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Inching closer to a cure for some cancers

So long as you avoid politics, there are some interesting things going on in the great wide world.

Sagiv-Barfi and Levy led the work on a possible cancer treatment that involves injecting two immune-stimulating agents directly into solid tumors.

The bottom line is this: 87 out of 90 mice were cured — as in they had no cancers after treatment. The three that weren’t did respond to a second treatment. These results are phenomenal.

Yes, humans don’t always respond as well as mice, etc., etc., etc. Even with all the caveats, these results are phenomenal.

What’s equally phenomenal is that the treatment does not cause the whole immune system to go into overdrive, which has caused problems, even fatalities, in some immunotherapies. It just kicks the responsible immune cells already in the tumor into recognizing the culprits. And then those T4 cells kill that cancer wherever it’s found in the body.

There’s no need to design proteins, culture patients’ cells, or do any other fancy, expensive and customized-to-each-patient procedures.

The treatment also worked on mice genetically engineered to develop solid tumors.

It was tested only on solid cancers, not, for instance, leukemia.

Both of the immune-stimulating agents have already been used in humans, one is already an approved treatment, so the regulatory slog is likely to be less sloggy than normal.

Can’t wait!

Ronald Levy and Idit Sagiv-Barfi, Stanford.

(Steve Fisch)

Eradication of spontaneous malignancy by local immunotherapy, by Idit Sagiv-Barfi, Debra K. Czerwinski, Shoshana Levy, Israt S. Alam, Aaron T. Mayer, Sanjiv S. Gambhir and Ronald Levy. Science Translational Medicine 31 Jan 2018: Vol. 10, Issue 426, eaan4488
DOI: 10.1126/scitranslmed.aan4488

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Vaccination (like everything else) is about rights

There is no controversy about vaccines. They work. The diseases they prevent are horrible. The vaccines themselves are about as harmless as it’s possible to be and still exist in the real world. For instance, Diphtheria-tetanus-pertussis, DTaP: fewer than one person in one million has serious complications. “Serious” means any reaction that requires medical attention, even if it’s temporary, such as high fever or a bad allergic reaction. Measles-mumps-rubella, MMR: fewer than one in one million with serious complications; inactivated polio, IPV: even fewer than the previous; shingles: none reported yet so “being monitored.” (Source: CDC)

As for the generated “controversy” about vaccines, it deserves as much attention as people who plan to fly by flapping their arms. It is nonsense. Yes, science and medicine have both been wrong about some very important things in the past, and they will be again. Vaccination is not one of them. The evidence in favor of it is beyond overwhelming. End of story. That is, it’s the end of the scientific and medical story.

Politically, it’s not the end of the story because there’s no law saying we always have to be rational. If I want to jump off a roof while flapping my arms and kill myself, I can do that.

But not vaccinating differs from the personal choice to be an idiot in one very important respect: it’s not just personal. It can take other people down with it. And there are laws against that.

So which law counts? The one that says I get to decide about my own medical treatments, or the one that says I can’t damage people?

Before the current measles outbreak, the comments on news sites would have fit comfortably into this Onion article. Now that there is an outbreak because so many people avoided vaccination, or had it avoided for them if they’re children, people feel vulnerable. Suddenly the comments are calling for these horrible parents to be jailed. Suddenly a lot of people are clear on the fact that vaccination is not a purely individual thing. Now they’re going nuts in the opposite direction, from loony libertarian straight to jackbooted totalitarian.

Both are wrong, obviously, because neither works, obviously. The only solution is a balancing act between the different rights.

I know that’s the last thing most people want to hear. It’s much easier to be simple and wrong than go to all the trouble of thinking things through. But the sad fact is that there’s no other way to get to what works. Luckily, in this case it’s not even difficult.

The right to make your own medical decisions is rather worthless if anybody can kill you at any time. The right not to be harmed by others takes precedence over all other rights because they are all meaningless if that one is not respected.

So the balancing act is quite easy: the public health issue of not infecting others with contagious diseases takes precedence over anyone’s personal medical choices.

This is yet one more example of the fact that rights are not equal, that there’s a hierarchy of rights, and that some are more essential than others. Some rights have to take precedence over others or else they all become meaningless.

Therefore the medical and public health requirements for vaccination take precedence over any non-medical objections. There can’t be allowances for religious or philosophical objections. It means the whole US has to follow the lead of Mississippi and West Virginia and have only medically necessary exemptions from vaccination.

A plague doctor. 1819

That said, though, the idea is to have as high a vaccination rate as possible. It’s not to beat people up for ignorance. So resources need to be directed toward the actual goal, vaccination, and not squandered on useless, resentment-building exercises like jailing recalcitrant parents. Yes, it’s important to stop the Onion mindset of “I Don’t Vaccinate My Child Because It’s My Right To Decide What Eliminated Diseases Come Roaring Back.” Even more important is to see that they get vaccinated, no matter what the voices in their heads are telling them.

Sometimes it takes very little to achieve that goal. For instance, in one health district [update-2015-02-04: near Duchesne, Utah], registering a philosophical objection to vaccination required nothing more than a tick mark in a box. Receiving the vaccination on the other hand cost $25. When the public health officials were trying to figure out how to get more people vaccinated, one bright worker noted that they should invert the incentives. So the vaccination was given free, but expressing a philosophical objection required payment of $25 for “administrative costs.” Which isn’t even a lie.

You know how that story ends. The number of objectors plummeted. The vaccination rates climbed above the medically essential 95% of the population, and the problem was solved, at least from the standpoint of public health. And that’s the first priority.

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There oughta be a law

I just saw this:

The backstory is that 23andMe pioneered direct-to-consumer genetic tests starting in 2006. It asked consumers to spit in a tube and send it in, and sent back a detailed summary of their risks for common diseases like macular degeneration. But then in 2013 the U.S. Food & Drug Administration banned the test out of concern that the information wasn’t accurate.

That put a big crimp in 23andMe’s business, but it didn’t end it. As Forbes points out, the real business here is mining this data.

Since it was founded in 2006, 23andMe has collected data from 800,000 customers and it sells its tests for $99 each.

…23andMe’s real business isn’t selling $99 tests, but selling access to data that it has managed to crowdsource as cleverly as Facebook has gathered other personal details. To some observers, that’s pretty worrisome. In 2013, journalist Charles Seife, writing in Scientific American, called 23andMe intentions “terrifying.”

As the FDA frets about the accuracy of 23andMe’s tests, it is missing their true function, and consequently the agency has no clue about the real dangers they pose. The Personal Genome Service isn’t primarily intended to be a medical device. It is a mechanism meant to be a front end for a massive information-gathering operation against an unwitting public.

Seife’s worry is that the consents customers agree to when they donate their DNA could turn out to be meaningless. Once you are hooked, companies like Google and Facebook often change their privacy policies to expose more and more of your data. Why should DNA be any different?…

According to the Fox Foundation, 23andMe actually gave its testing service away to Parkinson’s patients. That helped it assemble enough of them to create a useful resource it could sell to Genentech to start mining.

What’s the saying? If you’re not being paid, you’re the product. That’s bad enough when they’re high frequency trading thin slices of your mind. When they’re selling someone’s sorrow, pain, and suffering, when they’re selling people’s own DNA, it’s downright disgusting.

If we had a government, there’d be a law against selling people this way.

As things are, I’m betting the high and mighty in DC are fine with it so long as they get their cut of the data. As things are, we’re going to find out one day our own souls got sold to the company store, and the sign for refunds leads to nothing but a phone tree.

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Ebola First World Problems

This is not to minimize the real suffering of the real people who have contended with the real disease in the First World. It is a horrifying disease wherever it occurs.

No, this post is about what I’ve been seeing in the news here. When the disease was limited to Africa, it wasn’t seeing much at all in the US. Thousands died, and there was hardly a blip. What I did see seemed mostly to question whether there was any point in sending medical aid.

Now that there have been about seven cases here (the two Samaritan’s Purse health workers, Thomas Duncan, his two nurses, a freelance journalist in Nebraska, and the Doctors Without Borders physician there’s currently a flap about)– now that there have been cases here, the country is hysterical.

NASA artist's conception of asteroid destroying Earth

(artist unknown. NASA)

A school in Maine put a teacher on administrative leave after parents “expressed concern” — meaning panicked — that she could have been exposed because she visited Dallas with one Ebola patient in quarantine in a hospital that she never visited.

I’ve heard of a caller to emergency services complaining about a pilot running around loose who’d been to West Africa, which later turned out to be the same place in the caller’s small mind as Western Europe. And, yes, that’s funny, but it’s also bad. While that drivel is going on, the dispatcher and the ambulance (they sent out an ambulance?!) can’t respond to actual emergencies.

People of West African extraction are being shunned because, because what? They’re catching it by quantum juju from people 5000 miles away whom they’ve never met? White Africans, interestingly enough don’t seem to be seen as quite as susceptible to magical infection.

Most recently, a bunch of governors saw a great opportunity to get out in front of the hysteria and Doooo Something. Let’s quarantine everybody, sick or not, who’s ever been near West Africa. So when a selfless altruist like Kaci Hickox returns, a woman who’s a nurse for Doctors Without Borders and has treated Ebola patients and actually knows something about the disease, when she returns she becomes a political plaything for Chris Christie and Andrew Cuomo (bipartisanship!) to score points with ignorant voters by dumping her into a senseless quarantine.

Quarantine is for CONTAGIOUS people. It’s a useless waste of money and resources applied to any traveller some bozo happens to have fantasies about. Quarantine can be a medical necessity. It needs to be done on medical grounds. When it’s nothing but jerks lashing out in panic, it’s not only insane, it’s actually counterproductive and increases the spread of disease. (So much for Christie’s and Cuomo’s “leadership.”)

So, that’s the “Keep Calm” part. What about the “Carry On” part?
Are there things that could sensibly be done to help the situation? Why, yes. Yes, there are.

Number One. (This should be in bold all-caps, but I’ve done that already. Must ration myself.) The US needs to get itself an actual healthcare system. Using disease as a profit center for Big Medicine and Big Insurance just isn’t working.

When Thomas Duncan fell ill in Dallas everybody knows what happened next. After his first emergency room visit, he was sent home. Now, note this: Ebola is not contagious until after the patient has run a fever for some time, a day or so, when the virus starts being secreted in body fluids. (The main research paper so far on contagiousness: Bausch et al., 2007. Discussion in Science.)

So if the emergency room had actually worked, he went early enough that there would have been just about no chance he’d been contagious. But the emergency room didn’t work. What hasn’t been mentioned loudly enough is that he had no insurance. Stories about grievously ill uninsured people turned away from emergency rooms in the USA go on forever. There’s even a name for it: “patient dumping.” Some of them die, just like Thomas Duncan. But, this being the First World, most of them aren’t contagious. That was the only part Texas Presbyterian Hospital forgot. They needed a big sign in the physicians’ break room: “CAUTION. Do not kick out patients with incurable contagious diseases! Could have lethal Bad Publicity consequences!”

There’s the first culprit: a profit-oriented “health” system. If we really want to reduce the chances of catching Ebola from random strangers, then we need a health care system that encourages people to get help whenever they feel ill. Nor can it expect them to self-diagnose first so that hospitals see only “real emergencies.” And then the system has to actually treat them for whatever ails them.

Number Two in the list of useful things to do is to help deal with the problem at its source. (In fact, this is Number One, but this post is about first world problems.) They need many things to stem the disease in West Africa: Information distributed everywhere by trusted health workers on how not to transmit the disease. How best to treat ill family members. (There’s a surprising amount that could be done with that, as demonstrated by the knowhow and astonishing strength of the Liberian nurse who took care of her whole family and managed to save most of them.) How to reduce chance of infection. Contact tracing. Enough transport for sick people so they’re not crammed eight to an ambulance. Enough field hospitals and enough beds so contagious patients can be properly cared for.

Would that take money? Yes. But it’s peanuts compared to what it’ll cost if the disease continues to spread. And it’s not as if panic is cheap. (Panic is a total waste, but it’s not cheap.) Would the money have to be spent in Africa? Yes. Get over it.

Notice something about useful actions against Ebola: They involve admitting that fear is not useful. They involve restraining automatic reactions. They involve huge amounts of tedious work. They offer no excuse to lash out at anybody. They’re no fun.

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The worst news about Ebola so far

Eight members of a team trying to raise awareness about Ebola have been killed by villagers using machetes and clubs in Guinea, officials say.

From the BBC.

“[M]any villagers are suspicious of official attempts to combat the disease. … The motive for the killings has not been confirmed, but the BBC’s Makeme Bamba in Guinea’s capital, Conakry, says many villagers accuse the health workers of spreading the disease.

Others still do not believe that the disease exists.

Last month, riots erupted in Nzerekore, 50 km (30 miles) from Wome, after rumours that medics who were disinfecting a market were contaminating people.

When I was a toddler, I was sure the trees made the wind. (They move around, and you feel wind. ‘S obvious, right?) It’s easy to confuse cause and effect when you don’t know anything.

But then you learn. Ignorance is not bliss. Ignorance is hell.

The Witches’ Well near Edinburgh Castle. Commemorates over 300 women burned at the stake there.

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Ebola is not Over There

It’s right here on planet Earth.

Current genomic work shows it’s mutating quite rapidly. So far, none of those mutations has changed how it’s transmitted — that is, only by direct physical contact — but high mutation rates in viruses mean you never really know what they’ll be able to do next.

Which is why articles like this, by a doctor affiliated with Stanford University, no less!, are jaw-droppingly stupid. His main point is that there are plenty of lethal and far more widespread diseases such as malaria and AIDS. So when the WHO estimates five hundred million dollars to contain this Ebola outbreak, all that spending would be a waste of money when there are other more pressing priorities.

No. It means that the fights against malaria and HIV are horribly underfunded. Using the atrocious lack of money for one set of diseases as an excuse to ignore another disease is called compounding the error, not solving it.

The consequence will be that Ebola is not contained, that tens of thousands or many more will suffer and die, and (if you’re the sort of person who worries only about yourself) that the virus keeps merrily mutating until one day controlling it may not even be an option. Then, you who felt too safe to worry about it may die no matter how much money you decide is worth spending then.

The consequence is that tremendous people working to actually do something about this awful and incurable disease have to spend their time drumming up funds instead of, you know, working to actually do something about this horrible disease.

The consequence is that people with the stamina to work against hopeless odds, in heat, packed into layers of sealed plastic, because everything they do can change their life to death in one unnoticed heartbeat — the consequence is that those people have to report scenes like this:

The new patients sometimes arrive eight to an ambulance, those with suspected cases and those with probable cases all mixed together.

That increases infections. That increases the number of people needed encased in plastic in the heat to feed and bathe the patients and carry out and disinfect the dead bodies.

The consequence is that we’ll be seeing the following horrors more and more, maybe even right in your face one day, until enough of us realize that hanging on to money is not the most important thing in the world.

Health workers prepare to remove abandoned corpse in Duwala market, Monrovia, Liberia. Aug 17, 2014.



Trying to enforce quarantine in West Point, Liberia. Aug. 22, 2014. (Very counterproductive. Quarantine order later lifted.)


The future is here. It’s just not evenly distributed.

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If it costs money, it’s dumb

Even more so if it costs anyone who’s already comfortable.

From Krugman, this priceless proof They are always, always, trotting out the same claptrap. Spending anything for the common good is weak, namby-pamby, woolly-minded unwillingness to face hard choices.

[W]hat The Economist said, in 1848, about proposals for a London sewer system:

Suffering and evil are nature’s admonitions; they cannot be got rid of; and the impatient efforts of benevolence to banish them from the world by legislation, before benevolence has learned their object and their end, have always been more productive of evil than good.

Sewers are socialism!

It wasn’t until the Great Stink made the Houses of Parliament uninhabitable that the sewer system was created.

The sad thing is our modern Great Stinks and Great Warmings will be so bad by the time they reach our well-insulated elites that we’ll be neck-deep in the Big Muddy and there’ll be nothing to do but hope we float.

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We need a Plan B

It’s true of the pill. If that’s not obvious to you, you’re not paying attention. Or you have an agenda. One that does not include making the lives of girls healthier and easier. That’s been made clear by loads of people. Just one example, Violet at Reclusive Leftist in several posts.

What I want to add is: REMEMBER IN NOVEMBER!

Do not vote for the Current Occupant. Do not vote for him, no matter what. Do not enable your own abuse.


Obama does the classic abuse crap. Slam! Oh, quit yer snivelling. Where ya gonna go? (A bit of time goes by.) Gee, honey, I’ll do better, just give me one more vote. Slam! (Rinse and repeat.)

For those of us favored enough to be safe from direct hits, the line is “The other guy will beat the kids up even worse.”

Do you know what that’s called? Extortion.

When it happens to someone else, we’re all super-clear that the victim should leave. Get the hell out. Stop putting up with it. GO!

But when it happens to us, suddenly we’re the ones on the floor with a broken jaw saying to ourselves, “God help me, if I leave, what’ll happen to us? What’ll I do? Somebody else’ll beat us up even worse.”

Never again pretend you don’t know how abuse victims feel.

And for yourselves: Get the hell out. Stop putting up with it. GO!

Do not vote for Obama in November. It doesn’t matter who the Republicans run. It doesn’t matter if one of them becomes President for four years. The only thing that matters right now is not being part of your own destruction.

Get it through your heads that you will not be bullied, and you will not be held hostage, and you will not knuckle under to extortion.

Do not buy the story that you have no choice. Vote for somebody else, anybody else. Or nobody. Follow Plan B and get rid of the lying, two-faced, pandering toady.


Update: I wrote a post pointing it out back when, but BAR puts it more clearly: Obama: the lesser evil or the more effective evil?

But the most lucid summary of all is Vastleft’s:

cartoon by Vastleft: 'The Obama Administration is denying young girls access to Plan B contraception.' 'Would they rather have Newt Gingrich denying them access to Plan B contraception?'
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Cure for viruses. This is HUGE.

I just saw this, and I’m so excited I can barely contain myself. This is like being there at the discovery of penicillin.

MIT researchers have found a way to cure viral diseases, any viral diseases, from common colds through dengue and up to HIV. (Press release, PLoS One research article.) This is one huge, massive, “Wow!”

Rider drew inspiration for his therapeutic agents, dubbed DRACOs (Double-stranded RNA Activated Caspase Oligomerizers), from living cells’ own defense systems.

When viruses infect a cell, they take over its cellular machinery for their own purpose — that is, creating more copies of the virus. During this process, the viruses create long strings of double-stranded RNA (dsRNA), which is not found in human or other animal cells. …

Rider had the idea to combine a dsRNA-binding protein with another protein that induces cells to undergo apoptosis (programmed cell suicide) — launched, for example, when a cell determines it is en route to becoming cancerous. Therefore, when one end of the DRACO binds to dsRNA, it signals the other end of the DRACO to initiate cell suicide.

And here’s the result:

results of antiviral DRACO in infected and uninfected cells

What that shows is DRACO did not damage healthy cells at all. That’s the top row of each set of images. Infected cells, the bottom row, died without treatment (the lower left images in each set), and were indistinguishable from healthy ones with treatment (the lower right images).

Can you imagine? We could just laugh at viruses! Ebola? Hahahaha! (As I say, I’m a mite over-excited.)

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It’s enough to make anyone grumpy

I no longer remember to which kind blog I owe the enormous boon of finding Dr. Grumpy. At least once a day, sometimes oftener, his comments on life, neurology, and everything are laugh out loud funny. Today he’s on about insurance companies (go read the whole thing, it’s impossible to do it justice) and he manages to make even that funny. He needs to start a blog on death and taxes.

Doctor Grumpy in the House: Annie’s Song

If you don’t want bureaucrats between you and your doctor- TOO BAD. They’ve been there for years. THE ONLY PEOPLE WHO DON’T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING! …

So what happens to you the way it works NOW, with your non-government insurance?

You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.

Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page “pre-auth” form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn’t enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).

[A] few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don’t cover Capricorns when the moon is in Pisces. And we don’t know this until Annie calls back after a few days, because they’re hoping we forgot about it.

Eventually they’ll deny the whole thing, on the grounds that you don’t meet criteria for an MRI and MRA. …

[T]hey tell me I can appeal this via “peer-to-peer” review. Which means I need to personally call their “physician reviewer” to argue with them as to why I want the study.

So, during my insanely busy day at the office I have to call them. I’m promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. [And so it goes. Dr. Grumpy is an artist, so the story has an ending, but in the real world there is none. It just goes on and on.] …

So how did I get on this tangent? Because yesterday I was walking by Annie’s office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: “I’m calling because you people denied an MRI on a stroke patient?”

Pinhead: “Before we discuss this, I have to inform you that this is a recorded line.”

Annie: “Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn’t happened.”

Pinhead: “Let me look up the tracking number… Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call.”

Annie: “Oh, now THAT’s a surprise.”

Pinhead: “What do you mean?”

Annie: “Is this line really being recorded?”

Pinhead: “Yes. It’s to improve customer satisfaction.”

Annie: “Oh, goody, because I’m sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review.”

Pinhead: “We do this to save our customers money on unnecessary testing.”

It goes downhill from there, but at least you’re laughing all the way. That’s also not like real life.

Dr. Grumpy, single payer, health, reform

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Health care for everyone costs half as much

The facts of the cost control debate are crystal clear: Countries with universal, accessible health care (note that I didn’t say “health insurance”) have per capita costs that are about half those of the US. ( e.g. Klein, Krugman, Somerby also has links to original data.) Should I repeat that? Our system of health care for people who pay costs twice as much as health care for everybody.

It’s that simple. The data are out there. So why are they invisible? Why doesn’t Obama point that out in his many TV appearances? He talks about cost control, but makes it seem it’s so complicated we need a 1000-page bill for it and over four years to implement. Why isn’t the simple fact a small enough sound bite for the chattering classes?

I think we’re up against more than interests vested in obfuscation. All the vested interests in the world aren’t enough to explain why people are so willing to believe it when the facts are so blazingly simple.

I think we’re up against a fundamental sense, a lizard brain thing, that says you can’t possibly get something unless someone else loses it. Win-win is counterintuitive. Lose-lose is even more counterintuitive. If my money is not being spent on those no-goods, then I must have more left at the end, right? And when that falls flat, when the whole damn economy is suffering because we refuse to have universal health care, then the problem is, obviously!, that too much money is still somehow being spent on no-goods.

The facts are eclipsed by the inability to understand them.

That has a practical application. It means that in this health reform debate we’re having nationally, the point to hammer home is not only that compassion and cost control go together, as Krugman has pointed out. The corollary is even more important. Lack of compassion does not lead to savings. Lack of compassion leads to trillions in wasted money.

The ads we should be running should show fiscal “conservatives” clutching a single dollar bill while setting fire to a sea of burning hundreds.

health care, reform, cost control, zero sum

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News you can use: swine flu and face masks

Have you had the experience when hiking of shifting your way-too-heavy pack a bit and it feels better for a while? I feel like doing that just now. Enough with the hopelessness of getting real health care reform during our one opportunity in a generation. Enough with so-called Democrats, whether they’re warming chairs in the Oval Office or on Capitol Hill. Let’s talk about swine flu, and, specifically, face masks. Should you or should you not stock up on face masks?
an N95 face mask
The CDC–. Wait, I’ll start over. Even if you feel the government is not your friend, the CDC really does know about face masks. Honest. The CDC starts the discussion at what are known as N95 masks. These are rated to stop 95% of airborne particles and droplets that are larger than 0.3 microns in size. As you can see in the picture, these are reasonably formidable, thick, stuffy-to-breathe-through face masks.

The good news is that aerosolized droplets exhaled or sneezed out are mostly larger than 0.5 microns. The bad news is that if the particle floats long enough to evaporate the associated water, a “naked” flu virus is on the order of 100 nanometers. That’s 0.1 microns. Now, a bare virus doesn’t survive, but if it retains, say, half its water droplet, it might well be smaller than 0.3 microns. In other words, it’ll pass through the mask as easily as you can pass through a doorway.

Note that I’m not even addressing the issue of the space between the mask and your face. This is all assuming you have a perfect fit with no gaps which are, say a tenth of a millimeter big. A tenth of a millimeter is 100 microns. Picture how big that looks to a 0.5 micron droplet.
Read more »

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Medicine and the Unfree Market

Medicine and the so-called free market are incompatible in important ways. An outstanding article in the recent New Yorker by Atul Gawande makes that point from yet another new angle. ( has a nasty habit of putting archives behind a paywall, so I don’t know how long the link will be useful.) In all the talk of consumers, insurance, and governments, we’ve kind of lost sight of the doctors. Which is odd, considering that they’re the only ones who actually know what’s going on. Let’s begin somewhere near the beginning.

The issue of cost control in medicine is much in everyone’s mind. Krugman and Ezra Klein have been out in the forefront of the fact brigade. It’s supposed to be the central feature and purpose of health care reform. There are several approaches that boil down to a choice between free markets and regulated oversight. I’ll take the two in turn.

The free market, like anything with “free” in the name, has an appealing ring of being able to make one’s own decisions without interference. It doesn’t work in medicine. At all. I wrote a post a while back about how Profits Cost Us Cures, but it goes way beyond the pharmaceutical industry and touches every aspect of medicine.

Let’s face it, most medical expenses are in a class by themselves. People don’t go to the doctor like they go to buy a car. They don’t say, “Doc, insured patients pay $357 for this type of X-ray. If you’re gonna charge $973, I’m going to Doc B.” They don’t know enough to know a good deal from a bad one, or whether they need the deal at all. Nor should they have to. We’re paying doctors for their knowledge, so there’s something very bass-ackwards in the demand that we acquire the same knowledge before theirs is any use to us.

Even more important, nobody goes to the doctor because they no longer liked their old X-rays and wanted new ones. We’re at the doctor’s when we’re in pain, trying not to think about what it could be, and desperate to get the whole thing over with. At any price. That is also the exact opposite of a situation conducive to calm and careful comparison shopping.

The whole notion that somehow patients can control the costs of medicine is such an obvious crock that if it’s being propounded by anyone smart enough to have a public platform, they must have ulterior motives. As far as I’m concerned, those motives are obvious. Putting the powerless chickens to guard the henhouse is evidence of making sure that the fox meets no obstacles.

So we can forget all the classic consumer choice blather about controlling medical costs. On the evidence, we can also forget about the insurance companies doing it. Their concept is to cut care and grow salaries, an approach that has notably failed at controlling anything. The government? Judging by the Europeans and Canadians, they can do a better job than insurance companies, but at the price of inflexibility that simply can’t keep up with medical reseaarch. For someone fighting a recently curable but not yet insurable disease, that’s intolerable. There has to be a better way.

I think Atul Gawande has shown us in which direction it lies. As he notes:

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.

He goes on to question why there’s so much variation in the cost of care across US counties. The most expensive is over twice as much as the cheapest.

First of all, it’s got nothing to do with cheeseburgers. Gawande compares two communities, among others, McAllen and El Paso in Texas. Same demographics, same per capita cheeseburger snaffle rate, totally different costs.

The idea that it might have to do with quality of care is laid to rest as soon as he points out that one of the cheapest counties contains the Mayo Clinic.

And that also brings him to the most interesting observation. The Mayo Clinic achieves its lowest cost, bestest care by:

  • Money coming in is pooled across the whole hospital and everybody is paid a salary.
  • Patient care is explicitly the first priority, and people are promoted on that basis.
  • They “meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up.”
  • They have a “regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up.”

In short, the doctors get money, plenty of it, but they’re not going to get a whole lot more by each opening their own redundant MRI facility and steering patients toward it. That entrepreneurial, profit-oriented process is what’s gone wild in McAllen, aka The Expensive County.

The Mayo Clinic process is more of a one-for-all-and-all-for-one, dare I say it . . . socialist process than a purely market-driven one. It’s also open source, so to speak. Information is pooled, not hoarded.

And, it liberates doctors’ professional instincts to do their best for their patients. The same doctors who actually know what that is and how to achieve it with the least pain and anguish and expense.

An important point here is that changing only the payment method, eg single payer versus multiple payers without changing the incentive structure for doctors will not solve our problems. For me, that was a new insight. But I find it very valuable because it tells us what to do with single-payer once we get it.

Don’t laugh. I want you all to close your eyes and hum along with me . . . “Another world is possible.”

I wish.

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Single payer vs Public option

This is all you need. Shove this in anyone’s face who starts saying, “But, but, but . . . the guvvamint!” From a comment by Mikirivi on Krugman’s blog, a graphic prepared by Dr. Klein for the Arizona League of Women Voters:
Click on image for full size
side by side comparison of the two options

The one solitary “disadvantage” that I can see in the Single Payer column is that the insurance industry would need restructuring. I seem to remember reading somewhere that that’s over two million workers. So it’s nontrivial. But as I remember reading in the same place, most of the skills in the insurance industry are various office skills and are eminently transferable to other fields. (We could even, like, you know, help people make the switch.)

So we could have a system that costs half as much and insures everyone (“Single Payer and beyond” section in the link), or a variant on the baroque BS we have now. The choice is obvious. Baroque BS, of course.

The whole thing is eerily reminiscent of the electric car vs GM debacle. On the one hand everyone wins and GM has to be restructured, whereas on the other hand everyone loses and GM . . . .

health insurance, single payer

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My life in their claws

I feel like a mouse in a room full of cats. In the struggle for health care reform, will Big 0’s need for popularity or his need for Big Medicine’s money win out?
cat watching mouse across a chess board
A few weeks ago, I would have bet on number two. Never forget that this is the (expletive deleted) whose idea of the right way to gut Illinois’ attempt at State-assisted health care was to say

“We radically changed [the health care bill] in response to concerns that were raised by the insurance industry.” (Obama, 2004/05/19)

But (will wonders never cease?) the Dimmicrats seem to have understood that they have to get something accomplished this term or people might start to wonder why the Repugs were to blame for everything. Even Big 0 is on board for using the “nuclear option” to stop filibusters on health care reform. So they’re going to reform.

This is giving me that uncomfortable Hope(tm) feeling. They never did specify what they were hoping for. Turned out to be rather different from what I was hoping for. Now they’re going to reform health care from a Kafkaesque trap to . . . to what? They’re not saying.

But the fact that the health insurance moguls have suddenly started participating gives me a bad feeling. Next thing you know, health care will be radically reformed in response to their concerns. I can’t bring myself to share Krugman’s kind words, although I hope he’s right that industry interest in controlling costs is “some of the best policy news I’ve heard in a long time.”

I fear the worst, though. Our only leverage against it is threatening to throw the Congresscritters out of their jobs. Which brings me to the point of this post. (You knew I’d get somewhere eventually, right? Right?) Call, email, fax the relevant Critters daily. Hourly, if you have the stomach for it.

Katiebird has corralled a wealth of information in one place. Her posts and others at The Confluence have really helped me know when and what to do for maximum effect. (Keep it up, Katie! and Stateofdisbelief! and everybody!) The single payer day of action was a real W00T! moment. Now that the industry has decided to “help,” constant threats to Congress are our only hope(not tm).

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Medical Milestones

Three stories, the first more interesting, the next two much better than all the other depressing stuff smothering the news. (None of these are up-to-the-minute. I’ve been offline, not to say out of it, for a while.)

(J. Pathol., abstract, and ScienceDaily.) Professor Ruth Itzhaki and her team at the University [of Manchester’s] Faculty of Life Sciences have investigated the role of herpes simplex virus type 1 (HSV1) in [Alzheimers Disease] ….

Most people are infected with this virus, which then remains life-long in the peripheral nervous system, and in 20-40% of those infected it causes cold sores. Evidence of a viral role in AD would point to the use of antiviral agents to stop progression of the disease.

The team discovered that the HSV1 DNA is located very specifically in amyloid plaques: 90% of plaques in Alzheimer’s disease sufferers’ brains contain HSV1 DNA, and most of the viral DNA is located within amyloid plaques. The team had previously shown that HSV1 infection of nerve-type cells induces deposition of the main component, beta amyloid, of amyloid plaques. Together, these findings strongly implicate HSV1 as a major factor in the formation of amyloid deposits and plaques, abnormalities thought by many in the field to be major contributors to Alzheimer’s disease.

This is a major breakthrough against Alzheimers, if the results hold up on further research.

Two huge triumphs, quietly happening:
Read more »

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