Category: Health

Vuity Eyedrops and Americans’ love affair with new meds

by philg

“FDA-approved Vuity eyedrops could replace your reading glasses” (Today):

Just approved by the Food and Drug Administration, Vuity’s new product has been found to take effect in as little as 15 minutes.

“New FDA-approved eye drops could replace reading glasses for millions: “It’s definitely a life changer”” (CBS):

A newly approved eye drop hitting the market on Thursday could change the lives of millions of Americans with age-related blurred near vision, a condition affecting mostly people 40 and older.

Vuity, which was approved by the Food and Drug Administration in October, would potentially replace reading glasses for some of the 128 million Americans who have trouble seeing close-up. The new medicine takes effect in about 15 minutes, with one drop on each eye providing sharper vision for six to 10 hours, according to the company.

“I Swapped My Reading Glasses for Magical Eyedrops” (NYT):

To make matters worse, the whites of my eyes had a pink tinge. Picture Campbell’s tomato soup when you add an extra can of milk. My 20-year-old daughter assured me I did not look high: “But your eye bags are bigger than usual,” she said.

Not only did my eyes retain their bloodshot, rheumy cast during the five days I used the drops, my close-up vision never improved significantly enough to make reading glasses redundant. The drops burned as they went in, too. I’m not talking about an acid kind of pain, more like a lash in your eye, but still unpleasant.

A NYT reader’s comment:

I am an ophthalmologist. This “new” drop is just a rebranding and remarketing of a weaker version of pilocarpine, that we used ages ago to manage glaucoma. The drug is almost never used now to manage glaucoma because of its side effects, including the development of headaches, and, more importantly, an increased risk of retinal detachment. I think this drug represents extraordinary marketing of a very poor idea. The drug was very cheap in higher concentrations, and raising the price for a lower concentration of a drug that isn’t a good idea in the first place is quite extraordinary. I have been wearing progressive bifocals for 20 years. They took about a day to get used to, and provide me with excellent vision at distance near and points in between. and they have no possible side effects.

Is the doc correct? Wikipedia says pilocarpine dates to 1874 (Ulysses S. Grant was president) and, as a friend likes to point out, “If it’s not on the Internet, I don’t believe it.”

Another doc comments:

As an ophthalmologist, I will say that the amount of confusion and general lack of understanding of how eyes actually work that is on display in this article and in the comments here is astonishing. I don’t even know where to begin. To be clear, everyone will eventually experience the effects of presbyopia and cataracts. This is universal, not a “condition” that only some people get. Achieving better vision for near targets can be managed with glasses, contacts, laser refractive surgery (LASIK or PRK) or choice of refractive target when implanting an IOL in cataract surgery. Normal age related presbyopia, as occurs in all human beings, on its own is absolutely not a good reason to undergo surgery, though if there were other good indications to undergo surgery (LASIK, PRK, or cataract extraction) then as I said the near vision can be improved if one wanted through refractive target, though at some expense to the quality of distance vision. Looking through a pinhole aperture can offset some refractive error and enhance depth of focus, but it will reduce peripheral vision and make your vision dimmer. Rebranding Pilocarpine (which we have used for decades to constrict the pupil) seems really ill advised and I wouldn’t recommend it to a patient. But brilliant marketing that they managed to get it approved and have articles in the media calling it a “cure” for the mysterious “disease” of presbyopia. The only cure for presbyopia is for nobody to live beyond the age of 40.

I think that the above is a good illustration of how powerfully we want to believe that the latest products of the pharma industry are safe and effective and that health care = health.

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Measles as a best-case study of how humans stack up to respiratory viruses?

by philg

Nearly two years ago, when public health officials first began talking about “science” in the context of the measures they were taking that would eradicate SARS-CoV-2, the medical school professors whom I know would point out that humans had never beaten a respiratory virus and therefore there was no possible scientific basis for a confident belief that a proposed intervention would be effective.

Influenza is a familiar example of respiratory virus that has laughed at our science and medicine. The common cold viruses are another class that are apparently smarter than us. Measles is a unique case. It has a bizarre-for-an-organism inability to mutate. “Why you need one vaccine for measles and many for the flu” (ScienceDaily, 2015):

The surface proteins that the measles virus uses to enter cells are ineffective if they suffer any mutation, meaning that any changes to the virus come at a major cost.

It’s only possible to speculate why the measles virus would find an evolutionary advantage to being so rigid, but one hypothesis is that measles uses a more complex strategy to get into human cells than influenza. Influenza, for instance, simply requires the binding of one of the sugars that decorate the outside of cells as a means of getting inside. In contrast, measles requires binding to specific cellular protein receptors as its doorway.

Since measles can’t mutate, we have great drugs for treating it and near-100 percent vaccine coverage all over the world, right? Wrong. In fact, measles kills roughly 200,000 people per year (WHO). They’re mostly under the age of 5 so they would have lived at least 50 more years, even in the poorest countries. That’s 10 million life-years lost every year to measles.

How does losing 10 million life-years compared to the killing done by COVID-19? WHO says that 1.8 million humans were killed by COVID-19 in 2020. Unless each one had another 5.6 years to live, which seems unlikely given that the typical victim in Massachusetts was 82 with comorbidities, measles actually took away more life-years than COVID-19. And if we use the British technocrats’ quality-adjusted life year, measles was far more destructive than COVID-19. Measles prevents people from enjoying their healthiest and most vigorous years while COVID-19 chops off the years during which electric scooters are required for mobility.

(The above paragraph raises the obvious question of why hardly anyone in the EU or US cared about measles deaths prior to 2020 or, even now. Nobody would have been willing to spent $10 trillion to save 10 million high quality life-years destroyed by measles.)

Because it is free to mutate, SARS-CoV-2 is a much more elusive enemy than Measles morbillivirus, yet I think our definition of success against COVID-19 is much more stringent than the standard we’ve applied to ourselves when fighting measles. Unless humans have become vastly more capable in just the past year or two, aren’t we setting ourselves up for disappointment?

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Who followed the Elizabeth Holmes trial?

by philg

Who followed the Elizabeth Holmes trial closely? “The Elizabeth Holmes Verdict: Theranos Founder Is Guilty on Four of 11 Charges in Fraud Trial” (WSJ, which is the newspaper primarily responsible for bringing down the company):

At the 15-week trial, Ms. Holmes testified in her own defense, showing regret for missteps and saying she never intended to mislead anyone. She accused her former boyfriend and deputy at Theranos of abusing her, allegations he has denied.

She was found guilty on three of the nine fraud counts and one of two conspiracy counts. She was acquitted on four counts related to defrauding patients—one charge of conspiracy to commit wire fraud and three charges of wire fraud.

The verdict doesn’t make sense to me on its face. If the patients weren’t defrauded with false test results how could the investors have been defrauded? But I didn’t follow the trial, so probably the jury knows a lot that I don’t.

If it were up to me, I would imprison the investors for stupidity in thinking that a young American college dropout knew more about blood testing than the file cabinets full of Ph.D. chemists at Philips, Siemens, and F. Hoffmann-La Roche. I would have been reluctant to find Holmes guilty of anything or sentence this new mom to any prison time.

The man whom Holmes has accused of raping her daily, Ramesh Balwani, goes to trial next. Let’s see if readers, via the comments, can predict the ratio of prison sentence between these two defendants. I am going to guess that the immigrant/accused rapist receives a sentence that is 2X as long as whatever Holmes suffers. This is partly based on “Estimating Gender Disparities in Federal Criminal Cases” (University of Michigan Law and Economics Research Paper, 2018), which says, all else being equal, a person whom the jury identifies as a “man” will be sentenced to 1.6X the prison time that a person whom the jury identifies as a “woman” receives. I moved the needle from 1.6X to 2X because Mr. Balwani is an immigrant and I think both the jury and the judge will be angry that someone emigrated to the U.S. to become a criminal.

(If Mr. Balwani enters into a plea bargain, the above prediction should be revised to 1X.)

Related:

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What percent of GDP would we have to give to the health care industry in order to have enough Covid care capacity?

by philg

“U.S. Hospitals Feel Strained as Virus Cases Surge Again” (NYT, today):

As the Delta variant fuels hospitalizations in the U.S., health care systems struggle.

Health officials may be bracing for the Omicron variant to sweep through the country, but the Delta variant remains the more imminent threat as it continues to drive an increase in hospitalizations.

Health care workers said their situations had been worsened by staff shortages brought on by burnout, illnesses and resistance to vaccine mandates.

More than 55,000 coronavirus patients are hospitalized nationwide, far fewer than in September, but an increase of more than 15 percent over the past two weeks, according to a New York Times analysis. The United States is averaging about 121,300 coronavirus cases a day, an increase of about 27 percent from two weeks ago, and reported deaths are up 12 percent, to an average of about 1,275 per day.

Americans pay nearly 20 percent of GDP into the health care industry. 1 out of every 6055 Americans is hospitalized with/from Covid. That’s 0.017 percent of us. Nobody liked my April 2020 idea of building strip mall Covid care clinics like renal dialysis centers. Nobody likes the proven-to-work idea of home care for medium-sick Covid patients (NYT). So we’re apparently stuck with the model that everyone who needs supplemental oxygen will get it in a hospital bed (of which we have about 920,000). The NYT informs us that we don’t have enough capacity after paying 20 percent of GDP to the health care industry. So that leads to today’s question: how much would we have to pay in order to fund sufficient capacity?

(A friend is a business executive at a VA hospital. He said that the VA system set up some high-capacity Covid wards with appropriate ventilation systems to protect the rest of the hospital (filtering the exhaust air, unlike at private hospitals that dump Covid aerosols out into the environment!). He said that private hospitals won’t do this because Covid surges don’t happen often enough and therefore, profitable though it might be to treat an actual Covid patients, it wouldn’t be profitable to set up a big section that is usually idle.)

Note that Florida is edging out of the safe zone, according to CovidActNow. But, on the other hand, hardly anyone cares enough to talk about Covid, masks, vaccines, etc. From Marco Island, yesterday:

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Doctors admit stealing property, but refuse to give it back

by philg

From the American Medical Association’s Organization Strategic Plan to Embed Racial Justice and Advance Health Equity:

We acknowledge that we are all living off the taken ancestral lands of Indigenous peoples for thousands of years.

From “Prioritizing Equity video series: Police Brutality & COVID-19” (AMA):

I am Dr. Aletha Maybank, I am chief health equity officer at the American Medical Association over the Center for Health Equity. … We work to ensure equitable opportunities and conditions and innovation for marginalized and minoritized people and communities. … So I first want to recognize and acknowledge the land in which we are all sitting on and the Indigenous people who have been here for thousands of years before us, whose land was dispossessed at the same time, able to thrive and survive till this day.

(Doctors accuse the police of “brutality” (see the title), but aren’t doctors collectively a principal reason why lower income Americans end up entangled with the police? Medical bills, oftentimes starting at 5-10X what an insurance company would have paid, lead to evictions and personal bankruptcy (see “Enforcing Eviction: As a national housing crisis approaches, the police side with property against people.” (The Nation)).)

From the American Medical Association’s Advancing Health Equity: Guide to Language, Narrative and Concepts:

The Association of American Medical Colleges’ headquarters is located in Washington, D.C., the traditional homelands of the Nacotchtank, Piscataway and Pamunkey people. The American Medical Association’s headquarters is located in the Chicago area on taken ancestral lands of indigenous tribes, such as the Council of the Three Fires, composed of the Ojibwe, Odawa and Potawatomi Nations, as well as the Miami, Ho-Chunk, Menominee, Sac, Fox, Kickapoo and Illinois Nations.

Doctors are fairly rich. If they admit that they’re on stolen (“taken”) land, why don’t they give the land back to the nearest Native American and then pay him/her/zir/them rent?

Separately, the above language guide contains some helpful tips. It is not “individuals” but “survivors”; it is not “the obese” but “people with severe obesity” (remember that, whatever the term used, the #science-informed optimum medical response to a virus that attacks the obese is a next-to-the-fridge lockdown!):

Sometimes it is not that hard to achieve equity:

Sometimes it is, in fact, way easier than you’d think:

A revenue source by any other name would be just as lucrative?

If you hire people of only one skin color, that’s a “race-conscious” process:

How many enslaved persons show up at the typical U.S. healthcare facility?

If Justin Trudeau’s use of 2SLGBTQQIA+ has you scratching your head, turn to the glossary:

(“It is also not a term that can be used by a non-Indigenous person” yet there is no indication that a Native American contributed to this document. Isn’t putting the term in a glossary a “use” of the term?)

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Philip Roth biography: faith in psychotherapy

by philg

I checked Philip Roth: The Biography out of the local branch of the Palm Beach County Library. One fascinating aspect is the faith that Americans had in psychotherapy, especially Freudian psychoanalysis, in the 1960s. After becoming a bestselling author and National Book Award winner, Roth was paying 50 percent of his income for psychotherapy (for himself, a blonde to whom he was briefly married, and a stepdaughter who came with the blonde).

How insightful were these physician-analysts?

In September 1967, … Roth experienced an ominous malaise that, Kleinschmidt explained, was a psychosomatic manifestation of envy for his friend [William Styron]. Roth denied it: he loved Styron’s novel and was delighted by its success, but Kleinschmidt stood by his diagnosis “right down to the day I nearly died from a burst appendix and peritonitis,” as Roth recalled.”

How did Roth respond to this direct evidence of psychiatry’s lack of explanatory power? By paying Kleinschmidt for an additional 10+ years of therapy.

What did he do with the other half of his money at the time? By order of the New York Family Court, he was paying it to his plaintiff (the blonde). Margaret Martinson had a father who served prison time for petty theft, according to the book. She had two children from a previous marriage that she had broken up via litigation and from which she had a compelling victim narrative to spin (according to the biographer, Roth was a sucker for women who claimed to be victims). She was intelligent and had taken a few college classes, but as predicted by The Son Also Rises, eventually reverted to her family’s overall level of success. The stepdaughter’s valuable relationship with Roth was severed on the advice of Roth’s defense lawyer (since the plaintiff would eventually accuse him of having sex with the girl in order to enhance her alimony claim). One of the topics that Roth discussed with his psychoanalyst was his desire to kill his plaintiff and thereby more than double his spending power. (One reason that Roth was angry with his plaintiff, aside from her continuing bids for increased alimony, was that she had obtained his agreement to marry via fraud. She purchased urine from a pregnant woman and turned that into a positive pregnancy test result, which induced Roth to “do the right thing.”) The topic was being discussed with the medial-psychiatric professional at a tremendous weekly cost right up to the point that the plaintiff was killed in a car accident (1968), thus putting an end to family court litigation that had lasted longer than the marriage and to alimony payments and legal fees that consumed more than half of Roth’s income (he borrowed to pay his lawyers, his plaintiff, and the platoon of shrinks).

Roth avoided remarriage, which, in those pre-child-support-formula days, was a viable wealth-preservation strategy. Roth had sex with a lot of young women, but if they’d gotten pregnant they wouldn’t have been entitled to $millions and couldn’t have made bank like Hunter Biden’s plaintiff. Where did Roth, pushing 40, find women aged 20-23? Teaching at elite universities. It turned out that young female aspiring writers at the time wanted to have sex with a National Book Award winner (and future Pulitzer winner) with connections to New Yorker, Farrar, Straus and Giroux, agents and critics. Given this alternative, they did not want to have sex with their fellow undergraduates who had (a) no money, (b) no connections, and (c) no talent. (Roth actually did help launch the careers of some of his young friends.) Far from discouraging these liaisons, the Chair of the English Department at Penn actually preferentially admitted the best-looking girls to Roth’s oversubscribed class with the idea that sexual relationships would be fostered. (The procurer is described as “gay” in the book, so it is unclear if he is an 2SLGBTQQIA+ victim to be protected or an abettor of Roth’s predatory behavior and therefore on track for cancellation.)

One of the students, Lucy Warner:

Philip Roth never had any children of his own, which is kind of a shame because it would be interesting to see how they turned out and if scribbling out novels is hereditary.

Americans of only moderately high income could live like lords in Europe in the 1960s. Whenever Roth felt like it, he could move to a European capital and live in splendid hotels or apartments. What we today think of as the good life was also much more readily available, e.g., a summer rental in the Hamptons. The writer could be the host of the Wall Streeter, not vice versa.

One area where I developed new respect for Roth is in physical perseverance. He suffered a back injury in the Army (involving a massive potato kettle in the kitchen, not enemy action!) and never recovered. Working at a typewriter was often torture for his shoulders, back, and neck, but he stuck to it until an entire bookcase of works had been produced. This refusal to quit is tough to imagine in our present-day society where almost anyone will quit in exchange for $600/week.

Roth was a passionate Democrat who died in 2018, during the rule of the hated dictator and before he could enjoy seeing Joe Biden deliver his promised victories over both coronavirus and cancer. New Yorker tapped Roth’s spleen in 2017 (Roth was 84 years old at the time):

Last week, Roth was asked, via e-mail, if it has happened here. He responded, “It is easier to comprehend the election of an imaginary President like Charles Lindbergh than an actual President like Donald Trump. Lindbergh, despite his Nazi sympathies and racist proclivities, was a great aviation hero who had displayed tremendous physical courage and aeronautical genius in crossing the Atlantic in 1927. He had character and he had substance and, along with Henry Ford, was, worldwide, the most famous American of his day. Trump is just a con artist. The relevant book about Trump’s American forebear is Herman Melville’s ‘The Confidence-Man,’ the darkly pessimistic, daringly inventive novel—Melville’s last—that could just as well have been called ‘The Art of the Scam.’ ”

Trump isn’t a Nazi, exactly, but he is inferior as a human to a guy who had, according to Roth, “Nazi sympathies and racist proclivities.”

“I was born in 1933,” he continued, “the year that F.D.R. was inaugurated. He was President until I was twelve years old. I’ve been a Roosevelt Democrat ever since. I found much that was alarming about being a citizen during the tenures of Richard Nixon and George W. Bush. But, whatever I may have seen as their limitations of character or intellect, neither was anything like as humanly impoverished as Trump is: ignorant of government, of history, of science, of philosophy, of art, incapable of expressing or recognizing subtlety or nuance, destitute of all decency, and wielding a vocabulary of seventy-seven words that is better called Jerkish than English.”

COVID-19 lockdown proponents can certainly thank FDR for pointing out that the Constitution’s guarantees don’t apply any time that an executive declares an “emergency” (see Korematsu v. United States, in which the Supreme Court agreed with FDR that #AbundanceOfCaution was more important than the purported rights of Japanese-Americans to own property and live outside of detention camps).

“As for how Trump threatens us, I would say that, like the anxious and fear-ridden families in my book, what is most terrifying is that he makes any and everything possible, including, of course, the nuclear catastrophe.”

In other words, Roth foresaw that there would be a military catastrophe during Trump’s administration, maybe nuclear or perhaps a peasant army would defeat our military and its puppets in a foreign capital. Do we give Roth credit for this? He was off by only seven months and even Nostradamus didn’t hit all of the dates precisely.

In the age of 77-inch OLED and streaming everything, could there ever be another Philip Roth? How many people have the patience to read serious novels? Who here has read anything by Abdulrazak Gurnah, for example, winner of the Nobel Prize in Literature 2021? Which author on the current Amazon list of best-selling fiction is in the same league as Philip Roth?

Related:

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Don’t take health advice from the ignorant

by philg

“Why So Many Tennis Players Don’t Want the Covid Vaccine” (NYT, August 30) describes a heretic and a suspected marrano:

Third-ranked Stefanos Tsitsipas caused an uproar in his native Greece this month after he said he would get vaccinated only if it were required to continue competing.

“I don’t see any reason for someone of my age to do it,” said Tsitsipas, 23. “It hasn’t been tested enough and it has side effects. As long as it’s not mandatory, everyone can decide for themselves.”

Giannis Oikonomou, a spokesman for the Greek government, said Tsitsipas “has neither the knowledge nor the studies nor the research work that would allow him to form an opinion” about the necessity for vaccination, and added that people like athletes who are widely admired should be “doubly careful in expressing such views.”

Top-ranked Novak Djokovic has drawn scrutiny for his approach to health issues throughout the pandemic, and has declined to disclose his own vaccination status. Djokovic said it was a “personal decision” when asked about vaccine protocols on Friday. “Whether someone wants to get a vaccine or not, that’s completely up to them,” Djokovic said. “I hope that it stays that way.”

My favorite part of the above is the idea that nobody should listen to the 23-year-old Tsitsipas on the topic of maximizing personal health. From ATP:

(Having chosen to live in tax-free Monte Carlo (Greece, like nearly all of the world’s countries besides the U.S., doesn’t tax non-resident citizens), is it possible that Mr. Tsitsipas could obtain a New York Times stamp of approval as an expert on minimizing tax liability?)

From whom should we take health advice, if not Messrs. Tsitsipas and Djokovic? How about Assistant Secretary for Health in the U.S. Department of Health and Human Services? Here’s Dr. Rachel Levine:

Except in South Dakota and Florida, state governors have held themselves out as experts on public health, confident that muscular government action can, for the first time in human history and contrary to W.H.O. guidance through 2019, stop a respiratory virus. Let’s look at JB Pritzker, the governor of Illinois? He’s issued nearly 100 executive orders so far regarding health in the time of COVID-19. My favorite, of course, is Executive Order #3 (March 12, 2020):

WHEREAS, in late 2019, a new and significant outbreak of Coronavirus Disease 2019 (COVID-19) emerged; and,

WHEREAS, it is necessary and appropriate for the State of Illinois to immediately take measures to protect the public’s health in response to this COVID-19 outbreak;

THEREFORE, by the powers vested in me as the Governor of the State of Illinois, pursuant to Sections 7(1) and 7(12) of the Illinois Emergency Management Agency Act, 20 ILCS 3305, I hereby order the following:

Section 1. The application submission deadlines in the Cannabis Regulation and Tax Act and implementing regulations for submitting in-person applications by March 16, 2020, are suspended as follows:

(summary from the index page: “CANNABIS APPLICATIONS — The deadline for cannabis grower, infuser and transporter license applications is extended, and applicants are now allowed to mail completed applications, rather than submitting in person.”)

Can we see a photo of the heroic health expert governor who protected Illinois residents from a potential shortage of health-promoting marijuana during the global pandemic?

(Perhaps Governor Pritzker is an expert who contributed to CNN’s “Why does smoking pot give you the munchies?”)

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The first computerized medical diagnosis systems (late 1950s)

by philg

“The Automatic Digital Computer as an Aid in Medical Diagnosis” (1959, Crumb and Rupe) is an interesting example of hope versus reality. Computers will turn medicine into a science and they’ll also save money.

The authors predicted that computers in medicine would “contribute to the good of mankind”:

What do we have, 60+ years later? Epic, whose primary function is making sure that the providers get paid!

Were these authors the pioneers? No! The references include a 1956 punched card-based diagnosis system for diseases of the cornea (TIME).

The comments on the article are interesting. Then, as now, we don’t know if computers are useful in medicine because we don’t know how often human doctors are correct:

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Oshkosh: the diabetes organization sells soda

by philg

#OnlyInAmerica: the Juvenile Diabetes Research Foundation sells Pepsi, Mountain Dew, and other delicious drinks in 20 oz. bottles.

What you’ll look like after a week of event food…

The EAA bookstore has a section for the mentally deficient:

Always a good question to ask…

A T-shirt that probably won’t sell out…

Airbus A400 from Germany:

So far a great EAA AirVenture! Yesterday the stream of text messages probably did not bring too much cheer to those in tents:

The radar at 10:35 pm:

(KOSH is in the bottom right, surrounded by a dashed red line for the airshow temporary flight restriction.)

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#Science says masks are the best thing that ever happened to children

by philg

Parking a warm saliva-soaked mask in front of a child’s mouth all day isn’t the most obvious way to protect children from exposure to bacteria and viruses. And “Experimental Assessment of Carbon Dioxide Content in Inhaled Air With or Without Face Masks in Healthy Children” (JAMA Pediatrics, June) heretically suggested that children might be better off with an unobstructed airway.

All is right with the world once more, however. The paper has been retracted by the editors. The only question is why humanity didn’t discover the healing power of full-time mask-wearing centuries ago.

Loosely related:

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