Category: Health

Britain’s Socialist National Health Service Failed to Update Old Software

(p. A4) LONDON — Martin Hardy was in his hospital gown, about to be wheeled into the operating room for knee surgery on Saturday morning [May 13, 2017] at Royal London Hospital in East London, when, he said, his operation was abruptly canceled.
Mr. Hardy, 52, a caregiver for his father, said his surgeon told him the operation could not be carried out because the hospital’s computer system was not working and his condition was not life-threatening.
“I was in my hospital robe literally about to go in,” he said, wincing as he stood on crutches outside the hospital, waiting for a taxi home. “How can anyone in their right mind do such a thing?” he added, referring to the people behind the devastating cyberattack that affected organizations in nearly 100 countries and sent tremors across Britain’s National Health Service.
A day after one of the largest “ransomware” attacks on record, which left thousands of computers at companies in Europe, universities in Asia and hospitals in Britain still crippled or shut down on Saturday, Amber Rudd, the British home secretary, told the BBC that the N.H.S. needed to learn from what had happened and upgrade its information technology system.
. . .
Ms. Rudd conceded that the N.H.S., where many computers had outdated software vulnerable to malware and ransomware, had been ill prepared, despite numerous warnings. “I would expect N.H.S. trusts to learn from this and to make sure that they do upgrade,” she said.
. . .
“You can’t blame the hospital, but surely the N.H.S. knew this could happen?” he said, his face reddening with anger. “And I don’t understand why their computers weren’t secure. We all pay into the N.H.S., and this is what we get. What on earth is going on in this country?”
. . .
Dr. Krishna Chinthapalli, a senior resident at the National Hospital for Neurology and Neurosurgery in London, who predicted a cyberattack on the N.H.S. in an article published in the British Medical Journal a few days before the attack, said it was disturbing.
“I had expected an attack,” he said in an interview. “But not on this scale.”
He had warned in the article that hospitals were especially vulnerable to ransomware attacks because they held vital data, and were probably more willing than others to pay a ransom to recover it. He said in the interview that many of the N.H.S. computers still ran Windows XP, an out-of-date software.

For the full story, see:
DAN BILEFSKY. “British Patients Suffer as Hospitals Race to Revive Computer Systems.” The New York Times, First Section (Sun., MAY 14, 2017): 11.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date MAY 13, 2017, and has the title “British Patients Reel as Hospitals Race to Revive Computer Systems.”)

Socialized Medicine Seeks to Ensure “No One Does Anything New or Interesting”

(p. A15) Heart surgeons are among the superstars of the medical profession, possessing finely tuned skills and a combination of detachment and sheer guts that enables them to carve open fellow human beings and hold the most vital human organ in their hands. In “Open Heart,” British cardiac surgeon Stephen Westaby shares often astonishing stories of his own operating-room experiences, illuminating the science and art of his specialty through the patients whose lives he has saved and, in some cases, lost.
. . .
One theme in “Open Heart” is Dr. Westaby’s frustration with Britain’s National Health Service, which, he says, values saving money over saving lives. He grows frustrated as he tries to get the reluctant government-run payer to cover the costs of advanced interventions. There are other problems too: Dire situations often get worse, he says, because of treatment delays and poor attention to best practices, like administering clot-busting drugs after a heart attack. Medical directors, he says, seem intent on ensuring that “no one does anything new or interesting.”

For the full review, see:
Laura Landro. “BOOKSHELF; Priming the Pump; One procedure involved implanting a turbine heart-pumping device and screwing a titanium plug, Frankenstein-like, into the skull.” The Wall Street Journal (Fri., July 14, 2017): A15.
(Note: ellipsis added.)
(Note: the online version of the review has the date July 13, 2017.)

The book under review, is:
Westaby, Stephen. Open Heart: A Cardiac Surgeon’s Stories of Life and Death on the Operating Table. New York: Basic Books, 2017.

In Spite of Anxiety about Fatal Mistakes, Starzl Persevered

(p. A10) As he completed his medical training in the late 1950s, Thomas Starzl searched for a way to make his name in the annals of medicine. In an interview late in his life, he recalled asking himself: “What’s out there that needs development but looks impossible?”
The choice seemed obvious to him: transplanting organs.
He became the first surgeon to transplant a human liver successfully in 1967 and went on to do hundreds more, in dicey operations that could last as long as 20 hours. Tall, lean and cerebral, he pioneered drug therapies to fight the body’s rejection of foreign tissue. Though less famous than Christiaan Barnard, who in 1967 was the first to transplant a heart, Dr. Starzl was often called the “father of transplantation.”
. . .
In Miami, crime furnished more than enough gunshot wounds to train a young surgeon. He learned the arts of replacing blood vessels. In his spare time, he experimented on dogs, devised a technique for removing livers and began thinking about how to “install” new ones.
As his surgical skills improved, his anxieties about making potentially fatal mistakes worsened. “With growing concern, I came to believe that I was not emotionally equipped to be a surgeon or to deal with its brutality,” he wrote. “I did not like doing the one thing for which I had become uniquely qualified.” He also felt it was too late to turn back.

For the full obituary, see:
James R. Hagerty. “‘Father of Transplantation’ Defeated His Own Doubts.” The Wall Street Journal (Sat., MARCH 18, 2017): A10.
(Note: ellipsis added.)
(Note: the online version of the obituary has the date MARCH 17, 2017, and has the title “‘Father of Transplantation’ Defeated His Own Doubts and Fears.”)

Retiring Later Improves Health in Old Age

(p. 3) Despite what may seem like obvious benefits, scholars can’t make definitive statements about the health effects of working longer. The research is inherently difficult: Just as retirement can influence health, so can health influence retirement.
“I would say, in my experience, the research is mixed,” said Dr. Maestas of Harvard Medical School. “The studies I have seen tend to show that there are health benefits to working longer.”
As the economists Axel Börsch-Supan and Morten Schuth of the Munich Center for the Economics of Aging of the Max Planck Institute for Social Law and Social Policy put it in an article for the National Bureau of Economic Research, “Even disliked colleagues and a bad boss, we argue, are better than social isolation because they provide cognitive challenges that keep the mind active and healthy.”
Other studies have examined the impact of work and employment on the richness of social networks and social connectedness. The economists Eleonora Patacchini of Cornell University and Gary Engelhardt of Syracuse University tapped into a database of some 1,300 people from ages 57 to 85 that asked about their social networks in 2005 and 2010. After controlling for marital status, age, health and income, they concluded that people who continued to work enjoyed an increase in the size of their networks of family and friends of 25 percent. The social networks of retired people, on the other hand, shrank during the five-year period. In the study, the gains were found to be largely limited to women and older people with postsecondary education.

For the full commentary, see:
CHRISTOPHER FARRELL. “Retiring; Their Jobs Keep Them Healthy.” The New York Times, SundayBusiness Section (Sun., MARCH 5, 2017): 3.
(Note: the online version of the commentary has the date MARCH 3, 2017, and has the title “Retiring; Working Longer May Benefit Your Health.”)

The article by Börsch-Supan and Schuth, is:
Börsch-Supan, Axel, and Morten Schuth. “Early Retirement, Mental Health, and Social Networks.” In Discoveries in the Economics of Aging, edited by David A. Wise. Chicago: University of Chicago Press, 2014, pp. 225-50.

Fearing FDA, Schools Stop Students from Using Sunscreen Lotions

(p. A11) The Sunbeatables curriculum, designed by specialists MD Anderson Cancer Center, features a cast of superheroes who teach children the basics of sun protection including the obvious: how and when to apply sunscreen.
There’s just one wrinkle. Many of the about 1,000 schools where the curriculum is taught are in states that don’t allow students to bring sunscreen to school or apply it without a note from a doctor or parent and trip to the nurse’s office.
Schools have restrictions because the U.S. Food and Drug Administration labels sunscreen as an over-the-counter medication.
. . .
Melanoma accounts for the majority of skin cancer-related deaths and is among the most common types of invasive cancers. One blistering sunburn in childhood or adolescence can double the risk of developing melanoma, says Dr. Tanzi. And sun damage is cumulative. The Skin Cancer Foundation notes that 23% of lifetime sun exposure occurs by age 18. Regular sunscreen application is a widespread recommendation among medical experts though some groups have raised concerns about the chemicals in certain sunscreens.
“Five or more sunburns increases your melanoma risk by 80% and your non-melanoma skin cancer risk by 68%,” Dr. Tanzi says.
Pediatric melanoma cases add up to a small but growing number. There are about 500 children diagnosed every year with the numbers increasing by about 2% each year, says Shelby Moneer, director of education for the Melanoma Research Foundation.

For the full story, see:
Sumathi Reddy. “YOUR HEALTH; It’s School, No Sunscreen Allowed.” The Wall Street Journal (Tues., May 16, 2017): A11.
(Note: ellipsis added.)
(Note: the online version of the story has the date May 15, 2017, and has the title “YOUR HEALTH; Where Kids Aren’t Allowed to Put on Sunscreen: in School.”)

Government Regulations Suppress Poor Street Entrepreneurs

(p. 7) HANOI, Vietnam — As strips of tofu sizzle beside her in a vat of oil, Nguyen Thu Hong listens for police sirens.
Police raids on sidewalk vendors have escalated sharply in downtown Hanoi since March [2017], she said, and officers fine her about $9, or two days’ earnings, for the crime of selling bun dau mam tom — vermicelli rice noodles with tofu and fermented shrimp paste — from a plastic table beside an empty storefront.
“Most Vietnamese live by what they do on the sidewalk, so you can’t just take that away,” she said. “More regulations would be fine, but what the cops are doing now feels too extreme.”
Southeast Asia is famous for its street food, delighting tourists and locals alike with tasty, inexpensive dishes like spicy som tam (green papaya salad) in Bangkok or sizzling banh xeo crepes in Ho Chi Minh City. But major cities in three countries are strengthening campaigns to clear the sidewalks, driving thousands of food vendors into the shadows and threatening a culinary tradition.
. . .
. . . some experts say street food is not inherently less sanitary than restaurant food. “If you’re eating fried foods or things that are really steaming hot, then there’s probably not much difference at all,” said Martyn Kirk, an epidemiologist at the Australian National University.
. . .
Ms. Hong, the Hanoi vendor, said her earnings had cratered by about 60 percent since the start of the crackdown, when she moved to her present location from a busy street corner as a hedge against police raids.

For the full story, see:
MIKE IVES. “Food So Popular, Asian Cities Want It Off the Streets.” The New York Times, First Section (Sun., APRIL 30, 2017): 7.
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story has the date APRIL 29, 2017, and has the title “Efforts to Ease Congestion Threaten Street Food Culture in Southeast Asia.”)

Middle Class Wants to Be Free to Choose Skinnier Health Insurance

(p. B4) For Linda Dearman, the House vote last week to repeal the Affordable Care Act was a welcome relief.
Ms. Dearman, of Bartlett, Ill., voted for President Trump largely because of his contempt for the federal health law. She and her husband, a partner in an engineering firm, buy their own insurance, but late last year they dropped their $1,100-a-month policy and switched to a bare-bones plan that does not meet the law’s requirements. They are counting that the law will be repealed before they owe a penalty.
“Now it looks like it will be, and we’re thrilled about that,” Ms. Dearman, 54, said. “We are so glad to feel represented for a change.”
. . .
In interviews over the last few days, people who support repealing the Affordable Care Act pointed to their long-simmering resentment of its mandate that most Americans have health insurance or pay a tax penalty. Many also said that they could no longer afford the comprehensive coverage available on the individual market, and that they were eager to once again be allowed to choose skinnier policies without a penalty.
“Now I will no longer be expected to pay twice what I should for a product I don’t need and be treated like a criminal with a fine if I refuse,” said Edward Belanger, 55, a self-employed business appraiser in Dallas. He is an independent who usually votes Republican but last year chose Gary Johnson, the Libertarian candidate, over Mr. Trump.
Like the Dearmans, Mr. Belanger canceled a plan that complies with the Affordable Care Act and bought a short-term policy that does not meet the law’s standards, paying $580 a month for his family of four compared with the nearly $1,200 a month he paid last year. Policies like theirs usually have high deductibles and primarily offer catastrophic coverage for major injuries.

For the full story, see:
ABBY GOODNOUGH. “Feeling Hurt By Health Law, and Eager to See G.O.P. Repeal It.” The New York Times (Tues., May 16, 2017): A12.
(Note: ellipsis added.)
(Note: the online version of the story has the date May 12, 2017, and has the title “Why Some Can’t Wait for a Repeal of Obamacare.”)

“Death Has Never Made Any Sense to Me”

(p. 10) . . . , Kinsley is intent on being wryly realistic about coping with illness and the terminal prospects ahead. He makes fun of a fellow boomer, Larry Ellison, the C.E.O. of Oracle, who has spent millions in a quest for eternal life, and who was quoted as saying, “Death has never made any sense to me.” Kinsley quips: “Actually the question is not whether death makes sense to Larry Ellison but whether Larry Ellison makes sense to death. And I’m afraid he does.”

For the full review, see:
PHILLIP LOPATE. “Senior Moments’.” The New York Times Book Review (Sun., APRIL 24, 2016): 10.
(Note: ellipsis added.)
(Note: the online version of the review has the date APRIL 18, 2016, and has the title “Michael Kinsley’s ‘Old Age: A Beginner’s Guide’.”)

The book under review, is:
Kinsley, Michael. Old Age: A Beginner’s Guide. New York: Tim Duggan Books, 2016.

Justified Species Extinction

(p. A1) The death toll from diseases carried by mosquitoes is so huge that scientists are working on a radical idea. Why not eradicate them?
Mosquitoes kill more humans than any other animal and were linked to roughly 500,000 deaths in 2015, mostly from malaria. For more than a century, humans have used bed nets, screens and insecticides as weapons, but mosquitoes keep coming back. They are now carrying viruses like Zika and dengue to new parts of the world.
Powerful new gene-editing technologies could allow scientists to program mosquito populations to gradually shrink and die off. Some efforts have gained enough momentum that the possibility of mosquito-species eradication seems tantalizingly real.
“I think it is our moral duty to eliminate this mosquito,” entomologist Zach Adelman says about Aedes aegypti, a species carried afar over centuries by ships from sub-Saharan Africa.
. . .
(p. A8) Purposely engineering a species into extinction–or just diminishing it–is fraught with quandaries. Scientists must weigh the potential impact of removing a species on the environment and food chain. It will take years of more research, testing and regulatory scrutiny before most genetically altered mosquitoes can be released into the wild. And the strategy might not work.
Wiping a species off the face of the earth is “an unfortunate thing to have to do,” says Gregory Kaebnick, a research scholar at the Hastings Center, a bioethics research institute in Garrison, N.Y.
He says humans shouldn’t force a species into extinction to meet their own preferences. “We ought to try not to do it,” says Mr. Kaebnick. One justification, he says, would be to avert a serious public-health threat.

For the full story, see:
BETSY MCKAY. “A World with No Mosquitoes.” The Wall Street Journal (Sat., Sept. 3, 2016): A1 & A8.
(Note: ellipsis added.)
(Note: the online version of the story has the date Sept. 2, 2016, and has the title “Mosquitoes Are Deadly, So Why Not Kill Them All?”)

Tinkerers Build Their Own Pancreases, While Waiting for 100,000 Page Submission to FDA

(p. B1) Third-grader Andrew Calabrese carries his backpack everywhere he goes at his San Diego-area school. His backpack isn’t just filled with books, it is carrying his robotic pancreas.
The device, long considered the Holy Grail of Type 1 diabetes technology, wasn’t constructed by a medical-device company. It hasn’t been approved by regulators.
It was put together by his father.
Jason Calabrese, a software engineer, followed instructions that had been shared online to hack an old insulin pump so it could automatically dose the hormone in response to his son’s blood-sugar levels. Mr. Calabrese got the approval of Andrew’s doctor for his son to take the home-built device to school.
The Calabreses aren’t alone. More than 50 people have soldered, tinkered and written software to make such devices for themselves or their children. The systems–known in the industry as artificial pancreases or closed loop systems–have been studied for decades, but improvements to sensor technology for real-time glucose monitoring have made them possible.
The Food and Drug Administration has made approving such devices a priority and several companies are working on them. But the yearslong process of commercial development and regulatory approval is longer than many patients want, and some are technologically savvy enough to do it on their own.
. . .
(p. B2) “Biology isn’t quite as easy as controlling the temperature in a room,” said Francine Kaufman, chief medical officer for Medtronic’s diabetes division. She sees do-it-yourself efforts as a sign of the interest in the technology, but distinct from the process of getting a commercial device to market. Dr. Kaufman estimates Medtronic’s submission to the FDA will exceed 100,000 pages and hopes that the device will be approved in 2017.
The home-built project that the Calabreses followed, known as OpenAPS, was started by Dana Lewis, a 27-year-old with Type 1 diabetes in Seattle. Ms. Lewis began using the system in December 2014 as a sort of self-experiment. After months of tweeting about it, she attracted others who wanted what she had.
. . .
The FDA declined to comment on the project but said the agency is working with manufacturers to approve a device.
Sarah Howard became interested after she met Ms. Lewis last year. “My first question was: Was it legal?” said the 49-year-old, who has Type 1 diabetes, as does one of her two sons. “I didn’t want to do anything illegal.”
​After ​her husband ​built​ the system for her and her son, she said the main benefit is starting each day with her blood sugar in range and not having to wake in the night to check her son’s glucose levels.

For the full story, see:
Kate Linebaugh. “Tech-Savvy Families Build Robotic Pancreas; Companies work on developing diabetes device, but approval process is too long for many patients.” The Wall Street Journal (Mon., May 9, 2016): B1-B2.
(Note: ellipses added.)
(Note: the online version of the story has the Tech-Savvy Families Use Home-Built Diabetes Device; Companies work on artificial pancreas, but approval process is too long for many patients.”)