In the 1960s, [Mao] got an appeal from North Vietnam: Its fighters were dying because local malaria had become resistant to all known drugs. He ordered his top scientists to help.
But it wasn’t easy. The Cultural Revolution was reeling out of control, and intellectuals, including scientists, were being publicly humiliated, forced to labor on collective farms or even driven to suicide. However, because the order came from Mao himself and he put the army in charge, the project was sheltered. Over the next 14 years, 500 scientists from 60 military and civilian institutes flocked to it.
[...]
China’s effort formally began at a meeting on May 23, 1967, and was code-named Project 523, for the date.
Researchers pursued two paths. One group screened 40,000 known chemicals. The second searched the traditional medicine literature and sent envoys into rural villages to ask herbal healers for their secret fever cures.
One herb, qinghao, was mentioned on tomb carvings as far back as 168 B.C. and praised on medical scrolls through the centuries, up to the 1798 Book of Seasonal Fevers. Rural healers identified qinghao as what the West calls Artemisia annua, or sweet wormwood, a spiky-leafed weed with yellow flowers.
Worth a read without a doubt. Interesting stories like this make the New York Times the best newspaper in the world.
The Snooki tax, a 10% tax on indoor tanning services, that appeared as part of the ACA and its sister bills may or maynot be “working,” to reduce the use of indoor tanning services as some of the authors intended.
The impact of the tax on consumer behavior remains unclear. Only 26% of salons surveyed reported experiencing fewer clients after implementation of the tax, and distinguishing the impact of the tax from the current economic climate as the source of decline was difficult. Furthermore, a large number of respondents (78%) reported that clients did not seem to care about the tax.
Study participants frequently reported that the salon’s younger and first-time clients were less likely than its older clients to notice or care about the increased prices resulting from the tax. Taken as a whole, these results may indicate that the demand for indoor tanning services is somewhat inelastic and perhaps insensitive to a 10% tax level.
I’m not a proponent of targeted taxes in general; certainly not those targeted to influence behavior. I don’t support the cigarette tax and I don’t support any hypothetical soda taxes and I don’t support the indoor tanning levy. And I wouldn’t be surprised at all if, at 10%, the influence of the tax was nothing or so small as to be impossible to detect.
Senator Mark Kirk is the junior Senator from Illinois. He currently holds President Obama’s old seat which he won in a special election in 2010 to replace Roland Burris.
He has apparently suffered a large right sided, non-dominant hemisphere middle cerebral artery stroke, potentially after a carotid artery dissection on that side. And he’s now undergone a decompressive craniectomy on the right from the late edema suffered with such a large stroke.
Dr. Fessler said the stroke “will affect his ability to move his left arm, possibly his left leg and possibly will involve some facial paralysis. Fortunately, the stroke was not on the left side of his brain, in which case it would affect his ability to speak, understand and think.”
Chances for a full mental recovery were “good” but chances for a full physical recovery were “not great,” Fessler said.
The doctor said he was hopeful that, after rehabilitation at an acute care facility, Kirk would regain the use of his left leg, but said prospects for regaining the full use of his left arm were “very difficult.”
He said recovery is a matter of weeks or months — “it’s not going to be days.” Kirk’s relative youth and good physical shape are positives, Fessler said, and he expects Kirk could return to “a very vibrant life.”
I’m sure they’ve been aggressive considering his age and functional status, not to mention his stature. But to feel the need to go ahead with a craniectomy following a stroke implies a large area of ischemia. Decompressive craniectomy for large middle cerebral artery strokes is not terribly uncommon and the popularity for it has probably grown over the decades. As one, admittedly international paper, describes it.
Decompressive craniotomy in the setting of acute brain swelling from massive MCA infarct is a life saving procedure. It should be considered in patients with initial good GCS, who are deteriorating in neurological status. With the team effort of neurologist and neurosurgeons these cases have good outcome contrary to the natural history of disease…Thus an ideal candidate for decompressive craniotomy is the victim who is young, with no risk factors, who presents early and has nondominant, middle cerebral artery territory infarct, with a reasonable Glasgow Coma Scale with no (or) early signs of herniation. The key for success of these cases of large MCA infarcts is early detection. Clinicians should concentrate on formulating newer clinical, radiological and technical protocols to detect the suitable patients at an early stage.
Certainly from what we know Senator Kirk appears to be an ideal candidate. From the description of his possible long term deficits he appears to have had a large non-dominant hemisphere middle cerebral artery stroke. He is relatively young and fit. And, as The Chicago Tribune describes it, he presented with a relatively good exam and deteriorated quickly.
My thoughts and prayers are with him and his family. He has a long road ahead of him.
A group of public health researchers out of UCSF and Columbia have a piece in the pending edition of Health Affairs. In it they argue that 1c per ounce tax on sugar sweetened drinks would,
prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths, while avoiding more than $17 billion in medical costs
over the next ten years. If you can’t access the full study on Health Affairs behind the firewall then here’s a write up on a Los Angeles Times blog.
First and foremost I have a major problem with taxation to influence behavior. I don’t even like the federal tax on cigarettes. I understand the public health issues involved in second hand smoke. Even factoring those I think something like the tobacco tax, which is beyond discredit in terms of its success, is beyond the purview of the government.
And the junk food tax is likely to be something less effective than the tax on cigarettes and targets a behavior with far few social costs; even admitting that the bill for diseases associated with obesity is footed in part by society in general it is a far cry from say the public health effects of second hand smoke.
Plenty of previous data finds the conclusions of the Health Affairs paper optimistic.
[A] trio of economists analyzed 16 years of U.S. household health data to study the feasibility of using a soft-drink tax to help Americans lose weight. In a 2008 paper, the researchers calculated that a 1-percentage-point increase in the tax would reduce the average body mass index by just 0.003 units.
In other words, an overweight person with a BMI of 27 would end up with a BMI of 26.997 — still well short of the 20-25 range considered healthy.
Even a soft-drink tax increase of 20 percentage points wouldn’t help much, because soda accounts for only 7% of calories in the American diet.
I am highly dubious rising the cost of a can of soda 12c or a six pack by less than a dollar is liable to significantly discourage use.
Tobacco taxes are also much higher than anything likely to be adopted for food and beverages. Slapping a 10% tax on a $1.50-bottle of Coke would raise the price a mere 15 cents — not enough to persuade most shoppers to drink Diet Coke instead. Many calorie-laden foods are simply too cheap to be priced out of the market by any but the most draconian of taxes.
As well, such a tax would be highly regressive since sweetened drink use is inversely proportional to socioeconomic status (myself excluded of course; I go through 4-5 sodas a day).
In the end though, like I said, I just don’t like the idea of government dictating what we should and shouldn’t be eating and drinking. Their role in such, with agricultural subsidies and regulations of commercial foodstuff is already too big. The idea of a tax to specifically influence or diet is too much to take.
Thirteen doctors and nurses who treated anti-government protesters during demonstrations in Bahrain earlier this year have been jailed for 15 years for crimes against the state.
[W]hat human rights activists call a particularly odious aspect of the Bahraini protests: the government’s systematic effort to deny medical services to wounded protesters — partly by jailing or intimidating the doctors, nurses and paramedics who have tried to treat them.
Many medical workers in Bahrain are often too frightened to help protesters, activists say, and the wounded themselves are often too frightened to seek help, fearing they will be arrested.
At the height of the protests, led by the kingdom’s Shiite majority, seeking more rights from the Sunni monarchy, security forces commandeered the Salmaniya Medical Complex, Bahrain’s largest public hospital. Dozens of doctors and nurses who treated protesters were arrested.
In a report last month, Human Rights Watch said the crackdown included “attacks on health care providers; denial of medical access to protesters injured by security forces; the siege of hospitals and health centers; and the detention, ill-treatment, torture and prosecution of medics and patients with protest-related injuries.” It called the attacks “part of an official policy of retribution against Bahrainis who supported pro-democracy protests.”
Greek hospitals have large debts to many drug companies, according to the Hellenic Association of Pharmaceutical Companies, or SFEE. As of June 30 this year, Greek’s state-financed hospitals had paid for just 37% of the €1.9 billion ($2.62 billion) worth of drugs delivered by SFEE member companies in the 18 months to June, 2011, the organization said in a recent report.
[...]
Early this year, Greece tried to clear some of its pharmaceutical debts by giving companies government bonds. “We didn’t have a choice. Everybody got government bonds. The question was, you got nothing or you got government bonds,” Mr. Schwan said, adding that Roche sold the bonds immediately.
[...]
Patients at some hospitals now must take their prescriptions to a local pharmacy, and, in the case of intravenous or injected cancer drugs, bring them back to the hospital to be administered, he said.
Mr. Schwan said patients haven’t been deprived of their medication as a result of the new measures, which he said Roche may need to adopt in Spain, as well. Some state-funded hospitals in Portugal and Italy have also fallen far behind on payments, he said.
There are hospitals “who haven’t paid their bills in three or four years,” Mr. Schwan said. “There comes a point where the business is not sustainable anymore.”
I can’t say, the little I know, I blame the big pharmacutrical companies. I know their margins worldwide, but why, as a for profit enterprise, would you continue these hand outs? For instance Novo Nordisk recieved significant criticism last year when it pulled the FlexPen from the Greek market over a unilateral move by the Greek government to start paying less for medicines. As the Eurozone crisis widens however I’m not sure how far we should expect healthcare corporate compassion and loss to extend.
Sanjay Gupta has been offered, and apparently accepted, the post of Surgeon General in Barack Obama’s incoming administration. It appearsObama holds a special place in his heart for neurosurgeons, which of course brings a smile to my face. I heard on the interview trail that Chicago neurosurgeon, Dr. Gail Rosseau, was close to the Obama camp. Whatever the validity of those claims, apparently she was at least considered for the position of Surgeon General.
Neurosurgeons having their say on matters of public health and health policy is obviously something that interests me and that I have a stake in. But even if that wasn’t the case, Dr. Gupta’s nomination as Surgeon General is something that should be welcomed. That has not been uniformly the case in the media.
Sanjay Gupta Will Have To Grow The Beard
Definitions of both Dr. Gupta and the role of the Surgeon General are probably in order.
Dr. Sanjay Gupta is a Michigan raised neurosurgeon and journalist. He has a significant presence at CNN and has filed pieces and covered everything from public health issues in the United States to international natural disasters to the war in Iraq. Dr. Gupta got his MD and did his neurosurgery training at Michigan with a spine fellowship at UT-Memphis. Not small accomplishments. He holds a faculty position in the Department of Neurosurgery at Emory University.
The role Dr. Gupta would take on as Surgeon General is one with many hats. The Surgeon General heads up the U.S. Public Health Service Commissioned Corps. The Corp has several, sometimes ambiguous, goals but in general works to promote public health. In practice they play a large role in delivering health care to Native American and other underserved populations and providing medical officers for the U.S. Coast Guard. The U.S. Public Health Service Commissioned Corp is a uniformed service and as such shares unique organizational challenges with other uniformed services including the military. Beyond that role however, the Surgeon General’s most important and highest profile responsibility is in communicating public health issues to the public.
The reality is the Surgeon General is vested with little real authority. This is both a challenge and a gift. It has allowed prior Surgeon General’s to voice medically valid opinions on highly politicized topics such as sexuality or drugs of abuse or obesity.
That is where Dr. Gupta’s nomination is so brilliant. As the WaPo piece linked to above notes,
The offer followed a two-hour Chicago meeting in November with Obama, who said that Gupta could be the highest-profile surgeon general in history and would have an expanded role in providing health policy advice, the sources said.
Dr. Gupta would serve a cross appointment in Obama’s new Office of Health Reform directly under new Secretary of Health & Human Services Tom Daschle (who would technically be Dr. Gupta’s boss’ boss as Surgeon General).
I would argue their is no more important skill than communication for the Surgeon General considering his limited influence on policy and the public health of the nation. At least historically. Dr. Gupta is obviously unrivaled as a physician in that aspect. Because of his role on television he has established a relationship with the American public and indeed the world. As a journalist he has proven effective at distilling complicated medical issues down to bite sized chunks that the public can understand and digest.
I have no doubt that Obama intends to use the Surgeon General position as a spokesman not only on matters of public health, as has always been the role of the modern Surgeon General, but on maters of health care policy. I would hope that Dr. Gupta’s position in the Office of Health Reform would be a legitimate one and his voice would be prominent. Apparently he is satisfied as such, as he spoke with Tom Daschle before accepting the position. Dr. Gupta has legitimate experience in the policy arena, he served as a White House Fellow in a previous life. That is impressive.
His experience as a journalist, I would argue, has also made Dr. Gupta, admittedly far removed from some public health issues as a highly specialized surgeon, more than well versed on public health issues. The very issues the Corps is tasked to face.
Dr. Gupta’s nomination is not without criticism however. From what I’ve read the criticisms fall into two categories. Either people question Dr. Gupta’s experience or they cherry pick some commentary he made over the course of his career as a journalist to chide him.
For some the Surgeon General should have some experience in a uniformed service. Dr. Gupta has indeed never served in the military or the Public Health Service. But having donned a uniform in the past, in terms of being able to organize and lead a uniformed service, does not seem an absolute necessity.
Without a doubt, the most famous Surgeon General was C. Everett Koop. Dr. Koop served his time during World War II in the Public Health Service instead of in the military. When he came back to serve as Surgeon General under Reagan, it was to head a Corp he had been a member of. But you will never convince me the Commissioned Corp Dr. Koop came back to, forty years after he had left, was the same Corp he briefly served in during wartime.
Dr. Val over at Get Better Health has an interesting comment from an anonymous source apparently either somewhere in politics or in the U.S. Public Health Service. Here’s what s/he says,
If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.
First, obviously the Surgeon General is required to coordinate and interact with high ranking military leaders but playing the Commissioned Corps of the Public Health Service as analogous to a military uniformed service (as I read the anonymous commenter doing) is a little disingenuous. Let’s draw out that assumed analogy and see why it doesn’t hold up. C. Everett Koop spent a limited amount of time in the lower echelons of the Public Health Service, left for nearly forty years, and then came back to head it. And yet was both accepted and arguably effective (if controversial at times). A similar experience would be a drafted man serving as a private in the U.S. Army through World War II, then leaving and maybe working in the arms industry for thirty years and then suddenly being appointed to head the Joint Chiefs. Impossible, unrealistic and just itching for a disaster.
But that isn’t the case with the Public Health Service. While heading a uniformed service and coordinating with career military and other uniformed service officers, the skills necessary to be Surgeon General and lead the U.S. Public Health Service Commissioned Corp are readily learnable in other careers; making it completely unanalogous to the military.
I understand why those in the U.S. Public Health Service Commissioned Corp would want one of their own to lead them but their really is not something wholly unique about the role of Surgeon General that you must be a career public health servant to be effective.
Second, I think some criticizers are ignoring what the role of Surgeon General has grown into. Let’s be honest, the Surgeon General’s most important role is as a public relations man. Maybe not for the administration, but for something more ambiguous; for public health and healthy living. He or she is the chief medical correspondent for the American public. Dr. Gupta is as qualified as anyone I can think of for such a role.
The other criticisms of Dr. Gupta are more specific. Being a public figure in government is difficult when you’ve put a lot of the record. Dr. Gupta has certainly put a lot on the record as a journalist. He’s put both factual errors and his own opinions, free for others to disagree with, on the record. And even before word of Obama’s choice leaked, and certainly after, critics have cherry picked his work and cited his own words against him.
