Histotripsy: Solid Tumor Oblation With Ultrasound

“Early tests suggested that the sound waves successfully decimated up to 75 percent of liver tumor material in the rat bodies, which enabled the little critters’ immune systems to jump into action and beat the leftover cancerous tissues out of existence, preventing reemergence…

…The new treatment is called “histotripsy,” and it noninvasively directs ultrasound waves so that the target tissue is mechanically destroyed — and with millimeter precision. This novel technique is presently being deployed in a human liver cancer trial in both the U.S. and Europe.

This is significant because a great number of clinical situations preclude direct (read: invasive) interventions, because of the size of the tumor, its location, or stage. But this new study looked at reducing only a portion of the cancerous bodies, leaving behind much of the tumor intact. This method also enabled the team of UM researchers to exhibit the effectiveness of the novel approach in less than ideal conditions.

-Brad Bergan, “A new technique successfully fried up to 75 percent of tumors using ultrasound.” Interesting Engineering. April 18, 2022.

Lots of interesting developments with ultrasound. There’s point of care ultrasound, which is bringing ultrasound imaging into the clinic. And now, there’s an interventional technique for solid tumors. Really interesting.

Chances of Dying From an In-Hospital Medical Error

“Errors in medicine include wrong diagnoses, drug dosage miscalculations, and treatment delays. These errors are likely to be underestimated because studies tend to focus exclusively on hospitals and not on the rest of the healthcare system; because some errors may only have debilitating effects years down the road for a patient and are thus harder to trace; and because reporting these errors may not be encouraged by the medical culture. The patient safety movement is important because errors that can be prevented should be prevented…

…A study from the UK reports that 3.6% of hospital deaths were due to preventable medical error; a similar study out of Norway reports 4.2%; and a meta-analysis of the problem published in the BMJ in 2019 concludes that at least one in 20 patients are affected by preventable patient harm, with 12% of this group suffering from permanent disability or dying because of this harm.”

So, let’s do some back of the envelope math. The American Hospital Association says there were 36,241,815 hospital admissions in 2021. The most recent data (2019) I can find is on Wonder that has in-patient hospital deaths was 813,249, which is close to the what was previously reported for a year. So, roughly 28,000 people die in hospitals due to medical error and 56,000 have some kind of disability as a result. If you look look at mortality by condition for 2019, that can look like a lot, depending on what you want to focus on, such as the same level as flu or twice the level of dying from inhaling food or vomit. But, some of that is due to the categories of cause of death and how Wonder reports them. When those get put into official lists, like the top causes of death, the number of flu deaths doubles and more than twice as many commit suicide as die as in-patients in a hospital due to medical error.

So, I guess the lesson here is that any time you enter a hospital, it is not without some risk. But, let’s put that risk in context. Of those entering a hospital, 2.2%, die. The chances of someone dying as an in-patient due to medical error are 4% of the 2.2%, or ~0.88%. If you want to put that risk in some kind of comparable risk category of preventable deaths, its just a little less than dying from an accidental gun discharge or sunstroke. Presumably the risk is higher the more severe your condition and isn’t uniform.

The United States, Pro-Life as Sickness

When visiting Brussels, Belgium, Engelhart speaks to Wim Distelmans, an oncologist and euthanasia proponent, about whether assisted death should be offered to more people in the United States. “It’s a developing country,” he tells her. “You shouldn’t try to implement a law of euthanasia in countries where there is no basic healthcare.” A reader wonders, then, what it means to assert dignity within circumstances that do not do the same….

The Inevitable is interested in dignity and how people define it, but it does not ask so explicitly whether the state, and the laws it creates, can recognize people’s dignity in the first place. If our systems of governance fail to care for so many — and kill others on death row and in the streets — can they be trusted to control the choice to die? If a “developing country” without universal health care did offer wide access to assisted death, one wonders whether its use could make that country’s ills more obvious, more urgent, less ignorable…

…“Philip came to think that efforts to suppress rational suicide were ‘a sign of an increasingly sick society,’” Katie Engelhart writes. “They were a sign that, maybe, society wasn’t so confident in its reasons for insisting on life.”

-Elena Saavedra Buckley, “The Dignified Exit.Los Angeles Book Review. July 23, 2021.

Open Question: What is dignity, and what does it mean to die with it?

Open Question: Is the United States a developing country, from a moral, maturity or other perspective?

I has never occurred to me to think of the United States as a developing country. But, really, when you say something like “American Taliban”, you know exactly who that refers to and what that means. What is the difference? Does living in the “richest country in the world” make any difference if you can’t afford to see the doctor you need? How is that different than having no doctor to see at all?

Lipid Nanoparticles TED Talk by Kathryn A. Whitehead

“What if you were holding life-saving medicine … but had no way to administer it? Zoom down to the nano level with engineer Kathryn A. Whitehead as she gives a breakdown of the little fatty balls (called lipid nanoparticles) perfectly designed to ferry cutting-edge medicines into your body’s cells. Learn how her work is already powering mRNA-based COVID-19 vaccines and forging the path for future therapies that could treat Ebola, HIV and even cancer.”

CRISPR Enzyme Programmed to Kill Viruses in Human Cells

“Many of the world’s most common or deadly human pathogens are RNA-based viruses—Ebola, Zika and flu, for example—and most have no FDA-approved treatments. A team led by researchers at the Broad Institute of MIT and Harvard has now turned a CRISPR RNA-cutting enzyme into an antiviral that can be programmed to detect and destroy RNA-based viruses in human cells.”

Broad Institute of MIT and Harvard, “CRISPR enzyme programmed to kill viruses in human cells.” Phys.org. October 10, 2019

Clinical Trial Society

“One implication is that 25, 50, 250 years from now, we become a kind of clinical-trial society in which empirically driven decisions are constantly popping up. But by clinical-trial society, I mean all sorts of questions, because the information net becomes so rich — and the capacity to understand or deconvolute that information, because of computational power and because of A.I.-dependent algorithms, becomes so rich — that we begin to subject aspects of human behavior, human selves, that were previously considered outside the realm of assessment to a kind of deeper clinical assessment.”

—Siddhartha Mukherjee in roundtable discussion with Regina Barzilay, George Church, Jennifer Egan, and Catherine Mohr in “From Gene Editing to A.I., How Will Technology Transform Humanity?New York Times Magazine. November 16, 2018.

This discussion strikes me as terribly naïve and would have benefited from the perspective of someone like James C. Scott. Legibility on the scale imagined here may benefit the average person, but it will primary serve the interests of capital. It will be an instrument of social control and a catalyst of inequality, as Egan points out.

Another issue? What kind of human beings will be created when we start becoming a manufactured product? And what of those born outside this process? Will people whose DNA hasn’t been scrubbed to acceptable norms be second-class citizens? Who decides what those norms will be?

Technological utopianism is just as bad as any other fundamentalism. Science and knowledge will always be serving someone’s agenda, and while the benefits may trickle down, it shows a series lack of historical perspective to imagine it will primarily benefit those on the receiving end.

Who the Fuck is SWIM?

“SWIM has done it all, from the most obscure pharmaceuticals to the hardest street drugs, at every dosage, in every combination. SWIM has shot black tar heroin in Thailand, drunk ayahuasca in Peru, binged on Quaaludes in Beverly Hills. SWIM has been to hell and back, cheated death, seen God. SWIM has survived hospital stays, nights in jail, leaps from treacherous heights. But like any legend worth the designation, SWIM is an enigma, impossible to know firsthand. Other users endlessly refer to SWIM’s experiments, but novices search in vain for posts actually written by SWIM. There are none to be found. This absence results in a recurring refrain from first-time posters: ‘By the way—who the fuck is SWIM?'”

—Shuja Haider. “Ambien Diaries.” Popula. July 22, 2018.

Amazon Health – Stratechery by Ben Thompson

“At the same time, the U.S. healthcare system is inextricably tied up with the post-World War 2 order; indeed, the entire reason employers are so important to the system is because of World War 2 regulations that instituted price controls on wages, incentivizing employers to use benefits as a means of attracting workers (this was further enshrined by making healthcare benefits tax-exempt)…

…My expectation, then, is not that the Internet methodically disrupts industry after industry in some sort of chronological order, but rather that the entire edifice lasts far longer than technologists think, only to one day collapse far quicker than anyone expected.

The ultimate winners of this shakeout, then, are not only companies that are building businesses predicated on the Internet, but just as importantly, are willing and able to build those businesses with the patience that will be necessary to wait for the old order to collapse, particularly if that collapse happens years or decades after the underlying business models are rotten.

There is no more patient company than Amazon.”

—Ben Thompson, “Amazon Health.” Stratechery.com. January 31, 2018.

Reuters Investigates “The Body Trade”

“Each year, thousands of Americans donate their bodies in the belief they are contributing to science. In fact, many are also unwittingly contributing to commerce, their bodies traded as raw material in a largely unregulated national market.

Body brokers are also known as non-transplant tissue banks. They are distinct from the organ and tissue transplant industry, which the U.S. government closely regulates. Selling hearts, kidneys and tendons for transplant is illegal. But no federal law governs the sale of cadavers or body parts for use in research or education. Few state laws provide any oversight whatsoever, and almost anyone, regardless of expertise, can dissect and sell human body parts.

‘The current state of affairs is a free-for-all,’ said Angela McArthur, who directs the body donation program at the University of Minnesota Medical School and formerly chaired her state’s anatomical donation commission. ‘We are seeing similar problems to what we saw with grave-robbers centuries ago,’ she said, referring to the 19th-century practice of obtaining cadavers in ways that violated the dignity of the dead.”

—Brian Grow and John Shiftman, “The Body Trade.” Reuters. October 24, 2017.

UK Scientists Create World’s Smallest Surgical Robot to Start a Hospital Revolution 

“For robots to revolutionise surgery, he said, they need to be versatile, easy to use and small so that surgical staff can move them around the operating room or between operating theatres, or pack them away when they are not being used. “Our robot does all of this and is the first robotic arm to be designed specifically for laparoscopic surgery,” Frost said.”

—Ellis, Rachel. “UK scientists create world’s smallest surgical robot to start a hospital revolution.” The Guardian. August 19, 2017.