History

“All men are created equal” may be the guiding legal principle for citizens of the United States, but not when it comes to health care coverage and outcomes, says Victor Fuchs, PhD, one of the nation’s foremost health economists and the Henry J. Kaiser Jr. Professor, Emeritus, at Stanford.

In a Viewpoint published today in the Journal of the American Medical Association, Fuchs provides a history lesson on how and why the U.S. health care system spends more than double on per-person health expenditures than other advanced nations, and he offers some strategies for controlling future costs.

“This is the best short piece on U.S. health care that I’ve ever seen,” Howard Bauchner, MD, editor-in-chief of JAMA, told me.

Beginning today, the Affordable Care Act expands the number of Americans receiving preventive care, providing new federal funding to state Medicaid programs that choose to cover preventive services. It also requires that states pay primary care physicians no less than 100 percent of Medicare payment rates for primary care services.

While the health-care reforms mandated in the act include some provisions to motivate health-care providers to become more efficient, less fragmented and more accountable, it doesn’t include revenue sources for all its new services. Fuchs says, “More comprehensive reforms are necessary to avoid financial disaster.”

According to Fuchs, there are three fundamental differences in the U.S. system — driven by its history — that make it difficult for the U.S. to adopt a less costly government-financed health care system. There is a distrust of large government that began when America broke away from the strong-armed British Empire. There is a reluctance to redistribute wealth across all citizens, in part because of the country’s cultural diversity. And there are “choke points” in the U.S. political system — such as the cost of election campaigns and the Senate filibuster — that give deep-pocketed special interest groups the upper hand in preventing sweeping reforms.

As a new Congress returns to work with health care reform high on its new year’s resolutions, Fuchs’ editorial provides a starting point, grounded in history, for a new round of negotiations.

Previously: Study: If Americans better understood the Affordable Care Act, they would like it more, Does the Affordable Care Act address our health-cost problem?, Stanford economist Victor Fuchs: Affordable Care Act “just a start” and An expert’s historical view of health care costs

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.

As the editor of Stanford Medicine, I think a lot about new research, new discoveries, new treatments. So it’s no wonder I find stories of long ago a refreshing change when I’m reading for pleasure. A look at my 10 favorites this year shows my predilection, though there’s lots of new here too. History fan or not, if you read just one, read about the immortal jellyfish! I can’t stop thinking about them.

Undead: The rabies virus remains a medical mystery, by Monica Murphy and Bill Wasik, Wired
An account of a modern attempt to cure rabies, with lots of history woven in.

Can a jellyfish unlock the secret of immortality? by Nathaniel Rich, New York Times Magazine
Including wondrous jellyfish that grow younger and a researcher who breaks the mold, and it’s told with humor and lyricism.

Two hundred years of surgery, by Atul Gawande, New England Journal of Medicine
For gems like this: “Liston operated so fast that he once accidentally amputated an assistant’s fingers along with a patient’s leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.”

Post-Prozac nation: The science and history of treating depression, by Siddhartha Mukherjee, New York Times
Everything we knew about antidepressants like Prozac was wrong. But that’s OK.

The nature of the Knight Bus, by Chris Gunter, Story Collider
A look behind the scenes at top science journal Nature from one of the journal’s editors.

The island where people forget to die, by Dan Buettner, New York Times Magazine
On mellowing out on a Greek island to live to 100. It got me thinking about how to bring more mellowness into my life.

Fear fans flames for chemical makers, by Patricia Callahan and Sam Roe, Chicago Tribune
A great investigation into a chemical industry-funded front group’s deceptive campaign that fueled demand for flame retardants in furniture, electronics and baby products among many other items. The whole four-part series is worth reading. It also explains that the chemicals have been linked to cancer, neurological deficits, developmental problems and impaired fertility — and not only that, but they don’t work.

The measured man, by Mark Bowden, The Atlantic
On one man’s effort to use big data as a tool to guide him to better health. This is either insane, the future, or both.

A family learns the true meaning of the vow ‘in sickness and in health’, Washington Post Magazine
A heartrending, inspiring read for me, though not for all - as evident by the comments.

Previously: My top medical reads of 2011 (aside from those I edited)

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.

Throughout history, mankind has been making predictions about what the future will hold. While many of us only think a few years ahead, two enterprising interns working in 1949 at STAT, a publication from the Stanford School of Nursing (which no longer exists), daydreamed what life would be like at the start of the new millennium.

A colleague of mine stumbled upon the authors’ fun and satiric article (.pdf) not long ago, and I decided to take a moment to compare their predictions with reality. The story is set in the year 2000, where everything is done on screens and the world runs on the latest technologies of a fictitious technology conglomerate named Tele-Tele Inc.

While the story presents a lot of far-fetched and comical ideas of life in 2000, the imagined world of Tele-Tele Inc. actually has a few similarities to modern-day life. In one part of the story, the narrator explores how the School of Medicine has changed:

…I decided to take a look at the old Med School. Surely, this would not be changed by Tele-Med. But to my utter amazement, I found only a large Tele-Transmitter, which I was to learn later, would be used to send Tele-Lectures to the New Tele-Med Students. I was also to learn that these Tele-Lectures could only be received on specially built ceiling screens, designed to put the students in an obviously comfortable position.

Could this have been an early prediction of YouTube and Skype as a way for students to follow lectures?

The article also foretells the impact that advancements in technology would have on patient health care. I spoke about this with article co-author Eldon Ellis, a 90-year-old retired surgeon, who told me:

It’s really important to not let the relationship between doctor and patient get lost in all the technology. Unfortunately, the good features of technical changes sometimes get overwhelmed, and the first thing someone gets is a batch of X-rays and lab studies. What we really need to do is look at the patient and talk to the patient.

The full article is worth a read.

Hot on the heels of reading about the tobacco industry’s connection to the Olympics, I’ve just come across a post on Hodinkee (a great watch blog) detailing a surprising relationship between Swiss watch manufacturer Uhrenmanufaktur Heuer AG (now TAG Heuer) and Brown & Williamson. According to Jeff Stein, the relationship arose out of a need to better position Viceroy cigarettes:

For years, Viceroy’s advertising theme had been balance-”not too strong, not too light, Viceroy’s got the taste that’s right.” A normal ad might depict a woman offering her companion one of her cigarettes, and he, surprisingly, enjoys the taste. The Viceroy was “less masculine than its key competition,” and the brand had a “feminine orientation,” according to internal documents. While the Viceroy couple shopped for flowers, the Marlboro man rode his horse straight into more market share.

The solution, Stein writes, was to make Viceroy the brand of the “auto racer.” To help shape that perception, Brown & Williamson partnered with Heuer to offer a discounted chronograph wristwatch ($88!) with the purchase of a carton of Viceroy cigarettes:

Brown & Williamson contacted Heuer in late 1971 with the idea of offering the Heuer Autavia in a Viceroy promotion. Throughout the 1960s, Heuer was a dominant presence at the racetrack. Its stopwatches, handheld chronographs, dashboard timers, and timing systems were the gold standards in their respective categories.

I don’t want to spoil the rest of the entry, so head over to Hodinkee if you’d like to see another example of how the tobacco industry has, in Jackler’s words, “affiliated its products with cherished and admired cultural icons.”

Previously: A discussion of the tobacco industry’s exploitation of “smoke-free” Olympic Games

An article that appeared in The Telegraph today announced the release of medical records documenting World War I plastic surgery operations on wounded British soldiers.

Although many of the records are only available to descendants of the veterans, the article features an amazing set of before and after photos for one particular soldier. The images may be hard to look at for some, but they also illustrate the breakthrough work of plastic surgery pioneer Harold Gillies, MD, and his brilliant contributions to the field of reconstructive face surgery.

Family historian Debra Chatfield explains in the article:

The medical world owes a great deal to Dr Gillies, as do those who were treated by him in the early twentieth century and anyone who has ever received plastic surgery treatment since then. Without his pioneering developments in this field, plastic surgery might not be as advanced as it is today.

These records are an important source of information for historians, the medical world and those interested in learning about the reality and aftermath of World War I.

Previously: In scar wars, a new hope

Wired Science has a nice, succinct slideshow highlighting a selection of important scientific texts. Among them, of course, is Gray’s Anatomy. Tanya Lewis writes:

Without the work of intellectual giants like Einstein, Newton and Darwin, we might still be in the dark ages. But how many scientists still read the dust-ridden texts where these luminaries first expounded their theories? Thanks to the internet, you no longer have to hunt down these yellowing tomes in a moldy library vault. Here’s the story of 9 famous publications that spun the scientific world off its orbit.

If you have a few minutes, it’s worth looking through.

Photo from Gray’s Anatomy from Wikimedia Commons

As has been covered widely in the news, a researcher hunting through the National Archives for letters by Abraham Lincoln recently uncovered a doctor’s report of the 16th president’s assassination.

Army surgeon Charles Leale, MD, attended the theater the night the President was killed and was the first doctor on the scene. The report reads:

“Having been the first of our profession who arrived to the assistance of our late President, and having been requested by Mrs. Lincoln to do what I could for him I assumed the charge until the Surgeon General and Dr Stone his family physician arrived, which was about 20 minutes after we had placed him in bed in the house of Mr. Peterson opposite the theatre, and as I remained with him until his death, I humbly submit the following brief account.”

A news article from CNN captures the reaction of the researcher, Helena Iles Papaioannou, who works for Papers of Abraham Lincoln:

“You get a sense of helplessness,” said Papaioannou. “I think it was fairly immediate that he realized that the president wasn’t going to recover.” Papaioannou said that, to her, the most moving part of Leale’s report is his account of covering Lincoln shortly after the president was carried to a back bedroom of the Peterson House.

“He talks about how the president’s legs — his lower extremities, from the knees down — were cold, and they brought him hot water bottles and hot blankets. I find that a very touching part of the report.”

The report largely confirms other accounts of the assassination, but adds a few details about times and pulse rate during the night.

via 80beats
Image by the Papers of Abraham Lincoln

TEDMED curator Jay Walker took the stage at last month’s conference to share a medical artifact from the historic Apollo 11 mission. In the brief talk above, Walker recounts the heartstopping tale of the first manned mission to the moon and displays Buzz Aldrin’s electrocardiogram readout in the final moments before Neil Armstrong uttered the iconic phrase “the Eagle has landed.”

Via Medgadget

When Sharon Hunt, MD, arrived at Stanford as a first-year medical student in the fall of 1967, it was just months before the late cardiac surgeon Norman Shumway, MD, and his team would perform the first adult human heart transplantation in the United States. Then just an observer, Hunt would eventually become a key player in transplantation - staying on at Stanford, caring for more than 1,500 heart transplant patients, and becoming a pioneer in the field of post-transplant cardiology.

Hunt recently received a lifetime achievement award from the International Society for Heart and Lung Transplantation. And in a Stanford Hospital piece today, my colleague John Sanford shares some of Hunt’s history and describes the significance of her early work:

“Even after the surgical technique for heart transplantation had been developed and operations had been done, the field was naïve in that people didn’t know how to manage patients,” said cardiologist Michael Pham, MD, MPH, a clinical associate professor of medicine at Stanford. “How do you manage patients who will be on immunosuppressive medications for the rest of their lives? How do you balance the benefit of these drugs with their toxicities in the long run? How do you identify and treat patients who reject their transplanted hearts? These are some of the questions that Sharon has done more than anyone to answer.”

…

“Without Sharon, who took care of these transplant patients after figuring out their medications and complications, there would be no successful cardiac transplantation at all,” said Alan Yeung, MD, chief of cardiovascular medicine at Stanford Hospital and the Li Ka Shing Professor in Cardiology.

Previously: First U.S. heart transplant among the top 50 breakthroughs in science
Photo by Norbert von der Groeben

I’m a big fan of San Francisco Giant Brian Wilson (I’ve got a “Brian Wilson frozen in carbonite” statue sitting on my desk to prove it), so when I heard last week that the injured pitcher would need Tommy John surgery I was more than a little bummed. I did know that Tommy John is no longer synomous with “career-ending” (Wilson could be back on the mound in 12-15 months), but what I didn’t know - until this morning - is the history behind the procedure and the man for whom it’s named.

A CNN article provides a detailed look at Tommy John (medically known as ulnar collateral ligament reconstruction surgery), and offers a look back to July 1974, after the player John felt a “searing pain” in his elbow while pitching a game:

Dr. Frank Jobe was the Los Angeles Dodgers’ orthopedic surgeon and a good friend of John’s. After several examinations, Jobe gave the pitcher grim news: if he didn’t have surgery, he would never play major league baseball again. For John, the notion was unthinkable. And while he trusted Jobe and considered him a friend, the surgery had never been attempted by a medical professional.

“He told me what he was going to do,” John recalled, “He said, if you’ve pulled it off the bone, then what we’ll do is just reattach it to the bone and it will be no problem. But if it’s not, I’m going to have to take this tendon from your right forearm and graft it into your left elbow.”

John, a college math major, asked his surgeon friend for the odds of a successful outcome. Jobe put the odds at 1%.

“Well, I was valedictorian of my high school class and 1% or 2% in 100 is far better than zero percent in 100,” he said.

The article details what happened with John (I won’t spoil it for you if you don’t know) and also reveals what the former player thinks about having his name attached to “such a high-profile medical procedure:”

“If I’d known you could throw a perfect game with this, I would have tried a little harder,” quipped John, now 68. When he refers to the operation, without hesitation, he calls it Tommy John surgery, saying it’s an honor to have the operation referred to by his name.

Photo by StuSeeger