Weekend reading: The mystery of some innovations that are slow to be accepted; myths about the obesity crisis

Jul 26 2013

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New Yorker: Slow Ideas
Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics. ... On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw. ... By February, anesthesia had been used in almost all the capitals of Europe, and by June in most regions of the world. ... In the eighteen-sixties, the Edinburgh surgeon Joseph Lister ... perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field. The result was strikingly lower rates of sepsis and death. You would have thought that ... his antiseptic method would have spread as rapidly as anesthesia. Far from it. ... In our era of electronic communications, we've come to expect that important innovations will spread quickly. Plenty do ... But there's an equally long list of vital innovations that have failed to catch on. The puzzle is why (Dr. Atul Gawande, 7/29).

The New Republic: Weight Loss Is Not The Answer: What Michelle Obama Doesn't Get About Obesity
The biggest mystery when it comes to obesity is not how to prevent it. It's how to treat it. Don't get me wrong. We need to know what expands our girth so that millions more don't suffer the type 2 diabetes and heart disease that follow. But millions are obese, right now, and the medical establishment doesn't really know how to help them. I learned that to my dismay when I tried to find a program for a relative who seemed too young for stomach bands and gastric bypasses. The problem is simple and well known. It's hard but not impossible to lose weight. But it's nearly impossible to keep it off (Judith Shulevitz, 7/23).

The Atlantic: Answering To Patient Who Yell The Loudest
Few people would argue that scarce medical resources should simply go to patients and families who yell the loudest, but the recent case of a ten year-old Pennsylvania girl with cystic fibrosis shows how such a strategy can work. The parents of Sarah Murnaghan went to court to demand that their daughter be placed on the transplant list for new lungs.  The court agreed, and she has now received a second set of lungs after her immune system rejected the first set. There is a long-;and storied-;history of activist patients bucking the system to obtain treatments initially denied to them. ... But in an era of rising health care costs and passage of the Affordable Care Act (ACA), which seeks to reign and regulate spending, the privileges of activist patients need to be reexamined (Dr. Barron Lerner, 7/23).

New Scientist: Why Is The Rich U.S. In Such Poor Health?
Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released earlier this year by the U.S. National Research Council and the Institute of Medicine. … As distressing as all this is, much less attention has been given to the obvious question: Why is the United States so unwell? The answer, it turns out, is simple and yet deceptively complex: It's almost everything. ... we can hope that the evidence of a health disadvantage in the United States is now so compelling that the terms of the conversation and even the political calculus will begin to change. Then, perhaps, we can start addressing that disadvantage and stop paying for it with our lives (Laudan Aron, 7/15).

Boston Globe: Hypothermia Making A Comeback In Medicine
The last Dr. Peter Franklin remembers, he was lying on a table in the cardiac catheterization lab in a Miami hospital when his chest started to hurt. Then he died. The medical team raced to restart Franklin's heart, then placed a stent in a blocked artery to allow blood to again flow freely. His doctors also worked to save his brain, using a technique that's as old as ancient Greece -; hypothermia. With recent studies lending scientific credibility to the practice, doctors now know that lowering a patient's body temperature -; using methods including cooling blankets or an infusion of cold fluid -; can improve brain recovery in patients who are comatose after cardiac arrest (Dr. Daniela J. Lamas, 7/22).

The New England Journal of Medicine: The Residency Mismatch
For generations, the supply of practicing physicians in the United States has swung from too small to too large and back again. In 2006, alarmed about a growing physician shortage, the Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade. ... But there's another barrier to creating enough practicing physicians: there are insufficient residency posts to accommodate all these medical graduates. ... The absence of health-workforce planning, a hallmark of the freewheeling U.S. market economy, may come back to haunt policymakers, particularly when physician shortages become more apparent as the ACA's coverage expansion takes hold (John K. Iglehart, 7/25).