Health – Page 15 – artdiamondblog.com

“Entrepreneurs Can Appear in the Most Unpromising Environments”

(p. A11) Adam Fifield’s entertaining biography of the little-recognized Grant shows that entrepreneurs can appear in the most unpromising environments–such as within the dysfunctional bureaucracy of the United Nations.
. . .
While top-down planning is usually misguided in aid (and most everywhere else), it turned out to be suitable for the particular challenge of vaccinations. Unfortunately, the aid establishment learned the wrong lessons from Grant’s career. Instead of seeing him as an entrepreneur who saw a very specific unrealized opportunity to spread vaccination and oral rehydration salts, they viewed his success as vindicating top-down planning in general.
. . .
Those who came after Grant . . . seem to have developed even more of the paternalistic savior complex than he had–his counterparts today are the likes of Bono, Jeffrey Sachs and Bill Gates. But the condescending image of a powerful white male as the savior of helpless nonwhite children is thankfully a lot less acceptable today than it was in Grant’s time. Since 2000 we have witnessed the mainly homegrown economic growth of low- and middle-income countries surpassing that of rich countries–plus many other positive long-term trends from democratization to the explosion of cellphones. Aid alone cannot explain these large triumphs in poor countries. There is still room for humanitarian entrepreneurs like Grant to find new breakthroughs, but we can appreciate much more today that the poor are their own best saviors.

For the full review, see:
WILLIAM EASTERLY. “BOOKSHELF; The Father of Millions; The Unicef breakthrough on vaccinations and oral rehydration salts is still cited today as one of the few successes in foreign aid.” The Wall Street Journal (Fri., Oct. 16, 2015): A11.
(Note: ellipses added.)
(Note: the online version of the review has the date Oct. 15, 2015.)

The book under review, is:
Fifield, Adam. A Mighty Purpose: How Jim Grant Sold the World on Saving Its Children. New York: Other Press, 2015.

Majerus Did Not Need a Randomized Trial to Know that Aspirin Prevents Heart Attacks

(p. A21) Philip W. Majerus, a biochemist who was credited as being the first to theorize that taking small doses of aspirin regularly can prevent heart attacks and strokes in vulnerable patients, died last Wednesday [June 8, 2016] at his home in St. Louis. . . .
. . .
Even before his findings were confirmed in a study by other researchers a decade later, Dr. Majerus was taking aspirin daily.
“I was already convinced that aspirin prevented heart attacks,” he recalled in the journal Advances in Biological Regulation in 2014. “I was unwilling to be randomized into a trial where I might end up with the placebo. I refused to participate.”
Dr. Majerus recommended that “all adults should take an aspirin daily unless they are among the few percent of the population that cannot tolerate the drug.” The cardiovascular benefit of aspirin was fully achieved by 50 to 75 milligrams daily, he said, and “there is no evidence that branded aspirin, which is much more expensive, is in any way superior to the generic version.”
Later studies found that for people in their 50s who are vulnerable to heart disease, taking daily doses of aspirin reduces the risk of heart disease.
. . .
Investigating how aspirin inhibited clotting, Dr. Majerus concluded that the medicine modified an enzyme that leads to the formation of a platelet-made molecule that constricts blood vessels and aggregates platelets. The pills’ effect lasts for the platelets’ life span, typically about two weeks.
“Phil Majerus, more than any other individual, has produced the most original body of work on biochemistry of platelets as it relates to thrombosis,” Prof. Joseph L. Goldstein, a Nobel laureate at the University of Texas Southwestern Medical Center in Dallas, said when the Bristol-Myers Squibb Award was announced.

For the full obituary, see:
SAM ROBERTS. “Dr. Philip Majerus, Who Recognized Heart Benefits of Aspirin, Is Dead at 79.” The New York Times (Weds., JUNE 15, 2016): A23.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the obituary has the date JUNE 14, 2016, and has the title “Dr. Philip Majerus, Who Discerned Aspirin’s Heart Benefits, Dies at 79.”)

Tribe Uses Autonomy to Fight American Dental Association (A.D.A.) Credentialism

(p. A10) Mr. Kennedy, 56, a soft-spoken Tlingit Native Alaskan, is a dental therapist, the rough equivalent of a physician assistant. He is trained to perform the most common procedures that dentists do, from fillings to extractions. Since January, when he started at the Swinomish Dental Clinic, over 50 miles north of Seattle, he has been the only dental therapist on tribal land anywhere in the lower 48 states. He studied in Alaska, which has the nation’s only program — patterned after one in New Zealand — aimed at training therapists specifically to work in underserved tribal areas.
Laws here in Washington and most other states bar dental therapists, who have long been opposed by the American Dental Association, so the tribe created its own licensing system. The federal Indian Health Service, which pays for medical care on Indian lands, cannot compensate therapists unless authorized by the state, so the Swinomish (pronounced SWIN-o-mish) needed private foundation support and meticulous accounting so that no law was violated.
“We had to take matters into our own hands,” said Brian Cladoosby, the chairman of the Swinomish Senate and president of the National Congress of American Indians. The breaking point came in 2015, after Washington’s Legislature — pressured by the dental lobby, Mr. Cladoosby said — declined for the fifth year in a row to pass a bill allowing a therapist program. Asserting tribal sovereignty, the tribe forged ahead anyway.
“The American Dental Association is no friend to American Indian tribes,” Mr. Cladoosby said in an interview.
. . .
(p. A11) Dr. Rachael R. Hogan, a dentist who works at the Swinomish Clinic, supervises Mr. Kennedy’s work. At first she did not think the arrangement would work. The A.D.A.’s safety concerns made sense, she said.
“I was leery,” she said. But after watching Mr. Kennedy for the past four months and visiting the training school in Alaska, she has changed her mind. By practicing procedures over and over — more than most dental school graduates, who must also study a broad range of diagnostic and disease issues — therapists can hone procedures, she said, to an art.
“Their fillings are better,” she said. “Are we providing substandard care by providing a therapist? Actually, I would say it’s the opposite.”

For the full story, see:
KIRK JOHNSON. “Asserting Tribal Sovereignty to Improve Indian’s Dental Care.” The New York Times (Mon., MAY 23, 2016): A10-A11.
(Note: ellipsis added.)
(Note: the online version of the story has the date MAY 22, 2016, and has the title “Where Dentists Are Scarce, American Indians Forge a Path to Better Care.”)

If Rapamycin Works in Humans as in Mice, We Gain 20 Years in Good Health

“Dr. Matt Kaeberlein, a biology of aging researcher, with his dog Dobby in North Bend, Wash. He helped fund a drug study using his own money.” Source of caption: p. A12 of print version of the NYT article quoted and cited below. Source of photo: online version of the NYT article quoted and cited below.

(p. A12) But scientists who champion the study of aging’s basic biology — they call it “geroscience” — say their field has received short shrift from the biomedical establishment. And it was not lost on the University of Washington researchers that exposing dog lovers to the idea that aging could be delayed might generate popular support in addition to new data.
“Many of us in the biology of aging field feel like it is underfunded relative to the potential impact on human health this could have,” said Dr. Kaeberlein, who helped pay for the study with funds he received from the university for turning down a competing job offer. “If the average pet owner sees there’s a way to significantly delay aging in their pet, maybe it will begin to impact policy decisions.”
The idea that resources might be better spent trying to delay aging rather than to cure diseases flies in the face of most disease-related philanthropy and the Obama administration’s proposal to spend $1 billion on a “cancer moonshot.” And many scientists say it is still too unproven to merit more investment.
The National Institutes of Health has long been organized around particular diseases, including the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. There is the National Institute on Aging, but about a third of its budget last year was directed exclusively to research on Alzheimer’s disease, and its Division of Aging Biology represents a tiny fraction of the N.I.H.’s $30 billion annual budget. That is, in part, because the field is in its infancy, said the N.I.H. director, Dr. Francis Collins.
. . .
“The squirrels in my neighborhood have a 25-year life span, but they look like rats that live two years,” said Gary Ruvkun, a pioneer in aging biology at Harvard Medical School. “If you look at what nature has selected for and allowed, it suggests that you might be able to get your hands on the various levers that change things.”
. . .
Over 1,500 dog owners applied to participate in the trial of rapamycin, which has its roots in a series of studies in mice, the first of which was published in 2009. Made by a type of soil bacterium, rapamycin has extended the life spans of yeast, flies and worms by about 25 percent.
But in what proved a fortuitous accident, the researchers who set out to test it in mice had trouble formulating it for easy consumption. As a result, the mice were 20 months old — the equivalent of about 60 human years — when the trial began. That the longest-lived mice survived about 12 percent longer than the control groups was the first indication that the drug could be given later in life and still be effective.
Dr. Kaeberlein said he had since achieved similar benefits by giving 20-month-old mice the drug for only three months. (The National Institute on Aging rejected his request for funding to further test that treatment.) Younger mice, given higher doses, have lived about 25 percent longer than those not given the drug, and mice of varying ages and genetic backgrounds have been slower to develop some cancers, kidney disease, obesity and symptoms of Alzheimer’s disease. In one study, their hearts functioned better for longer.
“If you do the extrapolation for people, we’re probably talking a couple of decades, with the expectation that those years are going to be spent in relatively good health,” Dr. Kaeberlein said.
. . .
. . . what dog lovers have long considered the sad fact that their pets age about seven times as fast as they do, Dr. Kaeberlein knew, would be a boon for a study of rapamycin that would have implications for both species. An owner of two dogs himself, he was determined to scrounge up the money for the pilot phase of what he and Dr. Promislow called the Dog Aging Project.
Last month, he reported at a scientific meeting that no significant side effects had been observed in the dogs, even at the highest of three doses. And compared with the hearts of dogs in the control group, the hearts of those taking the drug pumped blood more efficiently at the end. The researchers would like to enroll 450 dogs for a more comprehensive five-year study, but do not yet have the money.
Even if the study provided positive results on all fronts, a human trial would carry risks.
Dr. Kaeberlein, for one, said they would be worth it.
“I would argue we should be willing to tolerate some level of risk if the payoff is 20 to 30 percent increase in healthy longevity,” he said. “If we don’t do anything, we know what the outcome is going to be. You’re going to get sick, and you’re going to die.”

For the full story, see:
AMY HARMON. “CHASING IMMORTALITY; Dogs Test Drug Aimed at Humans’ Biggest Killer: Age.” The New York Times (Tues., MAY 17, 2016): A1 & A12.
(Note: ellipses added.)
(Note: the online version of the story has the date MAY 16, 2016, and has the title “CHASING IMMORTALITY; Dogs Test Drug Aimed at Slowing Aging Process.”)

An academic paper that discusses the wide variability in life span of different species in the order Rodentia (which includes short-lived rats and long-lived squirrels), is:
Gorbunova, Vera, Michael J. Bozzella, and Andrei Seluanov. “Rodents for Comparative Aging Studies: From Mice to Beavers.” Age 30, no. 2-3 (June 25, 2008): 111-19.

Technology Can Restore Hand Control to Quadriplegic

(p. A1) Five years ago, a college freshman named Ian Burkhart dived into a wave at a beach off the Outer Banks in North Carolina and, in a freakish accident, broke his neck on the sandy floor, permanently losing the feeling in his hands and legs.
On Wednesday [April 13, 2016], doctors reported that Mr. Burkhart, 24, had regained control over his right hand and fingers, using technology that transmits his thoughts directly to his hand muscles and bypasses his spinal injury. The doctors’ study, published by the journal Nature, is the first account of limb reanimation, as it is known, in a person with quadriplegia.
Doctors implanted a chip in Mr. Burkhart’s brain two years ago. Seated in a lab with the implant connected through a computer to a sleeve on his arm, he was able to learn by repetition and arduous practice to focus his thoughts to make his hand pour from a bottle, and to pick up a straw and stir. He was even able to play a guitar video game.
. . .
“Watching him close his hand for the first time — I mean, it was a surreal moment,” Dr. Rezai said. “We all just looked at each other and thought, ‘O.K., the work is just starting.'”
After a year of training, Mr. Burkhart was able to pick up a bottle and pour the contents into a jar, and to pick up a straw and stir. The doctors, though delighted, said that more advances would be necessary to make the bypass system practical, affordable and less invasive, most likely through wireless technology. But the improvement was significant enough, at least in the lab, that rehabilitation specialists could reclassify Mr. Burkhart’s disability from a severe C5 function to a less severe C7 designation.
For now, the funding for the project, which includes money from Ohio State, Battelle and private donors, is set to run out this year — and with it, Mr. Burkhart’s experience of restored movement.
“That’s going to be difficult, because I’ve enjoyed it so much,” Mr. Burkhart said. “If I could take the thing home, it would give me so much more independence. Now, I’ve got to rely on someone else for so many things, like getting dressed, brushing my teeth — all that. I just want other people to hear about this and know that there’s hope. Something will come around that makes living with this injury better.”

For the full story, see:
BENEDICT CAREY. “Quadriplegic Gets Use of Hand from Chip Placed in His Brain.” The New York Times (Thurs., APRIL 14, 2016): A1 & A16.
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the story has the date APRIL 13, 2016, and has the title “Chip, Implanted in Brain, Helps Paralyzed Man Regain Control of Hand.”)

The scientific article in Nature reporting the advance, is:
Bouton, Chad E., Ammar Shaikhouni, Nicholas V. Annetta, Marcia A. Bockbrader, David A. Friedenberg, Dylan M. Nielson, Gaurav Sharma, Per B. Sederberg, Bradley C. Glenn, W. Jerry Mysiw, Austin G. Morgan, Milind Deogaonkar, and Ali R. Rezai. “Restoring Cortical Control of Functional Movement in a Human with Quadriplegia.” Nature 533, no. 7602 (May 12, 2016): 247-50.

Neurosurgical Establishment Waited Decade to Adopt Jannetta’s Cure

(p. C6) Dr. Peter J. Jannetta, a neurosurgeon who as a medical resident half a century ago developed an innovative procedure to relieve an especially devastating type of facial pain, died on Monday [April 1?, 2016] in Pittsburgh.
. . .
“This was a condition that had been documented for a thousand years: There are references in the ancient literature to what was originally called ‘tic douloureux,’ ” Mark L. Shelton, the author of “Working in a Very Small Place: The Making of a Neurosurgeon,” a 1989 book about Dr. Jannetta, said in a telephone interview on Thursday. “People knew of this unexplained, very intense, episodic facial pain but didn’t know the cause of it.”
. . .
In the mid-1960s, Dr. Jannetta made a striking discovery while he was a neurosurgical resident at the University of California, Los Angeles. Dissecting a set of cranial nerves for a class presentation, he noticed something amiss: a tiny blood vessel pressing on the trigeminal nerve.
“It came to him as something of a flash of insight,” Mr. Shelton said. “He saw this blood vessel literally impinging on the nerve so that there was actually a groove in the nerve where the vessel pressed.”
What if, Dr. Jannetta wondered, this were the source of the nerve damage? Though his insight is universally accepted today, it was novel to the point of subversion in the 1960s.
“The idea that a very small blood vessel, the diameter of a mechanical pencil lead, could cause such outsize pain didn’t resonate with people at the time,” Mr. Shelton said.
. . .
If the vessel was a vein, it could simply be cauterized and excised. If it was an artery, however — a more essential structure — it would, Dr. Jannetta realized, have to be gently nudged out of the way.
He created a means of doing so that involved slipping a tiny pad of soft Teflon, about the size of a pencil eraser, between the artery and the nerve.
Dr. Jannetta performed the first microvascular decompression operation in 1966. The patient, a 41-year-old man, was relieved of his pain.
It took about a decade for the procedure to win acceptance from the neurosurgical establishment, owing partly to Dr. Jannetta’s youth and partly to the novelty of his idea.
“He convinced many, many skeptics — and there were a lot of skeptics in the early years — because it seemed so counterintuitive as to what caused neurological disease,” Mr. Shelton said.
. . .
His many laurels include the medal of honor from the World Federation of Neurological Societies; the Olivecrona Award, presented by the Karolinska Institute in Sweden; and the Horatio Alger Award, which honors perseverance in the face of adversity or opposition.

For the full obituary, see:
MARGALIT FOX. “Dr. Peter J. Jannetta, Neurosurgeon and Pioneer on Facial Pain, Dies at 84.” The New York Times (Fri., APRIL 15, 2016): A22.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the obituary has the date APRIL 14, 2016, and has the title “Dr. Peter J. Jannetta, Pioneering Neurosurgeon on Facial Pain, Dies at 84.”)

The book about Jannetta, mentioned above, is:
Shelton, Mark. Working in a Very Small Place: The Making of a Neurosurgeon. New York: Vintage Books, 1990.

Many Empirical Research Results Are False

(p. B7) Research on 100 studies in psychology found in 2015 that more than 60% couldn’t be replicated. Similar results have been found in medicine and economics. Campbell Harvey, a professor at Duke University and president of the American Finance Association, estimates that at least half of all “discoveries” in investment research, and financial products based on them, are false.
. . .
Brian Nosek, a psychology professor at the University of Virginia and executive director of the Center for Open Science, a nonprofit seeking to improve research practices, has spent much of the last decade analyzing why so many studies don’t stand up over time.
Because researchers have an incentive to come up with results that are “positive and clean and novel,” he says, they often test a plethora of ideas, throwing out those that don’t appear to work and pursuing those that confirm their own hunches.
If the researchers test enough possibilities, they may find positive results by chance alone — and may fool themselves into believing that luck didn’t determine the outcomes.

For the full commentary, see:
JASON ZWEIG. “Chasing Hot Returns in ‘Smart-Beta’ Can Be Dumb.” The Wall Street Journal (Sat., Feb 13, 2016): B1 & B7.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date Feb 12, 2016, and has the title “Chasing Hot Returns in ‘Smart-Beta’ Funds Can Be a Dumb Idea.”)

Retail Clinics Provide Convenient Care

(p. A3) My wife and I both work. When one of our children wakes up complaining of a sore throat, we could begin a ritual stare-down to determine which of us is going to have to wait for the doctor’s office to open, make the phone call, wait on hold, schedule an appointment (which will inevitably be in the middle of the day), take off work, pick up the child from school, sit in the waiting room (surrounded by other sick children), get the rapid strep test, find out if the child is infected and then go to the pharmacy or back to school, before returning to work.
Or, one of us could just take the child to a retail clinic on the way to work and be done in 30 minutes. Strep throat is incredibly easy to treat (Penicillin still works great!). There’s a simple and very fast test for it. Moreover, physicians are really bad at diagnosing some of these common illnesses clinically; a study found that a doctor’s guess as to whether a respiratory infection is bacterial or viral is right about 50 percent of the time — no better than flipping a coin. The point is, you need to get the rapid strep test every time regardless, whether at your doctor’s office or at a clinic.
Aimee and I choose the retail clinic every time.
Why? Convenience is the biggest reason. Many doctors’ offices are open only on weekdays and during business hours. This also happens to be when most adults work and when children attend school. A 2010 survey of 11 countries found that Americans seek out after-hours care or care in a hospital’s emergency room more often than citizens of almost any other industrialized nation. More than two-thirds of Americans with a below-average income did so. But this isn’t just a problem for the poor. About 55 percent of those with an above-average income did so as well.
We complain all the time that people use the emergency room for primary care. But that’s not always about lack of insurance. It’s about access. The emergency room is open when people can actually go. Emergency room use has gone up, not down, since the passage of the Affordable Care Act. More people have insurance, and now can afford care when they need it.
That care is also coming from retail clinics, usually found either in stand-alone storefronts or inside pharmacies. Between 2007 and 2009, retail clinic use increased 10-fold. It turns out that my wife and I represent America pretty well. About 35 percent of retail visits for children are for pharyngitis — sore throats. Add in ear infections and upper respiratory infections, and you’ve accounted for more than three-quarters of visits for children. Parents bring their children to retail clinics to take care of quick, acute problems. Swap ear infections for immunizations, and you’ve got the main reasons adults use retail clinics, too.
Researchers for a study published in the American Journal of Medical Quality talked to patients who sought out care at retail clinics. Patients who had a primary care physician, but still went to a retail clinic, did so because their primary care doctors were not available in a timely manner. A quarter of them said that if the retail clinic weren’t available, they’d go to the emergency room.

For the full commentary, see:
Aaron E. Carroll. “The Hidden Cost of Retail Health Clinics.” The New York Times (Thurs., APRIL 14, 2016): A3.
(Note: the online version of the commentary has the date APRIL 12, 2016, and has the title “The Undeniable Convenience and Reliability of Retail Health Clinics.” Where the two versions differ, the quoted passages above follow the online version.)

The research on patient motivation for using retail clinics, is:
Wang, Margaret C., Gery Ryan, Elizabeth A. McGlynn, and Ateev Mehrotra. “Why Do Patients Seek Care at Retail Clinics, and What Alternatives Did They Consider?” American Journal of Medical Quality 25, no. 2 (March/April 2010): 128-34.

“Lifespan Research Really Should Be the Future of Medicine”

(p. D1) A research lab at a University of California campus has a big ambition–to extend the number of years people live disease-free. The animal model it uses for its experiments is decidedly smaller: the tiny fruit fly.
The Jafari Lab, located at UC Irvine, has run tests on substances as diverse as green tea, cinnamon and an Arctic plant called Rhodiola rosea, looking for an elixir of life. To pass muster, each experimental compound must help the fruit flies live longer and not have adverse effects.
The researchers are currently investigating the effects of cinnamon on lifespan. The spice passed the first test: A dose of 25 milligrams of cinnamon per milliliter of food resulted in fruit flies living up to 37% longer. But to be declared a success, the lab is putting cinnamon through three additional tests–does it harm reproductive ability and locomotion and what impact does it have on cognitive capacities such as memory.
“When you look at how we think about aging, we don’t really consider it a disease–it’s just considered a ‘natural’ thing. But I think aging and lifespan research really should be the future of medicine,” says Mahtab Jafari, an associate professor of pharmaceutical sciences at UC Irvine for whom the lab is named.

For the full story, see:
ANGELA CHEN. “HEALTH & WELLNESS; In Search of Elixir of Life, Scientist Studies Fruit Flies.” The Wall Street Journal (Tues., MARCH 8, 2016): D3.
(Note: italics in original.)
(Note: the online version of the story has the date MARCH 7, 2016, and has the title “HEALTH & WELLNESS; Seeking Elixir of Life, a Scientist Studies Fruit Flies.”)

A relevant academic article discussing possible metabolic pathways to increased lifespan, is:
Barzilai, Nir, Derek M. Huffman, Radhika H. Muzumdar, and Andrzej Bartke. “The Critical Role of Metabolic Pathways in Aging.” Diabetes 61, no. 6 (June 2012): 1315-22.

Those Who Suffer from a Problem, Can Invent to Solve It

(p. 1) Is it possible to extract blood from people without causing pain? For decades, this problem has stumped the medical industry. In an effort to replace the old-fashioned needle, companies are trying to deploy laser beams and tiny vacuums to draw blood.
In 2014, an engineer at Harvard named Ridhi Tariyal hit on a far simpler workaround. “I was trying to develop a way for women to monitor their own fertility at home,” she told me, and “those kinds of diagnostic tests require a lot of blood. So I was thinking about women and blood. When you put those words together, it becomes obvious. We have an opportunity every single month to collect blood from women, without needles.”
Together with her business partner, Stephen Gire, she has patented a method for capturing menstrual flow and transforming it into medical samples. “There’s lots of information in there,” Ms. Tariyal said, “but right now, it’s all going in the trash.”
Why did Ms. Tariyal see a possibility that had eluded so many engineers before her? You might say she has an unfair advantage: her gender.
. . .
(p. 4) Eric von Hippel, a scholar of innovation at M.I.T., has spent decades studying what seems like a truism: People who suffer from a problem are uniquely equipped to solve it. “What we find is that functionally novel innovations — those for which a market is not yet defined — tend to come from users,” he said. He pointed out that young Californians pioneered skateboards so that they could “surf” the streets. And surgeons built the first heart-and-lung machines to keep patients alive during long operations. “The reason users are so inventive is twofold. One is that they know the needs firsthand,” he said. The other is that they have skin in the game.

For the full commentary, see:
PAGAN KENNEDY. “The Tampon of the Future.” The New York Times, SundayReview Section (Sun., APRIL 3, 2016): 1 & 4-5.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date APRIL 1, 2016.)

Pagan Kennedy’s book, that is related to her commentary quoted above, is:
Kennedy, Pagan. Inventology: How We Dream up Things That Change the World. New York: Houghton Mifflin Harcourt Publishing Co., 2016.