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This is a healthcare, not a healthcure, website.  It's about all the things you can do to keep yourself and your community healthy.  We will try to combine common sense with current authoritative data.

This is how you stay healthy, not how you get healthy.  Some of it is about what you do (get thin, stop smoking, consume vegetables, run for 20 minutes).  But a lot is what we must do to our politicians (beef up disease prevention centers, cut water and air pollution, use airwaves for a host of public health information to enable our citizenry, target dollars at bigest disease conditions, expand charters of lower-rank and lower-paid health professionals).

218. -new- Cortisol and Chronic Fatigue Syndrome
“The researchers, writing online in The Journal of Clinical Endocrinology and Metabolism, said the low levels of the hormone, cortisol, might play a role in the severe fatigue found in many patients with the syndrome” (New York Times, January 29, 2008, p. D6).  “We were surprised that the effect was limited to women,” Dr. Reeves said in an email message, “and this may help to explain the higher prevalence of C.F.S. in women.”  We suspect the cortisol variation is a symptom of the disease condition, rather than a causative factor.  Nonetheless, it is still heartening to get any faint hint as to what goes on with this elusive disease.  See “Attenuated Morning Salivary Cortisol Concentrations in a Population-based Study of Persons with Chronic Fatigue Syndrome and Well Controls” (JCEM, December 26, 2007).  (4/16/08)

217. Garlic's Magic Gas
Garlic, it seems, stimulates the body’s generation of hydrogen sulfide—and that turns out to be a good thing.  See “Unlocking the Benefits of Garlic, “ New York Times, October 15, 2007.  “In the latest study, performed at the University of Alabama at Birmingham, researchers extracted juice from supermarket garlic and added small amounts to human red blood cells.  The cells immediately began emitting hydrogen sulfide, the scientists found.  The power to boost hydrogen sulfide production may help explain why a garlic-rich diet appears to protect against various cancers, including breast, prostate and colon cancer, say the study authors.  Higher hydrogen sulfide might also protect the heart, according to other experts.”  As it turns out, one needs to eat 5 to 8 cloves a day to get a bang.  Further, one should let the garlic sit 15 minutes after crushing, before using it in cooking.  (4/2/08)

216. Blood Pressure: Containing the Gorge
Another instance where we don’t know which is the chicken and which is the egg.  People with lower blood pressure are happier, and visa versa, but who knows what causes what.  “Researchers at the University of Warwick have found a direct connection between a nation’s overall happiness and its citizens’ blood pressure problems.  Sweden, Denmark and the UK come top of this blood pressure based happiness league while Germany, Portugal and Finland come bottom.”  “Happy countries have fewer blood-pressure problems.  Mental health in each country, they show, is also inversely correlated with its rate of hypertension.  The study ranks countries in this order: Sweden, Denmark, UK, Netherlands, Ireland, France, Luxembourg, Spain, Greece, Italy, Belgium, Austria, Finland, Germany, Portugal” (Press Release, University of Warwick, 18 Feb. 2007).  (1/30/08)

215. Dutch Health Insurance
The Dutch have come up with a scheme where everybody gets health insurance, but private health insurance carriers provide the coverage.  See “In Holland, Some See New Model for U.S. Health-Care System,” Wall Street Journal, September 6, 2007, pp. A1 and A14.  “Since a new system took effect here last year, cost growth is projected to fall this year to abot 3% after inflation from 4.5% in 2006.  Waiting lists are shrinking, and private health insurers are coming up with innovative ways to care for the sick.”   Everybody gets health insurance; insurers must accept everybody who applied; the government provides aid to those who cannot afford premiums through a tax on the rich. Menzi’s has opened primary care centers of its own to lower costs; UVIT gives discount vouchers to those using low cholesterol dairy products and offers other incentives for consumers leading healthy lives.  This is along the lines of Alain Enthoven’s managed competition.  The government also provides ‘risk equalization’ payments to companies for taking on the elderly and chronic patients with certain conditions. The changeover has apparently gone rather smoothly with premiums lower than predicted.  Generic drug prices have also come down due to negotiations by the government.  The insurers, however, have had some profit difficulties, and it remains to be seen whether they can get hospitals to cut costs to help shrink their burden.

214. Super Testing 
Akonni Biosystems in Maryland is working on a gadget that will test for everything on the cheap.  It will look for every kind of infection, and it won’t cost an arm and a leg as does the present battery of tests for diseases.  “Daitch calls his tool TruDiagnosis.  It combines advances in microfluidics (miniaturized pumps and channels), microarrays (micron-sized sensors affixed to a chip), and engineering into what could be the ultimate medical gadget: a handheld device that, using a small sample of blood or spit, reveals in mere minutes every pathogen inside the body.  It would work in hospitals, in labs, in the field, perhaps even in homes.  TruDiagnosis is Akonni’s twist on so-called molecular diagnostics, the promising discipline that detects the presence of a bacteria or virus when only a few molecules of DNA, protein, or other biomarkers are present.”  “Akonni … is going low-cost, high-volume.  The TruDiagnosis system has two parts: the credit card sized array, which can be tailored to detect combinations of diseases or strains of a particular disease, and the device that processes and reads the array.”

213. Mainstream Botanical Drugs?
The FDA, for the first time, is looking at botanical drugs in a serious way.  “Some 250 botanical drugs have … been cleared to proceed to clinical trials.  See “Dueling Therapies: Is a shotgun better than a silver bullet?” Wall Street Journal, March 2, 2007, p. B1.  On the Global Province we include an essay from one noted researcher—“A Third Arm for the First World”—suggesting to the FDA that botanical alternatives be included in all drug trials, since the vast majority of manufactured drugs show such an array of side effects.  At least the FDA has opened the door to useful botanical trials.

212. Counter “Sicko” 
“Average lifespan has increased 30 years over the past century—mostly due to commercially developed vaccines,” says Paul Offit, chief of infectious diseases at Children’s Hospital in Philadelphia (“Sick Propaganda,” Wall Street Journal, July 13, 2007, p. A13).  Nine vaccines—“which save about eight million lives a year”—were made by Maurice Hilleman of Merck.  Offit is right about vaccines, of course, which he uses to put down Michael Moore’s Sicko, which castigates the pharmaceuticals.  Unfortunately it’s a false argument.  The pharmaceuticals and the healthcare system are peddling treatments galore that are useless or worse, with responsible estimates suggesting that 1/3 of healthcare procedures simply should not be done. As Moore makes clear, this is wasteful and horribly expensive.  Vaccines and preventive care, which the hopeless Moore does not dwell on, must become the order of the day.  (9/19/07)

211. Training Rural Doctors 
“Now, a company called Haoyisheng.com Inc. … has set up outlets in remote villages and small cities like Mile (pronounced Meel-eh), where local doctors attend video classes in essential matters of diagnosis and care.  So far, Haoyisheng.com has outfitted 6,000 classrooms in eight provinces, with the blessing of the Chinese government, which has brought in more than 120,000 doctors to educate” (Wall Street Journal, July 10, 2007, p. B1).  Local doctors see videos that deal with the kind of clinical situations that are expected to crop up regularly.  Distance learning courses such as these are cheap and practical, but the trainees do suffer from lack of one-on-one contact with a medical professional.

210. Blood Pressure Vaccine? Brain Pressure? 
There are reports of a new blood-pressure vaccine “based on a protein found in the sea creature the limpet.  The new vaccine consists of a course of three injections followed by a booster every six months; the vaccine attacks a hormone called angiotensin which is produced by the liver and is the main culprit in raising blood pressure.” (Pharmaceutical News, 15 May 2007).  Developed by a firm called Protherics, there are already many questions about its efficacy.  A Swiss firm, Cytos Biotechnology, is also reported to be developing a similar product.

Interestingly, variant theories are now appearing as to what causes high blood pressure. Some UK scientists trace it to the brain, instead of the heart or blood vessels.  We suspect this will produce entirely new treatments that will affect other parts of the causal chain.  The University of Bristol, which is spawning much innovative research reports:

Professor Julian Paton and his colleagues Hidefumi Waki and Sergey Kasparov, have discovered a new protein, JAM-1 (junctional adhesion molecule-1), which is located in the walls of blood vessels in the brain.

JAM-1 traps white blood cells called leukocytes which, once trapped, can cause inflammation and may obstruct blood flow, resulting in poor oxygen supply to the brain.  This has led to the novel idea that high blood pressure—hypertension—is an inflammatory vascular disease of the brain.

209. Try a Little Tenderness 
The doctors have all sorts of wretched, leech sucking ways to make you think you are getting better.  If it does not hurt, it must not be doing you any good.  One of the mouthwash companies once improved the flavor of its brand, and sales went into the tank.  People figured that if it tasted good, it must not be going you any good.  So the brand managers made sure, once again, that it tasted awful.  Now imagine our substitute for antibiotics—honey.  How, some will ask, could honey be good for what ails you?

Honey was commonly used in medicine before antibiotics became widespread. It is still used in the Antipodes; an Australian company makes a product called Medihoney for medicinal use. This formulation is a certified medicine in Europe, but has not been much used there because doctors developed a taste for prescribing conventional antibiotics.

Research in Australia and New Zealand suggests that honey heals because it attacks bacteria in several different ways at once. Because honey is composed of saturated sugars, it sucks up water, depriving bacteria of the liquid they need to survive and multiply. As bees make honey they secrete glucoseoxidase, an enzyme that releases the bleach hydrogen peroxide when it comes into contact with wound liquids. The low-level but frequent release of this chemical ensures regular anti-bacterial washes of the wound. (Economist, 26 April 1007)

Importantly, honey seems to work against some of the deadly germs that are resistant to antibiotics and that one finds in hospitals.  (8/8/07)

Update: Honey for Coughs  
Every time we turn around we discover new uncanny applications for honey that touches on a variety of complaints.  The Penn State College of Medicine has discovered that it is a good thing to stem children’s uncontrollable coughing, better in fact than many standard cough medicines.  “The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications.”  See “Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents,” Archives of Pediatric and Adolescent Medicine, December 2007.  (4/30/08)

208. Britain Health Productivity Reforms 
The Labor government is trying to get its arms around National Healthcare Costs and Quality.  First off, it is paying its hospitals in a different way.  Before they got block grants based on previous budgets.  Now they get paid by transaction, and the hope is that they will do more for their money.  But, too, there is a counterbalance to make sure they are not doing lots of unnecessary procedures.  That is, the status of General Practitioners has risen, and they will be gatekeepers with a budget who pass on whether patients really need this or that treatment.  See the Economist, March 3, 2007, p.58.  It’s the latter problem that particularly affects America, where it is estimated that perhaps 1/3 of the medical procedures that are rendered are rather unnecessary.  We’re doing a whole mess of medicine that does not help the patient, and often hurts.  (8/1/07)

207. Looking into Eyeglasses 
Eyeglasses—and optometry—add up to one of the greatest scams in the healthcare systems with gullible consumers paying $200 or more for a pair of spectacles.  Simple glasses should cost you $5, or $10 at the worst.  Sam’s, Wal-Mart’s warehouse discount unit, once charged you $20 or so for 12 pairs, back before it got so heavily in the jewelry and eyeglass business—and they had good frames to boot.  Now the average drugstore sells off-the-rack glasses with shoddy frames for $15 a pair.  The New York Times, May 5, 2007, has done a credible job of looking at the problem in “Do-It-Yourself Eyeglass Shopping on the Internet.”  What it comes down to is that you can find some wares on the Internet at better, if not fair, prices, though it is still a fragmented, over-priced mess.  “But a frame that costs less than $25 to make in Italy can retail for at least $150 at an optical shop in the United States.”  Zenni Optical does seem to offer good bargains using China frames.  Glassy Eyes reviews various vendors—and tries to cut through the eyeglass scam.  “Although the frames carry fat profit margins, the real money for the retailer is in the lenses.  There the markup can be three to seven times the wholesale price.  Most single-vision lenses—those that are not bifocals or the ‘progressive lenses,’ which are bifocals without the line—are precast in large quantities and can cost about $1 to make.  The eyeglass dispenser just picks them out of a tray.”

206. Stroke Watch
“As of today, the Society for Vascular Surgery … is for the first time recommending these three tests to screen for artery disease in many people 55 years old and over” (Wall Street Journal, April 17, 2007, p. D2).  They are: a carotid ultrasound to find fatty plaque in neck arteries; ankle-brachial test to get at plaque in the legs and throughout the body;  and abdominal ultrasounds to see if the aorta has a bulge or aneurysm.  Some free offerings can be found at www.vascularweb.org.  A high percentage of the nation’s strokes are attributed to carotid blockages.  (7/18/06)

205. Coenzyme Q10 
“Companies that sell Coenzyme Q10 say daily doses improve heart function and increase energy levels.  Scientific evidence on Coenzyme Q10 is mixed, and physicians urge patients not to stop taking conventional drugs” (Wall Street Journal, March 27, 2007, p. D2).  Scientists are clearly mixed about it, though they generally seem to agree that it offers no harmful side effects.  There has been an issue as to quality—with samples sometimes not including intense enough quantities of the supplement.  Then too, one must test to find products with high enough absorption rates.  “For effective therapy in patients with heart failure,” one is apparently striving “for 2.5 to 3.5 micrograms of the coenzyme for every milliliter of blood,” compared with the normal .8 customarily found before treatment.  Advocates think it adds energy to parts of the body where high energy is required.  A wider range of applications is suggested in some articles.  While the WSJ urges readers not to discontinue other heart medications when using it, some researchers suspect that statins, beta blockers, and blood pressure drugs may cut its efficacy.  (7/11/07)

204. Happiness Is Very Low Key
“Mental health and blood pressure are a better guide to happiness in Europe than economic performance.”  A study of 16 countries found that people who regarded themselves as happy had lower blood pressure.  “People in Sweden, the Netherlands, Denmark, the UK and Ireland had the fewest blood pressure problems, while those in Portugal, Germany, Italy and Finland were among those with the most” (Financial Times, March 3-4, 2007, p. 2).  “It is now well established that people in richer countries tend to be happier,” but high economic growth rates do not necessarily correlate with happiness.  Economists studying happiness have had mixed success uncovering what kinds of things produce people with a high sense of wellbeing.  (5/30/07)

203. Doctors Who Write 
Abigal Zuger, a doctor herself, has written a very thin article about “Doctors Who Wield the Pen to Heal the Profession,” New York Times, May 15, 2007,  p. D6.  First off, we find that doctors who write are mainly healing themselves, sensitive individuals who actually have some guilt and remorse for the fact that they are made of mortal clay and have committed some grievous errors along the way as they have plied their trade.  It is not altogether certain that their writing, inspired as it is, really does much to change the profession, which has structural flaws that are so deep that they will not submit to the limited analysis of medical practitioners.  She particularly mentions two New Yorker writers, Atul Gawande and Jerome Groopman, both best-selling stars of the moment, who are part of the Harvard Medical/Mass General orbit.  Gawande has written convincingly about the venalities of the trade where habit and avarice affect performance.  Groopman has touched on many of the habits and mental shortcuts that lead to poor diagnosis, something that even led to poor treatment for him.  One wishes that Zuger had dealt with the raft of other fine medical writers such as Lewis Thomas of Memorial Sloane Kettering, Richard Selzer of Yale, and the incomparable Oliver Sacks—each of whom is endowed with a special esthetic sense that takes their writing to a higher plane.  Consistently, incidentally, the best writing in the New Yorker is about a health, probably indicating that both its editors and readers are a bunch of hypochondriacs.  Henry Finder, its editorial director, is a card-carrying health writer.  (5/23/07)

202. Anti-mottainai
Mottanai means ‘what a waste,’ and, more than ever, the Japanese are eager to waste not.  “Fruits and vegetables that are rejected for sale because they are irregularly shaped or bruised are often thrown away.  Now, however, these otherwise perfectly good foods are being used in purée form under the brand name Nepurée.”  See Trends in Japan, February 5, 2007.  “Nepurée products are made from fruit or vegetables that have been subjected to intense heat for a short time and then made into puree form using centripetal force.  The application of heat brings out the sweetness that fruits and vegetables naturally contain, and because no cutting instruments are used, the nutritional elements are undamaged at the cellular level.  The manufacturer Vegetech Co. and its partner Kanto Orto Co. released products last year bearing the message ‘the new shape of vegetables.’”  (4/4/07)

201. Tips Before You Go to the Hospital
“If your ailment doesn’t kill you, the hospital will.”  As we said in “Hyper-Germs and the Power of Soap,” hospital infections have gotten much more deadly and claim a considerable number of lives.  The AARP gives some good suggestions on things you personally can do to guard against infection: 

• Wash your hands frequently. And don’t be shy about reminding doctors, nurses and aides to wash theirs.

• People who smoke or are overweight are more susceptible to infection, so try to quit and lose before surgery.

• Wash with 4 percent chlorhexidine antibiotic soap for several days before surgery.

• Ask your doctor for a nasal swab test for MRSA.

• Be sure the doctor prescribes an antibiotic for you before surgery.

• Don’t allow the doctor to shave the surgical site—tiny cuts from the razor can get infected. Use hair clippers.

• Ask friends and family to stay away if they’re ill, and ask the doctor to limit the number of aides and medical students in your room.

• Call a nurse promptly if IVs or catheters become loose or damaged; the sites should be kept clean and dry.  (3/21/07)

200. China—Drugs, Hospitals, Tests, Fancy Procedures
The broken healthcare system in China—a great worry for the political leadership—exposes even more dramatically the conflict between the incentives built into the healthcare system and cost effective, health effective healthcare.  This is the same tension we discussed previously in respect to Virgina Mason Hospital in Seattle.  See “In China, Prevention Pits Doctor Against System,” Wall Street Journal, January 16, 2007, pp.A1 and A18.  The Chinese have lost the safety net offered in more doctrinaire times of public services and healthcare: now citizens must pay stiff fees without the aid of healthcare insurance.  Doctors and hospitals are rewarded for procedures and prescriptions, so large chunks of unaffordable, expensive healthcare are inflicted on patients without particular regard to outcome or cost effectiveness.  The WSJ discusses Dr.Hu Weimin of Loudi, who offers sensible preventive care measures and low-cost prescriptions to a burgeoning population of patients.  He has been ostracized and even beaten by doctors and barred from the wards of Loudi General Hospital because he has cut into their revenues. “Academic studies show that 50% of all Chinese health-care spending is for drugs.”  Some 63.8% of medical expenditures in China are paid privately, 87.6% coming out of the pockets of individuals—higher even than the U.S.  “With his Web site, he manages some 7,000 patients and runs a high-blood-pressure support group with 50,000 members…”  (3/14/07)

199. Getting Hospitals off Drugs
One of the impediments to health care reform is that the system incentivizes doctors and hospitals to spend money on the unnecessary—and does not reward them for frugality.  In “A Novel Plan Helps Hospital Wean Itself Off Pricey Tests,” Wall Street Journal,  January 12, 2007, p. A1, we learn how Virginia Mason Medical Center in Seattle has taken some halting steps to get off the tests, procedures, drugs bandwagon.  “A novel solution, crafted with the help of the big employers, ultimately let Virginia Mason share in some of the savings it created—by paying the medical center more for some cheaper treatments.  It offers a lesson in dealing with one of the most confounding elements in America’s health-care crisis: a perverse system of payments that rewards doctors and hospitals not for how well they treat patients, but for how much they treat them.”  “Virginia Mason's move is a gamble.  Only Aetna, which accounts for 10% of the medical center’s business, has adjusted fees to reward its more efficient care.  Seattle’s two biggest health insurers, Regence Blue Shield and Premera Blue Cross, haven’t matched the move so far.  Medicare, despite its own experiments, doesn’t have the flexibility to change its payments for one hospital—and it accounts for a third of Virginia Mason’s business.  Virginia Mason, a not-for-profit that is satisfied with an annual 1% to 3% operating margin, still hasn’t replaced all its lost revenue.”  “The medical center has pursued efficiency by adopting some assembly-line methods of Toyota Motor Corp. and Hitachi Ltd., which hospital officials and doctors observed on a visit to Japan in 2002.  For instance, Virginia Mason rerouted patient traffic in its cancer center, cutting the time patients had to wait for chemotherapy from four hours to 90 minutes.”  (2/28/07)

198. Cholesterol and Diet? Maybe
When one does comparative analyses of heart disease incidence in various nations, one can often find comparable disease rates in nations with quite disparate fat intake rates.  Namely, there are all sorts of anomalies that suggest that the simplistic cholesterol studies by which American doctors set their compass and which drives the vast dispensation and usage of Lipitor and its statin cousins may not hold water.  Also more data on the danger of statins is coming to light which we will share in a future entry.  While looking harder at the science, we would still say cut your fats; in fact, cut most everything except vegetables and fruits.  But don’t look askance at others who don’t share your bias.  For an very amusing look at some of the ‘fat’ anomalies, take a peek at the very amusing “The Case of the Missing Data,” which suggests that our understanding of heart disease is still pretty primitive, in spite of all the half baked theories that are foisted upon us.  (2/14/07)

197. Trust for America's Health
The Trust for America’s Health is trying to put preventive health at the top of our healthcare agenda and hopes to restore the public health system in the United States.  Its annual study just said that we are rather unprepared for any major emergency, be it a pandemic or a terrorist threat.  Buried in its website are rankings of all the states according to a variety of health yardsticks.  In troubled states, one will detect considerable weakness on child mortality and on other child issues.  (1/31/07)

196. Hibernation for Humans?
Cell biologist Mark Roth has done research on “induced metabolic hibernation, in which he has shown that it is possible to reversibly reduce the core temperature of mice to 10 degrees Celsius without loss of life or neurological problems,” which, in theory, could lead to breakthroughs in the treatment of trauma and cancer.  See “Buying Time Through Hibernation on Demand,” Fred Hutchinson Cancer Research Center Release, April 21, 2005.  For an abstract, see “H2S induces a suspended animation-like state in mice.”  It is thought that such treatment could, for instance, save accident victims by putting them on ice, as it were, until they can be treated at a full-scale emergency facility.  (1/24/07)

195. Preventive Health Websites
“Web Site Tallies Your Risk of Disease and Tells you What  You Can Do About It,” Wall Street Journal, October 31, 2006, p. D1. The site www.yourdiseaserisk.com, created by the Harvard Center for Cancer Prevention, provides custom, rather than generic information, to help patients understand their health situation and the odds that they will get a severe disease.  “More important, it also spits out a tailored action plan on ways to lower risk for health problems.”  “Other Web sites offer calculators to help users assess their risk for various health problems.”  The American Heart Association offers one at www.americanheart.org, but it does not take into account enough variables.  The National Cancer Institute’s www.cancer.gov/bcrisktool suffers from the same sort of problem: it does not take enough individual variables into account.  The Harvard site lets users calculate their risk for “12 different cancers … heart disease, stroke, diabetes and osteoporosis.”  (12/27/06)

194. Hyper-Germs and the Power of Soap
We cannot over-emphasize the importance of the rise of superbugs immune to traditional antibiotics—a topic on everybody’s lips that is much remarked upon in the media.  The New York Times, for instance, opined that “Concern Mounts as Bacteria Resistant to Antibiotics Disperse Widely” (August 22, 2006).  We have previously commented on “New Classes of Antibiotics,” talking about some scientists who are trying to develop radically different antibiotics that can do battle with a range of pill-resistant diseases that have sprouted up.  Oddly enough, Big Pharma, puzzled by the difficulty of uncovering effective new antibiotics, has dropped out of the fight.  The infection problems are accentuated by widespread and unnecessary use of antibiotics which leads to the development of resistant bacterial strains but which often kills off beneficial bacteria, especially in the human gut.  Promiscuous use of antibiotics in very young children is credited with creating higher asthma rates, especially when used in the first year of an infant’s life.  Hospital infections, especially in America, run rampant: it is such a problem that, by default, rural populations often live longer simply because they don’t have access to hospitals where they would otherwise stand a good chance of getting a life-threatening infection. 

Forbes (June 19, 2006, pp.60-74) does a fine job with the subject in an article entitled “Germ Warfare,” discussing “six strains of killer bacteria, built for destruction and rapid reproduction and bred in hospitals nationwide, [that] are among those that worry doctors most.”  They are: Methicillin-resistant staphylococcus (MRSA), which causes 100,000 hospital infections a year; Clostridium difficile, which causes 400,000 cases of diarrhea annually; Klebsiella pneumoniae, of which cases are up almost 50% in five years and, when untreated, kills two-thirds of patients; Acinetobacter baumannii, which is soil borne and heavily afflicts soldiers in Iraq and Afghanistan; Vancomycin-resistant Enterococcus Faecium (VRE), which is hard on those with weak immune systems and accounts for 10% of hospital infections; and Pseudomonas aeruginosa, which accounts for 18% of hospital-acquired pneumonia. 

“100,000 Americans die of hospital -bred infections” each year; “2 million patients get hospital infections….  This crisis costs $30 billion a year.” 

Sundry smaller companies are doing the pathfinding work now on new antibiotics and other drugs.  Stuart Levy, a Tufts infectious disease expert, co-founded Paratek Pharmaceuticals, which is testing a souped-up tetracycline. He is author of The Antibiotic Paradox, which deals with the over-use of antibiotics and the subsequent outbreak of antibiotic-thwarting killer bugs.  Roy Vagelos, retired chairman of Merck, now heads Theravance, which crushes fragments of old drugs to make powerful new versions.  He is aiming for a new and improved vancomycin. 

Old-fashioned treatments, such as silver, have shown considerable ability to reduce infections, as we mentioned in “Silver Standard.”  As well strict observance of protocols in intensive care units, with discipline reinforced at the highest level of a hospital, can result in a “95% Success Rate” in reducing infections. 

The more things change, the more things stay the same: cleanliness is still next to godliness.  Simple hand-washing and other old-fashioned hygienic measures among hospital personnel, and particularly doctors, can cut hospital infections dramatically.  “Strict infection-control measures and prudent antibiotic use have let hospitals in the Netherlands avoid the resistant staph strains that plague most U.S. hospitals.  Hospitals test patients to identify carriers of staph, which ‘colonizes’ the nose when it is not causing infection.  In the Netherlands at-risk patients go into isolation, and doctors who are carriers are sent home and can’t return until they are cleared, says Margaret Vos, who heads infection control at Erasmus University Medical Center.”  Testing has reduced infections 90% at the University of Pittsburgh Medical Center, and other tests are at various stages.  Prophylactic measures that prevent infection are more effective, and more cost efficient, than drugs administered after the fact. 

But we cannot under estimate the difficulty of getting professional health personnel to take hygiene seriously.  Doctors are the worst of the bunch.  Not to be missed in this respect is “Selling Soap,” New York Times Magazine, September 24, 2006, pp. 22-23.  “In its 2000 report ‘To Err Is Human,’ the Institute of Medicine estimated that anywhere from 44,000 to 98,000 Americans die each year because of hospital errors—more deaths than from either motor-vehicle crashes or breast cancer—and that one of the leading errors was the spread of bacterial infections.” 

Cedars-Sinai in Los Angeles “needed to devise some kind of incentive scheme that would increase compliance without alienating its doctors.  In the beginning, the administrators gently cajoled the doctors with e-mail, faxes and posters.  But none of that seemed to work.  (The hospital had enlisted a crew of nurses to surreptitiously report on the staff’s hand-washing.)  ‘Then we started a campaign that really took the word to the physicians where they live, which is on the wards,’ Silka recalls.  ‘And, most importantly, in the physicians’ parking lot, which in L.A. is a big deal.’” 

“When the nurse spies reported back the latest data, it was clear that the hospital’s efforts were working—but not nearly enough.  Compliance had risen to about 80 percent from 65 percent, but the Joint Commission required 90 percent compliance.”  “They pressed their palms into the plates, and Murthy sent them to the lab to be cultured and photographed.  The resulting images, Silka says, ‘were disgusting and striking, with gobs of colonies of bacteria.’  The administration then decided to harness the power of such disgusting images.  One photograph was made into a screen saver that haunted every computer in Cedars-Sinai.  Whatever reasons the doctors may have had for not complying in the past, they vanished in the face of such vivid evidence.”  (11/15/06)

Update: Pre-Screening and Discipline
Handwashing can do a lot.  But more complex strategies seem to be indicated in countries where super-infections are well entrenched.  Apparently scorched-earth policies in the Netherlands and Scandanavia have kept in-hospital infections rates low.  In England, University of Bath researcher Mark Enright notes, the rates are higher.  Something different is required where microorganisms have gotten well entrenched inside hospitals.

193. Competitive Disadvantage
In “Risk Pool,” New Yorker, August 8, 2006, Malcolm Gladwell discovers that the dividing line between the Asian Tigers (i.e, the high growth economies and companies of Asia) and the American and European sluggards is dependency costs.  In other words, Westerners, and particularly Americans, are laying out huge expenditures on a company by company basis for pensioners both for health and retirement.  Too high a dependency burden puts an unsupportable overhead cost burden on all companies, particularly those with overcapacity—such as the car companies:

The difference is that in most countries the government, or large groups of companies, provides pensions and health insurance.  The United States, by contrast, has over the past fifty years followed the lead of Charlie Wilson and the bosses of Toledo and made individual companies responsible for the care of their retirees.  It is this fact, as much as any other, that explains the current crisis.  In 1950, Charlie Wilson was wrong, and Walter Reuther was right.

Charlie Wilson was Engine Charlie Wilson, of course, the famed leader of GM who railed against pooled pension schemes, preferring to things on a company by company basis.  Walter Reuther was the auto union leader who understood that both workers, companies, and the countries would enjoy more stable growth if the burden was spread over a range of companies.

192. Chilies Fight Cancer
“Capsaicin, the chemical that makes chile peppers hot, may have the power to destroy cancer cells” (The Week, April 7, 2006, p. 20). Cedar-Sinai in California has discovered that it shrinks prostate tumors in mice 80%, and, in lab tests, the spice killed 75 percent of human cancer cells.  See “Capsaicin, a component of red peppers, inhibits the growth of androgen-independent, p. 53 mutant prostate cancer cells.” See PubMed.  (10/11/06)

191. Microbial Fat
“It’s clear that diet and genes contribute to how fat you are.  But a new wave of scientific research suggests that for some people, there might be a third factor—microorganisms” (“Fat Factors,” New York Times Magazine, August 13, 2006, pp. 28-33, 52-57).  “One year ago, the idea that microbes might cause obesity gained a foothold when the Pennington Biomedical Research Center in Louisiana created the nation’s first department of viruses and obesithy … headed by Nikhil Dhurandhar.”  Jeffrey Gordon at Washington University in St. Louis believes obesity is related to intestinal microorganisms.  (10/4/06)

190. Cleanliness and Antibiotics Equal Allergies
A Duke study tentatively confirms that the too-hygenic environment children encounter in advanced developed countries plays a significant part in the development of allergies. The study suggests that an overly hygienic environment could simultaneously increase the tendency to have allergic reactions and the tendency to acquire autoimmune disease, despite the fact that these two reactions represent two different types of immune responses.  See “Increased IL-4 production and attenuated proliferative and pro-inflammatory responses of splenocytes from wild-caught rats (Rattus norvegicus),” Scandanavian Journal of Immunology and other articles.  Meanwhile, British Columbia researchers believe that asthma rates among children continue to rise because of excessive use of antibiotics.  Infants who intake antibiotics during their first year of life are twice as likely as other children to develop asthma.  Earlier studies within the United States have led to much the same conclusion.  (9/27/06)

189. The Genes Will Out
For the first time, really, gene therapy seems to be getting at tumors.  See the Wall Street Journal, September 1, 2006, pp. All & A13.  Such therapy had only worked in a very small cohort—2 out of 17 patients with advanced melanoma.  Genes had previously worked for other kinds of disease conditions, but this is the first time they have bitten into cancer.  The work was done by Dr. Steven Rosenberg of the National Cancer Institute.  He took T-Cells and a receptor from one patient, and a couple of patients then showed “dramatic and durable regression in their tumors.”  They’re still clear a year and one half later, and none of the patients are showing side effects from the treatment.  Rosenberg and others wondered why the treatment did not work in more patients, speculating that a weak receptor or other technical difficulties could have limited the results.  See the National Cancer Institute.  (9/20/06)

188. Heart Tricks While You’re Waiting
A string of recent technological developments in Japan are holding out hope for patients awaiting heart transplants, particularly children.  The goal of the researchers involved in these developments is to improve ventricular assist devices (VADs) by making them smaller and more functional, so that they can be implanted into young children and others with serious heart problems.  VADs help the heart to pump blood around the body. For patients awaiting transplants, they play a critical role, helping them to survive until transplant surgery can be performed. 

But all that may change in the years ahead, thanks to the development of a prototype of the world’s smallest general-use VAD.  The breakthrough is the result of joint research between Tokyo Medical and Dental University and the Tokyo Institute of Technology. 

The device’s pump, a critical component, is circular in shape and small enough to fit into the palm of an adult’s hand.  It measures a mere 6.5 centimeters in diameter and is just 3.25 cm thick.  Due to its small size, researchers believe there is a high likelihood that the new VAD can be used in children as young as 5 years of age for short periods of time.  Clinical testing on the new generation of VAD is planned for around 2009. 

The device is implanted into the body of a patient whose heart is extremely weak from illness.  It is then connected to their heart and sends blood around the body through the turning of the pump’s impellers.  The researchers working on the project hope one day to develop a device that can operate even when the user goes outdoors.

Another recently developed VAD is the result of joint research in Japan by Sun Medical Technology Research Corp. and several universities.  This device is already in use in one patient.  The patient had it implanted in an operation in May 2005 and was released from the hospital the following February, after recovering to the point of being able to stand up and move around.  The developers hope to have this VAD in widespread use in a few years’ time. 

Terumo Corp., Japan, a major medical equipment maker, has completed clinical trials of its own VAD, expected to be sold in Europe by the end of fiscal 2006 (April 2006 to March 2007). 

187. Online Brokers for Lab Tests
A host of firms including MedLabUSA.com, MyMedLab.com, HealthCheckUSA, DirectLabs.com, etc. are acting as brokers over the Internet to directly secure consumers lab tests prescribed by doctors or simply desired by the consumer.  They have tie-ins with local labs in the area of each customer.  The savings can add up to 75% or more.  Quest Diagnostics and Laboratory Corp of America Holdings, the biggies in the lab game, have held back from this market, since they are so tied in to physicians and hospitals.  It is anticipated that this market will grow as consumers control more and more of their outlays in the future.  See the Wall Street Journal, June 20, 2006, p. D4.  (8/2/06)

186. Checking out Prescriptions and Treatments
Consumer Reports long has provided an online database on prescription drugs as part of a partnership with the American Society of Health-System Pharmacists.  Now it has added in for a $9 annual fee herbs and natural medicines from the Natural Medicines Comprehensive database of the Therapeutic Research Center in Stockton, California, as well as its guide to medical treatments.  Conceptually this is a terribly good idea, but we must add that the quality of these databases varies immensely, and we cannot avow that CR has tied itself to the right partners.  (7/5/06)

185. Anthrax Killers
Not all biological weapons are created equal.  They are separated into categories A through C, category A biological agents being the scariest:  they are easy to spread, kill effectively and call for special actions by the pubic health system.  One of these worrisome organisms is anthrax, which has already received its fair share of media attention.  But work in Vince Fischetti’s laboratory at Rockefeller University suggests that a newly discovered protein could be used to fight anthrax infections and even decontaminate areas in which anthrax spores have been released.

“Anthrax is the most efficient biowarfare agent.  Its spores are stable and easy to produce, and once someone inhales them, there is only a 48-hour window when antibiotics can be used,” says Fischetti.  “We’ve found a new protein that could both potentially expand that treatment window and be used as a large-scale decontaminant of anthrax spores.”  Because anthrax spores are resistant to most of the chemicals that emergency workers rely on to sterilize contaminated areas, a solution based on the protein would be a powerful tool for cleaning up after an anthrax attack.

All bacteria, anthrax included, have natural predators called bacteriophage.  Just as viruses infect people, bacteriophage infect bacteria, reproduce, and then kill their host cell by bursting out to find their next target.  The bacteriophage use special proteins, called lysins, to bore holes in the bacteria, causing them to literally explode.  Fischetti and colleagues identified one of these lysins, called PlyG, in 2004, and showed that it could be used to help treat animals and humans infected by anthrax.  Now, they have identified a second lysin, which they have named PlyPH, with special properties that make it not only a good therapeutic agent, but also useful for large-scale decontamination of areas like buildings and military equipment (News Release, Rockefeller University, April 21, 2006). 

184. Cholesterol Two
The first act in the drugmakers march against cholesterol was a whole line of statin-class drugs, today led by Pfizer’s Lipitor, which that company snapped up through an unfriendly acquisition of Warner-Lambert.  Lipitor is now ladled out at the rate of $11 billion a year, the heart doctors blind to the possible side effects of the statin drugs.  Cholesterol has been viewed as the prime culprit in heart disease since the vaunted Framingham study, and one only meets an occasional physician who looks at heart disease in a more complex way. 

183. Close at Hand
The fine medical writer and physician Jerome Groopman raises more than one interesting question in “Being There,” The New Yorker, April 3, 2006, pp. 34-39: 

In 2003, emergency rooms in the United States treated nearly a hundred and fourteen million people; about one in every hundred received CPR or underwent another kind of resuscitation procedure.  Resuscitations are gruesome … and just fifteen percent, at most, are successful. 

It’s a surprise to many that the revival rate is so low, but it only emphasizes that CPR and other procedures are best begun well before a patient can reach a hospital.  In “Distributed Defibrillators,” we underline the great success Las Vegas has had, simply by putting defibrillators in casinos for quick and easy access. 

182. Chiles and Cancer
A research team at Cedars-Sinai Medical Center in California, in conjunction with UCLA, has found that capsaicin (one of chile’s firey ingredients) shrinks tumors some 75% in mice with prostate cancer.  Phillip Koefler, the study’s senior author, notes, in effect, that the capsaicin abets “cell death,” a process cancer cells seek to avoid.  Additionally it tends inhibit cancer cell growth.  See Cedars-Sinai Release, March 15, 2006.  See also “Cancer Research.”  And for anti-microbial aspects of spices, see “Spice and Life.”  (5/24/06

181. Smelling out Malaria
The female mosquito, carrier of malaria, “locates her human prey with her exquisite sense of smell.  She can discern human scent from 50 meters away.”  Laurence J. Zwiebel of Vanderbilt, John Carlson of Yale, and three other research groups in Europe and Africa have joined together to see if these blood-sucking killers can be brought low by their noses.  They are developing odor blends to lure mosquitoes into traps.  See “Serial Killer,” Yale Alumni Magazine, March-April 2006, pp.53-58.  In 1986, Carlson “established what was probably the only fruit fly olfaction lab in the country and only the third he knows in the world.”  Twenty years later, there are more than 50.  Attending a London conference on mosquito olfaction in 1995, he learned that “10 percent of the world’s population gets” malaria every year. 

180. Metals Again
More and more, we are discovering the part that metals and sundry minerals play in inhibiting illness, and—in some instances—in provoking it.  We have discussed both arsenic and silver elsewhere.  Brian DeDecker, a cell biologist at Harvard Medical School, just has written abut the role of gold and platinum in Nature Chemical Biology.   “Noble Metals Strip Peptides from Class II MHC Proteins,” disabling the auto-immune system and possibly providing relief for lupus, child diabetes, and rheumatoid arthritis.  See The Economist, March 6, 2006, p. 74.  “Dr. Dedecker and his team have screened some 30,000 chemical compounds … that might adversely affect the proteins in question … without much success.”  Just recently they tried out drugs approved for other purposes: “two … worked, and they had a surprising element in common: platinum.”  In general, not just platinum, but the whole class of noble metals (such as palladium and gold) worked well.  Some gold-based drugs had long worked slowly against arthritis.  Now that it is understood that they curb MHC Protein, it is thought that faster acting drugs can be devised.  (4/19/06)

179. Distributed Defibrillators
“Las Vegas casino security officers have restored the heartbeats of about 1,800 gamblers and employees in the past nine years, according to the Clark County Fire Department.”  See the Wall Street Journal, January 28-29, 2006, pp. Al & A10.  Bryan Hindsoe, a George Washington University emergency-medicine doctor and co-author of paramedic textbooks, alleges that it’s now safer to suffer cardiac arrest in a casino than at a hospital. 

“Casino security officers have become so adept” with defibrillators “that they usually decline offers of aid from physician bystanders.”  Authoritative bodies such as the American Heart Association are now calling for wide distribution of the devices and broader use by lay persons. 

Richard Hardman, a paramedic in the Fire Department, pushed the idea of casino personnel having and operating defibrillators for the stricken.  He got Stan Smith, vice president of risk management at Boyd Gaming (Stardust Casino) to cooperate. 

“The state’s ‘good Samaritan law,’ giving legal protection to bystanders who help in a medical emergency, was extended to explicitly cover users of defibrillators, after lobbying by casinos and Mr. Hardman.” 

“The study’s survival rate astonished specialists in emergency medicine.  ‘This was groundbreaking—it showed what can be accomplished with quick response,’ say Leonard Cobb, professor emeritus of medicine at the University of Washington and the father of Seattle’s paramedic program, widely hailed at the fastest- reacting big-city operation in the country.”  Now corporations, such as Proctor & Gamble, and other institutions are laying in the defibrillators which keep falling in price. 

178. Bird Flu
Bird Flu is on the fly, and it is becoming a real worry.  A case here and a case there is cropping up—particularly in bird populations, brought on by wild birds on the wing.

Scientists of merit are taking its moves quite seriously, and are worried about a global pandemic.  This rise in concern, from a yellow to a red level if you will, has been brought to our attention by Max Wallace, a healthcare and biotech entrepreneur in the Research Triangle.  We intend to give it a lot of attention—right here. 

The implications are many.  It’s not only a threat to people across the globe, but it already is having business and economic implications.  Some businesses are already beginning their crisis planning, trying to imagine how they can carry on with decimated labor forces.  “Avian-Flu Concerns Overseas” are dampening U.S. chicken exports, according to the Wall Street Journal, March 11-12, 2006, p. A5.  Several importers, especially in Europe, are consuming less chicken, even though proper killing knocks out the virus.  “According to the World Health Organization, the H5N1 virus has killed 97 people since 2003 in the developing world, where people … live in much closer contact with poultry than they do in the West.”  “The wholesale price of so-called dark meat has plunged to about 14 cents a pound in recent weeks, compared with about 41 cents a pound last summer.”  Brazil plans to cut production about 15%, but currently the U.S. production schedules calls for a marginal increase. 

Mainland China, which already has rather serious, unmet healthcare problems, is once again a source for this latest flu, and some feel it is under-reporting its flu cases.  One wonders whether world public health bodies can do enough back channel communication with China to begin to get at some of the sources of its ongoing virus problems—or whether officialdom will try to stonewall this growing problem. 

There are outbreaks everywhere.  See “Sinister Droppings,” The Economist, February 18, 2006, p. 51.  Italy, Greece, Austria, Germany.  Official assurances notwithstanding, chicken consumption has dropped 70%.  Nigeria, a heavy poultry country, has had an outbreak, though there are few signs so far elsewhere in Africa.  Both Azerbaijan and Iraq are worrisome spots.

Controlling bird flu is a complex problem and raises some of the very same issues that we encounter with other kinds of viruses—computer outbreaks, terrorism, etc.  It requires intense collaboration that is not altogether easy, since the world’s public health system is rather broken.  Clearly there is fertile ground here for the application of network theory—a growing body of knowledge not well understood by governments anywhere. 

It is perfectly clear that national jealousies and scientific ambitions are an impediment to dealing with the disease.  Increasingly we are discovering that the only means of rapidly dealing with emerging threats is efficient knowledge markets.  That means widely distributed nodes (researchers) bound together by an open network as well as the will to work together. 

Update: Tracking Avian Flu. 
Airports. “The nation’s major airports aren’t prepared to quarantine a planeload of international passengers, if someone is suspected of carrying bird flu…” (USA Today, March 10, 2006, p.2A).  Honolulu is better prepared than airports on the mainland to spot and handle flu suspects.  The CDC is watching Hawaii to gain insight as to how to control ports and airports in general. 

Quantity Not Quality.  More generally, everyone involved with avian flu is having a hard time tracking it—including the science, public health controls, outbreaks, dispersal of the virus, etc.  There are a host of sites—from WHO to national authorities to self-invented experts: our team has not been able to work its way through all of them.  But we find that many have an axe to grind, from furthering national or scientific jealousies, to expanding on particular political biases.  The UN is trying to do a good job, but as might be expected with this and other institutions, it falls behind the information curve, as events race ahead of its statistics. We have yet to find a group that is doing a comprehensive job of covering avian events, much less a site where the information is presented in an accessible form.

The media is clear that it should be watching, but does not know how to do it.  The New York Times’s Science Times (March 28, 2006, pp. D1-D8) devoted a special section to the topic.  It calls Avian Flu “The Uncertain Threat.”  The title article, which is in itself indecisive and wandering, is entitled “How Serious Is the Risk?”  Dr. David Nabarro at the UN is a worrier; Dr. Jeremy Farrar at the Hospital for Tropical Diseases in Ho Chi Minh City, thinks a human pandemic is unlikely, having watched the slow progress of the disease over some 3 years.

Roeder.  In the absence of an authoritative and decisive news source, we suggest that researchers track what we will call here science entrepreneurs who are trying to manage, understand, and perhaps offer solutions to the disease.  In general the Wall Street Journal has been better at turning up these people than other publications.  See, for instance, “After Fighting a Cattle Disease, Vet Turns to Birds,” Wall Street Journal, March 16, 2006, which focuses on Dr. Peter Roeder, “a 60-year-old British veterinarian … who has spent decades fighting” rinderpest in Africa and Asia, a devastating disease that has long decimated cattle herds.  “Dr. Roeder … has recently been in Indonesia, helping lead the charge against another—the avian influenza know as H5N1, or bird flu.”  Roder knows that “mass vaccinations don’t always work as well as narrowly targeted attacks on the disease.”  “The key to rinderpest’s defeat, he says, lay in being selective.”  Bird-flu experts are beginning to flock to his thinking: at first they had been thinking about vaccinating billions.  Now they are talking about focusing on Guangdong province which is a particularly feisty breeding ground.  At a macro level, Roder also makes a lot of sense: the general problem in health is to learn how to leverage scarce resources for maximum effect, so much of healthcare being stridently wasteful.

Niman.  Dr. Henry L. Niman enjoys a mixed reception in the scientific community, but, nonetheless, he has been a successful communicator about bird flu, leading a voluntary band of bloggists, who collect and spread information about.  See “A Bird Flu Watched Developes a Following Through the Internet,” Wall Street Journal, March 24, 2006, pp. B1 and B4.  In his Pittsburgh home, “the 57-year-old biochemist keeps vigil over a blog and explosion of offshoot internet discussion groups tracking the avian flu virus….”  “They believe mainstream scientists are missing important clues about the virus’s evolution…”  He now has his own business called Recombinomics where he hopes to develop vaccines.  In general mainstream researches are skeptical about his research and flu theories.  He does think that we have moved decidedly closer to a flu pandemic, obviously scaring his tribe of adherents.  Oddly, the WSJ did not appear to publish a link to his website.  It is helpful to peek at WSJ’s Avian Flu Tracker, which is anecdotal but gives you a decent sense of the evolving news. 

George Mason.  Curiously enough, not many comment on the avian flu site that has been hatched by Tyler Cowen and Silviu Dochia at George Mason University.  The Masonites are doing more than basketball. 

Update: Indonesia Worsening
Indonesia is soon to overtake Vietnam as the site of worst human outbreaks of Avian flu. Forty-two people have died over the last year (New York Times, July 21, 2006, p. A10).  Thailand got control of the flu by killing millions of chickens and by Vietnam instituted mandatory vaccinations.  Indonesia has tried limited vaccinations and flock culling with limited success.  (8/9/06)

Update: Bird Flu Vaccine
GlaxoSmithKline reports that it now has produced effective human bird-flu vaccine (Wall Street Journal, July 27, 2006, p.A2).  “In a clinical trial of 400 people, two doses of Glaxo’s vaccine produced a strong immune response against the H5N1 virus in more than 80% of the people who received it.”  These results are much better than those achieved with vaccines of other drug companies. 

Update: Microchip Flu Test
“Scientists have developed a microchip-based test that could allow more laboratories to quickly diagnose and pinpoint the origin of flu viruses, including the H5N1 avian-flu strain” (Wall Street Journal, August 29, 2006, p. D4).  The FluChip represents a research collaboration between the Centers for Disease Control and the University of Colorado at Boulder.  It will ostensibly be two years before “the test is commercialized” and becomes inexpensive enough for wide laboratory use.  Results were included in the August 2006 issue of the Journal of Clinical Microbiology.  (11/29/06)

177. Arsenic for Brain Cancer
We keep traveling around in circles.  Silver, an old cure for pesky infections, is now being revived to stave off hospital infections.  Once upon a time, arsenic (in the form of salvarsan) was the only cure for syphilis.  Now it’s the hope for some intractable brain cancers.  (2/22/06)

176. Silver Standard
We have always preferred silver to gold—now we can rationalize our aesthetic choice.  Silver, it turns out, has curative powers.  Its use against bacteria dates back to the ancients.  “In 1884, a German doctor named C.S.F. Crede demonstrated that putting a few drops of silver nitrate into the eyes of babies born to women with venereal disease virtually eliminated the high rates of blindness amongst such infants” (New York Times, December 20, 2005, p. D5).  Silver is staging a comeback, because of bacterial resistance to many antibiotics and because scientists, manipulating silver ions, can put together more powerful potions.

175. Just Medical Blogs
Thomas P. Stossel, American Cancer Society Professor at Harvard Business School, has correctly urged us to take medical journals with a grain of salt.  In “Mere Magazines,” Wall Street Journal, December 30, 2005, p. A16, he finds that they are regarded with too much reverence, in that the research they include (a) is not subject to the rigorous detailed examination processes that are required, for instance, in FDA reviews and (b) is normally herd-driven—the articles that get accepted tend to tow the party line, tracking current conventional theories in the medical field.  “Anonymous peer review by jealous competitors has its merits, but it has a tendency to select for fashionable if relatively unoriginal and inoffensive papers.”  For this reason we should not get so exercised when editors at the journals raise a storm about researcher ties to corporate sponsors.  Plenty of bad research creeps in with the good under present editorial guidelines, and there is no clear indication that corporate sponsorship of researchers, in whatever form, has created tainted research we should suspect. 

174. 95% Success Rate
One really has to perk up when you come across a 95% success rate.  It’s a dirty secret of hospitaldom that infections run rampant in our best institutions and there’s a good chance you will die from them rather than from a high-risk operation on your next visit to the operating room.  But John Hopkins has found a way around this, as we learn from Peter Kindlmann of Yale and Lee Schulman, president of the Carnegie Foundation for the Advancement of Teaching: 

This makes thought-provoking reading.  It is about quality control in teaching, overtly here in a hospital setting, but by implication also in an engineering program or a company.  It proposes an aggressive attitude, such as in the Johns Hopkins program (described below) which is an aggressive drive to lower to zero the infection rate in intensive care units.  The protocols are stringent and are working.

Early on in this new routine, every nurse was handed two phone numbers—the home phones of the medical school dean and the university president—and told that if a physician didn’t follow protocol and refused to abort the procedure, they were to phone one of these numbers, even at 3 a.m.  That only happened once.  The infection rate at Johns Hopkins for that procedure is now approaching zero.

The piece concludes by asking how much engineering education and student success in courses could be improved by similar methods.

Faculty and teaching institutions face many impediments, just like physicians; the conditions and capabilities of our students are often unknown. But what if at some universities the president was called every time a student failed?  This proposal sounds crazy, I know, but that’s just the point.  We’re too comfortable with our failures; we take them for granted. The good news is that we can do much better. We know a great deal today about how to organize our institutions and classrooms so that students not only stay but achieve at high levels, and research in the cognitive sciences and other fields provides grist for further improvements.  I know we lack the resources.  I know we lack the administrative and policy support.  I know that some students we inherit are already deeply wounded.  Nevertheless, we need to ask much more of ourselves. Education is no place for modest ambitions.

173. Strokes—Before and After
A Simple Test.  If you think a friend has had a stroke, give him or her this simple test:  Ask him to smile; ask him to raise both arms; ask him to speak a simple sentence.  If he can’t do one of the three, call 911 for emergency help.  For more on the success of this procedure, look at the American Heart Association’s “Just a Minute.”  Or, if you prefer, look up the more complicated list of warning signs on the American Stroke Association website, which is a division of AHA.

172. Blood Readers
“Researchers at Royal Philips Electronics are developing pinprick blood sensors that can detect certain diseases within minutes.  Today’s blood screens can’t spot malaria at an early stage, when the infection is still treatable, because the tests don’t pick up trace particles of the malaria parasite.”  The Philips tests can, and the thought is that it would have high relevance to early detection of heart problems.  It is trying to bring this approach to market as early as 2009.  See Business Week, October 24, 2005.  Even more exciting, we think, is the prospect of biometric sensing systems which would not even prick the skin to read the blood.  The speculation is that they, too, could do very sensitive readings.  (12/7/05)

171. Surgery and Cancer
Years ago, when we could offer cancer patients little hope in many instances, we noticed that surgery seemed to exacerbate an existing cancer and hasten the death of patients upon whom operations had been performed.  Recent studies suggest that “removing a tumor can trigger a process that leads to new growth” (Wall Street Journal, September 13, 2005, pp. D1 and D3).  “In a database of 1,173 breast-cancer patients treated with surgery from 1964-1980 … 520 relapsed.”  “In a 2002 paper published in the journal Lancet, colon-cancer patients who had traditional surgery had a significantly higher rate of relapse than patients who had a minimally invasive laparoscopic procedure.”  See http://breast-cancer-research.com/content/6/4/R372.

170. Teeth without Pain
“Swedish dental implant maker Nobel Biocare … received Food and Drug Administration approval last May for Teeth in an Hour, a quick, minimally invasive procedure for replacing several to all of a patient’s teeth.”  Using Nobel software, dentists do a CT scan of patient’s mouth to perform an analysis.  “Nobel’s Swiss factory uses  these plans to make a stencil-like mouthpiece, predrilled with tiny holes to guide the dentist through surgery.  Once the patient is in the chair, the doctor can affix a set of new chompers in about an hour.”  There are 75 dentists doing the procedure now, but Nobel expects to quickly train more.  The treatment is pricey, $2,000 to $3,000 per implant, or some $60,000 for the whole mouth.  See Forbes, September 5, 2005, p. 103 and www.nobelbiocare.com/global/en/default.htm?langdetect=en.  (10/19/05)

169. Low Cost Medical Care in India
“Mr. Beeney’s story is becoming increasingly common as Europeans and Americans, looking for worldclass treatments at prices a fourth or fifth of what they would be at home, are traveling to India” (New York Times, April 7, 2005, p. C6). Also x-ray scan interpretations and lab testing is being done at low cost in India.  (9/28/05)

168. Growth of Wound-Care Market
Kinetic Concepts is expected to hit $1.2 billion this year, particularly because of double digit sales of its line of vacuum-assisted wound healing devices.  Most of its wound healing technology was acquired from Wake Forest University in 1994.  Its vacuum canisters keep wounds moist as well as sealing them to prevent infection.  “Other recent products include Smith & Nephew’s Acticoat dressings, which incorporate microscopic silver nanoparticles from NuCryst Pharmaceutical to enhance antimicrobial activity.  Another newcomer is a device from Celleration that uses ultrasonic energy to spray a saline mist on wounds.” Johnson and Johnson’s Regranex is a wound care gel incorporates blood cell proteins helpful in early stages of healing.  Oculus Innovative Sciences produces a “superwater,” chlorinated water with charged oxygen ions that it claims will rapidly kill bacteria, spores, etc.  The resultant liquid it calls Microcyn and it has had good results in Mexico, India, and Italy.  See the New York Times, August 5, 2005, p. C3.  (9/21/05)

167. Cutting Down on Cut Ups
Business Week (July 18, 2005, pp. 32-35) headlined a very provocative article called “Is Heart Surgery Worth It?”  To a host of medical experts, it is not at all clear that heart surgery isn’t vastly overdone, and many would contend it should be done away with except in instances where the patient is clearly in dire trouble. Norton Hadler, medical professor at UNC-Chapel Hill and author of Last Well Person, thinks bypass surgery in particular should have been relegated to the junk heap a decade ago.  On the other hand, Dr. Timothy Gardner, a cardiac surgeon in Delaware and co-editor of Operative Cardiac Surgery thinks bypasses have worked very well indeed.  Heart surgery is $100 billion industry, and so there are not only health but vast economic questions at stake.  Further, the amount of surgery done may be a proxy for a more general problem—runaway, costly, and ineffective treatment throughout the healthcare establishment.  Both Fisher and Wennberg at Dartmouth have long claimed that a sizable portion of healthcare is not driven by either need or results, but rather by available supply.  (9/7/05)

166. Ex-pounded Governor
We remember that Governor Bill, later Pres Bill, had a terrible fondness for all sorts of junk food, constantly battled his waistline, and finally had to give himself over to major heart surgery.  Now we learn that current Governor Mike Huckabee is battling weight in one and all.  He shed 100 pounds by the end of 2004, all recounted in his book Quit Digging Your Grave with a Knife and Fork.  See “The Governor Who Put his State on a Diet,” New York Times, August 10, 2005, p. D2. “His transformation led him to begin the Health Arkansas initiative … the goal of which has been to persuade” his fellow citizens “to join him….”  Under the program, state employees “are given 30 minutes a day for exercise.”  They also get days off as a reward for healthy living.  If all this is not satisfying, one can buy Liza Ashley’s Thirty Years at the Mansion, full of recipes she used to fatten up 7 Arkansas governors.  Read about the fatty years at www.augusthouse.com/catalog/detail.asp?bookID
=530&catID=52.  (8/31/05)

165. Piecework
Boston surgeon Atul Gawande in “Piecework,” New Yorker, April 4, 2005, pp. 44-53, wrote sensitively and provocatively about doctors’ compensation and skyrocketing health costs.  As he points out, physician incomes are a fairly small part of the out-of-control health care pie, but “we’re responsible for most of the spending.”  Nonetheless, some physician incomes are inordinately high.  In surgery, where one effectively gets paid by the operation, this leads, among other things, to an excessive numbers of procedures.  Recent articles have speculated that perhaps 90% of all heart surgery should not be done.  Responsible studies, basically using Medicare data, out of Dartmouth show tremendous treatment variability from one section of the country to another, with no improvement in care or mortality in regions with higher expenditures.  Researchers, as a result, believe that as much as 1/3 of our medical expenditures are unwarranted, driven by an excess supply of physicians and medical facilities.  Perhaps a great deal of this waste results from trade rules that allow a physician to get paid for procedures done or hours expended—instead of for health results.  (8/31/05)

164. Prostate Bible
A prostate specialist and surgeon for 25 years, Dr. Peter Scardino has authored a book—Dr. Peter Scardino’s Prostate Book—that looks at cancer, prostatitis, BPH, and everything else that can go wrong with the prostate.  As The Economist points out, the book is sorely needed.  Prostate cancer, if caught early, is curable, and yet more men die of it than any other cancer except lung.  See The Economist, April 9, 2005, p. 70. Scardino is prostate cancer chair at Memorial Sloan-Kettering.  Interestingly, Scardino got his first degree from Yale—in religious studies.   

Even with Scardino, prostate sufferers will want to read further.  One site with a great deal of digestible information is Phoenix5.org to include links to articles such as the famous Andrew Grove account in Fortune (www.phoenix5.org/articles/menuarticles.html).  We cannot emphasize enough that the Phoenix site is terrific and it should be consulted by anybody with even the vaguest interest in prostate cancer.  And here is yet another reading list: www.seattleprostateinst.com/readinglist.htm.  The sources on prostate problems are wide and deep.  (8/31/05)

163. Arsenic Aplenty
In our “Ninety Degrees of Uncertainty,” we touched upon the widespread arsenic contamination of water supplied in both the United States and abroad.  Environmental Health Perspectives, June 2005, looks broadly at the extent of this problem and at new tools for remediation, commenting also on the range of illnesses—cancers as well as cardiovascular and neurological complaints—that can result from this pollution.  See Environmental Health Perspectives.  We have come such a long ways from 1910 when Paul Ehrlich introduced salvarsan (arsenic based) for syphilis in those days before antibiotics, a time when venereal disease sufferers had no effective remedy for their complaints.  Now arsenic itself is the hidden scourge.  (8/3/05)

Update: Dealing with Arsenic
We have previously talked about a world pervasive problem: drinking water that is polluted by toxic quantities of arsenic.  Wells dug some 30 years ago to give villagers in developing countries clean water have turned out to have goodly quantities of arsenic. The wells were a response to bacterially afflicted surface water that led to a host of diseases (www.csmo
nitor.com/2005/0217/p14s01-sten.html).  Finally in 2004 “Tommy Ngai, an MIT graduate student, bought a round plastic bin at a street market in Kathmandu, Nepal.  He and the team filled it with layers of sand, brick chips, gravel, and the magic ingredient—a layer of locally bought iron nails, which chemically bind arsenic to them.  The filter may just be the MIT team's silver bullet, a combination arsenic and biological filter.  Cost: less than $16.”  Of course, this solution may work out in Bangladesh, one of the hardest hit nations, but probably won’t apply to millions of others with somewhat different water conditions in many other nations.  There’s a million-dollar prize out for a more comprehensive solution to the arsenic, and teams at both Harvard and Columbia are working on the problem.  (9/14/05)

162. The Ultimate Sunscreen
“Mexoryl SX, made by the Paris-based skin-care giant L’Oreal, is an illegal sunscreen in this country, one that is thought to be particularly useful in preventing wrinkles.”  It is sold on the side, in any event, by some druggists on the Upper East Side of Manhattan.  “The Canadian website feelbest.com “sells a three-ounce tube for a little over $20,” well under what U.S. druggists peddle it for.  In particular, mexoryl blocks the full range of sun rays effectively, not only the UVB rays to which we attribute sunburn, but the equally harmful UVA rays.  So far the FDA has approved only zinc oxide, titanium oxide, and avobenzone (Parsol) for UVA protection.  UVA rays (320 to 400 nanometers vs. 290 to 320 for UVB)  have a longer wavelength.  Here, we are reminded of the problem we have had in the microwave area, where, traditionally, American devices only offered protection for a narrow part of the spectrum, and waves that were actually more dangerous long term were allowed free range.  See the New York Times, June 9, 2005, p. E3.  (7/27/05)

161. Anti-Scar Drug
Mark Ferguson and Sharon O’Kane of Manchester University have formed a well-funded, venture-backed company called Renovo to develop, test, and market a drug they have developed called Juvista, a synthetic version of TGFbeta3, a protein that acts to both prevent and remedy scarring.  In the 1980s, Ferguson discovered “that wounds an alligator suffered as an embryo would not result in any scarring,” due, as it turned out, to presence of “transforming growth factor beta 3.”  Now in final stage clinicals, the drug should go to market in a few years.  “Scarring of the skin affects an estimated 42 million patients in the U.S.  …  Renovo has three other anti-scarring drugs in advanced clinical trials and an additional 13 in the pipeline.”  The thought, too, is deal with internal scarring as well.  See Business Week (May 30, 2005, p. 89) and www.renovo.com.  (7/13/05)

160. Gene Tests and Coumadin Safety
Scientists at the University of Washington in Seattle and Washington University in St. Louis report that an understanding of the genetic makeup of patients who require coumadin as an anti-clotting agent will eventually provide guidance to physicians trying to establish a proper dosage for this very tricky drug.  Our conversations with conservative physicians indicate that this would not be their drug of choice, because it is difficult to keep its presence or density in the proper range for effective treatment and yet avoid possible side effects.  We should note here that new drugs are beginning to enter late-stage trials that are safer and actually dissolve clots, rather than inhibiting the formation of new ones, which is all that coumadin achieves.  “Dr. Rieder said his team knew that variations in a gene controlling an enzyme known as CYP2C9 accounts for about 10 percent of the differences among patients in their response to warfarin.  But doctors seldom test for the gene, in part because the finding involves relatively few patients.  In this study, the team focused on another gene known as vitamin K epoxide reductase (VKORC1).  The gene makes a protein that breaks down warfarin in the body.”  The latter gene accounts for 25 percent of the variation in warfarin (coumadin) doses in patients under study.  See the New York Times, June 2, 2005 and “Effect of VKORC1 Haplotypes on Transcriptional Regulation and Warfarin Dose,” The New England Journal Of Medicine, June 2, 2005.  (7/6/05)

159. Artery Disease in Seniors
For people over 60 and for those particularly at risk for strokes, artery sc