kottke.org posts about medicine
I’ve been vaguely aware for awhile that researchers had traced the origins of HIV/AIDS back to Sub-Saharan Africa. But I didn’t know the whole story, which turns out to be really fascinating.
For decades, one man was blamed for bringing AIDS to America. But the “Patient Zero” story was wrong. This is the story of how genetic detective work traced HIV’s true origins — from chimpanzees in Central Africa to a global pandemic — and how science unraveled one of the biggest myths in modern medicine.
Disappointingly, they didn’t list any of their sources for the video. I poked around a little and found a book called The Origins of AIDS that a Science magazine review called:
Extensively referenced, the well-written book reads like a detective story, while at the same time providing a didactic introduction to epidemiology and evolutionary genetics. As far as the origins of AIDS are concerned, unless some completely new evidence emerges, it will be difficult to come up with a better explanation than Pepin’s.
The YouTube comments are worth a read too, filled with remarks from those who lived through the early years of the pandemic or knew someone who did (or someone who didn’t).
Had a gay uncle who lived in San Francisco in the 80s and 90s. He would get so upset when he talked about HIV/AIDS. He lost so many friends to the virus. When I went to visit him in the 2000s, we visited 27 graves over the course of a weekend and laid flowers. Rest in peace to all those young people.
I worked in blood banking at Cedars -Sinai Medical Center in Los Angeles. It was policy to freeze blood samples from patients that expired due an unknown cause. Once the HIV test was approved the samples were tested and some were reactive to it. The samples were collected over decades, going back to the 1950s.
I have family who were foreign hospital workers in the now-DRC in the 1970s, where what we call AIDS was known as the Slims because of how the patients wasted away and died. People on the ground knew there was something going around, but they didn’t have the resources to figure it out.
For New York magazine, Emily Gould writes about her quest to cry again: I Miss My Tears (archive).
I looked over at my husband, Keith, whose eyes were red, and felt … nothing. Not a clench in my chest, not a pang, not an incipient burning behind my eye sockets. It wasn’t totally surprising; by this point, I hadn’t cried for more than three years.
I’d started to suspect that something was wrong with me when a friend I’d known since childhood died and I didn’t shed a tear. I sat at her memorial service and felt something worse than nothing — a calcified layer around where feeling should have been, as if something were trapped in my body with no hope of emerging on its own. I noticed the absence at other times I would usually have sobbed. A late-night fight with my husband, at the point where any other form of communication feels impossible. Fifth-grade graduation, when the valedictorian thanked her teachers for helping her when she was going through chemo. Pixar movies, Call the Midwife, Sarah McLachlan singing “in the arms of the angel” — none of it moved me to tears. I wasn’t a monster, I was pretty sure. Something was wrong with me. I craved the cleansing sensation after the tears stop, that feeling in your sinuses that’s like you’ve been swimming in the ocean. The boneless relief that comes after sobbing has ceased to wrack your body and you can finally rest, absolutely drained. I had no idea what it would take to get back there, the place I’d been effortlessly able to access for the first 41 years of my life. But I would spend the next six months trying. I hoped it might even be fun.
I started taking an SSRI a few years ago with the goal of giving me enough space to approach life’s challenges without feeling completely overwhelmed (by anxiety, by depression). The medication didn’t “fix” me…it just kept the train from derailing all the time (sometimes over the smallest things) and gave me the freedom to work through things on my own and with my therapist.1
I was lucky to land on a good med/dose combo on my second try — the first pill I tried made me feel jittery and more anxious than I already was. But my current med does come with a couple of side effects. My sex drive is lower than it was (although that could also be age), which is not altogether unpleasant — a quieter mind in charge of things instead of a libido. The other side effect is that I don’t cry anymore, at least not as easily.
Crying is something I took up after my kids were born. Not often, but once every few weeks maybe. I cried when things got hard and for awhile, things were hard a lot of time: pandemic, parenting insecurity, divorce, living somewhere that really didn’t suit me, and always always the website & the discomfort of being an odd sort of “public figure”. Watching any movie with parents and kids (esp. dads and sons) got me — heck, even some Marvel movies got me. In sessions with my therapist, I cried when we’d hit a particularly tender vein of pain. As Gould says, the crying was cathartic and felt necessary — I always felt better and clearer afterwards.
But that’s mostly stopped since I’ve been on my meds. I still get sad, although less so, but I don’t cry. Movies don’t really get me going anymore. When my kids are struggling (in school, with friends), that gets me the closest. I miss that release — I feel a little pent-up sometimes. But I wouldn’t trade crying again for how I felt in the Before Times. I’m ok not having access to crying — at least for now.
From The Public Domain Review, The Many Lives of the Medieval Wound Man, a diagram found in many medical texts beginning in the early 1400s.
Living on today in libraries from Copenhagen to Munich, the strange figure of the Wound Man gives modern viewers a glimpse of the worrying injuries that the medieval body could receive through war, accident, and epidemic. But at the same time, it shows that medieval people did not think of themselves as helpless victims in the face of these assaults. Far from reinforcing the common perception of the European Middle Ages as a backwards and bloody period of human history, the Wound Man reminds us that it was in fact a period busy with innovative medical treatments, a vital link between the long-standing cures of the classical world and developments that were to follow in early Renaissance medicine.
Great Ormond Street Hospital for Children (GOSH) in London improved their surgery-to-ICU handoff process by observing how Ferrari’s F1 team handled pit stops.
GOSH doctors visited and observed the pit crew handoff in Italy. While visiting the Formula One pit crew the GOSH doctors became interested in the way they addressed possible failure. The crew sat around a big table analyzing and reanalyzing, asking, “What could go wrong?” and “What are we going to do if it does go wrong?” and “How important is it if it goes wrong?” Everyone’s ideas were given equal weight until the group ranked them using the failure modes and effect analysis (FMEA).
This anticipatory planning made the pit crew more prepared than the medical team whose strategy tended to be waiting until something went wrong to work out what they should have done. Observing the pit crew, the GOSH doctors noted the value of process mapping, process description, and trying to work out what people’s tasks should be. They learned the keys to a successful pit stop:
– The routine in the pit stop is taken seriously
– What happens in the pit stop is predictable so problems can be anticipated and procedures can be standardized
– Crews practice those procedures until they can perform them perfectly
– Everyone knows their job, but one person is always in charge
Among their findings that led to improvement:
While the main theme changes were more sophisticated procedures and better choreographed teamwork, another aspect of the Formula One handover process easily transferred to the hospital setting. The lollipop man is the one who waves the car in and coordinates the pit stop. He maintains overall situation awareness during the pit stop. In the old hospital handover there was no one like the lollipop man so it was unclear who was in charge. Under the new handover process, the anesthetist was given overall responsibility for coordinating the team until it was transferred to the intensivist at the termination of the handover. These same two individuals were charged with the responsibility of periodically stepping back to look at the big picture and to make safety checks of the handover.
According to this video about the hospital’s study, they were able to reduce the number of errors in the handover by 66%.
(thx, meg)
In a letter to the Times of London, Dr. Michael Baum tells how a line in Arcadia by Tom Stoppard sparked an idea which resulted in adjuvant systemic chemotherapy, a therapy Baum helped pioneer which greatly increased the survivability of breast cancer.
Sir, In 1993 my wife and I went to see the first production of Arcadia by Tom Stoppard (obituary, Dec 1), and in the interval I experienced a Damascene conversion. As a clinical scientist I was trying to understand the enigma of the behaviour of breast cancer, the assumption being that it grew in a linear trajectory spitting off metastases on its way. In the first act of Arcadia, Thomasina asks her tutor, Septimus: “If there is an equation for a curve like a bell, there must be an equation for one like a bluebell, and if a bluebell, why not a rose?” With that Stoppard explains chaos theory, which better explains the behaviour of breast cancer. At the point of diagnosis, the cancer must have already scattered cancer cells into the circulation that nest latent in distant organs. The consequence of that hypothesis was the birth of “adjuvant systemic chemotherapy”, and rapidly we saw a striking fall of the curve that illustrated patients’ survival.
Stoppard never learnt how many lives he saved by writing Arcadia.
Michael Baum
Professor emeritus of surgery; visiting professor of medical humanities, UCL
Certainly drives home the value of a robust and diverse culture of humanities in contradiction to the current backlash. (via @harrywallop.co.uk)
It’s not often that a movie trailer makes you cry — but this one might.1
Come See Me in the Good Light is a documentary film about poets Andrea Gibson and Megan Falley facing a cancer diagnosis that took Gibson’s life earlier this year.
This is the beginning of a nightmare, I thought. But stay with me, y’all, because my story is one about happiness, being easier to find, once we realize we do not have forever to find it.
Falley’s letter published just after Gibson’s death will give you a sense of the spirit of the film & the two humans at the center of it:
A couple years ago, Andrea said, “Whenever I leave this world, whether it’s sixty years from now, I wouldn’t want anyone to say I lost some battle. I’ll be a winner that day.”
Whatever beast of emotion bucks or whimpers through you right now, I hope you can hold that line beside it: Andrea didn’t lose anything. If you had been here in our home during the three days of their dying — if you’d seen dozens of friends drift in to help, to say goodbye, to say thank you, to kiss their perfect face, if you’d felt the love that floored every hospice nurse — you would have agreed. Andrea won.
The film is set to premiere Nov 14 on Apple TV.
Dr. Katelyn Jetelina (aka Your Local Epidemiologist) has a frustrating update on how Covid vaccines are probably going to work this fall under the ideologically corrupt Trump regime.
The FDA is expected to license the Covid-19 vaccine. Word is that the label will be restricted to adults 65+ and people at high risk.
The Vaccine Integrity Project and professional organizations likely won’t align with RFK Jr.’s FDA license, which will cause confusion.
If you’re younger than 65 and don’t have a chronic condition, could you still get it after the label change?
Yes, but it will be complicated. While a provider could prescribe it off-label, in practice, it’s likely that most people won’t be able to access it that way.
Jetelina continues:
If you’re under 65 and not high risk, the window to get a Covid-19 vaccine is right now — before the FDA label changes. Once it happens, access will be limited immediately (if it isn’t already). CVS is no longer booking appointments. As far as we know, Walgreens and local pharmacies still are.
That was as of Monday — no idea if that’s still the case. And of course, because this is the United States, insurance will probably be a mess too:
Recommendations from these two organizations are really important for insurers. The hope is they see them and cover all vaccines, regardless of what RFK does. It also provides extra information to physicians who will prescribe off-label if RFK Jr’s FDA changes the label (as expected) this Friday.
We will not know if any of these recommendations affect insurance coverage until insurance companies confirm coverage.
[insert a lot of profanity here; seriously, this makes me so incandescently mad that if I wrote anything more it would contain every fucking swear word I know and then some]
Sources: Aug 18 thread on Bluesky, Aug 20 thread on Bluesky, Aug 18 newsletter.
This is a great data-driven short documentary by Neil Halloran about how smallpox was eradicated from the face of the Earth. And what it took was humanity, through the use of science & humanitarianism, answering its own plea for something to be done about it.
Some philosophers believe there was a secondary humanitarian revolution that followed the scientific revolution. And I note this because the eradication of smallpox also had these two phases. The scientific breakthroughs of inoculation and the vaccine allowed many countries to become virtually smallpox-free — but not all countries. In fact, those 300 to 500 million deaths in the 20th century? They came well after the vaccine had been discovered. So clearly, for much of the world, something more was needed than medical innovation. And fortunately there’s reason to think that these two types of progress might be connected.
Part of being a human is contemplating why some of us get so sick. It’s a practical question and it’s more than that. As we learned about disease, the theory goes that we began to think a little differently about those who fell ill — to see that their suffering truly wasn’t meant to be. We stepped away from thinking it was up to a higher power and into the belief that, well, it was up to us.
See also How smallpox claimed its final victim (I’d never heard this story before watching Halloran’s video), How Children Took the Smallpox Vaccine Around the World, and No One Knows What’s Inside the Smallpox Vaccine.
I loved this short thread from Andrew Miller about how his pediatrician wife helps parents who are skeptical of vaccinating their children change their minds.
So my wife is a pediatrician and works in some hospitals with high vaccine and intervention hesitation (suburban ones). She has found *tremendous* success by just letting the families know she will have to document the higher risk of specific, and often fatal illness, in the chart of their child.
She explains that if their child goes to the ER, the ER might not think to ask about routine newborn care that the parents opted out of, so by putting it in the chart she might be saving the child from this very specific thing. But just as important it makes it feel REAL to the parents.
She identifies and describes the specific thing that their child is now more likely to die from. In detail, including symptoms to watch out for. It’s not abstract. It’s visceral.
Premiering this Friday (Nov 22) on FX is a short documentary from The New York Times called Weight of the World about GLP-1 drugs. Here’s the synopsis:
As GLP-1 drugs like Ozempic soar in popularity for weight loss, this film follows three people on their own GLP-1 journeys and explores how decades of diet culture and society’s relentless pursuit of thinness paved the way for their rise.
The doc features Roxane Gay & Tressie McMillan Cottom and will will be available on Hulu on Nov 23.
I’d missed that Time magazine is naming a “Kid of the Year” now and this year’s recipient is 15-year-old scientist Heman Bekele, who has developed a soap that could treat and even prevent skin cancer.
A few years ago, he read about imiquimod, a drug that, among other uses, is approved to fight one form of skin cancer and has shown promise against several more. Typically, imiquimod, which can help destroy tumors and usually comes in the form of a cream, is prescribed as a front-line drug as part of a broader cancer treatment plan, but Heman wondered if it could be made available more easily to people in the earliest stages of the disease. A bar of soap, he reckoned, might be just the delivery system for such a lifesaving drug, not just because it was simple, but because it would be a lot more affordable than the $40,000 it typically costs for skin-cancer treatment.
“What is one thing that is an internationally impactful idea, something that everyone can use, [regardless of] socioeconomic class?” Heman recalls thinking. “Almost everyone uses soap and water for cleaning. So soap would probably be the best option.”
Kurzgesagt explores what happens when a virus or bacteria enters a human body and the essential role fever plays in helping your body fight off disease.
Fever feels bad. So we take medication to suppress it — but is this a good idea? It turns out fever is one of the oldest defenses against disease. What exactly is a fever, and how does it make your immune defense stronger? Should you take a pill to combat it?
We often mistake fever for the disease…it’s actually part of the cure. When my kids were young, I vividly remember our laissez-faire French pediatrician urging us not to give them medication to get rid of their fevers because that was the body fighting back and doing useful work — unless their temps got too high of course.
This piece by Lydia Polgreen on The Strange Report Fueling the War on Trans Kids is so good — straightforward and informative, especially when compared to the incoherent nonsense that the NY Times has run about trans people over the past few years. The piece is about, in Polgreen’s words, “the sneaky effort to use what looks like science to justify broad intrusions in our personal freedom”.
I usually don’t do this, but I’ve excerpted the article’s conclusion here because it just gets right to the heart of an urgent concern: the freedom to control our own bodies.
Imagine that your health care required objective justification, if access to birth control or erectile dysfunction medications required proving that you were having monogamous sex, or good sex, or sex at all. Or if fertility care was provided only if you could prove that becoming a parent would make you happy, or you would be a good parent. Or that abortion would be available only if you could prove that it would improve your life.
In a free society we agree that these are private matters, decided by individuals and their families, with the support of doctors using mainstream medical science as a guide, even when they involve children. We invite politicians and judges into them at great peril to our freedom.
I encourage you to read the whole thing — it’s interesting throughout.
John Green recently teamed up with Kurzgesagt for a video on one of the world’s deadliest diseases: tuberculosis.
The white death has haunted humanity like no other disease following us for thousands, maybe millions of years. In the last 200 years it killed a billion people — way more than all wars and natural disasters combined. Even today it’s the infectious disease with the highest kill count.
The maddening bit is that tuberculosis is curable…it’s just that the cure is not equally distributed around the world.
4,000 people died of tuberculosis yesterday, and we simply don’t have to accept a world where so many of us still die of a disease we know how to cure. The White Death has been with us for millions of years. It is time to continue our journey without it.
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