Citizen Cartwright

Have you been victim of a drug shortage and not known it?

This front-page article in Friday’s New York Times is alarming, to say the least.

The short summary: While drug shortages are the “new normal” in American medicine, the resulting rationing has been “largely hidden from patients and the public.”

The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs — including anesthetics, painkillers, antibiotics and cancer treatments — and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drugmakers abandoning low-profit products, the paper says.

And at medical institutions across the country, choices about who gets drugs often have been made in ways that have resulted in contradictory conclusions, murky ethical reasoning and medically questionable practices, according to doctors, hospital officials and government regulators.

An international group of pediatric cancer specialists became so concerned about the profession’s unsystematic approach to distributing scarce medicine that it’s developed rationing guidelines that are being released Friday in The Journal of the National Cancer Institute.

A Cleveland Clinic pharmacist says children haven’t gotten priority over adults during chemotherapy shortages. But at other hospitals, they have, because of their potentially longer life span or because they sometimes need smaller doses of a drug.

In another example of rationing decisions, obese patients, who researchers found needed up to three times the amount of an antibiotic before surgery than average-size patients, were given only the standard dose at the Cleveland hospital until a shortage abated.

An anesthesiologist who, with colleagues, surveyed patients at Mayo clinics, says he was surprised that most wanted to know about a drug shortage that might affect their care during elective surgery, even if there was only a minor difference in potential side effects, and many said they would delay surgery.

“Doctors and hospitals often do not tell patients about shortages and the resulting rationing because they do not want them to worry, especially when alternative drugs are available, or because they feel it would stir up too much anger,” says the Times.

No, kidding. I’m sitting here angry. This is a problem caused by humans, and we can fix it and save people’s lives. If we muster up the will.

China seeing the ‘greatest episode of capital flight in history’

The country’s foreign-exchange reserves fell by $700 billion last year, more than the total foreign-currency reserves of all but three other central banks in the world — Japan, Switzerland and Saudi Arabia, according to the World Bank.

How come? The reasons, according to The Wall Street Journal, include:

— Billions that had been invested in China are being pulled back out.

— President Xi Jinping’s corruption crackdown and the effort to blame finance-industry executives for last summer’s stock-market collapse have led many people to try to get their cash out.

— The dream of many Chinese to have their children educated overseas is causing long-term outflows.

— People believe it will become harder to get money out.

“The biggest problem for China so far is perception,” says the WSJ. "Capital flight signals a loss of confidence in the government’s ability to run the economy. The perception is made worse in China by the government’s opacity and by the economy’s difficult transition from reliance on big infrastructure and exports to consumer spending.”

The bright side for China? The impact of capital flight has been much worse in Russia, the other major recent example of large outflows, says the WSJ.

The $330 billion that flowed out of Russia in 2014 and 2015 was much bigger relative to the size of the economy and had a far greater impact, contributing to a collapse in the ruble, a sharp contraction in the economy and a tightening of liquidity, the paper says.

Looking for good news but not finding it

So for the past few months, when the news has been demoralizing, I’ve looked through The Washington Post’s “The Optimist” email for positive stories to include in this blog.

But the last “Optimist” email I see in my inbox is from November.

In desperation this morning, given all the negative news, I’ve searched online for “good news” and “optimism.” And the best I can say is that I’ve gotten a rueful laugh out of the fact that most headlines involving “optimism” are saying there isn’t a reason for any, in whatever the topic is.

So it’s left to me to say that I’m grateful for the jasmine plant that’s blooming next to me, with its glorious fragrance. And for a multitude of other things.

And I know you are, too. Have a good day and weekend.

Also in the news

Syria peace talks derailed as opposition says it won’t attend

Bank of Japan stuns markets, cuts interest rate below zero to fight deflation

Report: Federal officials placed immigrant children in custody of human traffickers

In Trump vacuum, Ted Cruz is top target at Iowa GOP debate

Volkswagen may buy back diesel cars that it can’t fix

Volvos, Buicks, Cadillacs made in China are arriving in American showrooms

‘Politico implodes,’ reports The Washington Post

Zika virus is ‘spreading explosively,' U.N. health chief says

Study: Worldwide increase in breast-feeding could save 800,000 lives

Study casts doubts on existence of ‘seasonal’ depression

Major clue found to the cause of schizophrenia

The landmark study provides the first rigorously tested insight into the biology behind any common psychiatric disorder.

It’s a watershed moment for schizophrenia, with the potential for early detection and new treatments that were unthinkable only a year ago, according to Steven Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute at MIT. Hyman, a former director of the National Institute of Mental Health, calls it "the most significant mechanistic study about schizophrenia ever."

“I’m a crusty, old, curmudgeonly skeptic. But I’m almost giddy about these findings,” he says.

The researchers, mainly from the Broad Institute, Harvard Medical School and Boston Children’s Hospital, found that a person’s risk of schizophrenia is dramatically increased if they inherit variants of a gene important to “synaptic pruning" — the healthy reduction during adolescence of brain cell connections that no longer are needed.

In people with schizophrenia, a variation in a single position in the DNA sequence marks too many synapses for removal and that pruning goes out of control. As a result, there’s an abnormal loss of gray matter.

“This is the first exciting clue, maybe even the most important we’ll ever have, but it will be decades” before a true cure is found, Hyman says.

The study was published Wednesday in the journal Nature.

Astronomers discover biggest solar system yet

The lone planet in the system takes nearly a million years to orbit its star, says BBC News.

The planet, lyrically named 2MASS J2126-8140, is between 12 and 15 times the mass of Jupiter.

Republicans’ Trumpless debate in Des Moines

As you surely have been unable to avoid hearing, Donald Trump says he won’t participate in Thursday night’s GOP debate in Iowa, hosted by Fox News and Google.

Trump has cited concerns with one of the debate moderators, Megyn Kelly — but apparently made his decision not to attend following press statements from Fox News, says Fox News.

Trump’s detractors accuse him of dodging a last showdown with his chief rival, Texas Sen. Ted Cruz.

The undercard debate starts at 7 p.m. and the main debate at 9 p.m. The debate will be streamed live on foxnews.com and on the Fox News apps.

Also in the news

In France, Iran’s post-sanctions buying spree continues

On International Holocaust Remembrance Day, Obama honors 4 who protected Jews

Senate starts debate on the country’s first major energy bill in more than 8 years

Diminished ranks of House Democrats meet for ‘issues retreat’

Three more Oregon occupiers arrested, others leave as standoff appears to wane

South Carolina Senate committee approves bill to track refugees

Fed keeps interest rates unchanged, says it’s keeping an eye on global developments

Admiral in charge of Navy intelligence hasn’t been allowed to see military secrets for years

NASA’s Opportunity rover, expected to last 3 months on Mars, is going strong 12 years later

Study: Antidepressants appear to be much more dangerous for children, teens than reported

Theranos lab may pose a threat to patient safety, federal regulator says

Brain protein may offer new clues to Alzheimer’s treatment

‘Doomsday clock’ to stay at 3 minutes to midnight for second year

Increasing tension between Russia and the United States, North Korea’s recent nuclear test and a lack of aggressive steps against climate change are putting the world under grave threat, the scientists behind the clock measuring the likelihood of a global cataclysm said on Tuesday.

The scientists adjusted the clock from five minutes-to-midnight to three minutes-to-midnight last year, citing climate change, modernization of nuclear weapons and outsized nuclear weapons arsenals as “extraordinary and undeniable threats to the continued existence of humanity.” The clock previously was at three minutes-to-midnight in 1984, when the bulletin said talks between the United States and Russia virtually stopped.

The closest the clock has come to midnight was two minutes, in 1953, when the Soviet Union tested a hydrogen bomb that followed a U.S. hydrogen bomb test.

The Bulletin of the Atomic Scientists, founded in 1945 by scientists who helped develop the first atomic weapons, uses the metaphorical clock to convey how close we humans are to destroying civilization with dangerous technologies of our own making.

U.S., Britain get best scores ever in global corruption index

Denmark remains at the top of Transparency International's Corruption Perceptions Index, a closely watched global barometer, for the second consecutive year as the country perceived as least corrupt.

The United States rises one spot this year to 16th place; Britain is up three spots to 10th place.

North Korea and Somalia rank as most corrupt of the 168 countries ranked.

The index is based on expert opinions of public sector corruption, looking at a range of factors including whether governmental leaders are held to account or go unpunished for corruption, the perceived prevalence of bribery, and whether public institutions respond to citizens’ needs.