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kottke.org posts about medicine

How Flu Vaccines Are Made

posted by Jason Kottke   Oct 10, 2019

Ten years ago, in the midst of the 2009 swine flu pandemic, I wrote about the manufacturing process for the H1N1 flu vaccine. It involves billions of chicken eggs.

The most striking feature of the H1N1 flu vaccine manufacturing process is the 1,200,000,000 chicken eggs required to make the 3 billion doses of vaccine that may be required worldwide. There are entire chicken farms in the US and around the world dedicated to producing eggs for the purpose of incubating influenza viruses for use in vaccines. No wonder it takes six months from start to finish.

The post holds up pretty well because, according to the CDC, this is still the way most flu vaccines in America are manufactured. Here’s a look at pharmaceutical company GSK’s egg-based process:

Two other techniques for making flu vaccines were approved for use in the US in 2012 and 2013 respectively, cell-based flu vaccines:

‘Cell-based’ refers to how the flu vaccine is made. Most inactivated influenza vaccines are produced by growing influenza viruses in eggs. The influenza viruses used in the cell-based vaccine are grown in cultured cells of mammalian origin instead of in hens’ eggs.

A cell-based flu vaccine was developed as an alternative to the egg-based manufacturing process. Cell culture technology is potentially more flexible than the traditional technology, which relies upon adequate supply of eggs. In addition, the cell-based flu vaccine that uses cell-based candidate vaccine viruses (CVVs) has the potential to offer better protection than traditional, egg-based flu vaccines as a result of being more similar to flu viruses in circulation.

And recombinant flu vaccines:

NIAID and its industry partners have made progress in moving from both the egg-based and cell-based flu vaccine production methods toward recombinant DNA manufacturing for flu vaccines. This method does not require an egg-grown vaccine virus and does not use chicken eggs at all in the production process. Instead, manufacturers isolate a certain protein from a naturally occurring (“wild type”) recommended flu vaccine virus. These proteins are then combined with portions of another virus that grows well in insect cells. The resulting “recombinant” vaccine virus is then mixed with insect cells and allowed to replicate. The flu surface protein called hemagglutinin is then harvested from these cells and purified.

Both of these new techniques make production quicker, thereby resulting in more effective vaccines because they are more likely to match the strains of whatever’s “going around”.

As a reminder, you should get a flu shot every year in the fall. The CDC recommends that “everyone 6 months of age and older should get a flu vaccine every season with rare exception”, especially those “who are at high risk of serious complications from influenza”. Flu vaccines are covered by your health insurance without copay (thanks, Obama!) and are often available at drug stores without an appointment or a long wait. So go get one!

Fighting the Measles and Dangerous Ideas

posted by Jason Kottke   Aug 26, 2019

For the New Yorker, Nick Paumgarten writes about this year’s measles outbreak in the US, the largest such outbreak in decades. The outbreak is solely due to a growing number of people who decline to vaccinate their children, so the fight has become one not against a disease, as it was decades ago, but against dangerous ideas.

But, if we have to pick a Patient Zero, Andrew Wakefield will do. Wakefield is the British gastroenterologist who produced the notorious article, published in The Lancet in 1998, linking the M.M.R. vaccine to autism. The study, which featured just twelve subjects, was debunked, the article was pulled, and Wakefield lost his license to practice medicine — as well as his reputation, in scientific circles anyway. But, owing to his persistence in the years since, his discredited allegations have spread like mold. In the anti-vaxxer pantheon, he is martyr and saint. There are also the movement’s celebrities, such as Jenny McCarthy and Robert F. Kennedy, Jr., stubborn in the face of ridicule, and the lesser-known but perhaps no less pernicious YouTube evangelists, such as Toni Bark, a purveyor of homeopathic products, and the Long Island pediatrician Lawrence Palevsky. If your general practitioner is Dr. Google, you can find a universe of phony expertise. The movement seems to sniff out susceptibility. Not surprisingly, there is money there, though the financial incentives behind this strand of advocacy are less clear than, say, what has led the Koch brothers to champion fossil fuels. This spring, the Washington Post reported that the New York hedge-fund manager Bernard Selz and his wife, Lisa, have given more than three million dollars to anti-vaccination causes and helped finance “Vaxxed,” Wakefield’s 2016 documentary, which purports to reveal a C.D.C. conspiracy to cover up the connection between vaccines and autism. Needless to say, the anti-vaccination ethos is by no means exclusive to the New York tristate-area Orthodox community. It thrives in certain pockets — affluent boho-yoga moms, evangelical Christians, Area 51 insurgents. The vaccination rates are about the same in Monsey and in Malibu. Before New Square, the three most recent big outbreaks of measles occurred among Somali immigrants, in Minnesota; Amish farmers, in Ohio; and a hodgepodge of visitors to Disneyland.

“It’s shocking how strong the anti-vax movement is,” Zucker said. “What surprises me is the really educated people who are passionately against vaccinations. I see this as part of a larger war against science-based reality. We need to study vaccine hesitancy as a disease.” He gave a TEDX talk recently about the crippling disconnect between the speed at which information, good or bad, spreads now and the slow, grinding pace of public-health work. He managed, by way of the general theory of relativity, to establish the equivalence of H1N1, Chewbacca Mask Lady, and Pizzagate: “How do we immunize and protect ourselves from the damaging effects of virality?”

The internet is such an efficient way to spread ideas (regardless of their validity) that you begin to wonder if instant global individual-to-individual and individual-to-everyone communication is an insurmountable Great Filter for societies.

The Restaurant of Mistaken Orders

posted by Jason Kottke   Aug 19, 2019

The servers at The Restaurant of Mistaken Orders, a series of pop-up restaurants in Tokyo, are all living with dementia, which means that you might not receive what you ordered.

All of our servers are people living with dementia. They may, or may not, get your order right.

However, rest assured that even if your order is mistaken, everything on our menu is delicious and one of a kind. This, we guarantee.

“It’s OK if my order was wrong. It tastes so good anyway.” We hope this feeling of openness and understanding will spread across Japan and through the world.

At the first pop-up, 37% of the orders were mistaken. This video explains a bit more about the concept and shows the restaurant in action.

The Mosquito: Humanity’s Greatest Enemy

posted by Jason Kottke   Aug 13, 2019

For the New Yorker, Brooke Jarvis reviews Timothy C. Winegard’s The Mosquito: A Human History of Our Deadliest Predator.

It turns out that, if you’re looking for them, the words “mosquitoes,” “fever,” “ague,” and “death” are repeated to the point of nausea throughout human history. (And before: Winegard suggests that, when the asteroid hit, dinosaurs were already in decline from mosquito-borne diseases.) Malaria laid waste to prehistoric Africa to such a degree that people evolved sickle-shaped red blood cells to survive it. The disease killed the ancient Greeks and Romans — as well as the peoples who tried to conquer them — by the hundreds of thousands, playing a major role in the outcomes of their wars. Hippocrates associated malaria’s late-summer surge with the Dog Star, calling the sickly time the “dog days of summer.” In 94 B.C., the Chinese historian Sima Qian wrote, “In the area south of the Yangtze the land is low and the climate humid; adult males die young.” In the third century, malaria epidemics helped drive people to a small, much persecuted faith that emphasized healing and care of the sick, propelling Christianity into a world-altering religion.

And then there’s this:

In total, Winegard estimates that mosquitoes have killed more people than any other single cause — fifty-two billion of us, nearly half of all humans who have ever lived. He calls them “our apex predator,” “the destroyer of worlds,” and “the ultimate agent of historical change.”

Two other recent reviews of the book: In ‘The Mosquito,’ Humans Face A Predator More Deadly Than The Rest (NPR) and The mosquito isn’t just annoying — Timothy C. Winegard says we’re at war (LA Times).

What It Feels Like to Die from Heat Stroke

posted by Jason Kottke   Jul 23, 2019

From Outside magazine, an article on what your body goes through and what it feels like to die from heat stroke. A perhaps unnecessary note: this gets intense and a little graphic.

There are two kinds of heatstroke: classic and exertional. Classic heatstroke hits the very young, the elderly, the overweight, and people suffering from chronic conditions like uncontrolled diabetes, hypertension, and cardiovascular disease. Alcohol and certain medications (diuretics, tricyclic antidepressants, antipsychotics, and some cold and allergy remedies) can increase susceptibility as well. Classic heatstroke can strike in the quiet of upper-floor apartments with no air-conditioning.

Exertional heatstroke, on the other hand, pounces on the young and fit. Exercise drastically accelerates temperature rise. Marathon runners, cyclists, and other athletes sometimes push into what used to be known as the fever of exercise and is now called exercise-induced hyperthermia, where internal temperatures typically hit 100 to 104 degrees. Usually, there’s no lasting damage. But as body temperature climbs higher, the physiological response becomes more dramatic and the complications more profound. The higher temperature can ultimately trigger a cascading disaster of events as the metabolism, like a runaway nuclear reactor, races so fast and so hot that the body can’t cool itself down. A person careens toward organ failure, brain damage, and death.

It’s a sequel of sorts to this piece about what it feels like to freeze to death, which I vividly remember reading many years ago.

At 85 degrees, those freezing to death, in a strange, anguished paroxysm, often rip off their clothes. This phenomenon, known as paradoxical undressing, is common enough that urban hypothermia victims are sometimes initially diagnosed as victims of sexual assault. Though researchers are uncertain of the cause, the most logical explanation is that shortly before loss of consciousness, the constricted blood vessels near the body’s surface suddenly dilate and produce a sensation of extreme heat against the skin.

The Possible Link Between Seasonal Allergies and Anxiety & Depression

posted by Jason Kottke   Jul 11, 2019

Olga Khazan on The Reason Anxious People Often Have Allergies:

“There is good circumstantial evidence that’s growing that a number of mental illnesses are associated with immune dysfunction,” says Sandro Galea, a physician and epidemiologist at the Boston University School of Public Health.

If the link is in fact real, allergies could be causing anxiety and other mood disorders in a few different ways. For one, it’s stressful to be sick, and people with allergies frequently feel like they have a bad cold. The experience of straining to breathe, or of coughing and wheezing, could simply make people feel anxious.

Then there are biological explanations. Allergies trigger the release of the stress hormone cortisol, which can interfere with a feel-good brain chemical called serotonin. It’s not clear how the cortisol does this, Nanda says; it might inhibit the production of serotonin or make it fail to bind with its receptors properly. But when something goes wrong with serotonin, the theory goes, depression or anxiety might set in.

Huh. I definitely suffer from seasonal allergies (they have thankfully slacked off for the summer) and have struggled with anxiety since I was a kid (though I’ve never been clinically diagnosed). I’ll be following this research with interest.

Is Your Phone’s Electromagnetic Pollution Making You Ill?

posted by Jason Kottke   Jul 08, 2019

According this video by Kurzgesagt (and their extensive list of sources), the answer to that question for now is: no, our electronic devices are not causing long- or short-term health problems in the brains or bodies of people who use them.

Electrosmog is one of those things that is a bit vague and hard to grasp. When personal health is involved, feelings clash extra hard with scientific facts and there is a lot of misinformation and exaggeration out there. On the other hand, some people are really worried and distressed by the electricity that surrounds them. And just to wave this off is not kind or helpful.

While there is still a lot of researching being done on the dangers of constant weak electromagnetic radiation, it is important to stress that so far, we have no reason to believe that our devices harm us. Other than… well… spending too much time with them.

The Hayflick Limit

posted by Tim Carmody   Jun 28, 2019

Cells Dividing.jpg

Biology is one field I don’t know supremely well, having had a couple of college courses and then mostly just public television documentaries. So it’s always cool to get a new concept or two to play with, like the Hayflick Limit.

What is it?

In normal, replicating cells, all the important genetic code in a cell’s nucleus is protected by telomeres—sections of non-coding DNA on the ends of chromosomes. (Elizabeth Blackburn, who won a Nobel for her work on telomeres, compares them to the caps on the end of shoelaces that keep them from fraying.) Every time cells divide, telomeres shorten ever so slightly; the white blood cells in newborn humans have telomeres that consist of about 8,000 base pairs, which falls to around 1,500 in the elderly.

The Hayflick limit is thought to occur when telomeres are gone and cell division would be risky, because without their protection, loss of genetic information would occur. When cells no longer replicate, they’re considered “senescent”: they carry on most of their normal cellular activity and eventually die. The Hayflick limit is one cause, but external stress, like an infection, physical trauma, or UV radiation can hasten cell death, according to Jan van Deursen, a cancer biologist at the Mayo Clinic in Rochester, Minnesota.

Senescent cells are a culprit in aging, but they also have benefits. They give off proteins that can recruit immune cells, which can promote wound healing, and they’re one of our body’s defenses against cancer. One of the reasons cancer occurs is when cells switch on a gene that allows them to rebuild their telomeres—kind of like speeding through a stop sign. That’s why the only immortal human cells are cancer cells.

So the Hayflick Limit, if it could be waived, could theoretically prevent or delay aging. But as it is, it’s a built-in cap on how many replications a body’s cells and tissues can undergo, so it guarantees our mortality.

Here’s what Hayflick himself had to say about it:

To slow, or even arrest, the aging process in humans is fraught with serious problems in the relationships of humans to each other and to all of our institutions. By allowing asocial people, tyrants, dictators, mass murderers, and people who cause wars to have their longevity increased should be undesirable. Yet, that would be one outcome of being able to tamper with the aging process.

I guess at a minimum, as bad as everyone is, at least they (as an individual) are not around to be bad forever? I’ll take that silver lining.

On Managing Pain

posted by Tim Carmody   Jun 07, 2019

About two weeks ago, I had my right shoulder replaced. This was the second time I’ve had surgery on that shoulder, after multiple knee surgeries and arm surgeries, and abscesses and god knows what else. This surgery took place in the middle of what’s now, to me, a very familiar, and very tedious dance with my doctors around pain, pain management, and painkillers.

The way it works is this. Everyone knows that surgery, and the injuries that lead to surgery, are painful. Everyone also knows that the best way to treat pain of this kind is through the regular administration of opiates. However, because these drugs are addictive, everyone has to act as if they don’t know anything of the kind.

So instead of just prescribing the drugs, and preventing the pain, the doctors and nurses will wait until the patient asks for the pain medication. Or they’ll prescribe pain pills, but not enough to get the patient through to the next meeting with the doctor. They put the onus on the patient to beg for relief of his/her pain. Ideally with a buffer in between, like a nurse or a pain management specialist, so that the decision never comes directly from the person you’re interacting with, but an intercessor. This is why some patients end up medicated up to the gills, and others are left to grind their teeth and just get through it.

It’s really stupid. I suspect it heightens rather than lessening patients’ feelings of dependence on these drugs, which can do so much to reduce their acute pain and chronic discomfort. Instead, they’re doled out in a semi-arbitrary fashion, generally carefully rationed but sometimes overprescribed, based on your willingness to perform pain for someone else and that person’s level of compassion or complicity with your suffering.

This is all to say: no, I’m not on pain medication. Yes, I’m terribly uncomfortable. No, I’m not uncomfortable enough to jump through hoops and beg for more drugs. (Maybe if I were, things would be different.) And at the times I was most uncomfortable, those were the times when medicine was the least available to me, by design.

We’ve got to get over our weird Puritanical crap about pain and pain medication, and accept the fact that in certain contexts, we need the drugs. And by “we,” I mean myself, the medical system; everybody. We can’t be responsible for the entire opioid epidemic every second of every day. Sometimes we just need to be able to go to sleep.

What Illegal Abortion Was Like in the 1960s

posted by Jason Kottke   May 15, 2019

Diane Munday, an 86-year-old women’s rights activist, recalls what illegal abortion had been like in the UK in the 1960s.

“Women would drink bleach to try to induce miscarriage. They would have very hot baths, or move heavy furniture, or try to do it themselves with a needle or a crochet hook,” says Munday.

As a result, an underground network of backstreet abortionists ran quietly across the country. Some of them, says Munday, became involved by force. It was not unknown for women who had carried out abortions for their close friends and family to be blackmailed by desperate pregnant women who threatened to report them to the police if they didn’t help them, too. Like women who had abortions, those who carried out the procedure illegally could be sent to prison.

“These people were unskilled. Some might have had a bit of nursing experience or had worked in a hospital, or carried out procedures for a friend or daughter,” says Munday.

Munday became active in the campaign to legalize abortion in the UK after she had one herself following giving birth to three children in less than four years.

See also Harrowing Illegal Abortion Stories from Before Roe v. Wade.

On the Safety of Vaccines and the Low Risk of Side Effects

posted by Jason Kottke   May 13, 2019

The development of vaccines against infectious diseases is among the greatest of human accomplishments and has saved ten of millions of people from dying. And yet some are still hung up on their side effects (and also the widely disproved and debunked fraudulent claim that vaccines cause autism). In this video, Kurzgesagt looks at how vaccines work and compares the impact of their side effects (minuscule) to the potential effect of the diseases they protect against (children dying).

The extensive list of sources they used for the video can be found here.

The title of this video is “The Side Effects of Vaccines - How High is the Risk?”, which seems like it’s maximized for clicks and to spread amongst anti-vaxxers on social media. I wish it had a more accurate title — something like “The Absurdly Low Risk of Vaccine Side Effects” or maybe “Vaccines. And Now My Kids Don’t Die.” — but perhaps positioning it this way is a good strategy to get folks who may not be quite so radicalized to watch it.

Our World Is Built for Men

posted by Jason Kottke   Feb 27, 2019

In her new book, Invisible Women: Data Bias in a World Designed for Men, Caroline Criado Perez argues that the data that scientists, economists, public policy makers, and healthcare providers rely on is skewed, unfairly and dangerously, towards men.

…because so much data fails to take into account gender, because it treats men as the default and women as atypical, bias and discrimination are baked into our systems. And women pay tremendous costs for this bias, in time, money, and often with their lives.

The Guardian has a lengthy excerpt of the book, including a discussion of crash test dummies:

Crash-test dummies were first introduced in the 1950s, and for decades they were based around the 50th-percentile male. The most commonly used dummy is 1.77m tall and weighs 76kg (significantly taller and heavier than an average woman); the dummy also has male muscle-mass proportions and a male spinal column. In the early 1980s, researchers based at Michigan University argued for the inclusion of a 50th-percentile female in regulatory tests, but this advice was ignored by manufacturers and regulators. It wasn’t until 2011 that the US started using a female crash-test dummy — although, as we’ll see, just how “female” these dummies are is questionable.

Designing cars around the typical male body type means women are more likely to be injured or killed:

Men are more likely than women to be involved in a car crash, which means they dominate the numbers of those seriously injured in them. But when a woman is involved in a car crash, she is 47% more likely to be seriously injured, and 71% more likely to be moderately injured, even when researchers control for factors such as height, weight, seatbelt usage, and crash intensity. She is also 17% more likely to die. And it’s all to do with how the car is designed — and for whom.

Another example Criado Perez cites involves women’s healthcare:

When Viagra — sildenafil citrate — was tested initially as heart medication, its well-known properties for men were discovered. “Hallelujah,” said Big Pharma, and research ceased. However, in subsequent tests the same drug was found to offer total relief for serious period pain over four hours. This didn’t impress the male review panel, who refused further funding, remarking that cramps were not a public health priority.

On the Health Benefits of Sleep

posted by Jason Kottke   Feb 11, 2019

In this piece for The Guardian, Matthew Walker says that sleeping well is the best thing you can do for your health. Here are just a couple of examples:

Routinely sleeping less than six hours a night also compromises your immune system, significantly increasing your risk of cancer. So much so, that recently the World Health Organization classified any form of night-time shiftwork as a probable carcinogen.

Inadequate sleep — even moderate reductions of two to three hours for just one week — disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic. Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path towards cardiovascular disease, stroke and congestive heart failure.

A lack of sleep may also increase your chances of developing Alzheimer’s disease, decrease your athletic performance, make it more difficult to control your appetite, and have mental health consequences. Walker, who is the director of UC Berkeley’s Center for Human Sleep Science and author of Why We Sleep: Unlocking the Power of Sleep and Dreams, says we should change our cultural attitudes towards sleep.

I believe it is therefore time for us, as individuals and as nations, to reclaim our right to a full night of sleep, without embarrassment or the terrible stigma of laziness. I fully understand that this prescription of which I write requires a shift in our cultural, professional, and global appreciation of sleep.

In my media diet roundup post for 2018, I said that getting adequate sleep has “transformed my life” and that sleep is “even lower-hanging self-help fruit than yoga or meditation”. I have not been sleeping well for the past several weeks and it’s taking a toll: I’ve been sluggish, eating poorly & erratically, feeling down, and not anywhere near my peak mental performance. This morning I woke up at 4am, couldn’t really get back to sleep, and I feel like I’m running at 60% capacity, 65% tops.

Roald Dahl: Not Vaccinating Your Kids Is “Almost a Crime”

posted by Jason Kottke   Jan 25, 2019

Roald Dahl’s oldest daughter Olivia died from the measles when she was seven years old. She died because there wasn’t a reliable measles vaccine then, and in this heartfelt letter he wrote years later, Dahl wants everyone to know that there is such a vaccine now.

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

‘Are you feeling all right?’ I asked her.

‘I feel all sleepy,’ she said.

In an hour, she was unconscious. In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

I feel so tired when I think about parents not vaccinating their children against easily preventable fatal diseases. It’s child abuse and the kids know better! Here’s a tweet from Erin Faulk sharing some screenshots of teens asking how they can get vaccinated over their parents’ objections.

Teen Vaccine Legal

“Vaccines. And now my kids don’t die.”

The Incurable Disease vs the Relentless Couple

posted by Jason Kottke   Jan 16, 2019

When Sonia Vallabh lost her mother to a rare disease called fatal familial insomnia, she soon found out that she had inherited the disease, that there was no cure, and that she’d be dead in “a decade or two”. Despite almost no scientific training, Vallabh and her husband both quit their jobs to work on a cure. Talk about going all-in.

Within a few weeks of the diagnosis, Sonia had quit her job to study science full time, continuing classes at MIT during the day and enrolling in a night class in biology at Harvard’s extension school. The pair lived off savings and Eric’s salary. Sonia had expected to take a temporary sabbatical from her real life, but soon textbooks and academic articles weren’t enough. “The practice of science and the classroom version of science are such different animals,” Sonia says. She wanted to try her hand in the lab. She found a position as a technician with a research group focusing on Huntington’s disease. Eric, not wanting to be left behind, quit his job too and offered his data-crunching expertise to a genetics lab. The deeper they dove into science, the more they began to fixate on finding a cure.

They’re now on the brink of getting their Harvard PhDs and are pushing ahead with a promising medical therapy.

As soon as the couple began their presentation, Lander says, there was a sense of “pushing on an open door” — quite a surprise, given the agency’s stodgy reputation. “People still flat-out don’t believe the FDA was cool with it,” Minikel says. Afterward, one of the 25 scientists in the audience pulled Lander aside and said, “That was one of the best presentations I’ve ever seen.” Schreiber agreed. He alluded to a pharmaceutical company he’d helped set up early in his career. “Twenty-four years into that company, there was nothing to show for it. Not one thing,” he says. “For two graduate students who are not trained in science to come in and do what they did? Absolute forces of nature, savants. They keep seeing things that other people don’t see.”

Update: D.T. Max wrote a book on prions and prion-based diseases called The Family That Couldn’t Sleep. I looked in the kottke.org archives and found a 2010 post on a National Geographic article Max wrote about sleep that specifically referenced fatal familial insomnia:

The main symptom of FFI, as the disease is often called, is the inability to sleep. First the ability to nap disappears, then the ability to get a full night’s sleep, until the patient cannot sleep at all. The syndrome usually strikes when the sufferer is in his or her 50s, ordinarily lasts about a year, and, as the name indicates, always ends in death.

(via @mattbucher)

Sunshine Considered Harmful? Perhaps Not.

posted by Jason Kottke   Jan 14, 2019

For Outside magazine, Rowan Jacobsen talks to scientists whose research suggests that the current guidelines for protecting human skin from exposure to the sun are backwards. Despite the skin cancer risk, we should be getting more sun, not less.

When I spoke with Weller, I made the mistake of characterizing this notion as counterintuitive. “It’s entirely intuitive,” he responded. “Homo sapiens have been around for 200,000 years. Until the industrial revolution, we lived outside. How did we get through the Neolithic Era without sunscreen? Actually, perfectly well. What’s counterintuitive is that dermatologists run around saying, ‘Don’t go outside, you might die.’”

When you spend much of your day treating patients with terrible melanomas, it’s natural to focus on preventing them, but you need to keep the big picture in mind. Orthopedic surgeons, after all, don’t advise their patients to avoid exercise in order to reduce the risk of knee injuries.

Meanwhile, that big picture just keeps getting more interesting. Vitamin D now looks like the tip of the solar iceberg. Sunlight triggers the release of a number of other important compounds in the body, not only nitric oxide but also serotonin and endorphins. It reduces the risk of prostate, breast, colorectal, and pancreatic cancers. It improves circadian rhythms. It reduces inflammation and dampens autoimmune responses. It improves virtually every mental condition you can think of. And it’s free.

These seem like benefits everyone should be able to take advantage of. But not all people process sunlight the same way. And the current U.S. sun-exposure guidelines were written for the whitest people on earth.

Exposure and sunscreen recommendations for people with dark skin may be particularly misleading.

People of color rarely get melanoma. The rate is 26 per 100,000 in Caucasians, 5 per 100,000 in Hispanics, and 1 per 100,000 in African Americans. On the rare occasion when African Americans do get melanoma, it’s particularly lethal — but it’s mostly a kind that occurs on the palms, soles, or under the nails and is not caused by sun exposure.

At the same time, African Americans suffer high rates of diabetes, heart disease, stroke, internal cancers, and other diseases that seem to improve in the presence of sunlight, of which they may well not be getting enough. Because of their genetically higher levels of melanin, they require more sun exposure to produce compounds like vitamin D, and they are less able to store that vitamin for darker days. They have much to gain from the sun and little to fear.

AI Algorithm Can Detect Alzheimer’s Earlier Than Doctors

posted by Jason Kottke   Jan 07, 2019

A machine learning algorithm programmed by Dr. Jae Ho Sohn can look at PET scans of human brains and spot indicators of Alzheimer’s disease with a high level of accuracy an average of 6 years before the patients would receive a final clinical diagnosis from a doctor.

To train the algorithm, Sohn fed it images from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a massive public dataset of PET scans from patients who were eventually diagnosed with either Alzheimer’s disease, mild cognitive impairment or no disorder. Eventually, the algorithm began to learn on its own which features are important for predicting the diagnosis of Alzheimer’s disease and which are not.

Once the algorithm was trained on 1,921 scans, the scientists tested it on two novel datasets to evaluate its performance. The first were 188 images that came from the same ADNI database but had not been presented to the algorithm yet. The second was an entirely novel set of scans from 40 patients who had presented to the UCSF Memory and Aging Center with possible cognitive impairment.

The algorithm performed with flying colors. It correctly identified 92 percent of patients who developed Alzheimer’s disease in the first test set and 98 percent in the second test set. What’s more, it made these correct predictions on average 75.8 months — a little more than six years — before the patient received their final diagnosis.

This is the stuff where AI is going to be totally useful…provided the programs aren’t cheating somehow.

The Healthiest Vegetables, Ranked

posted by Jason Kottke   Jan 04, 2019

MEL Magazine’s Ian Lecklitner talked to clinical nutritionist David Friedman (author of Food Sanity: How to Eat in a World of Fads and Fiction) about which vegetables Friedman thinks are the healthiest. Happy to see that asparagus is #1:

“This tasty green stalk comes in first place on my vegetable ranking,” Friedman says. “Asparagus is a great source of vitamin K, which helps with blood clotting and building strong bones.” Friedman also mentions that asparagus provides vitamin A (which prevents heart disease), vitamin C (which supports the immune system), vitamin E (which acts as an antioxidant) and vitamin B6 (which, like vitamin A, also prevents heart disease).

Asparagus is also loaded with minerals, including iron (which supports oxygen-carrying red blood cells), copper (which improves energy production) and calcium (which improves bone health). “Asparagus increases your energy levels, protects your skin from sun damage and helps with weight loss,” Friedman continues. “It’s also an excellent source of inulin, a type of carbohydrate that acts as a prebiotic, supporting the growth of health-promoting bacteria in the colon.”

Personal faves brussels sprouts, beets, and broccoli also rank pretty high.

Optician Sans

posted by Jason Kottke   Dec 06, 2018

Optician Sans

Eye charts at your optometrist’s office typically only have 10 letters on them: CDHKNORSVZ. Inspired by that lettering, creative agency ANTI Hamar and typographer Fábio Duarte Martins have expanded that abbreviated alphabet into a free font with a full alphabet called Optician Sans. Here’s a video look at how they did it:

(via khoi)

What Doctors Know About CPR

posted by Jason Kottke   Dec 04, 2018

For this month’s issue of Topic, palliative care doctor Nathan Gray wrote & illustrated a comic about What Doctors Know About CPR. It does not match what you might have seen on TV.

CPR Comic

CPR holds an almost sacred space in medicine. Most doctors won’t refuse to perform it, even if they think it will be harmful or useless.

See also a hospital’s playlist of songs for doing perfect CPR chest compressions featuring Crazy in Love, Sweet Home Alabama, and Gloria Gaynor’s I Will Survive.

Why Doctors Hate Their Computers

posted by Tim Carmody   Nov 09, 2018

Nobody writes about health care practice from the inside out like Atul Gawande, here focusing on an increasingly important part of clinical work: information technology.

A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking—almost double the rate of the general working population.

Something’s gone terribly wrong. Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.

It’s not just the workload, but also what Gawande calls “the Revenge of the Ancillaries” — designing software for collaboration between different health care professionals, from surgeons to administrators, all of whom have competing stakes and preferences in how a product is used and designed, what information it offers and what it demands. And most medical software doesn’t handle these competing demands very well.

The Chicago Tylenol Murders of 1982

posted by Jason Kottke   Oct 19, 2018

I don’t know how many people under the age of 35 know about the Chicago Tylenol murders, but for a few weeks in 1982, it was a national news sensation. Seven people in the Chicago area died after ingesting Tylenol capsules laced with potassium cyanide. Retro Report took a look back at this episode, with a focus on how Johnson & Johnson and other drug companies modified their packaging to prevent in-store tampering.

The company considered renaming Tylenol, a word that incorporates some of the letters from 4- (aceTYLamino) phENOL, a chemical name for acetaminophen, the drug’s active ingredient. But a name change was rejected.

Instead, a mere six weeks after the crisis flared, the company offered a different solution, a new bottle with the sorts of safety elements now familiar (if at times exasperating) to every shopper: cotton wad, foil seal, childproof cap, plastic strip. Capsules began to be replaced with caplets the following year.

Johnson & Johnson was viewed as an exemplar of corporate responsibility, and enjoyed what some people described as the greatest comeback since Lazarus. Nowadays, all sorts of products come in containers deemed tamper-proof, or at least tamper-evident, meaning that consumers can readily tell if a seal has been broken or something else is amiss.

Incredibly, the case is still unsolved…no one knows who did it or why. Thinking about the amount of in-store surveillance that we have, it seems unlikely that such a crime would go unsolved for long today.

The Death of a Loved One from Opiate Addiction, Plainly & Honestly Told

posted by Jason Kottke   Oct 16, 2018

From an independent newspaper here in Vermont, the heartbreaking and brutally honest obituary of Madelyn Linsenmeir, a 30-year-old mother who died from a drug addiction to opiates that lasted for more a decade.

When she was 16, she moved with her parents from Vermont to Florida to attend a performing arts high school. Soon after she tried OxyContin for the first time at a high school party, and so began a relationship with opiates that would dominate the rest of her life.

It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie — when they saw her addiction, they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless, and resilient. She could and would talk to anyone, and when you were in her company you wanted to stay. In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders and doctors, who advocated for and believed in her ‘til the end. She was adored as a daughter, sister, niece, cousin, friend and mother, and being loved by Madelyn was a constantly astonishing gift.

This is powerfully straightforward writing by Linsenmeir’s family…my condolences are with them. They devoted a few paragraphs at the end of her obit to address addiction and its place in our society:

If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support.

If you work in one of the many institutions through which addicts often pass — rehabs, hospitals, jails, courts — and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.

As in many other states, more and more people are dying of opiate overdoses in Vermont even as doctors cut the number of opioid prescriptions they write faster than other areas of the country.

Update: On Facebook, Burlington, VT’s chief of police Brandon del Pozo wrote a response to Linsenmeir’s obituary that is very much worth reading.

Why did it take a grieving relative with a good literary sense to get people to pay attention for a moment and shed a tear when nearly a quarter of a million people have already died in the same way as Maddie as this epidemic grew?

Did readers think this was the first time a beautiful, young, beloved mother from a pastoral state got addicted to Oxy and died from the descent it wrought? And what about the rest of the victims, who weren’t as beautiful and lived in downtrodden cities or the rust belt? They too had mothers who cried for them and blamed themselves.

She died just like my wife’s cousin Meredith died in Bethesda, herself a young mother, but if Maddie was a black guy from the Bronx found dead in his bathroom of an overdose, it wouldn’t matter if the guy’s obituary writer had won the Booker Prize, there wouldn’t be a weepy article in People about it.

Why not?

But if there had been, early enough on, and we acted swiftly, humanely, and accordingly, maybe Maddie would still be here. Make no mistake, no matter who you are or what you look like: Maddie’s bell tolls for someone close to you, and maybe someone you love. Ask the cops and they will tell you: Maddie’s death was nothing special at all. It happens all the time, to people no less loved and needed and human.

(thx, caroline)

Music Can Save Lives: A Playlist for Perfect CPR Chest Compressions

posted by Jason Kottke   Oct 10, 2018

If you’re ever called on to perform CPR in an emergency but you don’t have training, the American Heart Association recommends performing “Hands-Only CPR”. There are two easy steps: you call 911 and then you press hard and fast in the center of the person’s chest 100-120 times per minute. As their fact sheet explains, familiar music can help maintain the proper tempo.

Song examples include “Stayin’ Alive” by the Bee Gees, “Crazy in Love” by Beyoncé featuring Jay-Z, “Hips Don’t Lie” by Shakira” or “Walk the Line” by Johnny Cash. People feel more confident performing Hands-Only CPR and are more likely to remember the correct rate when trained to the beat of a familiar song.

When performing CPR, you should push on the chest at a rate of 100 to 120 compressions per minute, which corresponds to the beat of the song examples above.

New York Presbyterian Hospital maintains a Spotify playlist of “Songs to do CPR to” that hit that 100-120 bpm sweet spot.

The playlist includes songs familiar to lifesavers of all generations, from Book of Love by the Monotones to Sweet Home Alabama by Lynyrd Skynyrd to Walk Like an Egyptian by The Bangles to Sorry by Justin Bieber. Stayin’ Alive or Justin Timberlake’s Rock Your Body are probably more appropriate to the situation, but should the need arise, my go-to CPR song is now Crazy in Love. Who knows, Beyoncé might help save someone’s life someday. (via @juliareinstein)

Google’s keyword voids

posted by Tim Carmody   Jul 06, 2018

This was a new term for me:

keyword void, or search void, n.: a situation where searching for answers about a keyword returns an absence of authoritative, reliable results, in favor of “content produced by a niche group with a particular agenda.”

An article by Renee DiResta at Wired uses the example of Vitamin K shots, a common treatment given to newborn babies at hospitals, but whose top search results are dominated by anti-vaccination groups.

There’s an asymmetry of passion at work. Which is to say, there’s very little counter-content to surface because it simply doesn’t occur to regular people (or, in this case, actual medical experts) that there’s a need to produce counter-content. Instead, engaging blogs by real moms with adorable children living authentic natural lives rise to the top, stating that doctors are bought by pharma, or simply misinformed, and that the shot is risky and unnecessary. The persuasive writing sounds reasonable, worthy of a second look. And since so much of the information on the first few pages of search results repeats these claims, the message looks like it represents a widely-held point of view. But it doesn’t. It’s wrong, it’s dangerous, and it’s potentially deadly.

I wondered what other examples of keyword voids might be out there, so I searched for it. Unsurprisingly — in retrosepect — you don’t get a lot of relevant results. It’s mostly programming talk, when you literally want a function to return no results.

Mosaicism, or DNA differences from cell to cell (not just person to person)

posted by Tim Carmody   May 25, 2018

Science writer Carl Zimmer has a new book on genetics and heredity called She Has Her Mother’s Laugh. The New York Times published an excerpt this week focusing on mosaicism — an unexpected but surprisingly common condition where different cells in the same organism display different DNA (sometimes strikingly, fatally different).

Dr. Walsh and his colleagues have discovered intricate mosaics in the brains of healthy people. In one study, they plucked neurons from the brain of a 17-year-old boy who had died in a car accident. They sequenced the DNA in each neuron and compared it to the DNA in cells from the boy’s liver, heart and lungs.

Every neuron, the researchers found, had hundreds of mutations not found in the other organs. But many of the mutations were shared only by some of the other neurons.

It occurred to Dr. Walsh that he could use the mutations to reconstruct the cell lineages — to learn how they had originated. The researchers used the patterns to draw a sort of genealogy, linking each neuron first to its close cousins and then its more distant relatives.

When they had finished, the scientists found that the cells belonged to five main lineages. The cells in each lineage all inherited the same distinctive mosaic signature.

Even stranger, the scientists found cells in the boy’s heart with the same signature of mutations found in some brain neurons. Other lineages included cells from other organs.

Based on these results, the researchers pieced together a biography of the boy’s brain.

I’ve always been drawn to the idea that each of us are many people, an assembly of mismatched parts, manifesting themselves in different times and contexts. It’s striking to see that reflected, albeit in a refracted way, in our array of possible genomes.

Can bacteriophages rescue us from drug-resistant bacteria?

posted by Jason Kottke   May 14, 2018

Last month when I posted a video comparing the sizes of various microorganisms, I noted the weirdness of bacteriophages, which are bacteria-killing viruses that look a bit like a 20-sided die stuck on the top of a sci-fi alien’s body.

Bacteriophages are really real and terrifying…if you happen to be a bacteria. Bacteriophages attack by attaching themselves to bacteria, piercing their outer membranes, and then pumping them full of bacteriophage DNA. The phage replicates inside of the bacteria until the bacteria bursts and little baby bacteriophages are exploded out all over the place, ready to attack their own bacteria.

I couldn’t find a good explainer (video or text) about these organisms, but over the weekend, Kurzgesagt rode to the rescue with this video. In the second part of the video, they discuss whether bacteriophages might form the basis of an effective treatment for antibiotic-resistant infections.

DNA sites show why we need a Hippocratic Oath for data science

posted by Tim Carmody   Apr 27, 2018

A suspect in the Golden State Killer murders has been arrested, based largely on DNA evidence that was apparently obtained in part through creating a dummy profile on a heredity website. California’s laws are apparently fairly permissive when it comes to using familial DNA to match suspects to crimes.

Solving unsolved rape and murder cases is generally good, but turning private websites into repositories of criminal evidence police can obtain without a warrant is generally bad. Like, extra bad.

One of the first things this reminded me of was Cathy O’Neil’s recent call for a Hippocratic Oath for data scientists. The idea is for data scientists to have some ethical guidelines, and above all to avoid doing harm or violating the rights of the people implicated by the practice of data science. In order to do that, you need to bring in the various stakeholders, properly weigh each of their concerns, and continually work to address them.

It’s always an incomplete process, because as O’Neil notes right away, data science isn’t limited to the acts of professional data scientists; it’s also the province of companies, and algorithms, and automated or self-learning uses of data. So in addition to a Hippocratic Oath (or some version of it), you also need a version of HIPAA (the law that guarantees the secure storage and distribution of health information).

DNA/heredity sites seem like the perfect test case for figuring out the compatibility of these two modes of operating. It seems like largely, they’re being treated either as a simple data regime, a la social media networks, and/or under criminal statutes. But a person’s DNA is, or should be, treated like medical information, with strict limits on its use. There has to be some way to figure out how to weigh all of these things together without compromising people’s rights.

How to reduce opioid addiction

posted by Jason Kottke   Apr 18, 2018

This morning I ran across news from two different studies about reducing deaths from opioid overdoses and they both had the same solution: medication-assisted treatment. First, from a study involving inmates in Rhode Island correctional facilities:

The program offers inmates methadone and buprenorphine (opioids that reduce cravings and ease withdrawal symptoms), as well as naltrexone, which blocks people from getting high.

The data set is small but the results are encouraging: there were fewer overdose deaths of former inmates after the program was implemented in 2016.

In the 90s, France used a similar program to cut heroin overdose deaths by 79%:

In 1995, France made it so any doctor could prescribe buprenorphine without any special licensing or training. Buprenorphine, a first-line treatment for opioid addiction, is a medication that reduces cravings for opioids without becoming addictive itself.

With the change in policy, the majority of buprenorphine prescribers in France became primary-care doctors, rather than addiction specialists or psychiatrists. Suddenly, about 10 times as many addicted patients began receiving medication-assisted treatment, and half the country’s heroin users were being treated. Within four years, overdose deaths had declined by 79 percent.

A young video blogger with cancer shares her story

posted by Jason Kottke   Mar 20, 2018

When she was 16, Charlotte Eades was diagnosed with glioblastoma, an extremely aggressive form of brain cancer. About a year after the diagnosis, she began documenting her illness and her life on her YouTube channel. After Eades died, her family made the video above, a short tribute to her life and video blog.