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Posts Tagged ‘medicine

“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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“‘Life’ is of course a misnomer, since viruses, lacking the ability to eat or respire, are officially dead”*…

The human genome contains billions of pieces of information and around 22,000 genes, but not all of it is, strictly speaking, human. Eight percent of our DNA consists of remnants of ancient viruses, and another 40 percent is made up of repetitive strings of genetic letters that is also thought to have a viral origin. Those extensive viral regions are much more than evolutionary relics: They may be deeply involved with a wide range of diseases including multiple sclerosis, hemophilia, and amyotrophic lateral sclerosis (ALS), along with certain types of dementia and cancer.

For many years, biologists had little understanding of how that connection worked—so little that they came to refer to the viral part of our DNA as dark matter within the genome. “They just meant they didn’t know what it was or what it did,” explains Molly Gale Hammell, an associate professor at Cold Spring Harbor Laboratory. It became evident that the virus-related sections of the genetic code do not participate in the normal construction and regulation of the body. But in that case, how do they contribute to disease?

An early clue came from the pioneering geneticist Barbara McClintock, who spent much of her career at CSHL. In the 1940s, long before the decoding of the human genome, she realized that some stretches of our DNA behave like infectious invaders. These DNA chunks can move around through the genome, copying and pasting themselves wherever they see fit, which inspired McClintock to call them “jumping genes.” Her once-controversial idea earned her a Nobel Prize in 1983.

Geneticists have since determined that jumping genes originate in the viral portion of the genome. Many of these genes turn out to be benign or even helpful. “But some of the things are full-on parasites,” Hammell says, like infections embedded within our own DNA. All it takes to set these bad actors loose, she is finding, is a slip-up in the body’s mechanisms that normally prevent the genes from jumping around and causing harm…

Half of your genome started out as an infection; if left unchecked, some parts of it can turn deadly all over again: “The Non-Human Living Inside of You.”

See also: “The Wisdom of Pandemics– viruses are active agents, existing within rich lifeworlds. A safe future depends on understanding this evolutionary story.”

* “‘Life’ is of course a misnomer, since viruses, lacking the ability to eat or respire, are officially dead, which is in itself intriguing, showing as it does that the habit of predation can be taken up by clusters of molecules that are in no way alive.” – Barbara Ehrenreich, Living with a Wild God: A Nonbeliever’s Search for the Truth about Everything

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As we check our baggage, we might send reforming birthday greetings to Abraham Flexner; he was born on this date in 1866.  The founding director of Princeton’s Institute for Advanced Studies, Flexner is best remembered for his pioneering work as a reformer of American higher education, especially medical education.  On the heels of his 1908 study, The American College, in which he effectively critiqued the university lecture as a method of instruction, he published the Flexner Report, which examined the state of American medical education and led to far-reaching reform in the training of doctors.  The report called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to the protocols of mainstream science in their teaching and research.  While one unintended consequence of Flexner’s impactful advocacy was the reversion of American universities to male-only admittance programs to accommodate a smaller admission pool (female admissions picked up again only later the century), most historians agree with his biographer, Thomas Bonner, that Flexner was “the severest critic and the best friend American medicine ever had.”

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“Biology gives you a brain. Life turns it into a mind.”*…

 

Mind

 

I have a confession. As a physicist and psychiatrist, I find it difficult to engage with conversations about consciousness. My biggest gripe is that the philosophers and cognitive scientists who tend to pose the questions often assume that the mind is a thing, whose existence can be identified by the attributes it has or the purposes it fulfils.

But in physics, it’s dangerous to assume that things ‘exist’ in any conventional sense. Instead, the deeper question is: what sorts of processes give rise to the notion (or illusion) that something exists? For example, Isaac Newton explained the physical world in terms of massive bodies that respond to forces. However, with the advent of quantum physics, the real question turned out to be the very nature and meaning of the measurements upon which the notions of mass and force depend – a question that’s still debated today.

As a consequence, I’m compelled to treat consciousness as a process to be understood, not as a thing to be defined. Simply put, my argument is that consciousness is nothing more and nothing less than a natural process such as evolution or the weather. My favourite trick to illustrate the notion of consciousness as a process is to replace the word ‘consciousness’ with ‘evolution’ – and see if the question still makes sense. For example, the question What is consciousness for? becomes What is evolution for? Scientifically speaking, of course, we know that evolution is not for anything. It doesn’t perform a function or have reasons for doing what it does – it’s an unfolding process that can be understood only on its own terms. Since we are all the product of evolution, the same would seem to hold for consciousness and the self.

My view on consciousness resonates with that of the philosopher Daniel Dennett, who has spent his career trying to understand the origin of the mind. Dennett is concerned with how mindless, mere ‘causes’ (A leads to B) can give rise to the species of mindful ‘reasons’ as we know them (A happens so that B can happen). Dennett’s solution is what he calls ‘Darwin’s dangerous idea’: the insight that it’s possible to have design in the absence of a designer, competence in the absence of comprehension, and reasons (or ‘free-floating rationales’) in the absence of reasoners. A population of beetles that has outstripped another has probably done so for some ‘reason’ we can identify – a favourable mutation which produces a more camouflaging colour, for example. ‘Natural selection is thus an automatic reason-finder, which “discovers” and “endorses” and “focuses” reasons over many generations,’ Dennett writes in From Bacteria to Bach and Back: The Evolution of Minds (2017). ‘The scare quotes are to remind us that natural selection doesn’t have a mind, doesn’t itself have reasons, but is nevertheless competent to perform this “task” of design refinement.’

I hope to show you that nature can drum up reasons without actually having them for herself. In what follows, I’m going to argue that things don’t exist for reasons, but certain processes can nonetheless be cast as engaged in reasoning…

Distinguished neuroscientist and psychiatrist Karl Friston argues that the special trick of consciousness is being able to project action and time into a range of possible futures: “The mathematics of mind-time.”

See also: “How the Brain Creates a Timeline of the Past” (source of the image above).

* Jeffrey Eugenides, Middlesex

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As we get our minds around our minds, we might spare a thought for Oliver Wolf Sacks; he died on this date in 2015.  A neurologist, naturalist, historian of science, and author, he had an active clinical practice, but is more widely-remembered for his writing, mostly case studies from his clinical experience and memoir in which which he treats himself as a clinical subject.  Awakenings, for example, recounted his experience treating post-encephalitic patients with a new drug (levodopa); it was a best seller that served as the basis of a BBC Discovery documentary and was adapted into a feature film.  Widely honored for his prolific work, Sacks was the recipient of the 2001 Lewis Thomas Prize for excellence in scientific writing.

250px-9.13.09OliverSacksByLuigiNovi source

 

Written by LW

August 30, 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.

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Clyde steamer Araphoe. Image from the Library of Congress.

 

 

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