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Posts Tagged ‘health

“You’re mugging old ladies every bit as much if you pinch their pension fund”*…

Who benefits from the commercial biomedical research and development (R&D)? Patients-consumers and investors-shareholders have traditionally been viewed as two distinct groups with conflicting interests: shareholders seek maximum profits, patients – maximum clinical benefit. However, what happens when patients are the shareholders?…

Adding investments by governmentally-mandated retirement schemes, central and promotional banks, and sovereign wealth funds to tax-derived governmental financing shows that the majority of biomedical R&D funding is public in origin. Despite this, even in the high-income countries patients can be denied access to effective treatments due to their high cost. Since these costs are set by the drug development firms that are owned in substantial part by the retirement accounts of said patients, the complex financial architecture of biomedical R&D may be inconsistent with the objectives of the ultimate beneficiaries…

It has been estimated that of the total $265 billion spent annually on biomedical research worldwide, over a third – $103 billion comes from public sources. Nevertheless, as public input capital is allocated predominantly into early stage research, nearly all output – medicines – is ultimately brought to the market by private firms. Importantly, these firms are not independent agents. They have owners-shareholders to report to. Until the end of the previous century the major type of owners-shareholders were individual households. At the turn of the millennium, however, they have been displaced by institutional investors, the largest of which are public retirements schemes or quasi-public funds, such as occupational pensions.

First, government money underwrites the basic R&D that goes into drug discovery and development, then public pension monies fund the private companies that bring those drugs to market. As the private companies are solving for highest profits, as opposed to optimal public health, those drugs are often priced out of the reach of the very people whose pension contributions funded their development. Drugs “priced out of reach” is certainly not a new phenomenon; AIDS drugs (to take one example) were priced by Western pharma companies at prices that rendered them inaccessible to most citizens of low-income countries in Africa and Asia. The pensioners in wealthy nations were, effectively, living off of the misery of those in poorer companies.

But the dynamic has continued, deepened– and come home to roost. Now patients in high-income countries are denied access to effective treatments due to their high cost, while these costs are being set by the drug development firms, owned in substantial part by the retirement accounts of those same patients, and benefiting from direct and indirect governmental support.

Investing in one’s own misery– the painful irony of pharma funding: “Pension and state funds dominating biomedical R&D investment: fiduciary duty and public health.”

[Image above: source]

* Ben Elton, Meltdown

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As we untangle unintended consequences, we might send healthy birthday greetings to Charles Value Chapin; he was born on this date in 1856. A physician and epidemiologist, he was a pioneer in American public health. He co-founded in first bacteriological laboratory in the U.S. (in 1888) in Providence, were he was Superintendent of Health– a position he held for 48 years. In 1910, he established Providence City Hospital where infectious disease carriers could be isolated under aseptic nursing conditions; his success inspired similar health control measures throughout the U.S. A professor (at Brown) and prolific writer, his impact on health policy and practice was so broad that he was hailed as “the Dean of City Public Health Officials.”

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“Gain not base gains; base gains are the same as losses”*…

When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. Banting’s co-inventors, James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it. [see here]

Today, Banting and his colleagues would be spinning in their graves: Their drug, which many of the 30 million Americans with diabetes rely on, has become the poster child for pharmaceutical price gouging.

The cost of the four most popular types of insulin has tripled over the past decade, and the out-of-pocket prescription costs patients now face have doubled. By 2016, the average price per month rose to $450 — and costs continue to rise, so much so that as many as one in four people with diabetes are now skimping on or skipping lifesaving doses

Why Americans ration a drug discovered– and given free to the world– in the 1920s: “The absurdly high cost of insulin, explained.”

* Hesiod (See also Proverbs 28:20: “he that maketh haste to be rich shall not be innocent”)

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As we ponder pleonexia, we might send healing birthday greetings to Edward Lawrie Tatum; he was born on this date in 1909. A geneticist, he shared half of the Nobel Prize in Physiology or Medicine in 1958 with George Beadle for showing that genes control individual steps in metabolism. During World War II, his work was of use in maximizing penicillin production, and it has also made possible the introduction of new methods for assaying vitamins and amino acids in foods and tissues. Tatum and Joshua Lederberg (the winner of the other half of the 1958 Nobel award), discovered genetic recombination in bacteria.

His discoveries were made freely available to the scientific community.

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“Don’t be afraid to break things. Don’t be romantic. Don’t take the time to breathe. Don’t aim for perfect. And whatever you do, keep moving.”*…

Eric Feigl-Ding picked up his phone on the first ring. “Busy,” he said, when asked how things were going. He had just finished up an “epic, long” social media thread, he added — one of hundreds he’s posted about society’s ongoing battle with the coronavirus. “There’s so many different debates in the world of masking and herd immunity and reinfection,” he explained, among other dimensions of the pandemic. “We at FAS, we’ve been kind of monitoring all the debates and how we’re seeing signals in which the data goes one way, the debate goes the other,” he said, referring to his work with the Federation of American Scientists, a nonprofit policy think tank. He rattled off a rapid-fire sampler of hot-button Covid-19 topics: the growing anti-vaxxer movement, SARS-CoV-2 reinfection and antibodies, the body of research suggesting masks could decrease viral load, along with a quick mention of the debate among experts about what “airborne” means.

This whirlwind tour through viral Covid-19 themes felt like the conversational equivalent of Feigl-Ding’s Twitter account, which has grown by orders of magnitude since the dawn of the pandemic. The Harvard-trained scientist and 2018 Congressional aspirant posts dozens of times daily, often in the form of long, numbered threads. He’s fond of emojis, caps lock, and bombastic phrases. The first words of his very first viral tweet were “HOLY MOTHER OF GOD.”

Made in January, weeks before the massive shutdowns that brought U.S. society to a halt, that exclamation preceded his observation that the “R0” (pronounced “R-naught”) of the novel coronavirus — a mathematical measure of a disease’s reproduction rate — was 3.8. That figure had been proposed in a scientific paper, posted online ahead of peer review, that Feigl-Ding called “thermonuclear pandemic level bad.” Further in that same Twitter thread, he claimed that the novel coronavirus could spread nearly eight times faster than SARS.

The thread was widely criticized by infectious disease experts and science journalists as needlessly fear-mongering and misleading, and the researchers behind the pre-print had already tweeted that they’d lowered their estimate to an R0 of 2.5, meaning that Feigl-Ding’s SARS figure was incorrect. (Because R0 is an average measure of a virus’s transmissibility, estimates vary widely based on factors like local policy and population density; as a result, researchers have suggested that other variables may be of more use.) He soon deleted the tweet — but his influence has only grown.

At the beginning of the pandemic, before he began sounding the alarm on Covid-19’s seriousness, Feigl-Ding had around 2,000 followers. That number has since swelled to over a quarter million, as Twitter users and the mainstream media turn to Feigl-Ding as an expert source, often pointing to his pedigree as a Harvard-trained epidemiologist. And he has earned the attention of some influential people. These include Ali Nouri, the president of FAS, who brought Feigl-Ding into his organization as a senior fellow; the journalist David Wallace-Wells, who meditated on Feigl-Ding’s “holy mother of God” tweet in his March essay arguing that alarmism can be a useful tool; and former acting administrator of the Centers for Medicare and Medicaid Services Andy Slavitt. (“We all learn so much from you,” he tweeted at Feigl-Ding in July.) Ronald Gunzburger, senior adviser to Maryland Gov. Larry Hogan, even wrote a letter to Feigl-Ding attesting to how his “intentionally provocative tweet” in January “elevated the SARS-CoV-2 virus to the top of our priorities list.”

But as Feigl-Ding’s influence has grown, so have the voices of his critics, many of them fellow scientists who have expressed ongoing concern over his tweets, which they say are often unnecessarily alarmist, misleading, or sometimes just plain wrong. “Science misinformation is a huge problem right now — I think we can all appreciate it — [and] he’s a constant source of it,” said Saskia Popescu, an infectious disease epidemiologist at George Mason University and the University of Arizona who serves on FAS’ Covid-19 Rapid Response Taskforce, a separate arm of the organization from Feigl-Ding’s work. Tara Smith, an infectious disease epidemiologist at Kent State University, suggested that Feigl-Ding’s reach means his tweets have the power to be hugely influential. “With as large of a following as he has, when he says something that’s really wrong or misleading, it reverberates throughout the Twittersphere,” she said…

A scientist has gained popularity as Covid’s excitable play-by-play announcer. But some experts want to pull his plug: “Covid’s Cassandra: The Swift, Complicated Rise of Eric Feigl-Ding.”

* Social media “influencer” Gary Vaynerchuk

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As we interrogate influence, we might send bombastic birthday greetings to Ted Knight; he was born on this date in 1923. An actor and comedian, he was well-known as Henry Rush in Too Close for Comfort, and Judge Elihu Smails in Caddyshack; but he is surely most famous for his role as newscaster Ted Baxter on The Mary Tyler Moore Show.

THE MARY TYLER MOORE SHOW, Ted Knight, Mary Tyler Moore, 1970-1977

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“A Dorito asks nothing of you, which is its great gift. It asks only that you are not there.”*…

As a young lawyer in Australia, Andrew Taylor couldn’t help but hurry through lunch, quickly and distractedly eating between meetings. Until that is, he bit down on the wrong tortilla chip, one that “severely scratched” his esophagus. “I was in quite a lot of pain for some time, but was told by my doctor and dentist there was little they could do,” he explains, adding that they basically informed him that he would have to wait until his throat healed on its own.

They did make sure, though, that he knew how lucky he was. “I was told of a situation where someone actually tore their throat,” Taylor explains, “and it was quite touch-and-go there for a while.”

The case Taylor is referring to is widely known in dental circles. The gist of it: On May 10, 1990, a gastroenterologist in San Diego named George Longstreth wrote into the New England Journal of Medicine, describing how a “poorly chewed tortilla chip can produce serious injury.” His patient, 63-year-old Irene Harnisch, had swallowed a tortilla chip that ripped a five-inch gash in her esophagus. After throwing up blood and experiencing severe chest pains, she was rushed to the hospital, where she was kept for six days (she was unable to eat solid food for another two weeks). 

“It was a very serious incident,” Longstreth told United Press International at the time. “She lost four pints of blood. It’s possible she could have died.”…

What happens when your chips bite back? From broken teeth to a ripped esophagus, history suggests that a sharp Dorito is an oral accident waiting to happen: “The Sick Hellscape of Tortilla Chip Injuries.”

* Aimee Bender, The Particular Sadness of Lemon Cake

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As we chew our food, we might spare a thought for Lucy Hobbs Taylor; she died on this date in 1910. She was the first female dentist in the U.S.– the first woman in the world to graduate from a dental college, and to receive a doctorate in dentistry.

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Written by LW

October 3, 2020 at 1:01 am

“Person, woman, man, camera, TV”*…

 

dementia

 

In a reversal of trends, American baby boomers scored lower on a test of cognitive functioning than did members of previous generations, according to a new nationwide study.

Findings showed that average cognition scores of adults aged 50 and older increased from generation to generation, beginning with the greatest generation (born 1890-1923) and peaking among war babies (born 1942-1947).

Scores began to decline in the early baby boomers (born 1948-1953) and decreased further in the mid baby boomers (born 1954-1959).

While the prevalence of dementia has declined recently in the United States, these results suggest those trends may reverse in the coming decades, according to study author Hui Zheng, professor of sociology at The Ohio State University… “what was most surprising to me is that this decline is seen in all groups: men and women, across all races and ethnicities and across all education, income and wealth levels.”…

Baby boomers’ childhood health was as good as or better than previous generations and they came from families that had higher socioeconomic status. They also had higher levels of education and better occupations.

“The decline in cognitive functioning that we’re seeing does not come from poorer childhood conditions,” Zheng said…

Reversing of a trend that has spanned decades: “Baby boomers show concerning decline in cognitive functioning.”

On a different, but quite possibly related note, these examples from Patrick Collison‘s recent post on the effects of pollution:

• Chess players make more mistakes on polluted days: “We find that an increase of 10 µg/m³ raises the probability of making an error by 1.5 percentage points, and increases the magnitude of the errors by 9.4%. The impact of pollution is exacerbated by time pressure. When players approach the time control of games, an increase of 10 µg/m³, corresponding to about one standard deviation, increases the probability of making a meaningful error by 3.2 percentage points, and errors being 17.3% larger.” – Künn et al 2019

• “Utilizing variations in transitory and cumulative air pollution exposures for the same individuals over time in China, we provide evidence that polluted air may impede cognitive ability as people become older, especially for less educated men. Cutting annual mean concentration of particulate matter smaller than 10 µm (PM10) in China to the Environmental Protection Agency’s standard (50 µg/m³) would move people from the median to the 63rd percentile (verbal test scores) and the 58th percentile (math test scores), respectively.” – Zhang et al 2018

• Politicians use less complex speech on polluted days. “We apply textual analysis to convert over 100,000 verbal statements made by Canadian MPs from 2006 through 2011 into—among other metrics—speech-specific Flesch-Kincaid grade-level indices. This index measures the complexity of an MP’s speech by the number of years of education needed to accurately understand it. Conditioning on individual fixed effects and other controls, we show that elevated levels of airborne fine particulate matter reduce the complexity of MPs’s speeches. A high-pollution day, defined as daily average PM2.5 concentrations greater than 15 µg/m³, causes a 2.3% reduction in same-day speech quality. To put this into perspective, this is equivalent to the removal of 2.6 months of education.” Heyes et al 2019

• “Exposure to CO2 and VOCs at levels found in conventional office buildings was associated with lower cognitive scores than those associated with levels of these compounds found in a Green building.” – Allen et al 2016. The effect seems to kick in at around 1,000 ppm of CO2.

The entire (chilling) piece is eminently worth reading.

And on another related note– one going not to the quality, but to the quantity of life– this characteristically-great set of infographics from Flowing Data exploring the demographic reality that underlies our (directionally-accurate) contention that “40 is the new 30 [or whatever]”: “Finding the New Age, for Your Age.”

* President Trump, recounting the memory test he took (not to establish his mental acuity, as he seemed to suggest, but rather as part of a screening for senile dementia)

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As we agonize over aging, we might recall that it was on this date in 1909, off the coast of Cape Hatteras, that telegraph operator Theodore Haubner called for help from the steamship, S. S. Arapahoe.  He was momentarily confused because a new telegraph code “SOS” had recently been ratified by the Berlin Radiotelegraphic Conference to replace the old “CQD” distress call, and he wondered which signal he should send.  He sent both.  Haubner’s transmission was the first recorded American use of “SOS” to call for help.

august_11_araphoe

Clyde steamer Araphoe. Image from the Library of Congress.

 

 

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