Medicine

Ebola plush toys have been selling so fast in response to this year’s outbreak that a Connecticut manufacturer, Giantmicrobes Inc., can’t keep them in stock.

The company, which was founded a decade ago, makes stuffed toys based on the appearance of microbes like Ebola, Chicken pox, bed bugs, and even non-harmful microscopic organisms things like brain and red blood cells.

The items are meant to be educational tools for young children, Laura Sullivan, vice president of operations, told CBS News.

There is more here, and for the pointer I thank James Lynch.  Via Tim Harford, here is GiveWell on whether you should donate to Ebola response causes.  Here is how Nigeria and Senegal beat back Ebola, let’s hope we can do the same.  It is a good example of how developing economies can innovate based on cheap labor costs and lots of available labor resources.

Hi future, competency-based learning

by on October 21, 2014 at 9:40 am in Education, Medicine | Permalink

From Inside Higher Ed:

The University of Michigan’s regional accreditor has signed off on a new competency-based degree that does not rely on the credit-hour standard, the university said last week. The Higher Learning Commission of the North Central Association of Colleges and Schools gave a green light to the proposed master’s of health professions education, which the university’s medical school will offer. In its application to the regional accreditor, the university said the program “targets full-time practicing health professionals in the health professions of medicine, nursing, dentistry, pharmacy and social work.”

The link is here, via Phil Hill.

The Ebola risk premium

by on October 19, 2014 at 1:48 am in Current Affairs, Economics, Law, Medicine | Permalink

Underpaid or overpaid?:

They’re looking for the few, the proud — and the really desperate.

For a measly $19 an hour, a government contractor is offering applicants the opportunity to get up close and personal with potential Ebola patients at JFK Airport — including taking their temperatures.

Angel Staffing Inc. is hiring brave souls with basic EMT or paramedic training to assist Customs and Border Protection officers and the Centers for Disease Control and Prevention in identifying possible victims at Terminal 4, where amped-up Ebola screening started on Saturday.

EMTs will earn just $19 an hour, while paramedics will pocket $29. Everyone must be registered with the National Registry of Emergency Medical Technicians.

The medical staffing agency is also selecting screeners to work at Washington Dulles, Newark Liberty, Chicago O’Hare and Hartsfield-Jackson Atlanta international airports.

There is more here, via Matthew E. Kahn.  How much does the regular (non-Ebola) staff earn?

Terrence McCoy reports:

Schultz wants $150,000 for Ebola.com — a price he thinks is more than reasonable. “According to our site meter, we’re already doing 5,000 page views per day just by people typing in Ebola.com to see what’s there,” said Schultz, who monitors headlines the way brokers watch their portfolios, to gauge his domain’s worth. “We’re getting inquiries every day about the sale of it. I have a lot of experience in this sort of domain business, and my sense is that $150,000 is reasonable.”

The full story is here, and for the pointer I thank Michael Rosenwald.

Neil Cummins has a new paper of interest, the abstract is this:

I analyze the age at death of 121,524 European nobles from 800 to 1800. Longevity began increasing long before 1800 and the Industrial Revolution, with marked increases around 1400 and again around 1650. Declines in violence contributed to some of this increase, but the majority must reflect other changes in individual behavior. The areas of North-West Europe which later witnessed the Industrial Revolution achieved greater longevity than the rest of Europe even by 1000 AD. The data suggest that the ‘Rise of the West’ originates before the Black Death.

For the pointer I thank the excellent Kevin Lewis.

IBM on Tuesday revealed details of how several customers are putting Watson to work, showing that cognitive computing has garnered at least an initial interest among different sorts of businesses. Naming customers also helps other businesses feel more at ease about trying the new technology.

In Australia, the ANZ bank will allow its financial planners to use the Watson Engagement Advisor to help answer customer questions. The idea is that the bank can then better understand what questions are being asked, so they can be answered more quickly.

Also in Australia, Deakin University will use Watson to answer questions from the school’s 50,000 students, by way of Web and mobile interfaces. The questions might include queries about campus activities or where a particular building is located. The service will be drawn from a vast repository of school materials, such as presentations, brochures and online materials.

In Thailand, the Bumrungrad International Hospital will use a Watson service to let its doctors plan the most effective treatments for each cancer patient, based on the patient’s profile as well as on published research. The hospital will leverage research work IBM did with the Memorial Sloan Kettering Cancer Center to customize Watson for oncology research.

In Cape Town, South Africa, Metropolitan Health medical insurance company will be using Watson to help provide medical advice for the company’s 3 million customers.

Watson is also being used by IBM partners and startups as the basis for new services.

Using Watson, Travelocity co-founder Terry Jones has launched a new service called WayBlazer, which can offer travel advice via a natural language interface. The Austin Convention and Visitors Bureau is testing the WayBlazer app to see if it can increase convention and hotel bookings.

Veterinarian service provider LifeLearn of Guelph, Canada, is using Watson as the basis of a new mobile app called LifeLearn Sofie, which provides a way for animal doctors to research different treatment options. The Animal Medical Center in New York is currently testing that app.

Watson is also being incorporated into other third-party apps serving retailers, IT security and help desk managers, nonprofit fund-raisers, and the health care industry.

There is more information here.

Average is Over: Physicians

by on October 6, 2014 at 11:18 am in Economics, Medicine | Permalink

Important new research from Fletcher, Horwitz and Bradley:

Like teacher value added measures that calculate student test score gains, we estimate physician value added based on changes in health status during the course of a hospitalization. We then tie our measures of physician value added to patient outcomes, including length of hospital stay, total charges, health status at discharge, and readmission. The estimated value added varied substantially across physicians and was highly stable for individual physicians. Patients of physicians in the 75th versus 25th percentile of value added had, on average, shorter length of stay (4.76 vs 5.08 days), lower total costs ($17,811 vs $19,822) and higher discharge health status (8% of a standard deviation). Our findings provide evidence to support a new method of determining physician value added in the context of inpatient care that could have wide applicability across health care setting and in estimating value added of other health care providers (nurses, staff, etc).

As with teacher value-added measures, which I strongly support, the gain here is not simply that we discover who the best teachers and physicians are it’s that by discovering who the best teachers and physicians are we can discover why they are the best–what techniques are they using that others are not? And from there we can begin to scale and apply those techniques more widely.

Swiss voters on Sunday rejected a plan to ditch the country’s all-private health insurance system and create a state-run scheme, exit polls showed.

Some 64 percent of the electorate shot down a plan pushed by left-leaning parties who say the current system is busting the budgets of ordinary residents, figures from polling agency gfs.bern showed.

Going public would have been a seismic shift for a country whose health system is often hailed abroad as a model of efficiency, but is a growing source of frustration at home because of soaring costs.

“Over the past 20 years in Switzerland, health costs have grown 80 percent and insurance premiums 125 percent,” ophthalmologist Michel Matter told AFP.

There is more here, and for the pointer I thank Samir Varma.

What it is like to be struck by lightning

by on September 28, 2014 at 7:43 am in Medicine, Science | Permalink

To some survivors, these more outlandish claims only serve to reinforce the idea that their very real issues are suspect, too. “I have met people who say they have been struck three times and say the can see the future, play the piano, fuck all night long,” says Utley. “It’s all bullshit.”

Utley’s own case is not so fortunate:

After leaving the hospital, Utley spent months relearning to swallow, move his fingers, and walk. Rehab was just the first chapter of his ordeal, however. In his previous life, Utley was a successful stockbroker who often went skiing and windsurfing. Today, at 62, he lives on disability insurance in Cape Cod. “I don’t work,” he says. “I can’t work. My memory’s fried, and I don’t have energy like I used to. I aged 30 years in a second. I walk and talk and play golf—but I still fall down. I’m in pain most of the time. I can’t walk 100 yards without stopping. I look like a drunk.”

There is much more here, by Ferris Jabr, interesting throughout, hat tip goes to Vic Sarjoo.

It’s one thing for parents to shell out for cram schools or private tutors for their children, but parents in China’s Zhejiang province are taking it a step further. There, parents can give their own blood to earn some extra points on their child’s zhongkao, or high school entrance exam.

Four liters of donated blood will get your child one extra point; 6 liters adds two points; and 8 liters, three. One 28-year-old man on Weibo, China’s version of Twitter, posted that he had surpassed the 4-liter mark, a gift to his unborn child: “[I] want to tell my future son: No worries with the high school entrance exams, Dad has already got you bonus marks!” the man said, quoted in the South China Morning Post. The policy began this July, but parents are able to take into account the blood they donated in the past. The 28-year-old had started donating when he was 18.

That is from Jeanne Kim, there is more here.

Logistics firm DHL is using a drone to fly parcels to the German island of Juist, in what it says is the first time an unmanned aircraft has been authorized to deliver goods in Europe.

The company, owned by Germany’s Deutsche Post, joins the likes of Amazon.com and Google in testing the potential for drones to deliver parcels and packages.

Its drone – the “parcelcopter” – can fly at up to 65 km (40 miles) an hour. It will deliver medication and other urgently needed goods to the car-free island of Juist, off Germany’s northern coast, at times when other modes of transport such as flights or ferries are not operating.

There is more here, via Eli Dourado.

I say yes.  A number of you have been asking me for comments on this now-famous Atlantic piece by Ezekiel Emanuel.  You should read his whole argument, but here is one bit:

…here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Ezekiel basically wishes not to live beyond age 75.  Not that he will do himself in, but he regards that as a limit past which it is probably not desirable to go.  Just to be clear, I don’t read Emanuel as wishing to impose or even “nudge” this view on others, he is stating a personal vision.  Still, it strikes me as a somewhat strange approach to understanding the value of a life or estimating when that value ends.  The value of an individual life is to be sure somewhat ineffable, but for that same reason it is difficult for a life to lose so much of its value.

It is easy for me to see how a person could be a valuable role model for others past the age of seventy-five.  I expect Ezekiel in particular to fulfill this function superbly.  I still think frequently of the late Marvin Becker, the Princeton (later UM) Renaissance historian, who for me was an important role model at the age of seventy-seven.  Marvin often used to say “Oh, to be seventy again!”  He had more than his share of aches and pains, but he was always a comfort and joy to his wife Betty, and most likely to his children and grandchildren as well.

Or visit the list of words in Emanuel’s paragraph, cited above.  Many people are “disabled” to begin with, and many other lives are “deprived” to begin with, for one thing most of the lives in the world’s poorer countries.   But they are still, on the whole, extremely valuable lives.  I don’t just mean that external parties should respect the rights and lives of those persons, but rather internally and individually those lives are of great value.

To pick another word from that paragraph, “creativity” is overrated and most of us do not have it in the first place.  And if one does have it, perhaps its passing is in some ways a liberation rather than a personal tragedy.

I would rather be remembered as “that really old guy who hung on forever because he loved life so much” than as vibrant.  At some points I felt this piece needed a…marginal revolution.

And to sound petty for a moment, I don’t want to pass away during the opening moments of a Carlsen-Caruana match, or before an NBA season has finished (well, it depends on the season), or before the final volumes of Knausgaard are translated into English.  And this is a never-ending supply.  The world is a fascinating place and I fully expect to appreciate it at the age of eighty, albeit with some faculties less sharp.  What if the Fermi Paradox is resolved, or a good theory of quantum gravity developed?  What else might be worth waiting for?

I cannot help but feel that Emanuel is overrating some key aspects of what are supposed to be making his current life valuable, and thus undervaluing his future life past age seventy-five.  (See David Henderson too on that point.)

It was Dan Quisenberry who once said: “The future is much like the present, only longer.”

More to the point, and coming from the marginalist camp, there is Art Buchwald, who noted: “Whether it’s the best of times or the worst of times, it’s the only time we’ve got.”

The Obama administration on Thursday announced measures to tackle the growing threat of antibiotic resistance, outlining a national strategy that includes incentives to spur the development of new drugs, tighter stewardship of existing ones and a national tracking system for antibiotic-resistant illness. The actions are part of the first major federal effort to confront a public health crisis that takes at least 23,000 lives a year.

The full story is here.

The Hill has more detail.  It is an executive order:

The president’s directive creates the Task Force for Combating Antibiotic-Resistant Bacteria, co-chaired by the secretaries of Defense, Agriculture and Health and Human Services.

The group is charged with implementing a plan to track and prevent the spread of antibiotic-resistant bacteria, promote better practices for the use of current drugs and push for a new generation of antibiotic medications.

To that end, the White House on Thursday announced a $20 million prize “to facilitate the development of rapid, point-of-care diagnostic tests for healthcare providers to identify highly resistant bacterial infections.”

The added incentive and the timeframe given to the task force indicate the urgency with which the administration is acting, said Dr. Eric Lander, who co-chairs the President’s Council of Advisors on Science and Technology.

“This is a pretty tight timeline to now come up with a national game plan,” Lander said.

There is also this:

In December, the Food and Drug Administration (FDA) unveiled a plan to phase out the use of antimicrobials for the purpose of fattening chickens, pigs or other animals destined for human consumption. But the plan relies in part on voluntary industry cooperation, and advocates argue the government’s efforts are lagging behind even some industry players.

Here is the new full 78 pp. report to the President on antibiotic resistance (pdf).

This initiative — or its failure — is potentially a more important health issue than Obamacare, yet it will not receive 1/1000th of the attention.  Without reliable antibiotics, a lot of now-routine operations would become a kind of lottery.

Here are previous MR posts on antibiotic resistance.  I would note it is difficult to judge such a plan at the current level of detail.  It is better than nothing, but any initial plan is going to be not nearly enough, relative to an ideal.  By the way, Alex tells me there is also a British prize, discussed here.

Black ebola markets in everything

by on September 15, 2014 at 2:21 am in Economics, Medicine | Permalink

A black market for an Ebola treatment derived from the blood of survivors is emerging in the West African countries experiencing the worst outbreak of the virus on record, the World Health Organization said.

The United Nations health agency will work with governments to stamp out the illicit trade in convalescent serum, WHO Director-General Margaret Chan told reporters today in Geneva, where the organization is based. There is a danger that such serums could contain other infections and wouldn’t be administered properly, Chan said.

The WHO is encouraging the use of properly obtained serum to treat current patients and said last week it should be a priority. A third U.S. missionary worker who was infected with Ebola in Liberia and flown to the U.S. for medical care was treated with blood transfusions from another American who recovered from the virus last month. Doctors hope the virus-fighting antibodies in the blood help the 51-year-old physician, Rick Sacra.

There is more here, and for the pointer I thank John Chilton.

The National Football League, which for years disputed evidence that its players had a high rate of severe brain damage, has stated in federal court documents that it expects nearly a third of retired players to develop long-term cognitive problems and that the conditions are likely to emerge at “notably younger ages” than in the general population.

There is more here, all of it a bit gruesome.