The science of public health has evolved since the 18th century, when it focused on isolating the ill and quarantining those exposed to diseases to prevent transmission of infection. In the 19th century, the focus was on sanitation, especially separating fecal contamination from food and water. Living conditions improved tremendously as a result. With the understanding of infectious disease transmission in the early part of the 20th century, the focus shifted to immunizations and infection control.

The price increase soon had an effect. The Netherlands has an insurance-based health system, and in April 2018, Dutch insurers – who had been paying for 50 or so patients across the country to receive the drug – balked at the fivefold increase, refusing to pay. Patients unable to pay themselves would have gone without treatment, so Kemper – whose hospital was one of the treatment centers for CTX – stepped in.

Although widespread signaling across the brain appears to be impaired when people are under general anesthesia, there is evidence that certain areas – including the auditory cortex – remain responsive, suggesting that medical staff might be able to send suggestions and encouragement, while a patient is unconscious, to reduce their pain after surgery. Studies investigating this possibility are few, but Jenny Rosendahl, at Jena University Hospital in Germany, and colleagues have attempted to gather all the evidence to date.