview, see:
James Taranto, interviewer. “THE WEEKEND INTERVIEW with Betsey DeVos; The Teachers Union’s Public Enemy No. 1.” The Wall Street Journal (Sat., Sept. 2, 2017): A11.
(Note: the online version of the interview has the date Sept. 1, 2017, and has the title “THE WEEKEND INTERVIEW; The Teachers Union’s Public Enemy No. 1.”)