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February 28, 2017        

By Mendy Hecht, Hamaspik Gazette

End of an Era: Dr. Thomas E. Starzl, Pioneer of Modern Transplant, 1926-2017

Dr. Thomas E. Starzl, the U.S. surgeon who rose from humble Iowa roots to perform the world’s first liver transplant in 1963 and eventually become the world’s leading authority on organ transplantation, died Saturday, March 4.  He was a day shy of his 91st birthday.

Dr. Starzl’s career-long authority in transplantation gave rise to numerous transplant advances and anti-rejection medicines which in turn saved thousands of lives and gave life to generations.

While launching his surgical career at Denver’s University of Colorado, he worked at the University of Pittsburgh Medical Center (UPMC) from 1980 to his 1991 retirement, turning it into the world’s busiest and highest-profile transplant center.

Dr. Starzl performed about 175 liver transplants at the University of Colorado.  By 2001, the 20th anniversary of Pittsburgh’s first liver transplant, the center’s team had transplanted more than 5,700 livers, 3,500 kidneys, 1,000 lungs and 500 hearts.

Doctors from around the world came to Pittsburgh to train with Dr. Starzl, and left to become head of their own transplant teams.  Today, according to colleague Dr. Ngoc Thai, about 90 percent of all U.S. and global transplant centers are headed by Starzl-trained surgeons or surgeons who trained under Starzl trainees.

“When he did the first liver transplant [in 1963], people called him a ‘monster’ because the surgery was so novel and the first four patients did not survive long,” said Dr. Thai.

In 1989, Dr. Starzl jointly developed FK506 (better known as tacrolimus), still the world’s most widely used immunosuppressant.

Dr. Starzl was also the recipient of over 200 awards (including the Presidential National Medal of Science, the nation’s highest scientific honor) and 26 honorary doctorates from universities worldwide.  He was a member of over 60 professional organizations and was one of only five Americans inducted into the prestigious National French Academy of Medicine.

A written joint statement from his family and colleagues read, in part, “His work… brought life and hope to countless patients. …Nobody who spent time with Thomas Starzl could remain unaffected.”

“The world has lost today the greatest figure in the history of transplant,” said Abhinav Humar, clinical director of the Thomas E. Starzl Transplantation Institute.  “The Starzl Transplant Institute will continue to work tirelessly to carry on his rich legacy.”

Dr. Starzl is survived by his wife, son and grandchild.

Arthur S. Levine, M.D., University of Pittsburgh senior vice chancellor for the Health Sciences, said, “There is not a transplant surgeon worldwide who has not, in some way, been influenced by his work.”

New York Big Insurance spending less on drugs

While several prominent U.S. politicians have recently denounced high drug prices, a recent Crain’s Health Pulse report says that drug spending by several New York health plans in 2016 actually dropped compared to 2015.

For example, drug costs for the 971,000 members of EmblemHealth’s GHI plan dropped 21 percent, while Empire BlueCross BlueShield saw drug spending fall 10.4 percent, said Crain’s.

While insurers are still experiencing an increase in drug prices, according to Crain’s, they are getting better at managing their own spending by moving toward generic drugs, using pharmacy benefit managers like Express Scripts to save on high-cost specialty drugs.

In related news on the Big Apple’s health insurance market, Crain’s also reported mid-March that “the fortunes of New York City insurers were mixed last year with plans backed by the largest U.S. insurers,” like Oxford and Empire HealthChoice Assurance, “reaping big profits while Affordable Care Act-focused startups continue to lose money.”

Bird flu: New wave in China, virus in Tennessee

The H7N9 “bird flu” strain of the Influenza A virus, which infects poultry but generally not humans, has hit 460 people in China since October, according to an early March CDC report.

Most people infected by the flu strain, including those in the current outbreak, are poultry workers. 

At the same time, a recent World Health Organization (WHO) meeting on H7N9 concluded that the current H7N9 virus does not seem to have mutated to become more infectious to people.  Instead, its most recent mutation has apparently made it more contagious among birds—which could be a good thing.  A stronger bird flu virus leads to visibly sicker birds—allowing poultry farmers to notice outbreaks faster and take countermeasures that are ultimately less costly.

Also, the North American strain of H7N9—according to the USDA, a different virus than the H7N9 hitting China—was found in early March on a Tennessee commercial chicken farm, leading to a culling of thousands of birds to prevent the virus’ spread.

The U.S. was forced to cull nearly 50 million birds, mostly egg-laying hens, during the last major bird flu outbreak in 2014/2015.  Those economic losses pushed U.S. egg prices to record highs.

Bird flu on U.S. soil was last found in a commercial turkey flock in Indiana in January 2016, and in a wild duck in Montana that appeared to match one of the strains of the 2014/2015 outbreak.

In the meantime, the CDC and the WHO are watching the spread of other bird flu viruses besides H7N9, like H7N2 and H5N1, which are also capable of infecting people.  France and South Korea were also respectively hit in recent months with the H5N8 and H5N6 bird flu strains.

Denser cities, bigger life plans?

Earlier population psychological studies indicated that the more crowded the living environment, the more negative effects on public mental health.  But a recent paper posits that population density may actually have positive long-term psychological effects.

The study cross-referenced public health data for a number of countries and all 50 U.S. states, looking at population densities and rates of long-term personal planning, long-term marriages, and investment in personal and children’s education.

The study found that people in U.S. and foreign regions with denser populations were more likely to: plan for the long-term future, get and stay married, and invest in both their own and their children’s schooling.

The study’s authors suggest that big-city living may prompt more long-term planning because life where there are more people generates more competitiveness—thus demanding more effort and planning towards reaching and maintaining quality of life.

Medical journalism: “Cancer Moonshot 2020”=hype

While former U.S. Vice President Joe Biden was launching his still-ongoing Cancer Moonshot project last year, billionaire surgeon and cancer researcher Dr. Patrick Soon-Shiong was launching his own, dubbed Cancer Moonshot 2020 (with the bold goal of eradicating cancer by that year).

But now, an investigation by medical news outlet STAT News finds that Dr. Soon-Shiong’s cancer research project has made very little scientific progress since its inception.

“At its core, the initiative appears to be an elaborate marketing tool—a way to promote his pricey new cancer diagnostic tool at a time when he badly needs a business success, as his publicly-traded companies are losing tens of millions per quarter,” STAT reported. 

The outlet also asked “several independent scientists” to review Soon-Shiong’s claims.  “Their conclusion: The data don’t back up the hype,” STAT reported.

Governors seeking Medicaid work requirement

Arkansas Gov. Asa Hutchinson is among a few Republican governors hoping to impose a work requirement on Medicaid recipients, The New York Times reported on Feb. 25.

According to the Times, Mr. Hutchinson believes that “extending Medicaid to millions of low-income adults without disabilities under the [Affordable Care Act] health law gave them an incentive not to work.”

Work requirements have long been central to the Republican goal of instilling a sense of “personal responsibility” in people who benefit from government programs.  But, the Times also noted, it was the embrace of work requirements for welfare recipients by Democratic Arkansas Gov. Bill Clinton that underpinned the 1996 federal welfare law enacted during his presidency.

New NYC rules for drowsy cabbies

In mid-February, New York City’s Taxi and Limousine Commission (TLC) published the final version of its new rules to reduce drowsy driving in the for-hire vehicle industry, Crain’s reported.  The new rules, which take effect in Mach, prohibit TLC-regulated drivers from transporting passengers for over ten hours in any 24-hour period.  The clock resets after eight hours of idling, and the weekly limit is now 60 hours.