(Roughly) Daily

Posts Tagged ‘public health

“God loveth the clean”*…

The history of ordinary things can be fascinating while offering insight into our immediate future. We’ve previously noted how artificial ice and assorted refrigeration/cooling technologies helped change demographics in the American South. Recent news from the Census Bureau confirms this trend as northern states like Michigan and New York lost population while the south, Texas and Florida in particular, gained. But the history of the ordinary can be hidden by ubiquity, tedium, and general disinterest. Unnoticed until they cry out for attention. Today’s Tedium is looking at the history of New York City restaurant inspections and the variety of ways restaurants cope. (And yes, the pandemic has certainly had an impact.)

There is no shortage of great New Yorkers, the people that helped shape the city and its culture. How one measures impact can vary. The wealthy and influential find their names on street signs, convention centers, and airports. A year into the COVID-19 pandemic, however, there is a renewed appreciation for those that helped lay the foundation for the city’s hospitals and medical care. In this regard, there are few New Yorkers greater than Dr. Sigismund Goldwater. 

A graduate of Columbia University and NYU medical school, Dr. Goldwater was a recognized authority in hospital construction. Among the numerous posts he held over a distinguished career included Superintendent at Mount Sinai Hospital, president of the American Conference on Hospital Service, and vice president of the New York Academy of Medicine. In recognition of his career and experience, he was appointed City Commissioner of Hospitals from 1934 to 1940. During his administration, Dr. Goldwater oversaw the construction of 25 new hospital buildings. His Times obituary credits him with adding more than 5,000 hospital beds to city capacity.

While his work in hospital administration and construction helped lay the foundation for New York City as a world-class center for health care, Dr. Goldwater has a legacy a bit more meaningful to modern restaurateurs. In 1914, Mayor John Purroy Mitchel was newly elected and in need of a health commissioner. His first choice, Dr. Goldwater, didn’t really want the job but finally acquiesced on the strong insistence of his predecessor. 

About six months after taking over the role, now Health Commissioner Goldwater announced a couple of general initiatives in public transportation and dining to ensure general cleanliness, pointing out to the Times that, “…the Sanitary Code at present did not call for regular inspection as in the case of bakeries and meat markets.” His solution was to require permits and require commercial restaurants to be inspected on an annual basis.

Public health, especially regarding sanitary food handling practices, had grabbed media attention in the early 20th century in part to Upton Sinclair’s The Jungle. Sinclair, an investigative journalist, went undercover to detail the working conditions in meat packing facilities. His account of rat infested factories and spoiled meat products shipped to consumers provoked outrage. Unfortunately for Sinclair, who was trying to shed light on the conditions of workers, readers were incensed to learn what was in their food. By 1905, the federal government had passed legislation to create what would become the Food and Drug Administration (FDA).

Another unique circumstance that kept food safety in the minds of New Yorkers was the terrible tale of Mary Mallon, better known as Typhoid Mary. A private cook that was also an asymptomatic carrier of typhoid, Mary Mallon became infamous for her condition, the number of people she infected, and her refusal to cooperate with safety guidelines. [See here]

There was another reason for the attention Mary Mallon received, explains Claire Stewart, a chef and hospitality management professor at the New York City College of Technology. “Typhoid was considered a disease of the poor and associated with immigrants and overcrowded tenements,” she said. “Mary Mallon spent a lot of her career cooking for wealthy people, so her bringing typhoid to the upper classes caused a lot of alarm.”

Still, by the time Dr. Goldwater became health commissioner, New York City had yet to regulate restaurants, creating a range of dining experiences and anxiety about the status of any given kitchen.

One concerned citizen wrote to the Times in a letter titled, “We Need Dainty Waiters.”, “In these days of pure food laws and Boards of Health… I would like to ask what assurance, if any, has the public that in our hotels, restaurants, and clubs proper supervision over their employes is exercised so as to insure us a fair degree of cleanliness on the part of those who handle the food we are to eat? This inquiry is prompted by occurrences coming under the personal observation of the writer, showing that employes in so-called high-class hotels, clubs, and restaurants are often guilty of practices which would not be tolerated in our own homes. One large restaurant in this city requires its waiters to pass an inspection by a manicure before they are allowed to handle food for its patrons.”

After Dr. Goldwater noted that other cities had also adopted regular restaurant inspections, and noting the potential for additional revenue via fines and permit fees, the city agreed. Now they just had to get some 15,000 owners and operators to comply. Should be easy, right?…

The wacky and surprising history of NYC restaurant inspections (and by extension, that same system in other cities). That letter grade is a lot more effective than you might think: “The Letter in the Window.” By Andrew Egan, in Ernie Smith’s (@ShortFormErnie) ever-illuminating newsletter Tedium (@readtedium).

* Francis Bacon

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As we wash our hands, we might recall that it was on this date in 1913 that Gideon Sundback was granted a patent on the first modern zipper. While he did well with his invention for several decades, he and his western competitors were overtaken in the mid-20th century by YKK.

Most checked chefs pants still have buttons.

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Written by (Roughly) Daily

April 29, 2021 at 1:01 am

“Let him that would move the world first move himself”*…

In 1930, Indiana Bell, a subsidiary of AT&T, needed a larger building for their headquarters. The problem? The old building needed to stay in operations at all times, providing an essential service to the city. Instead of tearing it down or simply moving to a new building, they decided to move it to a different part of the lot and build on the existing location. Just that.

The massive undertaking began on October 1930. Over the next four weeks, the massive steel and brick building was shifted inch by inch 16 meters south, rotated 90 degrees, and then shifted again by 30 meters west. The work was done with such precision that the building continued to operate during the entire duration of the move. All utility cables and pipes serving the building, including thousand of telephone cables, electric cables, gas pipes, sewer and water pipes had to be lengthened and made flexible to provide continuous service during the move. A movable wooden sidewalk allowed employees and the public to enter and leave the building at any time while the move was in progress. The company did not lose a single day of work nor interrupt their service during the entire period.

Incredibly most of the power needed to move the building was provided by hand-operated jacks while a steam engine also some support. Each time the jacks were pumped, the house moved 3/8th of an inch.

Via Kottke and The Prepared; TotH to @splattne and @mckinleaf

Fun fact: the entire project– including the move– was designed by a leading Indianapolis architect, Kurt Vonnegut Sr., father of the famous novelist (and of the chemist who developed the technique of seeding clouds with silver iodide to produce rain/snow).

Over a month in 1930, the Indiana Bell building was rotated 15 inch/hr– overall, 90°– all while 600 employees still worked there.

* Socrates

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As we change perspective, we might recall that it was on this date in 1915 that Mary Mallon, “Typhoid Mary,” was put in quarantine on North Brother Island, in New York City, where she was isolated until she died in 1938.  She was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever… before which, she inadvertently spread typhoid for years while working as a cook in the New York area.

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Written by (Roughly) Daily

March 26, 2021 at 1:01 am

“Thought is an infection. In the case of certain thoughts, it becomes an epidemic.”*…

Frank M. Snowden, a professor emeritus of history and the history of medicine at Yale, examines the ways in which disease outbreaks have shaped politics, crushed revolutions, and entrenched racial and economic discrimination. Epidemics have also altered the societies they have spread through, affecting personal relationships, the work of artists and intellectuals, and the man-made and natural environments. Gigantic in scope, stretching across centuries and continents, Snowden’s account seeks to explain, too, the ways in which social structures have allowed diseases to flourish. “Epidemic diseases are not random events that afflict societies capriciously and without warning,” he writes. “On the contrary, every society produces its own specific vulnerabilities. To study them is to understand that society’s structure, its standard of living, and its political priorities.”…

Epidemics as a mirror for humanity- Isaac Chotiner (@IChotiner) interviews Frank Snowden: “How Pandemics Change History,” conducted on the occasion of the publication of Snowden’s new book, Epidemics and Society: From the Black Death to the Present.

See also: “Late-Stage Pandemic Is Messing With Your Brain.”

And for thoughts on addressing the issues raised, see “Governing In The Planetary Age.”

* Wallace Stevens

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As we reflect, we might spare thought for August Paul von Wassermann; he died on this date in 1925. A bacteriologist and hygienist, he was director of the Institute for Infectious Diseases in Berlin, where he developed (in 1906) a universal blood-serum test for syphilis that helped extend the basic tenets of immunology to diagnosis. “The Wassermann reaction,” in combination with other diagnostic procedures, is still employed as a reliable indicator for the disease. He also he developed inoculations against cholera, typhoid, and tetanus.

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“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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January 17, 2021 at 1:01 am

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

When inventor Frederick Banting discovered insulin in 1921, 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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Written by (Roughly) Daily

December 14, 2020 at 1:01 am

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