Tag: medical news

How the World’s Richest Country Ran Out of a 75-Cent Face Mask

A very American story about capitalism consuming our national preparedness and resiliency.

Why is the United States running out of face masks for medical workers? How does the world’s wealthiest country find itself in such a tragic and avoidable mess? And how long will it take to get enough protective gear, if that’s even possible now?

I’ve spent the last few days digging into these questions, because the shortages of protective gear, particularly face masks, has struck me as one of the more disturbing absurdities in America’s response to this pandemic.

Yes, it would have been nice to have had early, widespread testing for the coronavirus, the strategy South Korea used to contain its outbreak. It would be amazing if we can avoid running out of ventilators and hospital space, the catastrophe that has befallen parts of Italy. But neither matters much — in fact, no significant intervention is possible — if health care workers cannot even come into contact with coronavirus patients without getting sick themselves.

That’s where cheap, disposable face masks, eye protection, gloves and gowns come in. That we failed to procure enough safety gear for medical workers — not to mention for sick people and for the public, as some health experts might have recommended if masks were not in such low supply — seems astoundingly negligent.

What a small, shameful way for a strong nation to falter: For want of a 75-cent face mask, the kingdom was lost.

I am sorry to say that digging into the mask shortage does little to assuage one’s sense of outrage. The answer to why we’re running out of protective gear involves a very American set of capitalist pathologies — the rise and inevitable lure of low-cost overseas manufacturing, and a strategic failure, at the national level and in the health care industry, to consider seriously the cascading vulnerabilities that flowed from the incentives to reduce costs.

Perhaps the only way to address the shortfall now is to recognize that the market is broken, and to have the government step in to immediately spur global and domestic production. President Trump, bizarrely, has so far resisted ordering companies to produce more supplies and equipment. In the case of masks, manufacturers say they are moving mountains to ramp up production, and some large companies are donating millions of masks from their own reserves.

But given the vast global need for masks — in the United States alone, fighting the coronavirus will consume 3.5 billion face masks, according to an estimate by the Department of Health and Human Services — corporate generosity will fall short. People in the mask business say it will take a few months, at a minimum, to significantly expand production.

“We are at full capacity today, and increased production by building another factory or extending further will take anywhere between three to four months,” said Guillaume Laverdure, the chief operating officer of Medicom, a Canadian company that makes masks and other protective equipment in factories around the world.

And though some nontraditional manufacturers like T-shirt factories and other apparel makers have announced plans to rush-produce masks, it’s unclear that they will be able to meet required safety standards or shift over production in time to answer demand.

Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.

But about 100 million masks in the stockpile were deployed in 2009 in the fight against the H1N1 flu pandemic, and the government never bothered to replace them. This month, Alex Azar, secretary of health and human services, testified that there are only about 40 million masks in the stockpile — around 1 percent of the projected national need.

As the coronavirus began to spread in China early this year, a global shortage of protective equipment began to look inevitable. But by then it was too late for the American government to do much about the problem. Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas. “China is a producer of 80 percent of masks worldwide,” Laverdure said.

Hospitals began to run out of masks for the same reason that supermarkets ran out of toilet paper — because their “just-in-time” supply chains, which call for holding as little inventory as possible to meet demand, are built to optimize efficiency, not resiliency.

“You’re talking about a commodity item,” said Michael J. Alkire, president of Premier, a company that purchases medical supplies for hospitals and health systems. In the supply chain, he said, “by definition, there’s not going to be a lot of redundancy, because everyone wants the low cost.”

In January, the brittle supply chain began to crack under pressure. To deal with its own outbreak, China began to restrict exports of protective equipment. Then other countries did as well — Taiwan, Germany, France and India took steps to stop exports of medical equipment. That left American hospitals to seek more and more masks from fewer and fewer producers.

Mammograms, CT scans, X-rays: Assessing the risk of all that radiation

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An X-ray for knee pain. A CT scan for a head injury. Mammograms every other year, starting at age 50. Over a typical lifetime of radiation exposure from medical tests, a person can start to wonder: How much is too much?

There’s no formula for answering that, experts say, in part because the health effects of radiation don’t add up in a linear way. And while massive doses of radiation are known to be harmful, the small doses used in routine tests are usually safe, especially compared with other health-care choices people make without thinking twice.

“Radiation does have some risk,” says Russ Ritenour, a medical physicist at the Medical University of South Carolina in Charleston. “But it is important for medicine. And in most cases, the risk is quite small compared to the risk of taking too much Advil over your life and other things like that.”

Ionizing radiation – the type that can damage cells – is a daily fact of life even for people who never go to the doctor. Rocks and soil contain radioactive materials, which also appear in our food, our bones and the air we breathe. Cosmic rays barrage us with radiation from space, with higher doses at altitude and on airplanes.

Overall, a person in the United States gets an annual average of about 3 millisieverts (mSv) of background radiation. (Millisieverts are units that measure radiation absorbed by our bodies.)

Added exposure, totaling another 3 mSV each year for the average American, comes from such man-made sources as power plants that run on coal and nuclear fuel, and consumer products including TVs and computer screens. But most of the extra radiation we get comes from X-rays and CT scans, Ritenour says.

Most routine diagnostic tests emit extremely small amounts of radiation. A patient will get about 0.001 mSv from an arm X-ray, 0.01 mSv from a from a panoramic dental X-ray, 0.1 mSv from a chest X-ray and 0.4 mSv from a mammogram, according to Harvard Medical School. (Those estimates vary somewhat, depending on the source and on the specific device used, the size of the patient and other factors.)

CT scans, which take multiple X-rays to create cross-sectional images, deliver higher doses: 7 mSv for a chest CT, and 12 mSV for a full-body scan, according to the National Cancer Institute. Studies have found doses of 25 mSv or more from a PET/CT, an imaging test that requires ingesting a radioactive substance.

With the increasing availability and affordability of imaging technologies, people are getting more tests than they used to. Today, Americans receive more than 85 million CT scans each year, compared with 3 million per year in the 1980s.

Many of those tests may be excessive, argue some researchers, who have been trying to quantify the risks of our increasing use of ionizing radiation in medical imaging. A 2009 study by scientists at the National Cancer Institute estimated that 2 percent – or about 29,000 – of the 1.7 million cancers diagnosed in the United States in 2007 were caused by CT scans. In a 2004 study, researchers estimated that a 45-year-old who planned to get 30 annual full-body CT exams would have a nearly 2 percent lifetime risk of dying of cancer. Other studies are underway to clarify risks, including in children.

But evaluating an individual’s chances of experiencing a bad outcome from any given test or a combination of tests is tricky. Some of the most definitive data on radiation’s health effects come from long-term studies of tens of thousands of people who survived the atomic bombings of Hiroshima and Nagasaki in 1945. Sudden exposure to 1,000 mSv, those studies have found, increased the risk of getting cancer by 42 percent and increased the risk of dying of cancer by 5 percent.

Risks of secondary cancers also rise with the high doses of radiation used in some cancer treatment – a trade-off that often makes sense because doing nothing would be even riskier.

Evidence is murkier about health consequences from lower doses. The Food and Drug Administration estimates that 10 mSv of radiation, an amount typical for a CT of the abdomen, increases lifetime cancer risk by 1 in 2,000. But that calculation assumes that risks are proportional to dose, which has not been proved. Below 10 mSv, there is not enough good data to draw clear conclusions.

There is also no absolute number of scans that constitute a tipping point for health, Ritenour says, in part because our bodies have repair mechanisms that can fix cells damaged by radiation. So while every scan adds to the chances that a problem will occur, radiation doesn’t build up in the body. And damage doesn’t accumulate like water poured into a glass. Theoretically, he adds, 10 mammograms in one day would be riskier than one mammogram a year for 10 years.

“All you can really say is that there’s very little chance a problem can happen” at low doses, says Ritenour, who often consults with patients who have questions about radiation. “It is very unsatisfying in a way. You can’t say, ‘You will definitely have no problems.’ ”

Although health risks from most imaging tests are extremely small, fear can be hard for people to rationalize away. There is a one-in-a-million chance of getting cancer from a chest X-ray, Ritenour says, the same tiny chance of getting cancer from toxins in peanut butter.

Making decisions about diagnostic tests ultimately requires comparing their potential benefits with their potential harms. That balance can be easy to measure if someone has a broken leg or a bullet fragment lodged in their body. But decisions become more nuanced for tests such as mammograms, which catch breast cancers in some women but also produce false alarms that cause unnecessary anxiety and follow-up testing that entails even more radiation. Given the trade-offs, the U.S. Preventive Services Task Force offers evidenced-based advice about many screening tests, and those guidelines can be helpful starting points for conversations with your doctor.

Online calculators can also offer food for thought. When I entered my location, estimated miles traveled by airplane and other information into a tool maintained by the Nuclear Regulatory Commission , I learned that I absorb an estimated 318 millirems, or 3.18 mSv, of radiation each year. Each millirem, according to this government agency, equates to a 1.2-minute reduction in life span, the same accrued from eating 10 extra calories (assuming I’m overweight) or crossing the street three times. In other words, I am likely to die 4 1/2 hours sooner than I would if I could avoid radiation altogether.

While some researchers work to better understand and communicate the risks of radiation, others are refining technologies and procedures, adds Louis Wagner, a diagnostic medical physicist at McGovern Medical School at the University of Texas Health Science Center at Houston. And the field has come a long way.

For example, after studies found an elevated risk of breast cancer among women who had received X-rays for childhood scoliosis, experts say, many health centers switched from taking images from the front of the body to taking images from behind to reduce the cancer risk.

Technicians have made mistakes, such as using higher doses of radiation than needed during scans, and some mistakes have led to expensive legal cases, Wagner says. But those cases are rare. And most machines are now equipped with safety features to avoid overexposure.

“The profession has sought to make use of radiation very, very beneficial to patients with minimal and, I believe, unrecognizable risks,” Wagner says. “I want patients to know the medical profession is avidly pursuing better ways to use radiation to increase the benefits-to-risks ratio. I think good progress is being made.”

V.A. Shuns Medical Marijuana, Leaving Vets to Improvise

7W4TV6V23ZFBJOX2N7Z5A4UJVQSANTA CRUZ, Calif. — Some of the local growers along the coast here see it as an act of medical compassion: Donating part of their crop of high-potency medical marijuana to ailing veterans, who line up by the dozens each month in the echoing auditorium of the city’s old veterans’ hall to get a ticket they can exchange for a free bag.

One Vietnam veteran in the line said he was using marijuana-infused oil to treat pancreatic cancer. Another said that smoking cannabis eased the pain from a recent hip replacement better than prescription pills did. Several said that a few puffs temper the anxiety and nightmares of post-traumatic stress disorder.

“I never touched the stuff in Vietnam,” said William Horne, 76, a retired firefighter. “It was only a few years ago I realized how useful it could be.”

The monthly giveaway bags often contain marijuana lotions, pills, candies and hemp oils, as well as potent strains of smokable flower with names like Combat Cookies and Kosher Kush. But the veterans do not get any medical guidance on which product might help with which ailment, how much to use, or how marijuana might interact with other medications.

SOURCE:https://www.nytimes.com/2018/07/25/us/marijuana-veterans