Saturday, February 14, 2009
Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.
Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.
A wireless sensor under Ms. Branch's bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.
Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.
But the devices, which can be expensive, remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.
Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.
"I lost a very close friend recently," she said. "She was also diabetic and she fell during the night. She didn't have the sensors. She went into a coma."
Without the sensors, Ms. Branch said, "I would probably be dead."
Friday, February 13, 2009
The three federal judges who convincingly rejected the theory that vaccines cause autism delivered a devastating blow to crank science today. The battle will go on in the blogs and in the courts. But the most important arena has always been the space between the ears of parents who are deciding whether it's safe to vaccinate their kids. This decision could do a heap of good by stemming the tide of vaccine-shunning that has led to outbreaks of preventable disease.
The rulings cap 10 years of divisive legal, scientific, and rhetorical battles. In reality, the science looked pretty settled by the end of 2002, as the first of 5,000 parents of autistic children began lodging claims in the Federal Court of Appeals' special vaccine injury compensation program. Hundreds of millions of dollars later, the court concluded as most other observers have for years. This was a slam dunk. "Petitioners' theories of causation were speculative and unpersuasive," wrote Special Master Denise Vowell in the case of Colten Snyder v. HHS. "To conclude that Colten's condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll's White Queen and be able to believe six impossible (or at least highly improbable) things before breakfast."
The vaccine court, which began operating in 1990, assigns special masters to weigh claims of vaccine injury brought by parents or guardians. In their ruling in the Autism Omnibus, the special masters considered three test cases in which the parents of autistic children alleged damage by two "toxic" vaccine mechanisms acting in concert. Traces of ethyl mercury in several vaccines had weakened their children's immune systems as infants, went the plaintiffs' theory, which allowed the measles-mumps-rubella vaccine to damage their brains when it was administered after their first birthdays.
Thursday, February 12, 2009
Wednesday, February 11, 2009
Dr. Javeed Siddiqui, an infectious-disease physician, was on the job at University of California Davis Medical Center when his iPhone rang with an urgent call. A colleague's niece was in distress, her right eye swollen from a dog bite.
Siddiqui asked the girl's father to send a digital photo of the 8-year-old's wounded eye — directly to the doctor's iPhone. He quickly viewed the injury and issued a soothing diagnosis: No need for an emergency room. Antibiotics, which he prescribed by phone, would do the job.
Over the next few days, Siddiqui monitored the injury via photos sent to his cellphone.
Beyond their cool quotient, smartphones such as the iPhone and other handheld devices are becoming as handy as stethoscopes in a doctor's arsenal.
With the ability to view X-rays, zoom in close on images of wounds and peruse pharmaceutical libraries, these brainier cellphones are putting new tools at the fingertips of doctors, pharmacists and health-care workers.
"So much about medicine is about making the right decision at the right time," said Siddiqui, an associate director at UCD's Center for Health and Technology.
Gone are the days when pagers ruled. While they remain standard issue at hospitals such as University Medical Center, many younger physicians see pagers as on the verge of becoming obsolete.
"My iPhone puts things right in the palm of my hands, and I'm able to access things quickly during my day-to-day work," Siddiqui said.
Perhaps soon, a patient's pulse and heart rhythms — even the contractions of a pregnant woman could be monitored remotely via cellphone.
"We haven't even scratched the surface," said Dr. Gregory Janos, 60, a pediatric cardiologist and medical director for children's services at Sutter Memorial Hospital.
Some call it a revolution. Janos calls it an evolution that is transforming how doctors do their jobs.
Privacy laws are holding back some potential advances, such as the ability to beam sensitive patient data over wireless networks. But cellphone access will eventually come, Janos predicts.
"As more and more patients are assuming responsibility for their own health care, they'll be able to share information with their doctor more quickly and efficiently," he said.
Stroll down almost any hospital corridor these days and you'll see the evidence: doctors pecking on tiny keyboards or tapping at images on their hand-held devices.
Surprisingly, just 54 percent of all physicians own smartphones or other hand-held devices, according to a survey late last year by New York-based Manhattan Research, which analyzes trends in the health-care industry. Janos, however, believes the number is higher at his hospital.
More medical schools are requiring personal digital assistants, or PDAs, but many students arrive already equipped with cutting-edge personal technology.
"Physicians my age went through medical school with PDAs in their hands," said Dr. Steven Chang, 31, a resident at the University Medical Center's Department of Family and Community Medicine. In 2007, Chang led a successful petition to persuade Apple to allow third-party developers to create medical applications for the iPhone.
Tuesday, February 10, 2009
Blowing your nose to alleviate stuffiness may be second nature, but some people argue it does no good, reversing the flow of mucus into the sinuses and slowing the drainage.
Counterintuitive, perhaps, but research shows it to be true.
To test the notion, Dr. J. Owen Hendley and other pediatric infectious disease researchers at the University of Virginia conducted CT scans and other measurements as subjects coughed, sneezed and blew their noses. In some cases, the subjects had an opaque dye dripped into their rear nasal cavities.
Coughing and sneezing generated little if any pressure in the nasal cavities. But nose blowing generated enormous pressure — "equivalent to a person's diastolic blood pressure reading," Dr. Hendley said — and propelled mucus into the sinuses every time. Dr. Hendley said it was unclear whether this was harmful, but added that during sickness it could shoot viruses or bacteria into the sinuses, and possibly cause further infection.
The proper method is to blow one nostril at a time and to take decongestants, said Dr. Anil Kumar Lalwani, chairman of the department of otolaryngology at the New York University Langone Medical Center. This prevents a buildup of excess pressure.
After waiting more than an hour in a doctor's waiting room, a friend of mine once presented his doctor with a bill for his time.
My friend's frustration probably sounds familiar to anyone who has been kept waiting at a physician's office. And while his response may seem a little extreme, perhaps he was on to something. After all, time is money. So, although it doesn't currently enter into our national statistics, the time that patients spend getting health care services should be reflected in the way we calculate America's national health care expenditures.
Any student of Econ 101 knows that economists measure costs by opportunity costs, meaning everything that is given up to get something else. Time spent interacting with the medical system could be used for other activities, like work and leisure. Moreover, spending time getting medical care is not fun. This time should be counted as part of the cost of health care.
Using the American Time Use Survey, I calculate that Americans age 15 and older collectively spent 847 million hours waiting for medical services to be provided in 2007. That's a lot of bills to be delivered to health care providers.
Three percent of Americans traveled from their home to receive health care on any given day in 2007. The corresponding figures are 5 percent for women and 2 percent for men.
If you count health care-related activities writ large – including time traveling to a doctor, waiting to see a doctor, being examined and treated, taking medication, obtaining medical care for others, and paying bills – the average American spent 1.1 hours a week obtaining health care in 2007.
Not surprisingly, those over age 60 spent twice as much time obtaining medical care, on average, than did those age 15 to 60. Women spent about 70 percent more time on health care activities than men.
If we value all people's time at the average hourly wage of production and nonsupervisory workers ($17.43 in 2007), Americans spent the equivalent of $240 billion on health care in 2007.
Put another way, omitting patients' time caused national health care expenditures to be undercounted by 11 percent in 2007.
For the past 10 years I've celebrated Valentine's Day two days early, because it was on Feb. 12, 1999, that my life — and my heart — was given back to me.
Although I had no conventional risk factors or symptoms, it turned out that two of my three major coronary arteries were 100 percent blocked, the third 90 percent. And so it was that three months short of my 61st birthday, I underwent a six-and-a-half-hour quintuple-bypass operation at Yale University Hospital.
I was back at work in a few weeks and have had no heart problems since. Now nearing 71, I swim three-quarters of a mile most days and play singles tennis (and sometimes win) against players decades younger than I am. And a year ago, after 20 years of bachelorhood, much of it as single parent to my three children, I married again.
How, nearly dead a decade ago, did I get so lucky?
In the aftermath of the revelation last year that Merck and Schering-Plough had been sitting on results of a failed clinical trial of a new cholesterol-lowering drug, an editorial in The New York Times noted that the trial's findings "raise doubts about the current belief that cholesterol is the key to cardiovascular health." Based on my experience, I would suggest that these doubts have been with us for a long time.
Newspapers, magazines, television shows, medical journals and — especially — drug company advertisements all reinforce the notion that lowering cholesterol will prevent heart disease and save your life. Friends regularly call to report their latest cholesterol scores, as if they are somehow gaining ground on the Angel of Death.
But cholesterol, as I've learned, is only a small part of the story. If you combine all known risk factors — high cholesterol, high blood pressure, smoking, genetics, obesity, lack of exercise — the combination still accounts for fewer than half the instances of heart disease. Conversely, as in my case, when none of these factors apply, one can still be days or hours away from cardiac death.
In addition, two doctors who examined me, including a cardiologist, saw no urgency in my condition. It remained for a lifelong friend, another cardiologist, to get the diagnosis right, and this by phone from 3,000 miles away.
When I told him I was concerned about occasional shortness of breath while swimming, and about an intermittent burning sensation in my back, he told me to get to a hospital as soon as possible. Why? Because he knew me, because he listened to me carefully and because he could place my new symptoms in the context of my overall story.
And so I went to a hospital where another lifelong friend, a physician at Yale, saw that I received immediate treatment. The fact that I was privileged — not only to have these doctors as friends, but also to have health insurance that allowed me to receive treatment anywhere and by any doctor — is what saved my life.
I had, that is, what many Americans do not have: access to the best and most timely medical care available.
To get diagnoses and treatment plans right, we need doctors who know us over time, and who have the time to know us. For just as every medication reacts differently in every patient, so too does the meaning of every test result vary with every patient. Paradoxically, the better tests are, the more we need the judgment of doctors to sort out the results and to come up with the right treatments.
We now have technologies to treat virtually all cardiovascular problems, and to save lives we were previously helpless to save. But what many of us do not have is access to these technologies and to doctors who know how to use them.
President George W. Bush famously said that all Americans, even the tens of millions without health insurance, can get health care by going to emergency rooms. Perhaps. But clearly the doctors one meets there have neither the time nor the knowledge — of specific illnesses or of individual patients — to provide anything resembling the best care.
There are moments when I feel I have spent large parts of my professional life dropping off my own marginally ill children at school (or at day care) and then hurrying to work to examine children who are notably less sick but have been kept home by their parents and brought to see the doctor.
I'm talking about the common cold, the winter crud, the lingering nasal drips and irritated coughs that mark our children's passage through the varied mix of respiratory viruses — or perhaps mark the viruses' passage through our children.
What I'm not talking about is childhood fever. I vigorously deny those vile rumors that I occasionally, in the distant deniable past, gave my warm-to-the-touch toddler a big dose of ibuprofen at day-care drop-off time — though we're admittedly entering into the Deepest Secrets of the Working Parent Zone here. The child with fever clearly needs to stay home, as does the child who is vomiting or is just plain miserable.
On the other hand, I do remember getting several calls from day-care directors or school nurses to inform me that although my child seemed happy and active, there was in fact a lurking fever — and I remember biting back the question, what kind of zealot takes the temperature of a happy, active child?
But of course, they were worrying about the other children. And that is a fair question with any child who is borderline sick: who is infectious, what's the risk, and is there anything we can do to reduce it?
Doctors, as a group, are big believers in sending children to school. Every doctor I've talked to is more concerned about children unnecessarily missing school than about their posing an infection risk to their classmates.
Monday, February 9, 2009
Two drugmakers spent hundreds of millions of dollars last year to raise awareness of a murky illness, helping boost sales of pills recently approved as treatments and drowning out unresolved questions -- including whether it's a real disease at all.
Key components of the industry-funded buzz over the pain-and-fatigue ailment fibromyalgia are grants -- more than $6 million donated by drugmakers Eli Lilly and Pfizer in the first three quarters of 2008 -- to nonprofit groups for medical conferences and educational campaigns, an Associated Press analysis found.
That's more than they gave for more accepted ailments such as diabetes and Alzheimer's. Among grants tied to specific diseases, fibromyalgia ranked third for each company, behind only cancer and AIDS for Pfizer and cancer and depression for Lilly.
Fibromyalgia draws skepticism for several reasons. The cause is unknown. There are no tests to confirm a diagnosis. Many patients also fit the criteria for chronic fatigue syndrome and other pain ailments.
Experts don't doubt the patients are in pain. They differ on what to call it and how to treat it.
Many doctors and patients say the drugmakers are educating the medical establishment about a misunderstood illness, much as they did with depression in the 1980s. Those with fibromyalgia have often had to fight perceptions that they are hypochondriacs, or even faking their pain.
But critics say the companies are hyping fibromyalgia along with their treatments, and that the grantmaking is a textbook example of how drugmakers unduly influence doctors and patients.
"I think the purpose of most pharmaceutical company efforts is to do a little disease-mongering and to have people use their drugs," said Dr. Frederick Wolfe, who was lead author of the guidelines defining fibromyalgia in 1990 but has since become one of its leading skeptics.
Whatever the motive, the push has paid off. Between the first quarter of 2007 and the fourth quarter of 2008, sales rose from $395 million to $702 million for Pfizer's Lyrica, and $442 million to $721 million for Lilly's Cymbalta.
Cymbalta, an antidepressant, won Food and Drug Administration approval as a treatment for fibromyalgia in June. Lyrica, originally approved for epileptic seizures, was approved for fibromyalgia a year earlier.
Drugmakers respond to skepticism by pointing out that fibromyalgia is recognized by medical societies, including the American College of Rheumatology.
"I think what we're seeing here is just the evolution of greater awareness about a condition that has generally been neglected or poorly managed," said Steve Romano, a Pfizer vice president who oversees its neuroscience division. "And it's mainly being facilitated by the fact the FDA has now approved effective compounds."
The FDA approved the drugs because they've been shown to reduce pain in fibromyalgia patients, though it's not clear how. Some patients say the drugs can help, but the side effects include nausea, weight gain and drowsiness.
Helen Arellanes of Los Angeles was diagnosed with fibromyalgia in September 2007 and later left her job to go on disability. She takes five medications for pain, including Lyrica and Cymbalta.
"I call it my fibromyalgia fog, because I'm so medicated I go through the day feeling like I'm not really there," Arellanes said. "But if for some reason I miss a dose of medication, I'm in so much pain."
A single mother of three, Arellanes sometimes struggles to afford all her medications. She said she is grateful that a local Pfizer sales representative occasionally gives her free samples of Lyrica "to carry me through the month."
The drugmakers' grant-making is dwarfed by advertisement spending. Eli Lilly spent roughly $128.4 million in the first three quarters of 2008 on ads to promote Cymbalta, according to TNS Media Intelligence. Pfizer Inc. spent more than $125 million advertising Lyrica.
But some say the grants' influence goes much further than dollar figures suggest. Such efforts steer attention to diseases, influencing patients and doctors and making diagnosis more frequent, they say.
"The underlying purpose here is really marketing, and they do that by sponsoring symposia and hiring physicians to give lectures and prepare materials," said Wolfe, who directs the National Data Bank for Rheumatic Diseases in Wichita, Kan.
Similar criticisms have dogged drugmakers' marketing of medicines for overactive bladder and restless legs syndrome.
Many of the grants go to educational programs for doctors that feature seminars on the latest treatments and discoveries.
Pfizer says it has no control over which experts are invited to the conferences it sponsors. Skeptics such as Wolfe are occasionally asked to attend.
The drug industry's grants also help fill out the budgets of nonprofit disease advocacy groups, which pay for educational programs and patient outreach and also fund some research.
"If we have a situation where we don't have that funding, medical education is going to come to a screeching halt, and it will impact the kind of care that patients will get," said Lynne Matallana, president of the National Fibromyalgia Association.
Matallana founded the group in 1997 after she was diagnosed with fibromyalgia. A former advertising executive, Matallana said she visited 37 doctors before learning there was a name for the crushing pain she felt all over her body.
A decade later, her patient advocacy group is a $1.5 million-a-year operation that has successfully lobbied Congress for more research funding for fibromyalgia. Forty percent of the group's budget comes from corporate donations, such as the funds distributed by Pfizer and Eli Lilly.
Pfizer gave $2.2 million and Lilly gave $3.9 million in grants and donations related to fibromyalgia in the first three quarters of last year, the AP found. Those funds represented 4 percent of Pfizer's giving and about 9 percent of Eli Lilly's.
Eli Lilly, Pfizer and a handful of other companies began disclosing their grants only in the past two years, after coming under scrutiny from federal lawmakers.
The message in company TV commercials is clear. "Fibromyalgia is real," proclaimed one Lyrica ad. Researchers who've studied the condition for decades say it's not that simple.
Since the 1970s, Wolfe and a small group of specialists have debated the condition in the pages of medical journals. Depending on whom you ask, it is a disease, a syndrome, a set of symptoms or a behavior disorder.
The American College of Rheumatology estimates that between 6 million and 12 million people in the U.S. have fibromyalgia, more than 80 percent of them women. It's not clear how many cases are actually diagnosed, but Dr. Daniel Clauw of the University of Michigan said pharmaceutical industry market research shows roughly half are undiagnosed. People with fibromyalgia experience widespread muscle pain and other symptoms including fatigue, headache and depression.
After 30 years of studying the ailment, rheumatologist Dr. Don Goldenberg says fibromyalgia is still a "murky area."
"Doctors need labels and patients need labels," said Goldenberg, a professor of medicine at Tufts University. "In general, it's just more satisfying to tell people, 'You have X,' rather than, 'You have pain.'"
While Goldenberg continues to diagnose patients with fibromyalgia, some of his colleagues have stopped, saying the condition is a catchall covering a range of symptoms.
Dr. Nortin Hadler says telling people they have fibromyalgia can actually doom them to a life of suffering by reinforcing the idea that they have an incurable disease.
"It's been shown that if you are diagnosed with fibromyalgia, your chances for returning to a level of well-being that satisfies you are pretty dismal," said Hadler, a professor at the University of North Carolina, who has occasionally advised health insurers on how to deal with fibromyalgia.
Hadler said people labeled with fibromyalgia are indeed suffering, not from a medical disease but from a psychological condition. Instead of drugs, patients should receive therapy to help them "unlearn" their predicament, he said.
Research by the University of Michigan's Clauw suggests people with fibromyalgia experience pain differently because of abnormalities in their nervous system. Brain scans show unusual activity when the patients experience even minor pain, though there is no abnormality common to all.
Clauw's work, however, illustrates the knotty issues of drug company funding. He has done paid consulting work for the drugmakers, and he's received research funding from the National Fibromyalgia Research Association, which receives money from the drugmakers.
While Clauw acknowledges that Lyrica and Cymbalta do not work for everyone, he has little patience for experts who spend more time parsing definitions than helping patients.
"At the end of the day I don't care how you categorize this -- it's a legitimate condition and these people are suffering," Clauw said.
Sunday, February 8, 2009
The doctor who sparked the scare over the safety of the MMR vaccine for children changed and misreported results in his research, creating the appearance of a possible link with autism, a Sunday Times investigation has found.
Confidential medical documents and interviews with witnesses have established that Andrew Wakefield manipulated patients' data, which triggered fears that the MMR triple vaccine to protect against measles, mumps and rubella was linked to the condition.
The research was published in February 1998 in an article in The Lancet medical journal. It claimed that the families of eight out of 12 children attending a routine clinic at the hospital had blamed MMR for their autism, and said that problems came on within days of the jab. The team also claimed to have discovered a new inflammatory bowel disease underlying the children's conditions.
However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children's ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.
Despite involving just a dozen children, the 1998 paper's impact was extraordinary. After its publication, rates of inoculation fell from 92% to below 80%. Populations acquire "herd immunity" from measles when more than 95% of people have been vaccinated.
Last week official figures showed that 1,348 confirmed cases of measles in England and Wales were reported last year, compared with 56 in 1998. Two children have died of the disease.
With two professors, John Walker-Smith and Simon Murch, Wakefield is defending himself against allegations of serious professional misconduct brought by the GMC. The charges relate to ethical aspects of the project, not its findings. All three men deny any misconduct.
Through his lawyers, Wakefield this weekend denied the issues raised by our investigation, but declined to comment further.
A month-old baby girl lies anesthetized in an operating room at London's Great Ormond Street Hospital for Children (GOSH). Her life prospects up to this point have not been good. She suffers from a congenital condition known as atrioventricular septal defect (AVSD) — a complex hole between the right and left sides of her heart, compounded by a drastically undersized left ventricle – the chamber that pumps fresh, oxygenated blood from her lungs to the rest of her body. Without corrective surgery, she faces a shortened life and a childhood robbed of vitality. Professor Martin Elliott and his surgical team have planned this surgery carefully on a Mac using a 3D model derived from CT scan images. They have already closed the hole, dividing the heart into its normal right and left sides. Their mission now is to enlarge her left ventricle to create normal blood flow. Elliott is working inside a heart the size of a walnut, in a ventricle less than a cubic centimeter in volume. He inserts the 3mm tip of a camera into the ventricle. Instead of the normal smooth interior, the camera's monitor display reveals multiple trabeculi - bundles of muscle - connecting its right and left sides. He cuts the bundles, and the ventricle springs open to normal size. This is a new procedure, created for a tiny patient with a rare and unusual problem. Captured on video, archived, edited, and labeled using Apple technology — it will be shared with surgeons around the world. Many other children will benefit. More ...
A month-old baby girl lies anesthetized in an operating room at London's Great Ormond Street Hospital for Children (GOSH). Her life prospects up to this point have not been good. She suffers from a congenital condition known as atrioventricular septal defect (AVSD) — a complex hole between the right and left sides of her heart, compounded by a drastically undersized left ventricle – the chamber that pumps fresh, oxygenated blood from her lungs to the rest of her body. Without corrective surgery, she faces a shortened life and a childhood robbed of vitality.
Professor Martin Elliott and his surgical team have planned this surgery carefully on a Mac using a 3D model derived from CT scan images. They have already closed the hole, dividing the heart into its normal right and left sides. Their mission now is to enlarge her left ventricle to create normal blood flow. Elliott is working inside a heart the size of a walnut, in a ventricle less than a cubic centimeter in volume. He inserts the 3mm tip of a camera into the ventricle. Instead of the normal smooth interior, the camera's monitor display reveals multiple trabeculi - bundles of muscle - connecting its right and left sides. He cuts the bundles, and the ventricle springs open to normal size.
This is a new procedure, created for a tiny patient with a rare and unusual problem. Captured on video, archived, edited, and labeled using Apple technology — it will be shared with surgeons around the world. Many other children will benefit.
LAST WEEK, Supreme Court Justice Ruth Bader Ginsburg disclosed the sad news that she is undergoing treatment for pancreatic cancer. True to her nature, the 75-year-old justice also announced that she plans to be on the bench Feb. 23 when the court resumes hearing cases after a long winter break. Justice Ginsburg is a remarkable person, one who exhibited boundless energy during her early career three decades ago waging and winning uphill battles for women's equality. We trust that her grit and her indomitable spirit will serve her well during this difficult time.
This is not her first battle with serious illness; she successfully fought colon cancer in 1999. Then, as now, she promptly disclosed her condition with a level of specificity rarely seen before or since from a justice. Such candor helps to avert rumors and the kind of media frenzy that unfortunately surrounded the late chief justice William H. Rehnquist Jr., who became ill in 2004 with thyroid cancer but did not fully disclose the nature of the ailment. Mr. Rehnquist deflected reporters' questions by saying, "That's for me to know and for you to find out." The media gladly took up Mr. Rehnquist's inadvertent dare -- and there were other consequences. Then-Justice Sandra Day O'Connor apparently delayed announcing her retirement because of uncertainty about the chief justice's condition or plans.
There can be no fixed rule in these matters: Even public figures deserve privacy, and little is more personal than health. But generally the public is entitled to know whether officials are healthy enough to carry out their duties responsibly. This is especially true when the official is one of only nine people who hold life-tenured positions on the highest court in the land. Justice Ginsburg is right to recognize this.