Health – Page 46 – artdiamondblog.com

Why You Want Your Surgeon to Be a Disciple of Lister

The sources of new ideas are diverse. Sometimes, as below, even a newspaper article can provide inspiration.
The passage below also provides another example of the project oriented entrepreneur, who is motivated by a mission to get the job done.

(p. 60) In Lister’s early years, the mid-1800s, half of all amputation patients died from hospital fever; in some hospitals the rate was as high as 80 percent. Lister, like all surgeons, had little idea of how to improve the situation. Then he chanced on a newspaper article that caught his interest. It described how the residents of a local town, tired of the smell of their sewage, had begun treating it by pouring into their system something called German Creosote, a by-product of coal tar. Something in the creosote stopped the smell. Lister had heard about the work of Pasteur, and he made the same mental connection the French chemist had: The stink of sewage came from putrefaction, rotting organic matter; the stink of infected wounds also came from putrefaction; whatever stopped the putrefaction of sewage might also stop the putrefaction of infected wounds. So Lister decided to try coal-tar chemicals on his patients. And he found one that worked exceptionally well: carbolic acid, a solution of what today is called phenol. . . .
. . .
(p. 61) Lister’s insistence on stopping the transfer of bacteria in the operating room became absolute. Once when a visiting knighted physician from King’s College idly poked a forefinger into a patient’s incision during one of Lister’s operations, Lister flung him bodily from the room.

Source:
Hager, Thomas. The Demon under the Microscope: From Battlefield Hospitals to Nazi Labs, One Doctor’s Heroic Search for the World’s First Miracle Drug. New York: Three Rivers Press, 2007.
(Note: ellipses added.)

Doctors Rejected Pasteur’s Work

Whether in science, or in entrepreneurship, at the initial stages of an important new idea, the majority of experts will reject the idea. So a key for the advance of science, or for innovation in the economy, is to allow scientists and entrepreneurs to accumulate sufficient resources so that they can make informed bets based on their conjectures, and on their tacit knowledge.
A few entries ago, Hager recounted how Leeuwenhoek faced initial skepticism from the experts. In the passage below, Hager recounts how Pasteur also faced initial skepticism from the experts:

(p. 44) If bacteria could rot meat, Pasteur reasoned, they could cause diseases, and he spent years proving the point. Two major problems hindered the acceptance of his work within the medical community: First, Pasteur, regardless of his ingenuity, was a brewing chemist, not a physician, so what could he possibly know about disease? And second, his work was both incomplete and imprecise. He had inferred that bacteria caused disease, but it was impossible for him to definitively prove the point. In order to prove that a type of bacterium could cause a specific disease, precisely and to the satisfaction of the scientific world, it would be necessary to isolate that one type of bacterium for study, to create a pure culture, and then test the disease-causing abilities of this pure culture.

The Benefits from the Discovery of Sulfa, the First Antibiotic

I quoted a review of The Demon Under the Microscope in an entry from October 12, 2006. I finally managed to read the book, last month.
I don’t always agree with Hager’s interpretation of events, and his policy advice, but he writes well, and he has much to say of interest about how the first anti-bacterial antibiotic, sulfa, was developed.
In the coming weeks, I’ll be highlighting a few key passages of special interest. In today’s entry, below, Hager nicely summarizes the importance of the discovery of antibiotics for his (and my) baby boom generation.

(p. 3) I am part of that great demographic bulge, the World War II “Baby Boom” generation, which was the first in history to benefit from birth from the discovery of antibiotics. The impact of this discovery is difficult to overstate. If my parents came down with an ear infection as babies, they were treated with bed rest, painkillers, and sympathy. If I came down with an ear infection as a baby, I got antibiotics. If a cold turned into bronchitis, my parents got more bed rest and anxious vigilance; I got antibiotics. People in my parents’ generation, as children, could and all too often did die from strep throats, infected cuts, scarlet fever, meningitis, pneumonia, or any number of infectious diseases. I and my classmates survived because of antibiotics. My parents as children, and their parents before them, lost friends and relatives, often at very early ages, to bacterial epidemics that swept through American cities every fall and winter, killing tens of thousands. The suddenness and inevitability of these epidemic deaths, facts of life before the 1930s, were for me historical curiosities, artifacts of another age. Antibiotics virtually eliminated them. In many cases, much-feared diseases of my grandparents’ day—erysipelas, childbed fever, cellulitis—had become so rare they were nearly extinct. I never heard the names.

Kronman Thinks It’s Good that We Die (and Charles Murray Applauds)

Over the weekend of August 16-17, 2008, I caught a few minutes of an interview on one of the C-SPAN channels. Charles Murray was handing softball questions to an academic philosopher named Kronman. Kronman was pontificating that life could only be meaningful because there was death. He suggested that those pursuing longevity research were misguided.
I sat there appalled, pondering how many wonderful, amazing projects we could get done, if only we had more time.
Some wise philosopher once said that you can only have useful dialogue with someone if the two of you have some shared assumptions. I don’t expect to be dialoguing with Anthony Kronman anytime soon. And that is just as well, since life is way too short to waste much time worrying about the Anthony Kronman’s of the world.
(In case you think I’m making this up, I quote below, from Kronman.)

(p. 229) The spiritual emptiness of our civilization has its source in the technology whose achievements we celebrate and on whose powers we all now depend.

Technology relaxes or abolishes the existing limits on our powers. There is no limit to this process itself. Indeed, every step forward is merely a provocation to go further. This might be called the (p. 230) technological “imperative.” . . .
. . .
(p. 230) If we lived forever, our powers, however great, would have no significance. How could it possibly matter whether we exercised them one way or another, sooner rather than later? This can matter to us only within the framework of a lifetime, that is, within the boundaries of a mortal existence. That we sometimes imagine (or think we imagine) that we want to have and use limitless powers in a limitless life is an illusion that always depends on our covertly smug-(p. 231)gling into our imagined picture of such an existence some essential feature of the human mortality we can never escape. In reality, the idea of immortality is for us quite unimaginable. It remains an empty abstraction.

PS: The following sentence appears on the copyright page of Kronman’s book: “The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources.”
So the longevity of books is pompously praised, while the longevity of humans is belittled?

Don’t waste time on:
Kronman, Anthony T. Education’s End: Why Our Colleges and Universities Have Given up on the Meaning of Life. New Haven, CT: Yale University Press, 2007.
(Note: ellipses added.)

Emergency Room Waiting Time Continues to Increase

(p. D4) ATLANTA — The average time that hospital emergency-room patients wait to see a doctor has grown to almost an hour from about 38 minutes over the past decade, according to new federal statistics released Wednesday.
The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the U.S. Centers for Disease Control and Prevention.
“There are more people arriving at the ERs. And there are fewer ERs,” said Dr. Pitts, an associate professor of emergency medicine at Emory University.
The average time is based on a national survey of 362 hospital emergency departments.
Over all, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 — a 32% increase.
Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.
. . .
The amount of time a patient waited before seeing a physician in an ER has been rising steadily, from 38 minutes in 1997, to 47 minutes in 2004, to 56 minutes in 2006.
Dr. Pitts added that 56 minutes may be the average, but it’s not typical: The average was skewed to nearly an hour because of some very long waits.
. . .
“Millions more people each year are seeking emergency care, but emergency departments are continuing to close, often because so much care goes uncompensated,” Dr. Linda Lawrence, president of the American College of Emergency Physicians, said in a statement.
“This report is very troubling, because it shows that care is being delayed for everyone, including people in pain and with heart attacks.”

For the full story, see:

ASSOCIATED PRESS. Average ER Waiting Time Jumps to Nearly an Hour.” The Wall Street Journal (Thurs., August 7, 2008): D4.
(Note: eillipses added.)

Urgent Care Clinics Are Replacing Emergency Rooms

“An urgent-care clinic in Atlantic Beach, Fla.” “Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. D1) When a heavy metal door swung over her 14-year-old son’s foot, ripping the nail almost completely off his big toe, Tina Mobley didn’t want to take her chances in a crowded hospital emergency room or wait for an appointment at the pediatrician’s office the next day. Instead, she drove to an urgent-care clinic inside a Wal-Mart in Yulee, Fla., near her rural home. Within minutes, the doctor on duty numbed the pain with an injection, removed the nail, and cleaned and bandaged the injury.

Patients who need immediate care for injuries and illness, be it a nail-gun puncture or a severe stomach bug, are increasingly turning to walk-in urgent-care clinics. These facilities aim to fill the gap between the growing shortage of primary-care doctors and a shrinking number of already-crowded hospital emergency departments, with no appointment necessary and extended evening and weekend hours. Urgent-care clinics are staffed by physicians, offer wait times as little as a few minutes and charge $60 to $200 depending on the procedure — a fraction of the typical $1,000-plus emergency department visit. Some offer discounts and payment plans for the uninsured; for those with coverage, co-payments vary by insurance plan but may be less than half the amount of an ER visit, which can range from $50 to $200.

While the Yulee clinic that treated Ms. Mobley’s son is one of three operated inside Wal-Mart stores by Jacksonville, Fla.-based Solantic, urgent-care centers aren’t to be confused with the new crop of retail health clinics popping up in drugstores, which are run by nurse practitioners who prescribe medicine for minor illnesses and provide vaccinations. Urgent-care-center physicians and other medical staffers can put casts on broken bones, sew up lacerations, provide intravenous fluids for dehydrated patients, and deploy advanced life-support equipment for both adults and children. They often have equipment not available in physicians’ offices, such as X-rays.

For the full story, see:
LAURA LANDRO. “THE INFORMED PATIENT; Options Expand For Avoiding Crowded ERs.” The Wall Street Journal (Weds., August 6, 2008): D1-D2.

Fewer Jobs Under Obama’s High-Cost Health Plan

“Dave Ratner, owner of four pet stores in Western Massachusetts, is worried about being able to pay into a state health benefits plan.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A16) AGAWAM, Mass. — Dave Ratner, owner of Dave’s Soda and Pet City, is pretty sure he is about to get “whacked” by the new state law that requires employers to contribute to health care benefits for their workers or pay a $295-per-employee penalty. In order to avoid thousands of dollars in fines, Mr. Ratner is considering not adding part-time workers at his four pet supply stores in Western Massachusetts.

But the penalty in Massachusetts is picayune compared with what some health experts believe Senator Barack Obama, the Democratic presidential nominee, might impose as part of his plan to provide affordable coverage for the uninsured. Though Mr. Obama has not released details, economists believe he might require large and medium companies to contribute as much as 6 percent of their payrolls.
That, Mr. Ratner said, would be catastrophic to a low-margin business like his, which has 90 employees, 29 of them full-time workers who are offered health benefits.
“To all of a sudden whack 6 to 7 percent of payroll costs, forget it,” he said. “If they do that, prices go up and employment goes down because nobody can absorb that.”

For the full story, see:

KEVIN SACK. “Businesses Wary of Details in Obama Health Plan.” The New York Times (Mon., October 27, 2008): A16.

Hospitals Lack Hospitality

Source of book image: http://www.simplenomics.com/wp-images/settingthetable-1.jpg

(p. R7) Most successful entrepreneurs like rattling on about how they did it.

The bookshelves have never been more crowded with such exploits from consultants, real-estate moguls and retailers. And publishers say there are more on the way. With layoffs and cutbacks dominating the headlines, demand for advice books based on true-life stories is peaking.
. . .
So what does it take to succeed?
“Pragmatic advice, [a book written by] somebody with a fairly high public profile, and a person who can hit the lecture circuit after the first rush of publicity and keep the book selling,” says Grand Central’s Mr. Wolff.
Those factors have contributed to the staying power of restaurateur Danny Meyer’s book, “Setting the Table: The Transforming Power of Hospitality in Business.”
News Corp.’s HarperCollins Publishers first published 30,000 copies in October 2006. (News Corp. also publishes The Wall Street Journal.) Mr. Meyer’s work, chatty personal anecdotes wrapped around a core message that emphasizes hospitality as the key to creating satisfied customers, proved a hit.
. . .
“The most surprising thing was the interest from the hospital community,” Mr. Meyer says. “That’s an industry in turmoil based on the absence of hospitality. They over-focus on the metrics of stays and cure rates rather than how they make people feel.”

For the full story, see:

JEFFREY A. TRACHTENBERG. “Running the Show; Me, Me, Me; So many entrepreneurs are writing books about how they made it. Their books, though, aren’t nearly as successful.” The Wall Street Journal (Mon., June 16, 2008): R7.
(Note: ellipses added.)

Medicare Pays $110 for Walker that Wal-Mart Sells for $60

Source of table: online version of the NYT article quoted and cited below.

(p. C1) On Wal-Mart’s Web site, you can buy a walker for $59.92. It is called the Carex Explorer, and it’s a typical walker: a few feet high, with four metal poles extending to the ground. The Explorer is one of the walkers covered by Medicare.
But Medicare and its beneficiaries aren’t paying $59.92 for the Explorer or any similar walker. In fact, they’re not paying anything close to it. They are paying about $110.
. . .
(p. C5) In the abstract, fixing the health care system sounds perfectly unobjectionable: it’s about reducing costs (and then being able to cover the uninsured) by getting rid of inefficiency and waste. In reality, though, almost every bit of waste benefits someone.
Doctors who perform spinal fusion surgeries, despite decidedly mixed evidence that they’re effective, are making a nice living. Hospitals that order $1,000 diagnostic tests, even when a cheaper one would work just as well, are helping their bottom line. Medical equipment makers selling walkers for $110, while Wal-Mart sells them for $60, are fattening their profits.
The current fight to protect those profits is a microcosm of what you can expect to see if a larger effort to rein in health costs ever gets going. The defenders of the status quo won’t say that they are protecting themselves. Instead, they’ll use the same arguments that the medical equipment makers are using — that a change will destroy jobs, bankrupt small businesses and, above all, harm patients.
. . .
But this is a case in which the market can clearly do a better job than a government-mandated fee schedule. Just look at Wal-Mart’s Web site or, for that matter, the bids that Medicare has already received.
By standing in the way of this competition, Congress is really standing up for higher health care costs.

For the full commentary, see:
DAVID LEONHARDT. “ECONOMIC SCENE; High Medicare Costs, Courtesy of Congress.” The New York Times (Weds., June 25, 2008): C1 & C5.
(Note: ellipses added.)

A.D.A. Tries to Stop Dental Therapists from Competing with Dentists

“Aurora Johnson, left, a dental therapist, filled cavities for Paul Towarak, 10, in the village of Unalakleet, Alaska. For more involved procedures, Ms. Johnson refers patients to a dentist.” Source of caption and photo: online version of the NYT article quoted and cited below.

Clayton Christensen (and co-authors) have suggested that disruptive technologies could reduce the cost and improve the quality of health care. One pathway for this to occur is new technologies that permit effective treatment to be carried out by para-professionals with less education than MD’s.
The article below illustrates Christensen’s idea, and also highlights the main obstacle to its implementation: professional organizations asking the government to regulate and restrict competition from the lower-cost para-professionals.

(p. A1) UNALAKLEET, Alaska — The dental clinic in this village on the edge of the Bering Sea looks like any other, with four chairs, a well-scrubbed floor and a waiting area filled with magazines.
But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.
Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. John-(p. A15)son’s. And while such arrangements are common outside the United States, only one American dental school, in Anchorage, offers such a program.
. . .
(p. A15) In Alaska, the A.D.A. and the state’s dental society had filed a lawsuit to block the program that trained people like Ms. Johnson, who are called dental therapists. The groups dropped the suit last summer after a state court judge issued a ruling critical of the dentists. But the A.D.A. continues to oppose allowing therapists to operate anywhere in the lower 49 states. Currently, therapists are allowed to practice only in Alaska, and only on Alaska Natives.
. . .
Therapists are a low-cost way to provide care to people who might not otherwise have access to it, according to Dr. Ron Nagel, a dentist and consultant for the Alaska Native Tribal Health Consortium, a nonprofit group financed mostly by federal money that provides medical and dental care to tribal communities. “There’s a huge need for these basic services,” Dr. Nagel said.
. . .
Since 1990, the number of private dentists has remained roughly flat, at 150,000, even as the United States population has increased 22 percent. As a result, dentists can easily fill their appointment books without seeing people who cannot meet their fees, and patients who have decayed teeth are suffering needlessly, said Tammy Guido, 50, who is one of seven students now training in Anchorage to become a therapist.
“We’re meeting a need that is not being met,” Ms. Guido said.
Alaskan tribal organizations sponsor Ms. Guido and the other students in Anchorage for the program. To be accepted, students must have a high school diploma or equivalency degree; for the newest class, 7 of 18 candidates were accepted.
In interviews, the students in this year’s class all said they were enthusiastic about the chance to serve communities that have little access to care. All seven had quit full-time jobs and must now get by on a $750 monthly stipend during the two years of training.
“Anybody who’s ever had a toothache can tell you it hurts,” said Ben Steward, 24, the only man in this year’s class. “But talk to someone who’s had a toothache for a year.”

For the full story, see:
ALEX BERENSON. “Dental Clinics, Meeting a Need With No Dentist.” The New York Times (Mon., April 28, 2008): A1 & A15.
(Note: ellipses added.)

One source of Christensen’s views on health care can be found in a chapter in:
Christensen, Clayton M., Scott D. Anthony, and Erik A. Roth. Seeing What’s Next: Using Theories of Innovation to Predict Industry Change. Boston, MA: Harvard Business School Press, 2004.