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kottke.org posts about medicine

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.

A surgery resident analyzes medical scenes from TV & movies

posted by Jason Kottke   Mar 15, 2018

Annie Onishi is a general surgery resident at Columbia University and Wired asked her to break down scenes from movies and TV shows featuring emergency rooms, operating rooms, and other medical incidents. Spoiler alert: if you seek medical treatment from a TV doctor, you will probably die. Secondary spoiler alert: that adrenaline-shot-to-the-heart scene in Pulp Fiction is not as implausible as you might think, even if some of the details are wrong.

A powerful video of every concussion in the NFL this year

posted by Jason Kottke   Feb 01, 2018

Data artist Josh Begley edited together a 5m30s video of every concussion suffered in an NFL game this year. I was barely able to get through this…I had to pause a couple of times. From an article about the video at The Intercept:

The NFL has done a masterful job at mainstreaming the violence of the game, so that fans and spectators don’t feel too bad about what’s actually happening out there. No single word has protected the NFL from the true costs of this violence more than “concussion.” That word puts a protective barrier between us and what’s really going on out on the field.

It’s not a headache. It’s not “getting your bell rung.” You don’t have a bell. It’s a traumatic brain injury. Every single concussion is a new traumatic brain injury. In addition to the torn ACLs and MCLs, in addition to all of the horrible broken bones, the NFL diagnosed at least 281 traumatic brain injuries this season. And no document has ever quite displayed the horror of it all like “Concussion Protocol,” a film by Josh Begley and Field of Vision.

The backwards slow-mo technique is a bit off-putting at first, but as Greg Dorsainville noted in the video’s thread:

If it was in forwards it would be like any big hits package you see in an espn highlight show where we celebrate the football and hit and not mourn the result of the moment: a human in pain, disorientation, and slowly killing themselves.

Having big second thoughts on watching the Super Bowl this weekend, karma offsets or no. (via @harmancipants)

Art observation skills can transfer to the medical lab

posted by Jason Kottke   Jan 17, 2018

In a study done by UPenn researchers, first-year medical students who were taught art observation classes at the Philadelphia Museum of Art were more proficient at reading clinical imagery than students who didn’t take the classes.

If you’re unfamiliar or uncomfortable with how art and science can mingle to produce something clinically beneficial, it’s a study premise that might seem far-fetched — but it didn’t seem that way to Gurwin, an ophthalmology resident at Penn, in part because she’d already seen the benefits of art education on a medical career firsthand.

“Having studied fine arts myself and having witnessed its impact on my medical training, I knew art observation training would be a beneficial practice in medical school,” she said. “Observing and describing are skills that are taught very well in fine arts training, and so it seemed promising to utilize their teachings and apply it to medicine.”

Gurwin and Binenbaum’s findings, published in the journal Ophthalmology in September: The medical students who’ve dabbled in art just do better.

It’s a glimpse at how non-clinical training can and does make for a better-prepared medical professional. Not only does art observation training improve med students’ abilities to recognize visual cues, it also improves their ability to describe those cues.

The results of this study reminded me of Walter Isaacson’s assertion in his book that Leonardo da Vinci’s greatest skill was his keen observational ability. Not coincidentally, Leonardo was both an artist and a medical researcher who dissected more than 30 human cadavers to study human anatomy. These dissections helped him to represent the human form more realistically in his paintings and drawings.

Leonardo Anatomy

It’s easier to draw a hand, particularly a hand that appears to be moving (as Leonardo liked to do), if you know that’s going on underneath the skin. Looking carefully and purposefully at art, at anatomy, at the physical world, at people’s actions, at movies; it’s all the same skill that can be applied to anything.

I’ve been preoccupied with observation lately…the new kottke.org newsletter is named Noticing for good reason. Again, Leonardo factors in:

Isaacson argues that Leonardo’s observational powers were not innate and that with sufficient practice, we can all observe as he did. People talk in a precious way about genius, creativity, and curiosity as superpowers that people are born with but noticing is a more humble pursuit. Noticing is something we can all do.

In 90 seconds, Penn & Teller show why vaccination is great

posted by Jason Kottke   Dec 07, 2017

In only 90 seconds with the use of a few props (and some profanity), entertainers Penn & Teller offer a succinct and compelling argument of the benefits of vaccinating our children.

So even if vaccination did cause autism, WHICH IT FUCKING DOESN’T, anti-vaccination would still be bullshit.

Along with “Vaccines. And now my kids don’t die.”, this might be my favorite anti-vaxxers broadside ever.

Increasing human healthspans

posted by Jason Kottke   Nov 08, 2017

Kurzgesagt takes a look at three possible areas of research that may help people live longer and healthier: senescent cells, NAD+, and stem cells. The distinction articulated early on in the video between optimizing for human lifespan versus increasing human healthspan seems particularly important in this search for a cure for aging.

Cancer survival rates have increased dramatically over the past 35 years

posted by Jason Kottke   Nov 08, 2017

Cancer Survival Rates

According to a study published in March 2017 in the Journal of the National Cancer Institute, cancer death rates continue to fall across most cancer types. From 2010 to 2014 (the most recent year that statistical data is available), overall death rates decreased by 1.8%.

Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = -1.8% to -1.8%) per year in men, by 1.4% (95% CI = -1.4% to -1.3%) per year in women, and by 1.6% (95% CI = -2.0% to -1.3%) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers.

But the trends are much clearer when you look at progress over a longer time period. As this graph from Axios shows, the five-year survival rates for most common types of cancer have increased quite significantly in the past 30-40 years. Survival rates from all cancers increased by 16% and jumped 26% and almost 29% for non-Hodkin lymphoma and leukemia respectively. If you have prostate or thyroid cancer, you’re almost guaranteed to survive 5 years at this point and the female breast cancer survival rate is up to almost 91%. (via @Atul_Gawande)

Researchers may have found a CTE test for living patients

posted by Jason Kottke   Sep 28, 2017

Currently, the only way to diagnose chronic traumatic encephalopathy (CTE), a disease caused by repeated head trauma, is by posthumously examining brain tissue for signs of tau protein buildup. But a group from Boston University may have found a way to test for CTE in living patients.

McKee and her team discovered a specific biomarker in the brains of former football players. A biomarker is a measurable substance which is, in this case, found in the brain and identifies an abnormality.

This particular biomarker is called CCL11, and it’s a secreted protein the human body uses to help regulate the immune system and inflammation in the body.

As The Ringer’s Claire McNear writes, if a CTE test is easily available to players, what will that do to football? (Or indeed, what will it do to sports like soccer, boxing, skateboarding, or even skiing?)

“After learning all of this,” the retiring Ferguson wrote of the clarity he gained when he began researching CTE, “I feel a bit betrayed by the people or committees put in place by the league who did not have my best interests at heart.” He should feel betrayed, as should many of his fellow players. As will, certainly, so very many, once they have the ability to see what has happened to them. They may wonder, rightfully, about the people who trained them and paid them, sometimes even as they attempted to shut down research into CTE. They may look at the league’s structure, at the lopsided contracts that rob many players of their leverage, forcing them to choose between getting back on the field or losing a paycheck (and possibly getting cut), and at how the league cycles through players like they’re nothing more than easily broken pieces on a board.

Former NFL player Aaron Hernandez had severe CTE

posted by Jason Kottke   Sep 22, 2017

Former New England Patriots player Aaron Hernandez, who was serving a life sentence for murdering a friend and who died in prison from suicide earlier this year, was found to have “a severe form” of CTE, a brain disease linked to repeated head trauma that has also been found in many other former NFL players.

Researchers who examined the brain determined it was “the most severe case they had ever seen in someone of Aaron’s age,” said a lawyer for Hernandez in announcing the result at a news conference on Thursday. Hernandez was 27.

Hernandez played three seasons in college and only three in the NFL, yet the damage to his brain was similar to “players with a median age of 67 years”. If you’re a young football player in college or the NFL right now, you have to be looking at this situation pretty hard right now.

See also: Don’t Let Kids Play Football, what the ball boy saw, I’m quitting football, NFL deliberately campaigned against science regarding head injuries, Junior Seau’s family sues NFL over concussions, how professional football might end (sooner than you think), and a message in an NFL player’s suicide.

Disturbed by on-field violence, top football TV analyst quits

posted by Jason Kottke   Aug 30, 2017

Former NFL player Ed Cunningham has resigned from his job as a college football color analyst for ABC/ESPN because of “his growing discomfort with the damage being inflicted on the players he was watching each week”.

If Ed Cunningham had not already seen enough, he would be back in a broadcast booth on Saturday afternoon, serving as the color analyst for another top college football game televised on ABC or ESPN. It is the work he has done each fall for nearly 20 years.

But Cunningham, 48, resigned from one of the top jobs in sports broadcasting because of his growing discomfort with the damage being inflicted on the players he was watching each week. The hits kept coming, right in front of him, until Cunningham said he could not, in good conscience, continue his supporting role in football’s multibillion-dollar apparatus.

Another domino falls. Unless there are big changes to the game play, sooner or later football will likely become a marginalized sport in the US.

Beating cancer is a team sport

posted by Jason Kottke   Jul 20, 2017

Senator John McCain has been diagnosed with a particularly aggressive form of brain cancer. The tumor has been removed and McCain is recovering at home with his family. I wish Senator McCain well and hope for a speedy recovery.

In the wake of his diagnosis, many of those expressing support for McCain reference his considerable personal strength in his fight against cancer. President Obama said:

John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.

McCain’s daughter Meghan references his toughness and fearlessness in a statement released yesterday. Vice-President Joe Biden expressed similar sentiments on Twitter:

John and I have been friends for 40 years. He’s gotten through so much difficulty with so much grace. He is strong — and he will beat this.

This is the right thing to say to those going through something like this, and hearing this encouragement and having the will & energy to meet this challenge will undoubtably increase McCain’s chances of survival. But what Biden said next is perhaps more relevant:

Incredible progress in cancer research and treatment in just the last year offers new promise and new hope. You can win this fight, John.

As with polio, smallpox, measles, and countless other diseases before it, beating cancer is not something an individual can do. Being afflicted with cancer is the individual’s burden to bear but society’s responsibility to cure. In his excellent biography of cancer from 2011, The Emperor of All Maladies, Siddhartha Mukherjee talks about the progress we’ve made on cancer:

Incremental advances can add up to transformative changes. In 2005, an avalanche of papers cascading through the scientific literature converged on a remarkably consistent message — the national physiognomy of cancer had subtly but fundamentally changed. The mortality for nearly every major form of cancer — lung, breast, colon, and prostate — had continuously dropped for fifteen straight years. There had been no single, drastic turn but rather a steady and powerful attrition: mortality had declined by about 1 percent every year. The rate might sound modest, but its cumulative effect was remarkable: between 1990 and 2005, the cancer-specific death rate had dropped nearly 15 percent, a decline unprecedented in the history of the disease. The empire of cancer was still indubitably vast — more than half a million American men and women died of cancer in 2005 — but it was losing power, fraying at its borders.

What precipitated this steady decline? There was no single answer but rather a multitude. For lung cancer, the driver of decline was primarily prevention — a slow attrition in smoking sparked off by the Doll-Hill and Wynder-Graham studies, fueled by the surgeon general’s report, and brought to its full boil by a combination of political activism (the FTC action on warning labels), inventive litigation (the Banzhaf and Cipollone cases), medical advocacy, and countermarketing (the antitobacco advertisements). For colon and cervical cancer, the declines were almost certainly due to the successes of secondary prevention — cancer screening. Colon cancers were detected at earlier and earlier stages in their evolution, often in the premalignant state, and treated with relatively minor surgeries. Cervical cancer screening using Papanicolaou’s smearing technique was being offered at primary-care centers throughout the nation, and as with colon cancer, premalignant lesions were excised using relatively minor surgeries. For leukemia, lymphoma, and testicular cancer, in contrast, the declining numbers reflected the successes of chemotherapeutic treatment. In childhood ALL, cure rates of 80 percent were routinely being achieved. Hodgkin’s disease was similarly curable, and so, too, were some large-cell aggressive lymphomas. Indeed, for Hodgkin’s disease, testicular cancer, and childhood leukemias, the burning question was not how much chemotherapy was curative, but how little: trials were addressing whether milder and less toxic doses of drugs, scaled back from the original protocols, could achieve equivalent cure rates.

Perhaps most symbolically, the decline in breast cancer mortality epitomized the cumulative and collaborative nature of these victories — and the importance of attacking cancer using multiple independent prongs. Between 1990 and 2005, breast cancer mortality had dwindled an unprecedented 24 percent. Three interventions had potentially driven down the breast cancer death rate-mammography (screening to catch early breast cancer and thereby prevent invasive breast cancer), surgery, and adjuvant chemotherapy (chemotherapy after surgery to remove remnant cancer cells).

Understanding how to defeat cancer is an instance where America’s fierce insistence on individualism does us a disservice. Individuals with freedom to pursue their own goals are capable of a great deal, but some problems require massive collective coordination and effort. Beating cancer is a team sport; it can only be defeated by a diverse collection of people and institutions working hard toward the same goal. It will take government-funded research, privately funded research, a strong educational system, philanthropy, and government agencies from around the world working together. This effort also requires a system of healthcare that’s available to everybody, not just to those who can afford it. Although cancer is not a contagious disease like measles or smallpox, the diagnosis and treatment of each and every case brings us closer to understanding how to defeat it. We make this effort together, we spend this time, energy, and money, so that 10, 20, or 30 years from now, our children and grandchildren won’t have to suffer like our friends and family do now.

Google search data shows “a crisis of self-induced abortions”

posted by Jason Kottke   Jun 26, 2017

For his book Everybody Lies: Big Data, New Data, and What the Internet Can Tell Us About Who We Really Are, Seth Stephens-Davidowitz combed through data on Google Trends for five years, looking for data on searches that Google users “don’t tell to possibly anybody else, things they might not tell to family members, friends, anonymous surveys, or doctors”.

According to a recent interview with Stephens-Davidowitz, right now the data is showing an increase in search queries on how to perform abortions at home and, no surprise, the activity is highest in parts of the country where access to abortion is most difficult.

I’m pretty convinced that the United States has a self-induced abortion crisis right now based on the volume of search inquiries. I was blown away by how frequently people are searching for ways to do abortions themselves now. These searches are concentrated in parts of the country where it’s hard to get an abortion and they rose substantially when it became harder to get an abortion. They’re also, I calculate, missing pregnancies in these states that aren’t showing up in either abortion or birth rates.

That’s pretty disturbing and I think isn’t really being talked about. But I think, based on the data, it’s clearly going on.

What bullets do to bodies

posted by Jason Kottke   Jun 16, 2017

Emergency room doctor Leana Wen writes in the NY Times about what bullets do to human bodies.

Early in my medical training, I learned that it is not the bullet that kills you, but the damage from the bullet. A handgun bullet enters the body in a straight line. Like a knife, it damages the organs and tissues directly in its path, and then it either exits the body or is stopped by bone, tissue or skin.

This is in contrast to bullets from an assault rifle. They are three times the speed of handgun bullets. Once they enter the body, they fragment and explode, pulverizing bones, tearing blood vessels and liquefying organs.

Earlier this year, Jason Fagone wrote a much longer piece on the same topic for HuffPost.

“As a country,” Goldberg said, “we lost our teachable moment.” She started talking about the 2012 murder of 20 schoolchildren and six adults at Sandy Hook Elementary School. Goldberg said that if people had been shown the autopsy photos of the kids, the gun debate would have been transformed. “The fact that not a single one of those kids was able to be transported to a hospital, tells me that they were not just dead, but really really really really dead. Ten-year-old kids, riddled with bullets, dead as doornails.” Her voice rose. She said people have to confront the physical reality of gun violence without the polite filters. “The country won’t be ready for it, but that’s what needs to happen. That’s the only chance at all for this to ever be reversed.”

She dropped back into a softer register. “Nobody gives two shits about the black people in North Philadelphia if nobody gives two craps about the white kids in Sandy Hook. … I thought white little kids getting shot would make people care. Nope. They didn’t care. Anderson Cooper was up there. They set up shop. And then the public outrage fades.”

I think about this tweet all the time:

In retrospect Sandy Hook marked the end of the US gun control debate. Once America decided killing children was bearable, it was over.

Update: Radiologist Heather Sher was on duty at a Florida trauma center when victims from the shooting at Marjory Stoneman Douglas High School were coming in. In this piece for The Atlantic, she explains how drastically different the wounds are from the AR-15 than from other guns.

In a typical handgun injury that I diagnose almost daily, a bullet leaves a laceration through an organ like the liver. To a radiologist, it appears as a linear, thin, grey bullet track through the organ. There may be bleeding and some bullet fragments.

I was looking at a CT scan of one of the victims of the shooting at Marjory Stoneman Douglas High School, who had been brought to the trauma center during my call shift. The organ looked like an overripe melon smashed by a sledgehammer, with extensive bleeding. How could a gunshot wound have caused this much damage?

The reaction in the emergency room was the same. One of the trauma surgeons opened a young victim in the operating room, and found only shreds of the organ that had been hit by a bullet from an AR-15, a semi-automatic rifle which delivers a devastatingly lethal, high-velocity bullet to the victim. There was nothing left to repair, and utterly, devastatingly, nothing that could be done to fix the problem. The injury was fatal.

In addition to the obvious horrorshow of carnage caused by AR-15-propelled bullets, what gets me is the phrase “a typical handgun injury that I diagnose almost daily”. In other countries, daily gunshot wounds would be an alarming situation in need of immediate response, but the in the US, it’s just a prelude to even greater horrors.

Dylan Matthews donated a kidney to a complete stranger

posted by Jason Kottke   Apr 11, 2017

Last August, Dylan Matthews donated one of his kidneys to someone he’d never met before.

On Monday, August 22, 2016, a surgical team at Johns Hopkins Hospital in Baltimore removed my left kidney. It was then drained of blood, flushed with a preservative solution, placed on ice, and flown to Cincinnati.

Surgeons in Cincinnati then transplanted the kidney into a recipient I’d never met and whose name I didn’t know; we didn’t correspond until this past month. The only thing I knew about him at the time was that he needed my kidney more than I did. It would let him avoid the physically draining experience of dialysis and possibly live an extra nine to 10 years, maybe more.

Why did he do it? Because he thought it was the right thing to do morally.

I’d wanted to give a kidney for years — at least since I first heard it was possible after reading Larissa MacFarquhar’s New Yorker piece on “good Samaritan” kidney donors when I was in college. It just seemed like such a simple and clear way to help someone else, through a procedure that’s very low-risk to me. I studied moral philosophy as an undergrad, and there’s a famous thought experiment about a man who walks by a shallow pond where a child is drowning and does nothing, because leaping in to save the child might muddy his clothes.

As Matthews notes, all you need to do to get started on the road to becoming a living donor is fill out this form.

An epidemic of middle-aged male loneliness

posted by Jason Kottke   Mar 10, 2017

Um…

Vivek Murthy, the surgeon general of the United States, has said many times in recent years that the most prevalent health issue in the country is not cancer or heart disease or obesity. It is isolation.

Oh.

Beginning in the 1980s, Schwartz says, study after study started showing that those who were more socially isolated were much more likely to die during a given period than their socially connected neighbors, even after you corrected for age, gender, and lifestyle choices like exercising and eating right. Loneliness has been linked to an increased risk of cardiovascular disease and stroke and the progression of Alzheimer’s. One study found that it can be as much of a long-term risk factor as smoking.

The research doesn’t get any rosier from there. In 2015, a huge study out of Brigham Young University, using data from 3.5 million people collected over 35 years, found that those who fall into the categories of loneliness, isolation, or even simply living on their own see their risk of premature death rise 26 to 32 percent.

Eep!

That fainting life

posted by Jason Kottke   Mar 10, 2017

Fainting

Isabella Rotman drew a comic for The Nib about her life as a hemophobe (someone who faints at the sight of blood).

Once at a former deli job, I passed out onto a pizza oven in response to a coworker’s particularly graphic description of a lawn mower injury. Had the oven been on, I would have suffered some pretty drastic burns.

I’m a fainter, though not at the sight of blood. After fainting a couple of times in high school, a doctor chalked it up to low blood pressure — I am the chillest mofo you know, blood pressure-wise — and urged me not to stand up too quickly after lying down. Just this morning, I did not heed that advice and almost toppled over after getting out of bed and stretching my arms above my head.

But my bigger problem, and what made Rotman’s comic resonate with me, is that medical procedures and doctor’s offices also cause me to faint. This wasn’t always the case. When I was younger, I received allergy shots up to three times a week and had no problem going into the clinic to get my shot…I even looked at the thin needle going into my arm every time. Flu shots, dentist visits, doctor’s appointments? No problem. Then when I was 17, I went to the local clinic for a mandatory physical for college. They did a blood draw, which went smoothly, but right afterwards, as I was sitting in a chair in the hallway, I fainted — probably because of my low blood pressure. Weird, but not a big deal.

Fast forward 12-15 years, during which time (because I was young and healthy and dumb and medical care is expensive) I did not visit a doctor’s office1 and somehow I had developed a phobia of needles going into my skin. I found this out when I went to get a flu shot, watched the needle sink into my arm, and promptly passed the fuck out.2 Since then, any time I’ve had to get a shot or blood drawn, I have fainted (or at least felt like I was going to).

That’s bad enough, but the problem became psychosomatic. Any trip to a doctor’s office will now trigger a faint feeling, even if I’m not the patient. Every time I take my kids to the pediatrician, there’s a possibility I’ll end up on the floor. When my wife was pregnant with our first kid, I nearly fainted at one of her ultrasound appointments and the ultrasound tech plopped me down in a nearby chair and handed me a glucose drink, telling me that becoming a father is a lot to handle for some men. (I think I nodded weakly, not even able to muster a “yeah, it’s not that”.) It’s gotten to the point where even *thinking* about it makes me feel weird. My palms have been sweaty and I’ve felt lightheaded the entire time I’ve been writing this post. The same thing happens when I tell people about it in person. It’s ridiculous and I feel stupid about it, even though it’s a stark reminder how much your subconscious thoughts can affect your body (and how little control we have over ourselves sometimes).

As Rotman did, I have been attempting exposure therapy with some success. When I went in for a physical a few months ago, I told the nurse that I might faint during the blood draw. She had me lay down on the table and just before she came over with the kit, I popped my headphones in and put on some relaxing music (Tycho I think). I broke out in a sweat and the procedure took much longer than it should have — she had to stick me *twice* because she didn’t get enough the first time — but I got through it without passing out. Progress to build on, I hope!

  1. Aside from a trip to the emergency room from — you guessed it! — a fainting incident when I was 24. Came to on the floor of the bathroom having slammed my mouth on the edge of the counter. It was exactly as painful as it sounds and it totally fucked up my grill.

  2. And wow, did the nurse look alarmed when I came to a few seconds later. They all look alarmed, even when I tell them ahead of time that I might faint. One of the last times, the nurse said, “I didn’t think you were actually serious.” (That fainting experience was the weirdest one I’ve ever had. According to the nurse, I was out for about 6-8 seconds but had a whole experience in my head that lasted for at least a half hour. I wasn’t near death, but it felt very real and I can definitely see how some people would interpret that as an out-of-body or religious experience.)

The best medical science images of the year

posted by Jason Kottke   Mar 06, 2017

Wellcome Images 2017

Wellcome Images 2017

Wellcome Images 2017

The Wellcome Image Awards 2017 recognize the best images related to healthcare and biomedical science taken during the past year.

The Wellcome Image Awards are Wellcome’s most eye-catching celebration of science, medicine and life. Now in their 20th year, the Awards recognise the creators of informative, striking and technically excellent images that communicate significant aspects of healthcare and biomedical science. Those featured are selected from all of the new images acquired by Wellcome Images during the preceding year. The judges are experts from medical science and science communication.

From top to bottom, there’s Mark R. Smith’s photo of a baby Hawaiian bobtail squid, neural stem cells growing on a synthetic gel photographed by Collin Edington and Iris Lee, and Scott Echols’ image of a pigeon’s blood vessel network. (via digg)

Harrowing illegal abortion stories from before Roe v. Wade

posted by Jason Kottke   Feb 21, 2017

Before the Roe v. Wade Supreme Court decision in 1973, most women seeking abortions in the US had to get them illegally. Illegal abortions were often unsafe & painful, and many women died, were injured, or were sexually assaulted by the men performing the procedures. In this video, three women who had abortions before 1973 and a woman who worked at a Brooklyn hospital in that era described their experiences.

“He said, ‘I’m not going to give you any anesthetic’ and he said ‘If you scream, they will hear you.’”

That’s how Connie described the illegal abortion she received in 1953 when she was 16 years old. Now a retired teacher, mother and grandmother, Connie said that after she received the abortion, the man who performed the procedure proceeded to sexually assault her as she lay bleeding on the table.

The Gates Foundation Annual Letter for 2017

posted by Jason Kottke   Feb 17, 2017

Each year, Bill and Melinda Gates write a letter about the work they’re doing with the Bill and Melinda Gates Foundation. In 2006, Warren Buffett donated more than billion to their foundation, which effectively doubled its available resources. This year’s letter from the Gateses is addressed to Buffett and details the return on his investment so far.

Bill: If we could show you only one number that proves how life has changed for the poorest, it would be 122 million — the number of children’s lives saved since 1990.

Melinda: Every September, the UN announces the number of children under five who died the previous year. Every year, this number breaks my heart and gives me hope. It’s tragic that so many children are dying, but every year more children live.

Bill: More children survived in 2015 than in 2014. More survived in 2014 than in 2013, and so on. If you add it all up, 122 million children under age five have been saved over the past 25 years. These are children who would have died if mortality rates had stayed where they were in 1990.

Bill calls saving children’s lives “the best deal in philanthropy”. Melinda continues:

Melinda: And if you want to know the best deal within the deal — it’s vaccines. Coverage for the basic package of childhood vaccines is now the highest it’s ever been, at 86 percent. And the gap between the richest and the poorest countries is the lowest it’s ever been. Vaccines are the biggest reason for the drop in childhood deaths.

Melinda: They’re an incredible investment. The pentavalent vaccine, which protects against five deadly infections in a single shot, now costs under a dollar.

Bill: And for every dollar spent on childhood immunizations, you get $44 in economic benefits. That includes saving the money that families lose when a child is sick and a parent can’t work.

Vaccines. And Now my kids don’t die.

A short animated history of Planned Parenthood

posted by Jason Kottke   Jan 20, 2017

From Now This, a short animated history of Planned Parenthood, the origins of which date back more than 100 years.

No woman can call herself free who does not own and control her body.

Voices in the video include Mindy Kaling, Amy Schumer, and Meryl Streep.

“Life is a preexisting condition waiting to happen”

posted by Jason Kottke   Jan 17, 2017

I posted earlier about Atul Gawande’s piece in the New Yorker on the importance of incremental care in medicine. One of the things that the Affordable Care Act1 did was to make it illegal for insurance companies to deny coverage to people with “preexisting conditions”, which makes it difficult for those people to receive the type of incremental care Gawande touts. And who has these preexisting conditions? An estimated 27% of US adults under 65, including Gawande’s own son:

In the next few months, the worry is whether Walker and others like him will be able to have health-care coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.

That’s 52 million people, potentially ineligible for health insurance. And that’s not counting children. Spurred on by Gawande, people have been sharing their preexisting conditions stories on Twitter with the hashtag #the27Percent.

The 27% figure comes from a recent analysis by the Kaiser Family Foundation:

A new Kaiser Family Foundation analysis finds that 52 million adults under 65 — or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act.

In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%).

36% uninsurable in West Virginia! You’ll note that all 11 of those states voted for Trump in the recent election and in West Virginia, Trump carried the day with 68.7% of the vote, the highest percentage of any state. The states whose people need the ACA’s protection the most voted most heavily against their own interest.

Update: An earlier version of this post unfairly pinned the entire blame for the lack of coverage of those with preexisting conditions on the insurance companies.2 I removed the last paragraph because it was more or less completely wrong. Except for the part where I said we should be pissed at the Republican dickheads in Congress who want to repeal the ACA without replacing it with something better.3 And the part where we should be outraged. And the part where we regulated cars and cigarettes and food to make them safer, forced companies to build products in ways they didn’t want, and saved millions of lives. We can’t make everyone healthier and raise taxes to do it? Pathetic for what is supposedly the world’s most powerful and wealthy nation. (thx @JPVMan + many others)

  1. I hope, for the love of Pete, that everyone reading this site is aware that the Affordable Care Act (the ACA) is Obamacare. Obamacare is the derogatory name the Republicans gave to the ACA that everyone, including Obama himself, ended up using. Which is unfortunate. President Obama and his administration deserve neither all of the credit nor should shoulder all of the blame for the ACA.

    I would also like to add that I, as a (very) small business owner, rely on the protections afforded by the ACA to get insurance coverage for me and my family. Something to keep in mind if you otherwise don’t know anyone who would be affected by the ACA’s repeal. (Of course, the cushy insurance policy you get through work might be affected as well, you never know.)

  2. At the heart of the ACA is a compromise between the US government and the insurance companies. The insurance companies don’t want to sell people insurance only when people are sick…that would be prohibitively expensive. That’s where the preexisting conditions thing comes in. So, the ACA says, ok, you have to sell insurance to people with preexisting conditions and we’ll make sure that everyone has to buy insurance, whether they’re sick or not. That bargain makes sure more people are covered and gives the insurance companies a larger pool of people to draw premiums from.

    You can see why Republicans don’t like it: it forces people to buy something even if they don’t want to and it forces companies to sell things to people they would rather not sell. And as a bonus, people the Republicans don’t give a shit about — women, the poor, people of color — are disproportionately helped by the ACA. So they’ll repeal it and replace it with magic! And the only cost will be an increase in dead Americans.

  3. I am all for this, BTW. If Paul Ryan and Donald Trump come up with a plan to give better and cheaper healthcare coverage to everyone in America, let’s do it.

Slow and steady wins the healthcare race

posted by Jason Kottke   Jan 17, 2017

In a piece called The Heroism of Incremental Care for the New Yorker, surgeon Atul Gawande argues that our healthcare system is built for and celebrates heroic intensive care over the slower but more effective efforts of long-term primary care givers.

We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors.

But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. Much of what ails us requires a more patient kind of skill.

A human-powered paper centrifuge

posted by Jason Kottke   Jan 13, 2017

Testing human blood for tropical diseases like malaria can be difficult in some parts of the world. Centrifuges used to separate the blood for testing are expensive and require electricity. Researchers from Stanford have developed an ingenious human-powered centrifuge made of paper and string inspired by a children’s toy invented 5000 years ago (paging Steven Johnson, Steven Johnson to the courtesy desk please).

In a global-health context, commercial centrifuges are expensive, bulky and electricity-powered, and thus constitute a critical bottleneck in the development of decentralized, battery-free point-of-care diagnostic devices. Here, we report an ultralow-cost (20 cents), lightweight (2 g), human-powered paper centrifuge (which we name ‘paperfuge’) designed on the basis of a theoretical model inspired by the fundamental mechanics of an ancient whirligig (or buzzer toy; 3,300 BC). The paperfuge achieves speeds of 125,000 r.p.m. (and equivalent centrifugal forces of 30,000 g), with theoretical limits predicting 1,000,000 r.p.m. We demonstrate that the paperfuge can separate pure plasma from whole blood in less than 1.5 min, and isolate malaria parasites in 15 min.

A million rpm from paper and string…that’s incredible. (via gizmodo)

“This is what happens to the bodies of the women you know”

posted by Jason Kottke   Dec 19, 2016

My friend Courtney Skott wrote an intense piece about the three miscarriages she’s had, including one just a couple of weeks ago. (Note: you may find the images disturbing, but that might also be a good thing.)

It wasn’t until after that miscarriage that I learned how common they are. But even if you know the statistics — that perhaps 20% of confirmed pregnancies miscarry — they are easy to dismiss. After all, it’s much more likely that you will be in the other 80%, isn’t it? But 1 in 5 is still pretty high, and once you start telling your friends that you had a miscarriage, all the miscarriages around you come out of the woodwork. “My sister had one. My best friend had one. I had two.”

Why didn’t I know that before?

Waaaay more people should know this — I didn’t until, well, you know. Like Courtney says, you don’t realize until you start talking to other people about it and…”out of the woodwork” is right.

Can hypothermia save lives in the trauma center?

posted by Jason Kottke   Nov 22, 2016

Nicola Twilley reports on a relatively new technique being used in a Baltimore trauma center: freezing trauma victims to give the doctors working on them more time to save their lives.

When this patient loses his pulse, the attending surgeon will, as usual, crack his chest open and clamp the descending aorta. But then, instead of trying to coax the heart back into activity, the surgeon will start pumping the body full of ice-cold saline at a rate of at least a gallon a minute. Within twenty minutes (depending on the size of the patient, the number of wounds, and the amount of blood lost), the patient’s brain temperature, measured using a probe in the ear or nose, will sink to somewhere in the low fifties Fahrenheit.

At this point, the patient, his circulatory system filled with icy salt water, will have no blood, no pulse, and no brain activity. He will remain in this state of suspended animation for up to an hour, while surgeons locate the bullet holes or stab wounds and sew them up. Then, after as much as sixty minutes without a heartbeat or a breath, the patient will be resuscitated.

Brain damage is a risk — as is, you know, dying from hypothermia — but there are many instances of people surviving even after their hearts stop for an hour or two.