I took a mold of my teeth with some cheap alginate powder, Permastone, and a 3d printed impression tray, to get a better picture of what was really going on. Notice LI-r (right lateral incisor) projected outward, and CI-r (right central incisor) depressed inward and overlapping.
At the time of writing this, I'm an undergrad, which means that a) I'm broke, and b) I have access to expensive digital fabrication tools - definitely an unusual dichotomy. I was researching [name brand clear-aligner treatment], and I ran across a photo that caught my eye.
Those look like the layer striations from a 3D print!
What is to stop someone, who has access to a 3D printer, from making their own orthodontic aligners?
Belli notes, "He moved these teeth in only 16 weeks. You can cause a lot of problems with that. If you move a tooth too fast, you can actually cause damage to the bone and gums. And if you don't put the tooth in the right position, you could throw off your bite," leading to additional damage and wear on the teeth.
John Hofsess helped eight people die and just before he died late last month at an assisted death facility in Switzerland, he wrote this piece.
I was horrified anew in 1999 when the gifted conductor Georg Tintner, who was dying from a rare form of melanoma, jumped from the balcony of his 11th-floor apartment in Halifax to end his agony. Many Canadians would hear such news, shake their heads, utter a few sympathetic platitudes and move on. But I couldn't just sit back and wring my hands. That year, I went from advocating for assisted suicides to facilitating them. Let's not mince words: I killed people who wanted to die.
In an all-white room, mosquitoes are mated and the resulting larvae divided by sex. Workers whisk at stray mosquitoes with electrified tennis rackets -- the kind you see in novelty stores, but which have sold out in mosquito-obsessed Brazil.
For an episode called The Fix, Radiolab explores what anti-addiction drugs are available and why they aren't more widely known and used to treat alcoholism and drug addiction.
Reporter Amy O'Leary was fed up with her ex-boyfriend's hard-drinking, when she discovered a French doctor's memoir titled The End of My Addiction. The fix that he proposed seemed too good to be true. But her phone call with the doctor left her, and us, even more intrigued. Could this malady -- so often seen as moral and spiritual -- really be beaten back with a pill?
We talk to addiction researcher Dr. Anna Rose Childress, addiction psychologist Dr. Mark Willenbring, journalist Gabrielle Glaser, The National Institute of Health's Dr. Nora Volkow, and scores of people dealing with substance abuse as we try to figure out whether we're in the midst of a sea change in how we think about addiction.
Neoantigen vaccines use the DNA from a cancer patient's own tumor to, hopefully, eradicate the cancer.
For some 50 years, cancer biologists have tried to incite the immune system to attack cancer by targeting molecules that commonly stud the surfaces of malignant cells. These "antigens" act as homing beacons that immune cells find and lock onto (much as antigens on viruses attract the immune system, the basis for preventive vaccines such as that for measles).
Trouble is, normal cells sometimes sport the same antigens as tumors, and the immune system is programmed not to attack antigens found on healthy cells. As a result, revving up the immune system to target common tumor antigens hasn't worked, leading to a number of failed experimental cancer vaccines.
That led biologists to a different approach: siccing the immune system on antigens found only on cancer cells -- and only on the cancer cells of a single patient. "It's highly unlikely that any two patients have the same neoantigens," said Dr. Catherine Wu of Boston's Dana-Farber Cancer Institute. "That's why we have an opportunity to make cancer vaccines truly personalized, loaded with patient-specific neoantigens."
Over the years, there's been a growing consensus that suggests being happy is correlated with living a long life. Well, you can wipe that smile off your face because a massive study published in The Lancent makes it clear that no such correlation exists. So what about all those studies suggesting that stress and joylessness hastened death's arrival? According the new study's co-author:
In our view, the previous studies haven't been well done. All that's going on is ill health actually was causing unhappiness and stress.
In other words, your unhappiness is going to last longer than you thought.
Retro Report looks back on the story of the boy in the plastic bubble.
The epitaph on David Phillip Vetter's gravestone observes correctly that "he never touched the world." How could he have? From a few seconds after his birth until two weeks before his death at age 12, David lived life entirely in one plastic bubble or another. Touching the world would have killed him in fairly short order. Even his two weeks outside a plastic cocoon were spent in a hospital trying, futilely, to stave off the inevitable.
There was never a child quite like David Vetter. Americans above the age of, say, 45 may remember him not so much by name as by a phenomenon of the 1970s and early '80s: "the boy in the bubble." The Retro Report series of video documentaries, exploring major news developments of the past, returns to that era through interviews with, among others, David's mother and one of his doctors. More than just a look backward, the report examines medical strides that now give hope to the once-hopeless, coupled with ethical questions long part of the "bubble boy" story.
I remember very clearly watching the news reports about "the boy in the bubble" when I was a kid. Now, as an adult and a parent, the ethical concerns hit me somewhat harder. (via @DavidGrann)
Today, the NY Times is running an editorial by Dr. Bennet Omalu called Don't Let Kids Play Football. Omalu was the first to publish research on CTE in football players.
If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name Chronic Traumatic Encephalopathy, or C.T.E., a disease that I first diagnosed in 2002.
Depending on the severity of the condition, the child now has a risk of manifesting symptoms of C.T.E. like major depression, memory loss, suicidal thought and actions, loss of intelligence as well as dementia later in life. C.T.E. has also been linked to drug and alcohol abuse as the child enters his 20s, 30s and 40s.
The story of Omalu, his research, and its suppression by the NFL is the subject of Concussion, a movie starring Will Smith that comes out on Christmas Day, as well as a book version written by Jeanne Marie Laskas.
But for the love of Julia Child and the sake of every other soul in the restaurant, particularly the underpaid line cooks sweating their way through another Saturday night shift, please, please stop describing your food preferences as an allergy.
In 1948, contact lenses were huge hunks of glass that don't look at all comfortable. And the fittings started with a plaster cast of your eyeball. Ok, probably not plaster but still, ew. (via @FastidiumSum)
Based on patients' ratings of their pain, the effect of trialled drugs in relieving symptoms stayed the same over the 23-year period -- but placebo responses rose. In 1996, patients in clinical trials reported that drugs relieved their pain by 27% more than did a placebo. But by 2013, that gap had slipped to just 9%. The phenomenon is driven by 35 US trials; among trials in Europe, Asia and elsewhere, there was no significant change in placebo responses. The analysis is in press in the journal Pain.
Concussion, starring Will Smith, is about Dr. Bennet Omalu, who discovered the link between football and CTE (Chronic Traumatic Encephalopathy) and will be out in December.
The movie is based on the 2009 GQ article, Game Brain.
Let's say you run a multibillion-dollar football league. And let's say the scientific community -- starting with one young pathologist in Pittsburgh and growing into a chorus of neuroscientists across the country -- comes to you and says concussions are making your players crazy, crazy enough to kill themselves, and here, in these slices of brain tissue, is the proof. Do you join these scientists and try to solve the problem, or do you use your power to discredit them?
Saw someone on Twitter saying that maybe this will be football's The Insider. Let's hope it moves the needle.
In dozens of studio emails unearthed by hackers, Sony executives; the director, Peter Landesman; and representatives of Mr. Smith discussed how to avoid antagonizing the N.F.L. by altering the script and marketing the film more as a whistle-blower story, rather than a condemnation of football or the league.
"Will is not anti football (nor is the movie) and isn't planning to be a spokesman for what football should be or shouldn't be but rather is an actor taking on an exciting challenge," Dwight Caines, the president of domestic marketing at Sony Pictures, wrote in an email on Aug. 6, 2014, to three top studio executives about how to position the movie. "We'll develop messaging with the help of N.F.L. consultant to ensure that we are telling a dramatic story and not kicking the hornet's nest."
Matt Might, who is a professor in computer science at the University of Utah and a professor at the Harvard Medical School, responded to a question on Quora about minimizing the chances of having a disabled child and ended up answering two seemingly unrelated questions as well: How do you get tenure? and How do you live the good life? Long story short: he got tenure and started living the good life because he had a disabled child. But you should read the long story; it's worth it.
My son forced me to systematically examine what matters in life -- what really matters -- and in the end, I came to appreciate a quote from his namesake, Bertrand Russell, more than I could have ever imagined:
"The good life is one inspired by love and guided by knowledge."
My first year as a tenure-track professor cannot be described as anything other than an abject failure. I was so desperate to publish and raise funds that I began thin-slicing my research and submitting lots of poor quality papers and grant proposals.
I must have had a dozen rejections in a row that year. It sucked.
I remember huddling on the porch at the end of that year with my wife, telling her, "Well, I'll at least have a job for six more years."
I looked at my young son, cuddled in her arms. I saw his very existence hung in the balance between knowledge and ignorance.
Then it hit me: Life is too precious and too fleeting to waste my time on bullshit like tenure. I didn't become a professor to get tenure. I became a professor to make the world better through science. From this day forward, I will spend my time on problems and solutions that will matter. I will make a difference.
I stopped working on problems for the sole purpose of notching up a publication. I shifted gears to cybersecurity. I found a project on cancer in the med school. I joined a project in chemical engineering using super-computing to fight global warming.
The Rosses were expecting twins but learned that one of the two, Thomas, wouldn't live much past birth. They decided to donate Thomas's body to science. And then, they decided to investigate just what it was they had given and how it had helped others. Great piece by Radiolab.
The next day, Gray met James Zieske, the institute's senior scientist, who told her "infant eyes are worth their weight in gold," because, being so young, they have great regenerative properties. Thomas' corneas were used in a study that could one day help cure corneal blindness.
Thirteen more studies had cited that study. Gray felt a new emotion: pride.
A company called Oxitec has genetically modified mosquito eggs so that the mosquitos born from them pass along a gene to their offspring that prohibits the mosquitos from reaching sexual maturity and mating. They release the mosquitos into the wild, they mate with the local population of mosquitos, and those born from those matings will die before mating themselves. Voila! Pest control.
Oxitec has conducted trials with its modified mosquito in dengue-ridden regions of Panama, Brazil, Malaysia, and the Cayman Islands. The results show population suppression rates above 90 percent-far greater than the typical 30 percent achieved with insecticides.
The company is currently planning a trial in Florida using this technique to curb an influx of mosquito-borne illness.
Colorado has spent the last six years conducting a real life test to see if they could reduce the number of unwanted pregnancies and abortions. As the NYT's Sabrina Tavernise explains, the results were stunning.
If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to.
While reading this otherwise excellent article written by US soccer player Christie Rampone, I discovered a type of diet I'd never heard of before, the blood type diet (italics mine).
Age and parenting make me think about longevity. I definitely believe one big reason for my longevity has to do with the dietary and fitness changes I made after being diagnosed with auto-immune conditions after giving birth to my youngest daughter Reece in 2011. For example, I've gone gluten-free and have started to eat to my blood-type. Also, a friend introduced me to a natural ingredient called EpiCor to help strengthen my immune system. I have taken EpiCor daily for the past three years and it has become a beneficial part of my daily routine of rest, recovery, working out, eating healthy, and being in airports and hotels more than my own house.
The underlying theory of blood type diets is that people with different blood types digest lectins differently, and that if people eat food that is not compatible with their blood type, they will experience many health problems. On the other hand, if a person eats food that is compatible, they will be healthier.
That theory is, in turn, based on an assumption that each blood type represents a different evolutionary heritage. "Based on the 'Blood-Type' diet theory, group O is considered the ancestral blood group in humans so their optimal diet should resemble the high animal protein diets typical of the hunter-gatherer era. In contrast, those with group A should thrive on a vegetarian diet as this blood group was believed to have evolved when humans settled down into agrarian societies. Following the same rationale, individuals with blood group B are considered to benefit from consumption of dairy products because this blood group was believed to originate in nomadic tribes. Finally, individuals with an AB blood group are believed to benefit from a diet that is intermediate to those proposed for group A and group B."
As you might have already guessed, there is no evidence that eating your blood type is beneficial nor do the claims of differing lectin digestion have scientific merit. Homeopathic nonsense.
Dr. Blair Grubb, a professor at the University of Toledo who has studied syncope extensively, characterized NCS in a 2005 article in The New England Journal of Medicine as the autonomic nervous system's failure to keep blood pressure high enough to maintain consciousness.
Physical activity, he said, pools blood in the lower half of the body, reducing blood flow to the heart. In response, the heart pumps more vigorously. In people with NCS, the brain misreads that as high blood pressure and tries to lower the pressure, which leads to decreased blood flow to the brain and, thus, fainting.
Peterman often does not remember the ends of races -- she blacked out the last 60 meters of a recent race -- which has prompted her father to wonder why she faints after races and not during. See also No pain, possible gain. (via @atul_gawande)
In the Harry Potter series, his parents are famous wizards, who were famous in all the world for their unparalleled love for the boy Harry, which set the whole series in motion, killing them and leaving the boy a scarred orphan. (This is a fantasy, crafted as the direct opposite of the way in which children usually end up scarred -- through abuse and neglect.)
If we interpret the story as Harry's fantasy, then the Dursleys are Harry's real parents, and the Potters are imaginary. The Durselys either can't cope with the increasingly-delusional boy living with them, or perhaps they are merely abusive, and it's the abuse that's making him delusional. In any event, the parent-figures constantly mistreat him, favor the brother, and inflict endless cruelty and humiliation on him. One day, Harry snaps, and Dudley (who is really Harry's brother) is severely injured, in a way requiring repeated hospital treatments. (In the delusion, Harry imagines that a pig's tail is magically grown from Dudley's buttocks.) As a result of this incident, Harry is taken away to a "special school."
Oh, this sounds fantastic: PBS is set to air a six-hour documentary series, Cancer: The Emperor of All Maladies, starting at the end of March. How have I not heard about this before today?
This "biography" of cancer covers its first documented appearances thousands of years ago through the epic battles in the 20th century to cure, control and conquer it, to a radical new understanding of its essence. The series also features the current status of cancer knowledge and treatment -- the dawn of an era in which cancer may become a chronic or curable illness rather than its historic death sentence in some forms.
Thanks to Sarah Klein at Redglass Pictures for letting me know about this. Redglass created a pair of videos for the series featuring Terrence Howard and Ken Jeong talking about their experiences with cancer.
Two years ago, Angelina Jolie wrote in the NY Times1 about her choice to have a preventive double mastectomy. Today, she is back with an update on her choice to have another elective preventive surgery, the removal of her ovaries and fallopian tubes.
Two weeks ago I got a call from my doctor with blood-test results. "Your CA-125 is normal," he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. I have it every year because of my family history.
But that wasn't all. He went on. "There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer." I took a pause. "CA-125 has a 50 to 75 percent chance of missing ovarian cancer at early stages," he said. He wanted me to see the surgeon immediately to check my ovaries.
I went through what I imagine thousands of other women have felt. I told myself to stay calm, to be strong, and that I had no reason to think I wouldn't live to see my children grow up and to meet my grandchildren.
I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful.
I wrote a post on Jolie's first article with more information about the genetic issues surrounding her choice.↩
All the babies were between 4 and 11 months old when they were enrolled, and all had either an egg allergy, severe eczema, or both-putting them at high risk of a peanut allergy down the road. Indeed, 98 of them were already heading in that direction: They tested positive for mild peanut sensitivity in a skin-prick test. This meant that these babies were already churning out antibodies to the peanut protein. Eating peanuts in the future could set off an allergic reaction.
The team divided the babies into two groups. Half were to avoid eating peanut products until they were 5 years old. The other half received at least 6 grams of peanut protein a week, spread across at least three meals, until they were 5 years old. Bamba was the preferred offering, though picky eaters who rejected it got smooth peanut butter.
Around the 5th birthdays of the trial subjects came the big test. The children consumed a larger peanut portion than they were used to in one sitting, and the results were clear-cut. Among 530 children who had had a negative skin-prick test when they were babies, 14% who avoided peanuts were allergic to them, compared with 2% of those who'd been eating them. In the even higher risk group, the children who were sensitized, 35% of the peanut-avoiders were allergic versus just over 10% of the peanut eaters.
Even if further studies confirm these results, will American parents start feeding their infants peanuts? I don't know...there are lots of similarities to vaccines in play here.
Update: Somewhat related: children in developed countries might be growing up too clean, making them more likely to develop allergies.
The findings are the latest to support the "hygiene hypothesis," a still-evolving proposition that's been gaining momentum in recent years. The hypothesis basically suggests that people in developed countries are growing up way too clean because of a variety of trends, including the use of hand sanitizers and detergents, and spending too little time around animals.
As a result, children don't tend to be exposed to as many bacteria and other microorganisms, and maybe that deprives their immune system of the chance to be trained to recognize microbial friend from foe.
That may make the immune system more likely to misfire and overreact in a way that leads to allergies, eczema and asthma, Hesselmar says.
Kellan Roberts died suddenly at 22. He had decided to be an organ donor and his heart went to a high school student from Minnesota, Connor Rabinowitz. After receiving the heart, Connor visited Kellan's family in Seattle and met Kellan's sister Erin. After a few years, Erin and Connor, well, just watch...this is a wonderful story well told.
Host Hank Green of the SciShow looks at the anti-vaccination movement from a scientific perspective: why are US parents growing less likely to vaccinate their children?
In psychology, the search for these explanations is called "Explanatory Attribution" and different people have different "explanatory styles". Some people are more prone to blame themselves, while others search for an external event to blame. But one thing is clear: we are very bad at not blaming anything. It's not surprising that parents of children with autism, especially parents who notice a sudden loss of previous development, will search for a possible cause. And when the most significant recent event in the health of the child was a vaccination, as can be said for many moments in the life of a young American, we might identify that as a potential cause and deem that link worthy of further examination.
Now this, is completely logical. The problem is that over a dozen peer-reviewed papers have found no correlation between autism and the MMR vaccine, or any other vaccine for that matter. And yet, when you Google vaccines and autism, a fair number of the results claim that there is a link between the two, and that that link is being covered up either by the government or by big corporations. A parent, already experiencing frustration with the medical community's inability to tell them why this thing has happened to their child, will, on the internet, find a vibrant community of similarly frustrated people who share their values and experiences. These communities are full of anecdotes that draw connections between vaccines and autism. And so, unsurprisingly, some people become convinced that they have found the reason for their child's disability.
Once their mind has been made up, confirmation bias sets in. Confirmation bias is simply our tendency to more readily, and with less scrutiny, accept information, anecdotes, and world views that confirm our existing beliefs. And, again, it is a completely normal thing that every person does. Indeed, trying to convince someone that a previously held belief is incorrect has been proven to actually increase their affinity for that idea. And so a community is born, and the safety of vaccines is called into question. And once the procedure for getting a vaccine goes from the doctor telling you that it is now time for a vaccine -- and 99% of parents agreeing because that person went through medical school -- to it being a question to ponder, vaccination rates will go down.
Administrators at Palm Desert High School in California have banned 66 students who never got measles vaccinations.
"I think some parents see it as a personal choice, like homeschooling. But when you choose not to vaccinate, you're putting other children at risk." From WaPo: Why this baby's mom is so angry at the anti-vaxxers.
"I respect people's choices about what to do with their kids, but if someone's kid gets sick and gets my kid sick, too, that's a problem." A Marin County father has demanded that his district keep unvaccinated kids out of school.
Molly Beauchemin is a dental health enthusiast. She talked to several dentists about what the current best practices are for keeping your teeth and gums as healthy as possible: The Truth About Your Smile.
Most people have heard a common criticism of hand sanitizer: using it too often makes you more vulnerable to sickness because it kills off even the beneficial germs that fight viruses like the cold and flu. The same is true for the bacteria in your mouth: mouthwash is so antiseptic that most dentists recommend you only use it if you are impaired or have an injury that prevents you from brushing. Otherwise, you risk killing off even the beneficial flora (yes, our mouths are disgusting wastelands of bacteria, but a lot of them are good guys) that help fight plaque and odor-causing bacteria.
I've been searching around for something like this for a few months. Dental hygiene, for me, is a set of mesofacts -- I'm mired in the knowledge of my youth about how to brush, when to floss, etc. -- but increasingly the kids would come home from the dentist with some new tidbit I'd never heard of before, like the thing about not rinsing the toothpaste out of your mouth after brushing. I have to say though, the oil pulling bit at the end sounds like a bunch of hokum.
A team of scientists led by Kim Lewis from Northeastern University have identified a new antibiotic called teixobactin, which kills some kinds of bacteria by preventing them from building their outer coats. They used it to successfully treat antibiotic-resistant infections in mice. And more importantly, when they tried to deliberately evolve strains of bacteria that resist the drug, they failed. Teixobactin appears resistant to resistance.
Bacteria will eventually develop ways of beating teixobactin -- remember Orgel -- but the team are optimistic that it will take decades rather than years for this to happen. That buys us time.
...and also that the process by which teixobactin was discovered is the real breakthrough:
Teixobactin isn't even the most promising part of its own story. That honour falls on the iChip-the tool that the team used to discover the compound. Teixobactin is a fish; the iChip is the rod. Having the rod guarantees that we'll get more fish-and we desperately need more.
America's Bitter Pill is Steven Brill's much-anticipated, sweeping narrative of how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing -- and failing to change -- the rampant abuses in the healthcare industry. Brill probed the depths of our nation's healthcare crisis in his trailblazing Time magazine Special Report, which won the 2014 National Magazine Award for Public Interest. Now he broadens his lens and delves deeper, pulling no punches and taking no prisoners.
Brill's intention is to point out how and why Obamacare fell short of true reform. It did heroic work in broadening coverage and redistributing wealth from the haves to the have-nots. But, Brill says, it didn't really restrain costs. It left incentives fundamentally misaligned. We needed major surgery. What we got was a Band-Aid.
I haven't read his book yet, but I agree with Brill on one thing: the ACA1 did not go nearly far enough. Healthcare and health insurance are still a huge pain in the ass and still too expensive. My issues with healthcare particular to my situation are:
- As someone who is self-employed, insurance for me and my family is absurdly expensive. After the ACA was enacted, my insurance cost went up and the level of coverage went down. I've thought seriously about quitting my site and getting an actual job just to get good and affordable healthcare coverage.
- Doctors aren't required to take any particular health insurance. So when I switched plans, as I had to when the ACA was enacted, finding insurance that fit our family's particular set of doctors (regular docs, pediatrician, pediatric specialist that one of the kids has been seeing for a couple of years, OB/GYN, etc.) was almost impossible. We basically had one plan choice (not even through the ACA marketplace...see next item) or we had to start from scratch with new doctors.
- Many doctors don't take the ACA plans. My doctor doesn't take any of them and my kids' doc only took a couple. And they're explicit in accepting, say, United Healthcare's regular plan but not their ACA plan, which underneath the hood is the exact same plan that costs the same and has the same benefits. It's madness.
- The entire process is designed to be confusing so that insurance companies (and hospitals probably too) can make more money. I am an educated adult whose job is to read things so they make enough sense to tell others about them. That's what I spend 8+ hours a day doing. And it took me weeks to get up to speed on all the options and pitfalls and gotchas of health insurance...and I still don't know a whole lot about it. It is the most un-user-friendly thing I have ever encountered.
The ACA did do some great things, like making everyone eligible for health insurance and getting rid of the preexisting conditions bullshit, and that is fantastic...the "heroic work" mentioned by Gladwell. But the American healthcare system is still an absolute shambling embarrassment when you compare it to other countries around the world, even those in so-called "developing" or "third world" countries. And our political system is just not up to developing a proper plan, so I guess we'll all just limp along as we have been. Guh.
I hate the word "Obamacare" and will not use it. It's a derisive term that has been embraced for some reason by ACA/Obama supporters. It needlessly politicizes an already over-politicized issue. ↩
A major study conducted by the Harvard School of Public Health has found a significant link between autism and the exposure of the mother to high levels of air pollution during the third trimester of pregnancy.
Researchers focused on 1,767 children born from 1990 to 2002, including 245 diagnosed with autism. The design of the study and the results rule out many confounding measures that can create a bias, Weisskopf said. The researchers took into account socioeconomic factors that can influence exposure to pollution or play a role in whether a child is diagnosed with autism.
The fact that pollution caused problems only during pregnancy strengthened the findings, since it's unlikely other factors would have changed markedly before or after those nine months, he said in a telephone interview.
The ultimate cause of autism remains a mystery in most cases, said Charis Eng, chairwoman of the Lerner Research Institute's Genomic Medicine Institute at the Cleveland Clinic in Ohio. While the Harvard study isn't definitive and the findings could be coincidental, it's not likely given the large size and the precise results, she said in a telephone interview.
"The truth is there has to be gene and environmental interactions," said Eng, who wasn't involved in the study. "I suspect the fetus already had the weak autism spectrum disorder genes, and then the genes and the environment interacted."
It would be a huge help (and I am not in any way being facetious about this) if Jenny McCarthy and all the other celebrity "vaccines cause autism" folks threw their weight behind cleaning up pollution the way they attacked vaccination. Redeem yourselves. (via @john_overholt)
Today's Google Doodle honors Jonas Salk on what would have been his 100th birthday. Salk developed the first successful polio vaccine in 1955 and was hailed as a hero for it.
On April 12, 1955, Dr. Thomas Francis, Jr., of the University of Michigan, the monitor of the test results, "declared the vaccine to be safe and effective." The announcement was made at the University of Michigan, exactly 10 years to the day after the death of President Roosevelt. Five hundred people, including 150 press, radio, and television reporters, filled the room; 16 television and newsreel cameras stood on a long platform at the back; and 54,000 physicians, sitting in movie theaters across the country, watched the broadcast on closed-circuit television. Eli Lilly and Company paid $250,000 to broadcast the event. Americans turned on their radios to hear the details, department stores set up loudspeakers, and judges suspended trials so that everyone in the courtroom could hear. Europeans listened on the Voice of America. Paul Offit writes about the event:
"The presentation was numbing, but the results were clear: the vaccine worked. Inside the auditorium Americans tearfully and joyfully embraced the results. By the time Thomas Francis stepped down from the podium, church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping. One shopkeeper painted a sign on his window: Thank you, Dr. Salk. 'It was as if a war had ended', one observer recalled."
Because of Salk's vaccine and subsequent vaccines, the US has been polio-free since 1979.
As Ebola enters a deepening relationship with the human species, the question of how it is mutating has significance for every person on earth.
From the front lines in West Africa to the genomics researchers who hope to control the outbreak, The New Yorker's Richard Preston provides a detailed and interesting look at The Ebola Wars. Preston is the author of 1995's The Hot Zone, the bestselling account of the first emergence of Ebola, which is back in the top 50 on Amazon.
I spoke with more than 200 people about their experiences with aging or serious illness, or dealing with a family member's -- many of them my own patients, some in my own family. I interviewed and shadowed front-line staff members in old age homes, palliative-care specialists, hospice workers, geriatricians, nursing home reformers, pioneers, and contrarians. And among the many things I learned, here are the two most fundamental.
First, in medicine and society, we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them. Hence the wide expert agreement that payment systems should enable health professionals to take sufficient time to have such discussions and tune care accordingly.
You don't have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver's chance of benefit. These days are spent in institutions -- nursing homes and intensive-care units -- where regimented, anonymous routines cut us off from all the things that matter to us in life.
Too many books to read! Gotta make time for this one though.
Great piece about how Lufthansa cares for those who need medical attention while flying.
On a Lufthansa flight, making a public call for any medical professionals on the plane is a last resort. The airline prefers to be far more discreet. After all, does the whole plane always need to know that somebody on board is having a problem? To accomplish this, Lufthansa launched the Doctors on Board program for physicians.
Doctors on Board allows Lufthansa to identify doctors long before an emergency occurs. By doing this, the cabin crews can personally and discreetly summon the doctor if their skills are needed during a flight. In order to find doctors who could potentially participate in this program, the airline scoured the data from its Miles and More frequent flier program. By doing this, Lufthansa was able to identify 15,000 doctors who regularly fly the airline. Of those, 10,000 opted to join the program.
Participation in the Doctors on Board program carries with it several benefits. The doctors are issued a handbook about aviation medicine, as well as receiving news and information via both the internet and postal mailings. They are insured by Lufthansa for any care that they provide during a flight. They are also rewarded with 5,000 Miles and More award miles and a discount code for €50 off of their next flight, plus they receive a special bag tag identifying their participation in the program. Finally, they are given the opportunity to participate in a course on aviation medicine and on-board emergency handling, for which they are paid an additional fee.
This is real customer service: thoughtful, anticipatory, active, thorough. (via @marcprecipice)
Our fridge was empty. I went to Andronico's grocery store and browsed the aisles, a blur of colors and letters and shapes. What was it we needed? I wondered. I could not figure out how the pieces fit together, that I would need onions because we used onions for everything, that I would need bread for sandwiches, that I would need meat for a possible entree. They were shapes and colors and textures. That fleshy pink package was a fleshy pink rectangle. The countless numbers of canned soup and canned vegetables were mere metal cylinders.
I emerged with one thing: a jar of Muir Glen spaghetti sauce. I grabbed it because I had seen it before, because I could read the label. If it was something I could understand, it must be something I needed. I did not need spaghetti sauce.
I still do not remember how it is I paid, whether by cash or by debit or credit card. I do not remember swiping or handing over bills. I just remember blinking in the cold winter sun at my car in the parking lot. Holding a jar of spaghetti sauce.
And wondering how to get home. I did not know how to get home.
I got in the car and started driving. If I just drove, I thought, I would somehow get home.
Each time I thought about whether I needed to make a left turn or right or stop or go, I felt lost. I had no idea. And so I pressed on without thinking, while relying on intuition. Each time I stopped, I recognized landmarks - a tree or a house or a store. I knew I was getting closer to home, but I did not know how to continue.
Intuition carried me when logic and memory failed.
I made it home.
And then I thought, I need to get to a hospital.
I picked up the phone and then I asked myself, What is the phone number for 911?
I looked at the numeric keypad, and I could not figure out what number each shape represented. And what is the number for 911?
I thought perhaps I should try calling my husband. I could not remember his phone number, either. It did not occur to me to look for it in the contacts list on my BlackBerry, either.
I finally decided I would mash a bunch of numbers on the keypad and talk to whomever it was I dialed on the landline. I did not think about the fact that I did not know where I lived, but I punched in a set of numbers anyway.
"Hello," a man said.
"Hi!" I said.
"Hi," he said.
"Who is this?" I asked.
"This is A-," he replied.
"Oh! I have been trying to reach you! I forgot your phone number and I didn't know how to get ahold of you! I called this phone number, because it was in my fingers."
Hmm, this is interesting. Recent studies suggest that food allergies may be caused by the absense of certain intestinal bacteria...in part due to increased use of antibiotics in very young children.
Food allergies have increased about 50% in children since 1997. There are various theories explaining why. One is that the 21st century lifestyle, which includes a diet very different from our ancestors', lots of antibiotic use, and even a rise in cesarean section deliveries, has profoundly changed the makeup of microbes in the gut of many people in developed countries. For example, the average child in the United States has taken three courses of antibiotics by the time he or she is 2 years old, says Martin Blaser, an infectious disease specialist and microbiologist at New York University in New York City. (See here for more on the reach of microbiome research these days.)
Cathryn Nagler, an immunologist at the University of Chicago in Illinois, has spent years probing links between the immune system, intestinal bacteria, and the onset of allergies. Back in 2004, she and her colleagues reported that wiping out gut bacteria in mice led to food allergies. Since then, Nagler has continued trying to understand which bacteria offer allergy protection and how they accomplish that.
Surgeon and New Yorker writer Atul Gawande has a new book about death coming out in October called Being Mortal.
Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.
Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.
This piece Gawande wrote for the New Yorker in 2010 was probably the genesis of the book. I maintain a very short list of topics I'd like to write books about and death is one of them. Not from a macabre Vincent Price / Tim Burton perspective...more like this stuff. Dying is something that everyone has to deal with many times during the course of their life and few seem to have a handle on how to deal with it. That's fascinating. Can't wait to read Gawande's book.
According to many psychiatrists and brain experts, about one in 10 autistic children sheds symptoms before adulthood. Duke researcher Geraldine Dawson explains that "there is this subgroup of kids who start out having autism and then, through the course of development, fully lose those symptoms." Now they just have to figure out why. From the NYT Magazine: The Kids Who Beat Autism.
Journalist Miles O'Brien lost his left arm in February. He wrote about the experience and what he's learned from it so far for New York magazine.
But here are two things you need to know about life after an arm amputation: First, your center of gravity changes dramatically when you are suddenly eight pounds lighter on one side of your body. Second, while my arm may be missing physically, it is there, just as it always has been, in my mind's eye. I can feel every digit. I can even feel the watch that was always strapped to my left wrist. When I tripped, I reached reflexively to break my very real fall with my completely imaginary left hand. My fall was instead broken by my nose, and my nose was broken by my fall.
Lying on that sidewalk, moaning in pain, I reached the end of Denial River and flowed into the Sea of Doubt. It finally dawned on me in that instant that I was, indeed, handicapped. That may not be the term of choice these days -- "differently abled" or "physically challenged" may be de rigueur -- but as I touched my bloody face, feeling embedded chips of concrete in the wounds, "handicapped" sure seemed to fit.
The woman I was passing on the sidewalk when I fell took one look at me and cried out in panic to her husband: "My God, what's happened to his arm?" "It's gone," I said. "But don't worry, that didn't happen today."
O'Brien also mentions he's tried mirror therapy pioneered by V.S. Ramachandran, which I've written about previously.
So, as part of a two-patient clinical trial, doctors at the Mayo Clinic injected Erholtz with 100 billion units of the measles virus -- enough to inoculate 10 million people.
Her doctor said they were entering the unknown.
Five minutes into the hour-long process, Erholtz got a terrible headache. Two hours later, she started shaking and vomiting. Her temperature hit 105 degrees, Stephen Russell, the lead researcher on the case, told The Washington Post early Thursday morning.
"Thirty-six hours after the virus infusion was finished, she told me, 'Evan has started shrinking,'" Russell said. Over the next several weeks, the tumor on her forehead disappeared completely and, over time, the other tumors in her body did, too.
The cancer of the other person in the trial was unaffected and larger randomized trials still have to be performed, but this is encouraging news. Between this and the remission of cancer using HIV, it looks like viral therapy has a real shot at being a powerful weapon in fighting cancer.
The streetlights in Buenos Aires are considerably dimmer than they are in New York, one of the many things I learned during my family's six-month stay in Argentina. The front windshield of the rental car, aged and covered in the city's grime, further obscured what little light came through. When we stopped at the first red light after leaving the hospital, I broke two of my most important marital promises. I started acting like my wife's doctor, and I lied to her.
I had just taken the PET scan, the diagnostic X-ray test, out of its manila envelope. Raising the films up even to the low light overhead was enough for me to see what was happening inside her body. But when we drove on, I said, "I can't tell; I can't get my orientation. We have to wait to hear from your oncologist back home." I'm a lung doctor, not an expert in these films, I feigned. But I had seen in an instant that the cancer had spread.
The last sentence here really got to me:
Our life together was gone, and carrying on without her was exactly that, without her. I was reminded of our friend Liz's insight after she lost her husband to melanoma. She told me she had plenty of people to do things with, but nobody to do nothing with.
America experienced the height of polio in the 1940s and '50s, when about 35,000 people became disabled every year. Fear and panic spread and parents were known to warn their children to not drink from public water fountains, avoid swimming pools and stay away from crowded public places like movie theaters. Perhaps the most famous case of polio in America was Franklin Delano Roosevelt, the first president with a significant physical disability.
The development of the Salk and Sabine vaccines helped lead to eradication of polio in the United States in 1979. In India, too, vaccination was critical.
"There were three keys to our success," Kapur says. "Immunize, immunize and immunize."
Three years ago, Kayla Montgomery was diagnosed with multiple sclerosis. Faced with the prospect of being confined to a wheelchair someday, Montgomery, one of the slower runners on her high school cross country team, told her coach she was short on time and wanted to run faster. Now she's one of the fastest runners in the country and perhaps the MS has something to do with it.
Kayla Montgomery, 18, was found to have multiple sclerosis three years ago. Defying most logic, she has gone on to become one of the fastest young distance runners in the country -- one who cannot stay on her feet after crossing the finish line.
Because M.S. blocks nerve signals from Montgomery's legs to her brain, particularly as her body temperature increases, she can move at steady speeds that cause other runners pain she cannot sense, creating the peculiar circumstance in which the symptoms of a disease might confer an athletic advantage.
But intense exercise can also trigger weakness and instability; as Montgomery goes numb in races, she can continue moving forward as if on autopilot, but any disruption, like stopping, makes her lose control.
"When I finish, it feels like there's nothing underneath me," Montgomery said. "I start out feeling normal and then my legs gradually go numb. I've trained myself to think about other things while I race, to get through. But when I break the motion, I can't control them and I fall."
Researchers, however, have long noted a link between neurological disorders and athletic potential. In the late 1800's, the pioneering French doctor Philippe Tissie observed that phobias and epilepsy could be beneficial for athletic training. A few decades later, the German surgeon August Bier measured the spontaneous long jump of a mentally disturbed patient, noting that it compared favorably to the existing world record. These types of exertions seemed to defy the notion of built-in muscular limits and, Bier noted, were made possible by "powerful mental stimuli and the simultaneous elimination of inhibitions."
Questions about the muscle-centered model came up again in 1989 when Canadian researchers published the results of an experiment called Operation Everest II, in which athletes did heavy exercise in altitude chambers. The athletes reached exhaustion despite the fact that their lactic-acid concentrations remained comfortably low. Fatigue, it seemed, might be caused by something else.
In 1999, three physiologists from the University of Cape Town Medical School in South Africa took the next step. They worked a group of cyclists to exhaustion during a 62-mile laboratory ride and measured, via electrodes, the percentage of leg muscles they were using at the fatigue limit. If standard theories were true, they reasoned, the body should recruit more muscle fibers as it approached exhaustion -- a natural compensation for tired, weakening muscles.
Instead, the researchers observed the opposite result. As the riders approached complete fatigue, the percentage of active muscle fibers decreased, until they were using only about 30 percent. Even as the athletes felt they were giving their all, the reality was that more of their muscles were at rest. Was the brain purposely holding back the body?
"It was as if the brain was playing a trick on the body, to save it," says Timothy Noakes, head of the Cape Town group. "Which makes a lot of sense, if you think about it. In fatigue, it only feels like we're going to die. The actual physiological risks that fatigue represents are essentially trivial."
Some athletes with TS attribute near-magical powers to their condition. Tim Howard, the goalkeeper of last year's U.S. World Cup soccer team, says that TS has given him vision and reflexes that other players simply don't have. Famed physician Oliver Sacks once wrote about a ping-pong player whose abnormal quickness and ability to knock back unreturnable shots, he believed, had to be connected to TS. One reason is that people with Tourette's also tend to have Obsessive Compulsive Disorder (Amaris included). They need to repeat behaviors-whether it's preventing balls from going into the net or running improbably long distances-until they do it just right. "I'm not saying it's a good thing to have," Sacks told a reporter last year, "but if one has Tourette's, there are advantages." New research out of the University of Nottingham shows that the brains of TS patients are physically different from everyone else's, transformed by years of operating under much greater than normal resistance and better at controlling the body.
Neurologists at the Tourette Syndrome Association aren't quite ready to embrace a connection between TS and superior athleticism. They are more comfortable saying that people with TS often see their symptoms subside when they're playing sports or otherwise engaged in something that focuses their attention away from the urge to tic.
Soccer quieted the noise in Amaris' head. After taking up the game, she began to tic less off the field. She did better in school. She talked more. Actually, she talked a lot, like she does now. In her last game in England, she scored three goals and the other kids lifted her up on their shoulders and carried her around. She would have had a major problem with that just months before-too many germs-but she loved it.
I hope that by posting this article about anxiety here, I will feel less anxious about having to read it for tips on how to reduce my extremely high levels of current stress and anxiety.
It doesn't solve the riddle, either, but that's not Stossel's fault. It's because anxiety of the kind he is afflicted with is not a riddle. It's an illness. There is therefore nothing, except in the medical sense, to solve. That's not what Stossel wants to believe, though. He has an idea that more is at stake. He thinks that there is a metaphysics of anxiety. "To grapple with and understand anxiety," he says, "is, in some sense, to grapple with and understand the human condition."
As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox. In my 20s I got precancerous HPV and spent six months of my life wondering how I was going to tell my two children under the age of 7 that Mummy might have cancer before it was safely removed.
This is the part that really gets to me: Parker wasn't vaccinated but was given so many antibiotics for her childhood illnesses that she became immune to them! [Hair-tearing-out noise]
My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got so many illnesses requiring treatment with antibiotics that I developed a resistance to them, which led me to be hospitalized with penicillin-resistant quinsy at age 21 -- you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.
Update: Slate has corrected the passage above, taking out the part about Parker's resistance to antibiotics. It now reads:
My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got many illnesses requiring treatment with antibiotics. I developed penicillin-resistant quinsy at age 21 -- you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.
People do not develop antibiotic resistance, microorganisms do. I regret the idiotic error and tearing out my hair. (thx @chrismize)
Diana Hardeman is 30, healthy, and has no history of past medical issues. A few days before Christmas, she had a stroke.
My right arm seemed no longer a part of my body. I couldn't control it; it was limp at my side, like the worst dead arm you can imagine, but completely out of nowhere. My boyfriend was just coming to check on what time we are leaving and I exited the bathroom, slumped on the ground, and told him what was going on. Except I didn't. I couldn't. What I was saying in my head came out as gibberish. I could not get words out of my mouth. I felt stupid, even laughing at myself, saying, "It's ok, it's ok" to him, thinking it might just go away. But then the reminder that something was wrong set in again. In a whisper, I finally got out the words "call my dad." He did. My parents happened to be right outside and my father, a physician, ran up the stairs to find us. When he saw me stuttering and holding my dead arm, he called for an ambulance. By now I was crying, perhaps in hysterics, as the numbness had seeped from my arm to my whole right side. I then calmed, stopped tying to speak, as it was frustrating and pointless, and looked into my boyfriend's eyes saying to him with mine, I may not walk again. I may die, somewhat acquiescing to whatever it was that was happening to me. I caught myself, though, and thought, No, that can't happen, I gotta fight it, and kicked off my boots to try to move legs and focused my mind on, well, not dying.
In case you don't know me, Hi. Im Diana. I'm a 30 year old lady. Itallerthan your average girl, thinner tha your average girl, and and active than your average girl. Yeah I run an ice crea business for a living, but like to thing I'm healthier than your average girl too. No priorn medical history. Nothing.
my first ever ride in an ambulance was uneventful - the hops;ital is a 5 minute drive from my folks' house. By now I had somehow regained some ability to sspeak and answered the EMT's incessant questionsining. still stuumbling over my words, even laughin at my mstakes.
If the Merck scientists succeeded at the F.D.A., they would be the first to bring an orexin-related drug to market. "It's an amazing achievement," Richard Hargreaves, the fourth colleague at the Hilton, said. "Everyone should be really proud." But, he added, "my worry is that a new mechanism is being evaluated on the science of an old mechanism."
"With Ambien, you've got a drug that's got basically only onset," Renger said, dismissively. That is, it sends you to sleep but might not keep you asleep. "Suvorexant has the onset, but it has the great maintenance, especially in the last third of the night, where other drugs fail." And even though suvorexant keeps working longer than Ambien, suvorexant patients don't feel groggier afterward, as you might expect. Impassioned, Renger imagined himself addressing the F.D.A.: "Why aren't you giving this a chance?"
"Drugs usually have some side effects," Schoepp said. "It's all benefit-risk." He added, "There is some dose where suvorexant will be ultimately safe-because nothing will happen. If you go low enough, it becomes homeopathic."
They stood to go to their rooms. Schoepp murmured, "I'd love to take it right now."
In 1988 there were 350,000 cases of polio worldwide. Last year there were 223. But getting all the way to zero will mean spending billions of dollars, penetrating the most remote regions of the globe, and facing down Taliban militants to get to the last unprotected children on earth.
Hall of Famer Tony Dorsett is among a growing group of former NFL players who have been diagnosed with diseases caused by years of head trauma and other injuries.
The former Cowboys running back, now 59, said that when he took his Oct. 21 flight from Dallas to Los Angeles for testing, he repeatedly struggled to remember why he was aboard the plane and where he was going. Such episodes, he said, are commonplace when he travels.
Dorsett said he also gets lost when he drives his two youngest daughters, ages 15 and 10, to their soccer and volleyball games.
"I've got to take them to places that I've been going to for many, many, many years, and then I don't know how to get there," he said.
The 1976 Heisman Trophy winner and eighth all-time leading NFL rusher said he has trouble controlling his emotions and is prone to outbursts at his wife and daughters.
"It's painful, man, for my daughters to say they're scared of me." After a long pause, he tearfully reiterated, "It's painful."
In an interview with Fox affiliate WFLD-TV, aired Wednesday, the 53-year-old McMahon says he knows where he's going when in an airport. But when he meets people, "I'm asking two minutes later, 'Who was that?'
"When my friends call and leave me a message ... I'll read it and delete it before I respond and then I forget who called and left me a message."
McMahon says he is not worried about his mind withering away. He says he still reads a lot and is doing other things to keep his mind active. However, he said he doesn't know whether he is getting worse.
These stories are just going to keep coming. Perhaps a true tipping point will come when one of the league's past megastars is dianosed with CTE...if Brett Favre or Dan Marino or John Elway or Troy Aikman or Ray Lewis or any of the other former players that appear regularly on NFL game broadcasts announces he has CTE or dementia, maybe then the league will take real action? Or not? (via df)
In an interview accompanying a Frontline episode on drug-resistant bacteria, an associate director for the CDC, Dr. Arjun Srinivasan, says that "we're in the post-antibiotic era".
The more you use an antibiotic, the more you expose a bacteria to an antibiotic, the greater the likelihood that resistance to that antibiotic is going to develop. So the more antibiotics we put into people, we put into the environment, we put into livestock, the more opportunities we create for these bacteria to become resistant. ...We also know that we've greatly overused antibiotics and in overusing these antibiotics, we have set ourselves up for the scenario that we find ourselves in now, where we're running out of antibiotics.
We are quickly running out of therapies to treat some of these infections that previously had been eminently treatable. There are bacteria that we encounter, particularly in health-care settings, that are resistant to nearly all -- or, in some cases, all -- the antibiotics that we have available to us, and we are thus entering an era that people have talked about for a long time.
For a long time, there have been newspaper stories and covers of magazines that talked about "The end of antibiotics, question mark?" Well, now I would say you can change the title to "The end of antibiotics, period."
We're here. We're in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can't.
You know how when you first hear a joke it's the funniest thing ever and then you hear it a second time and it's less funny and then a third, fourth, and fifth times and it just keeps getting less and less funny until you're not laughing at all and it actually becomes annoying? That's how antibiotics work across the entire human population. And if Dr. Srinivasan is correct, we're transitioning into the not laughing stage and the annoying stage where lots of people start dying can't be far behind (unless we get some new jokes/treatments).
Yesterday, Mark Sample tweeted about disasters, low-points, and chronic trauma:
"Low point" is the term for when the worst part of a disaster has come to pass. Our disasters increasingly have no low point.
After the low point of a disaster is reached, things begin to get better. When there is no clear low point, society endures chronic trauma.
Disasters with no clear low point: global warming, mass extinction, colony collapse disorder, ocean acidification, Fukushima.
To which I would add: drug-resistant infectious diseases. (via digg)
Excerpts published Wednesday by ESPN The Magazine and Sports Illustrated from the book, "League of Denial: The NFL, Concussions and the Battle for Truth," report that the NFL used its power and resources to discredit independent scientists and their work; that the league cited research data that minimized the dangers of concussions while emphasizing the league's own flawed research; and that league executives employed an aggressive public relations strategy designed to keep the public unaware of what league executives really knew about the effects of playing the game.
What's so confounding is that many of the parents requesting exemptions for their children cite specious, disproven fears -- such as that the vaccine could cause autism -- many of which were based on a fraudulent, retracted study or fringe research published in non-peer-reviewed journals. And the rest of the country hasn't been as successful as Massachusetts in containing measles infections. Earlier this year, an intentionally unvaccinated 17-year-old from Brooklyn, New York, was infected with measles while on a trip to the United Kingdom. Because he lived in a community with a large number of other deliberately unvaccinated children, the virus quickly spread. By the time the outbreak was contained, 58 people had been infected -- making it the largest outbreak in the country in more than 15 years. Nationwide, the Centers for Disease Control and Prevention reported 159 total cases between January and August, which puts 2013 on track to record the most domestic measles infections since the disease was declared eliminated from the United States in 2000.
After experimenting on protozoa, rats, and his eight children, Ehret recommended that the international traveler, in the several days before his flight, alternate days of feasting with days of very light eating. Come the flight, the traveler would nibble sparsely until eating a big breakfast at about 7:30 a.m. in his new time zone -- no matter that it was still 1:30 a.m. in the old time zone or that the airline wasn't serving breakfast until 10:00 a.m. His reward would be little or no jet lag.
The diet was adopted by US government agencies and other groups as well as Ronald Reagan, but it difficult to stick to. Recently, researchers in Boston have devised a simpler anti-jet lag remedy:
The international traveler, they counsel, can avoid jet lag by simply not eating for twelve to sixteen hours before breakfast time in the new time zone-at which point, as in Ehret's diet, he should break his fast. Since most of us go twelve to sixteen hours between dinner and breakfast anyway, the abstention is a small hardship.
According to the Harvard team, the fast works because our bodies have, in addition to our circadian clock, a second clock that might be thought of as a food clock or, perhaps better, a master clock. When food is scarce, this master clock suspends the circadian clock and commands the body to sleep much less than normally. Only after the body starts eating again does the master clock switch the circadian clock back on.
Totally trying this the next time I have to travel, although the Advil PM/melatonin combination my doctor suggested worked really well for me on my trip to New Zealand. (via @genmon)
The patient had an infection with Saccharomyces cerevisiae, Cordell says. So when he ate or drank a bunch of starch -- a bagel, pasta or even a soda -- the yeast fermented the sugars into ethanol, and he would get drunk. Essentially, he was brewing beer in his own gut. Cordell and McCarthy reported the case of "auto-brewery syndrome" a few months ago in the International Journal of Clinical Medicine.
Some clever entrepreneur will undoubtedly turn this syndrome into a product...the market opportunity for a pill that allows you to get drunk on spaghetti *and* be the owner/operator of your own microbrewery is too large to ignore. (via ★interesting)
This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt-these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.
The global problem of death in childbirth is a pressing example. Every year, three hundred thousand mothers and more than six million children die around the time of birth, largely in poorer countries. Most of these deaths are due to events that occur during or shortly after delivery. A mother may hemorrhage. She or her baby may suffer an infection. Many babies can't take their first breath without assistance, and newborns, especially those born small, have trouble regulating their body temperature after birth. Simple, lifesaving solutions have been known for decades. They just haven't spread.
Or rather, protozoan? Toxoplasma gondii is a protozoan parasite which is transmitted from rodents to cats through a crafty mechanism...it makes mice attracted to the smell of cat urine. Mouse goes near cat, cat eats mouse, T. gondii has a new host. From cats, the parasite can jump into humans, where it may be responsible for all sorts of nastiness:
Well, the behavioral influence plays out in a number of strange ways. Toxoplasma infection in humans has been associated with everything from slowed reaction times to a fondness toward cat urine -- to more extreme behaviors such as depression and even schizophrenia. And here's the kicker: Two different research groups have independently shown that Toxo-infected individuals are three to four times as likely of being killed in car accidents due to reckless driving.
And maybe makes us want to invent networking technology and share cool links? In this five-minute talk, Kevin Slavin cleverly connects viral media with T. gondii:
That video was so good, I watched the whole thing twice.
Yes, and there's also $20 over-the-counter test for HIV that gives results in 20 minutes.
Two recent developments could make these conversations less awkward, or even render them moot. But they also raise troubling questions about promiscuity and responsibility that are reminiscent of debates from the 1980s.
The first development was the approval, last summer, by the Food and Drug Administration of an over-the-counter rapid-response at-home H.I.V. test kit. The test, called OraQuick and available nationwide since October, gives results 20 minutes after a cheek swab. The second is the increasing availability of PEP and of pre-exposure prophylaxis, or PrEP.
PEP - the medication I am taking - has been called the H.I.V. morning-after pill, and PrEP, to follow the analogy, is akin to birth control. A study in the British medical journal The Lancet this month found that drug-injecting addicts who took PrEP were half as likely to become infected with H.I.V. as those who did not; other studies have shown that the drug reduces transmission of the virus from mother to child, and transmission among both gay men and heterosexuals.
Wednesday, August 31, the next day. Sicker, bewildered. In my office chair quaking with exertion, like a car with its accelerator and brake simultaneously floored. My breathing's all wrong-the sharp, uneven gasps of an overworked dog. When I lumber off to the can, the urine is purple and oily looking. At three minutes after one, Doc Mike calls with the blood results. "Stop whatever you're doing," he orders. "Get in here now."
The results are as reliable as flipping a light switch, but even after decades of testing, no one knows exactly why it works. Dr. Kaplitt, the surgeon who installed Rebecca Serdans' implant, explains it by likening the brain to a collection of electrical circuits. A disorder like dystonia is a failure of those circuits. When you install a brain stimulation device, "it's presumably blocking abnormal information from getting from one part of the brain to another, or normalizing that information." But Kaplitt is the first to acknowledge that this is just a theory. "The mechanism by which brain stimulation works is still somewhat unclear and controversial."
But the lingering questions haven't slowed down research. There are already patents that would use brain stimulation implants to enhance memory or prevent stuttering, to cure anorexia or bring a person to orgasm. Experimental studies use the device to treat Alzheimer's disease and drug addiction. Those circuits aren't as well understood as the circuits governing movement disorders, but the principle is no different. Once you've got a line into the circuitry of the brain, Parkinson's is just the beginning.
Andrew Johnson has been diagnosed with Early Onset Parkinson's Disease and recently underwent deep brain stimulation (DBS) surgery to implant a brain pacemaker that supplies his brain with regular and reliable electrical pulses. In this incredible video, Johnson turns the pacemaker off and you can see the effect that DBS has had on his life.
Understatement of the year at the end of the video. Wow. Johnson writes about his experience with Parkinson's on his site, Young and Shaky. (thx, eamon)
"Give me your tired, your poor, your huddled masses yearning to breathe free." And I'll give them heart disease, high blood pressure, diabetes, and a shorter lifespan. A growing body of research suggests that there is often a high health toll when it comes to coming to America.
A growing body of mortality research on immigrants has shown that the longer they live in this country, the worse their rates of heart disease, high blood pressure and diabetes. And while their American-born children may have more money, they tend to live shorter lives than the parents.
The pattern goes against any notion that moving to America improves every aspect of life. It also demonstrates that at least in terms of health, worries about assimilation for the country's 11 million illegal immigrants are mistaken. In fact, it is happening all too quickly.
In this morning's NY Times, Angelina Jolie writes about her decision to have a preventive double mastectomy to hopefully ward off cancer.
My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.
We often speak of "Mommy's mommy," and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a "faulty" gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
It happens that just last night I read about the BRCA-1 gene in Siddhartha Mukhergee's excellent biography of cancer, The Emperor of All Maladies. This part is right near the end of the book:
Like cancer prevention, cancer screening will also be reinvigorated by the molecular understanding of cancer. Indeed, it has already been. The discovery of the BRCA genes for breast cancer epitomizes the integration of cancer screening and cancer genetics. In the mid-1990s, building on the prior decade's advances, researchers isolated two related genes, BRCA-1 and BRCA-2, that vastly increase the risk of developing breast cancer. A woman with an inherited mutation in BRCA-1 has a 50 to 80 percent chance of developing breast cancer in her lifetime (the gene also increases the risk for ovarian cancer), about three to five times the normal risk. Today, testing for this gene mutation has been integrated into prevention efforts. Women found positive for a mutation in the two genes are screened more intensively using more sensitive imaging techniques such as breast MRI. Women with BRCA mutations might choose to take the drug tamoxifen to prevent breast cancer, a strategy shown effective in clinical trials. Or, perhaps most radically, women with BRCA mutations might choose a prophylactic mastectomy of both breasts and ovaries before cancer develops, another strategy that dramatically decreases the chances of developing breast cancer.
Radical is an understatement...what a tough and brave decision to make. Again from the book, I liked this woman's take on it:
An Israeli woman with a BRCA-1 mutation who chose this strategy after developing cancer in one breast told me that at least part of her choice was symbolic. "I am rejecting cancer from my body," she said. "My breasts had become no more to me than a site for my cancer. They were of no more use to me. They harmed my body, my survival. I went to the surgeon and asked him to remove them."
Five to 10 percent of breast cancers occur in women with a genetic predisposition for the disease, usually due to mutations in either the BRCA1 or BRCA2 genes. These mutations greatly increase not only the risk for breast cancer in women, but also the risk for ovarian cancer in women as well as prostate and breast cancer among men. Hundreds of cancer-associated BRCA1 and BRCA2 mutations have been documented, but three specific BRCA mutations are worthy of note because they are responsible for a substantial fraction of hereditary breast cancers and ovarian cancers among women with Ashkenazi Jewish ancestry. The three mutations have also been found in individuals not known to have Ashkenazi Jewish ancestry, but such cases are rare.
Update: Two things. First, and I hope this isn't actually necessary because you are all intelligent people who can read things and make up your own minds, but let me just state for the official record that you should never never never never NEVER take medical advice, inferred or otherwise, from celebrities or bloggers. Come on, seriously. If you're concerned, go see a doctor.
But many doctors, patients and scientists aren't happy with the situation.
Some are offended by the very notion that a private company can own a patent based on a gene that was invented not by researchers in a lab but by Mother Nature. Every single cell in every single person has copies of the BRCA1 and BRCA2 genes.
Myriad officials say they deserves the patent because they invested a great deal of money to figure out the sequence and develop "synthetic molecules" based on that sequence that can be used to test the variants in a patient.
"We think it is right for a company to be able to own its discoveries, earn back its investment, and make a reasonable profit," the company wrote on its blog.
I do know the 23andme test covers something related to the BRCA1 and BRCA2 mutations...a friend of a friend did the 23andme test, tested positive for the BRCA1 mutation, and decided to have a preventive double mastectomy after consulting her doctor and further tests. (thx, mark, allison, and ★spavis)
An article from a mother who was anti-vaccine until her daughter (and then the rest of the family) got the whooping cough. And still she feels "funny" about vaccination.
And yet I still wondered about that list of things that I would now, I suppose, have to surrender to and immunise my child against. Polio, for one -- a couple of my parents' pensioner friends still carry the limp left by their childhood polio, but none of my friends do, because it isn't around any more. And diphtheria -- what was that, even? I knew it had killed one of Queen Victoria's daughters, but that wasn't our reality.
The reason it wasn't our reality was, of course, due to a continuous programme of immunisation. Duh. Diphtheria is a disease that still kills one in five infants it meets, even if they get treatment, their necks swelling up until they can no longer breathe. I have now seen a picture of a child whose neck was ravaged by diphtheria, bloated like a foie gras goose about to burst. I wish I could unsee it.
The numbers, especially for competitive athletes, are sobering. According to their calculations, static stretching reduces strength in the stretched muscles by almost 5.5 percent, with the impact increasing in people who hold individual stretches for 90 seconds or more. While the effect is reduced somewhat when people's stretches last less than 45 seconds, stretched muscles are, in general, substantially less strong.
They also are less powerful, with power being a measure of the muscle's ability to produce force during contractions, according to Goran Markovic, a professor of kinesiology at the University of Zagreb and the study's senior author. In Dr. Markovic and his colleagues' re-analysis of past data, they determined that muscle power generally falls by about 2 percent after stretching.
And as a result, they found, explosive muscular performance also drops off significantly, by as much as 2.8 percent. That means that someone trying to burst from the starting blocks, blast out a ballistic first tennis serve, clean and jerk a laden barbell, block a basketball shot, or even tick off a fleet opening mile in a marathon will be ill served by stretching first. Their performance after warming up with stretching is likely to be worse than if they hadn't warmed up at all.
I'm currently reading The Emperor of All Maladies: A Biography of Cancer (which is excellent) and I'm up to the chapters on prevention, specifically the prevention of lung cancer through reduction of cigarette smoking. I had no idea cigarette smoking was so uncommon in the US as recently as 1870...but we caught up quickly.
In 1870, the per capita consumption in America was less than one cigarette per year. A mere thirty years later, Americans were consuming 3.5 billion cigarettes and 6 billion cigars every year. By 1953, the average annual consumption of cigarettes had reached thirty-five hundred per person. On average, an adult American smoked ten cigarettes every day, an average Englishman twelve, and a Scotsman nearly twenty.
For some context on that 3500/yr per person number (and the unbelievable 7000/yr Scottish rate), the current rate in the US is around 1000/yr and the highest current rate in the world is in Serbia at almost 2900/yr per person.
Whenever I start to feel sick, I hit the Internet and start searching for more information about my symptoms. When a doctor writes me a prescription and I start feeling something unexpected, I search the web for side effects. And I'm not the only one whose first instinct is to turn my head and search. So many of us have adopted this behavior that researchers are gathering valuable information by studying our search queries and "have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration's warning system."
After starting on treatment, the baby's immune system responded and tests showed diminishing levels of the virus until it was undetectable 29 days after birth. Ten months later, when the baby returned to the hospital (her mother stopped bringing her, without explanation) the researchers tested her again for HIV and found no sign of the virus. It appeared she had been functionally cured.
From back in August, Atul Gawande visits a Cheesecake Factory and wonders if the combination of "quality control, cost control, and innovation" achieved by chain restaurants can offer lessons to hospitals and other health care organizations.
The company's target last year was at least 97.5-per-cent efficiency: the managers aimed at throwing away no more than 2.5 per cent of the groceries they bought, without running out. This seemed to me an absurd target. Achieving it would require knowing in advance almost exactly how many customers would be coming in and what they were going to want, then insuring that the cooks didn't spill or toss or waste anything. Yet this is precisely what the organization has learned to do. The chain-restaurant industry has produced a field of computer analytics known as "guest forecasting."
"We have forecasting models based on historical data-the trend of the past six weeks and also the trend of the previous year," Gordon told me. "The predictability of the business has become astounding." The company has even learned how to make adjustments for the weather or for scheduled events like playoff games that keep people at home.
A computer program known as Net Chef showed Luz that for this one restaurant food costs accounted for 28.73 per cent of expenses the previous week. It also showed exactly how many chicken breasts were ordered that week ($1,614 worth), the volume sold, the volume on hand, and how much of last week's order had been wasted (three dollars' worth). Chain production requires control, and they'd figured out how to achieve it on a mass scale.
As a doctor, I found such control alien-possibly from a hostile planet. We don't have patient forecasting in my office, push-button waste monitoring, or such stringent, hour-by-hour oversight of the work we do, and we don't want to. I asked Luz if he had ever thought about the contrast when he went to see a doctor. We were standing amid the bustle of the kitchen, and the look on his face shifted before he answered.
"I have," he said. His mother was seventy-eight. She had early Alzheimer's disease, and required a caretaker at home. Getting her adequate medical care was, he said, a constant battle.
This piece was on several best-of-the-year longreads lists and deservedly so. But the Factory's 3000-calorie plate of pasta will probably not help the state of American health care.
"We were saddened to learn that Junior, a loving father and teammate, suffered from CTE," the family said in a statement released to the AP. "While Junior always expected to have aches and pains from his playing days, none of us ever fathomed that he would suffer a debilitating brain disease that would cause him to leave us too soon.
"We know this lawsuit will not bring back Junior. But it will send a message that the NFL needs to care for its former players, acknowledge its decades of deception on the issue of head injuries and player safety, and make the game safer for future generations."
Plaintiffs are listed as Gina Seau, Junior's ex-wife; Junior's children Tyler, Sydney, Jake and Hunter, and Bette Hoffman, trustee of Seau's estate.
The lawsuit accuses the league of glorifying the violence in pro football, and creating the impression that delivering big hits "is a badge of courage which does not seriously threaten one's health."
It singles out NFL Films and some of its videos for promoting the brutality of the game.
Seau is a pretty boldfaced name...I wonder what effect this will have on public perception, etc.
CTE (chronic traumatic encephalopathy), the degenerative brain disease that could dramatically change the way pro football is played in the future (if it's played at all), can't be identified in victims until after death. That makes it difficult to prove (or disprove) the connection between pro football, concussions, and death from CTE. But researchers have discovered a possible technique that could diagnose CTE in living patients.
Last year five retired N.F.L. players who were 45 years and older and suffered from mood swings, depression and cognitive problems were given PET, or positron emission tomography, scans. The authors of the study said those scans revealed tau protein deposits in their brains, a signature of C.T.E. While not definitive, the distribution of tau in the retired players was consistent with those found in the autopsies of players who had C.T.E.
If it's actually possible, this could be huge. Many more players, current and former, can be tested and diagnosed and if CTE was found regularly and consistently, you'd think that insurance companies would flee from the NFL like rats leaving a sinking ship and football would have to adapt (to be more like soccer? flag football?) or die.
"The worst injury I've ever had on the field -- for my wife and kids, at least, and my mom and dad -- was an injury I got against the 49ers," says Matt Hasselbeck. "Patrick Willis hit me as I was diving for the goal line. He hit me, and twenty minutes later I'm in an ambulance on my way to Stanford Medical. I'd broken a rib on the left and I'd broken a rib on the right. The rib on the right was right next to my aorta, and it was really dangerous for my health. I couldn't breathe. It was like there was a weight on top of me. It's a scary thing, because it feels like you're drowning. I couldn't breathe at all, and I got up off the field because it was a two-minute situation - I didn't want the team to have to take a time-out. I tried to run off the field, and when the trainers met me they saw I was, like, purple in the face. And they immediately put me on the ground. Sometimes they'll put you on the ground to evaluate you and sometimes to give the backup quarterback a chance to get loose. They put me on the ground because I was purple."
That instinct - the instinct to run when you can't breathe in order to save your team a time-out - is not one often encountered in civilian life. Indeed, it is one encountered almost exclusively in war, in which people's lives, rather than simply their livelihoods, are at stake. Now, the NFL is replete with military symbolism, not to mention military pretensions. But the reality of injury is what makes it more than fantasy football, more than professional wrestling, more than an action movie, more than a video game played with moving parts who happen to be human. The reality of injury - and the phantasmagoric world of pain - is what makes it, legitimately, a blood sport. And it is what makes Dr. Yates, the Steelers' team doctor, define his job simply and bluntly: "My job is to protect players from themselves."
Former NFL star Jason Taylor was so injured (and yet still playing every week) that for a period of two years, the 6'6" 240-pound linebacker couldn't lift his kids into bed. So how did he play? Shots to kill the pain and then more shots to kill the pain of the first shots. And so on. Until he almost had to have his leg amputated.
The trainer rushed to Taylor's house. Taylor thought he was overreacting. The trainer told him they were immediately going to the hospital. A test kit came out. Taylor's blood pressure was so high that the doctors thought the test kit was faulty. Another test. Same crazy numbers. Doctors demanded immediate surgery. Taylor said absolutely not, that he wanted to call his wife and his agent and the famed Dr. James Andrews for a second opinion. Andrews also recommended surgery, and fast. Taylor said, fine, he'd fly out in owner Daniel Snyder's private jet in the morning. Andrews said that was fine but that he'd have to cut off Taylor's leg upon arrival. Taylor thought he was joking. Andrews wasn't. Compartment syndrome. Muscle bleeds into the cavity, causing nerve damage. Two more hours, and Taylor would have had one fewer leg. Fans later sent him supportive notes about their own compartment syndrome, many of them in wheelchairs.
"I was mad because I had to sit out three weeks," he says. "I was hot."
He had seven to nine inches of nerve damage.
"The things we do," he explains. "Players play. It is who we are. We always think we can overcome."
At the New Yorker, Reeves Wiedeman reminds us that the NFL is unlikely to change because so much of what happens with injuries is hidden from view.
As we watch a game that we know is dangerous, we soothe ourselves with the idea that these men must be aware of the risks, too; that they are being well compensated to take on those risks; and that, at least when they're on the field, in front of the cameras, they are living the dream that we all craved as kids, and they're having fun.
But what we can take from this story, and from the fact that, on the surface, this weekend's games were filled with such excitement, is the fact that so much of football's barbarism takes place beyond our vision and behind closed doors.
There are four big telltale signs that can help you distinguish among a cold, a flu, norovirus and whooping cough:
#1. Fever equals flu. You might get a slight temperature from a cold, but if you're really heating up, it's probably the flu.
#2. Colds are mild and long lasting. Colds usually start with a sore throat, then progress to symptoms like a runny nose and congestion, followed by a cough that won't go away. And they don't usually cause fevers. Sometimes it can take up to 3 weeks to get rid of a cold entirely. The flu, though, tends to come on quickly all at once and be more intense, but it doesn't linger. If you're running a fever and your body aches and you can't get out of bed and don't feel like eating anything, it's flu time.
"I think it's important for everyone to know that Junior did indeed suffer from CTE," Gina Seau said. "It's important that we take steps to help these players. We certainly don't want to see anything like this happen again to any of our athletes."
She said the family was told that Seau's disease resulted from "a lot of head-to-head collisions over the course of 20 years of playing in the NFL. And that it gradually, you know, developed the deterioration of his brain and his ability to think logically."
Studies have long shown evidence of placebos doing something to help ill patients. Harvard Medical School's Ted Kaptchuk is studying this effect to determine how and why it works.
Two weeks into Ted Kaptchuk's first randomized clinical drug trial, nearly a third of his 270 subjects complained of awful side effects. All the patients had joined the study hoping to alleviate severe arm pain: carpal tunnel, tendinitis, chronic pain in the elbow, shoulder, wrist. In one part of the study, half the subjects received pain-reducing pills; the others were offered acupuncture treatments. And in both cases, people began to call in, saying they couldn't get out of bed. The pills were making them sluggish, the needles caused swelling and redness; some patients' pain ballooned to nightmarish levels. "The side effects were simply amazing," Kaptchuk explains; curiously, they were exactly what patients had been warned their treatment might produce. But even more astounding, most of the other patients reported real relief, and those who received acupuncture felt even better than those on the anti-pain pill. These were exceptional findings: no one had ever proven that acupuncture worked better than painkillers. But Kaptchuk's study didn't prove it, either. The pills his team had given patients were actually made of cornstarch; the "acupuncture" needles were retractable shams that never pierced the skin. The study wasn't aimed at comparing two treatments. It was designed to compare two fakes.
We've spent the two dozen years putting computers in everything from our bodies to our cars. Now those devices increasingly have wireless connections to the outside world. Throw in a little lax security and the whole world becomes hackable.
Hospital equipment like external defibrillators and fetal monitors can at least be picked up, taken apart, or carted away. Implanted devices -- equipment surgically implanted into the body -- are vastly more difficult to remove but not all that much harder to attack.
You don't even have to know anything about medical devices' software to attack them remotely, Fu says. You simply have to call them repeatedly, waking them up so many times that they exhaust their batteries-a medical version of the online "denial of service" attack, in which botnets overwhelm Web sites with millions of phony messages. On a more complex level, pacemaker-subverter Barnaby Jack has been developing Electric Feel, software that scans for medical devices in crowds, compromising all within range. Although Jack emphasizes that Electric Feel "was created for research purposes, in the wrong hands it could have deadly consequences." (A General Accounting Office report noted in August that Uncle Sam had never systematically analyzed medical devices for their hackability, and recommended that the F.D.A. take action.)
Denis Duthie was recently struck blind by vodka reacting poorly to his diabetes medication. Doctors in his native New Zealand thought he might have formaldehyde poisoning, which you can get from drinking methanol. The cure? More cowbell, er, ethanol. Since the hospital didn't have enough medical ethanol for treatment, a nurse went to the liquor store for Johnnie Walker Black, which was then dripped directly into Duthie's stomach.
It worked because the ethanol competed with the methanol and prevented it from being metabolised into harmful formaldehyde, which can cause blindness.
"There are two potential ways of doing it: one is to give intravenous ethanol through a drip, but that is not available in all hospitals. There is also nothing wrong with supplying that alcohol via the gastro-intestinal tract, which is what they've chosen to do in this circumstance, and that's a well established treatment. If the patient's awake they can just drink it."
Ashlyn Blocker does not feel pain, a condition called 'Congenital insensitivity to pain.' Although she can feel pressure, and warm or cool, she can't feel extreme heat or cold. In this profile in the NY Times Magazine, though, she seems like a relatively well-adjusted 13 year-old girl, which is a credit to her and her parents. Pretty fascinating story.
Tara and John weren't completely comfortable leaving Ashlyn alone in the kitchen, but it was something they felt they had to do, a concession to her growing independence. They made a point of telling stories about how responsible she is, but every one came with a companion anecdote that was painful to hear. There was the time she burned the flesh off the palms of her hands when she was 2. John was using a pressure-washer in the driveway and left its motor running; in the moments that they took their eyes off her, Ashlyn walked over and put her hands on the muffler. When she lifted them up the skin was seared away. There was the one about the fire ants that swarmed her in the backyard, biting her over a hundred times while she looked at them and yelled: "Bugs! Bugs!" There was the time she broke her ankle and ran around on it for two days before her parents realized something was wrong. They told these stories as casually as they talked about Tristen's softball games or their son Dereck's golf skills, but it was clear they were still struggling after all these years with how to keep Ashlyn safe.
"It is an extraordinary disorder," Woods said. "Boys die at a younger age because of more risky behavior. It's quite interesting, because it makes you realize pain is there for a number of reasons, and one of them is to use your body correctly without damaging it and modulating what you do."
Matter, a new publication that raised funds on Kickstarter, has launched and their first story is fantastic. Do No Harm by Anil Ananthaswamy profiles those suffering from Body Integrity Identity Disorder...people who believe that one or more of their limbs don't belong to them and want them amputated.
Sitting at home in a small, somewhat rural American town not too far from the ocean, Patrick recalled the day his wife found out about his obsession. It was during the mid-'90s. As with almost all BIID sufferers, Patrick was fascinated with amputees, so he began downloading pictures of them off the Internet and printing them out. One day his wife was sitting in front of their computer, while Patrick sat in a wingback chair. She noticed a pile of printouts. They were images of men, but "completely clothed, no nudes or anything like that." It was an awkward moment. "She was thinking that maybe I was gay," Patrick recalls. "I must have been crimson." Patrick asked her to take a closer look. She did, and soon realised that the men were all amputees.
Patrick told his wife that he had felt odd about his leg since he was four years old, a feeling that eventually grew into an all-consuming desire to be rid of it. It was a shock: they had been married for decades, and the revelation that he had been hiding something was hard to take. But his confession also brought relief. For more than four decades he had suffered alone. Growing up in small-town America, with conservative parents, in an era when "people didn't believe in going and seeing mental health professionals," Patrick was mystified by what he felt.
The last third of the piece, in which Ananthaswamy accompanies a BIID sufferer to have an amputation in Asia, was really difficult to read...powerful stuff. The piece is 99 cents for web/ePub/Kindle versions.
Now, the nearest Level One trauma centers for residents of lower Manhattan aren't all that close: New York Presbyterian/Weill Cornell Medical Center is on the Upper East Side at East 68th Street and St. Luke's/Roosevelt Hospital is on the Upper West Side.
Officials say there's no reason to think that, for now, trauma victims in lower Manhattan will be any worse off than those in other parts of the city. The response speed is still acceptable, they say. And if a trauma victim is in an immediately life-threatening situation, such as a traumatic cardiac arrest, ambulances bring them to the closest hospital, regardless of whether it's a trauma center.
But the fear is that there won't be enough surge capacity at other hospitals if there is a major disaster, or that overworked staff at other hospitals will grow fatigued under the load and patient care could suffer.
Well, I'm sure the free market will sort all of this out. (via @Atul_Gawande)
Many diseases affect metabolism and many changes in metabolism can be detected in the urine. For example, diabetics will excrete sugar in their urine -- sometimes enough sugar that it can be fermented into whisky. There are many other diseases that change the smell of a person's urine, including the very descriptively named Maple Syrup Urine Disease or Sweaty Feet Syndrome, now much more likely to be diagnosed by electronic sensor arrays than actually tasting the urine.
Over the past few years, we've seen an endless parade of stories debunking the value of many of the products that line the shelves of our local pharmacies. Well, here's a different kind of story. A massive study that included more than 15,000 men and lasted more than 13 years found that taking a daily multivitamin (in this case Centrum Silver) reduced the risk of cancer. It looks like there's something to taking one multivitamin as opposed to swallowing high doses of individual vitamins.
Because of the frequent testing and safety measures, adult film stars are perhaps the world's safest community, STD-wise. No one in the industry has been infected with HIV since 2004. Porn star Stoya explains:
The production manager printed out a copy of each performer's page in the APHSS database. I signed my own copy and James's, indicating that my results were mine and accurate and that I had seen James's and was comfortable working with him and his clean test which had been taken less than 14 days prior. He did the same. Then the production manager performed an inspection. He looked in our mouths, at both sides of our hands, and at our genitals to make sure there were no visible sores or open wounds. There was another paper to sign stating that we have no sores or open wounds on or in our mouths, hands, and genitals and had been inspected. We also looked at each others genitals, mostly for fun but if either of us had seen (or smelled) something odd we would have called off the scene ourselves.
In No Evidence of Disease, Maciej Cegłowski writes about his girlfriend's cervical cancer and the appearance of a new friend in her life, fellow cancer patient Stephanie. Except that, well, that's not the whole story.
Cancer comes with an entourage: fear, loneliness, and isolation. Diane didn't go to the makeup event expecting to make a new friend, but it was a way to get out of the house. She came home excited about having met Stephanie.
Stephanie was ten years younger than Diane. Her illness was acute myeloid leukemia (AML), a type of blood cancer in which cancerous precursor cells completely take over the bone marrow. Steph had gotten her diagnosis while studying abroad in Spain, and had been treated there long enough to put her into remission and send her home. Now her life was on hold, and the cancer was coming back.
Her long-term prognosis was poor. Steph was reticent in talking about it straight out, but after she and Diane became better friends, it became clear that she did not expect to survive a year. Her only hope lay in a difficult and risky transplant procedure. I couldn't imagine having to face this at 23, but of course no one gets to make the choice.
Maciej is a great writer and this is a crazy-ass story and I don't know exactly what you're supposed to feel after reading this piece (sad? mad? defeated?), but you'll definitely feel something. (via @sippey)
Using just the camera on your iPhone, the Cardiio app can accurately measure your heart rate. Here's how it works:
Every time your heart beats, more blood is pumped into your face. This slight increase in blood volume causes more light to be absorbed, and hence less light is reflected from your face. Using sophisticated software, your iPhone's front camera can track these tiny changes in reflected light that are not visible to the human eye and calculate your heart beat!
This video shows this process in action (with a short explanatory intro of the mathematical technique):
AIDS patients are susceptible to cancers, but they usually stop taking HIV drugs before receiving cancer treatment. "That allows the virus to come back and it infects their donor cells," Kuritzkes said.
About 34 million people are infected with HIV, the virus that causes AIDS, globally; 25 million have died from it. While there's no vaccine, cocktails of powerful antiviral drugs called antiretroviral therapy (ART) can keep the virus suppressed and keep patients healthy. No matter how long patients take ART, however, they are never cured. The virus lurks in the body and comes back if the drugs are stopped. Scientists want to flush out these so-called reservoirs and find a way to kill the virus for good.
Brown, and now these two other men, offer some real hope.
Dr. Timothy Henrich and colleagues at Brigham and Women's Hospital launched a search about a year ago for HIV patients with leukemia or lymphoma who had received bone marrow stem cell transplants. Bone marrow is the body's source of immune system cells that HIV infects and it's a likely place to look for HIV's reservoirs.
"If you took an HIV patient getting treated for various cancers, you can check the effect on the viral reservoirs of various cancer treatments," Kuritzkes, who works with Henrich, said. They found the two patients by asking colleagues at Dana-Farber Cancer Institute in Boston which, like Brigham and Women's, is associated with Harvard Medical School.
Both men had endured multiple rounds of treatment for lymphoma, both had stem cell treatments and both had stayed on their HIV drugs throughout. "They went through the transplants on therapy," Kuritzkes said.
It turns out that was key.
"We found that immediately before the transplant and after the transplant, HIV DNA was in the cells. As the patients' cells were replaced by the donor cells, the HIV DNA disappeared," Kuritzkes said. The donor cells, it appears, killed off and replaced the infected cells. And the HIV drugs protected the donor cells while they did it.
The two men have been HIV-free for two years and three-and-a-half years, respectively. Another man who benefited from a bone marrow transplant from a donor whose immune cells resist HIV infection has been free of HIV for five years. (via @gavinpurcell)
Researchers led by Harvard Medical School's John N. Kheir engineered tiny, gas-filled microparticles, which were about three micrometers in size and invisible to the naked eye. They used a device called a sonicator, which uses high-intensity sound waves, to produce a foamy liquid solution with microparticles that consist of a single layer of lipids that trap a tiny pocket of oxygen gas. They then injected the resulting mixture directly into the bloodstream of rabbits that were severely oxygen-deprived.
Within seconds, infusions of the microparticles restored the blood oxygen saturation of these mammals to near-normal levels. When the rabbits' windpipes were completely blocked, the solution kept them alive for 15 minutes without a single breath and reduced the likelihood of cardiac arrest and organ injury.
Before anesthesia, the sounds of patients thrashing and screaming filled operating rooms. So, from the first use of surgical anesthesia, observers were struck by the stillness and silence. In London, Liston called ether anesthesia a "Yankee dodge" - having seen fads such as hypnotism come and go - but he tried it nonetheless, performing the first amputation with the use of anesthesia, in a 36-year-old butler with a septic knee, 2 months after the publication of Bigelow's report. As the historian Richard Hollingham recounts, from the case records, a rubber tube was connected to a flask of ether gas, and the patient was told to breathe through it for 2 or 3 minutes. He became motionless and quiet. Throughout the procedure, he did not make a sound or even grimace. "When are you going to begin?" asked the patient a few moments later. He had felt nothing. "This Yankee dodge beats mesmerism hollow," Liston exclaimed.
It would take a little while for surgeons to discover that the use of anesthesia allowed them time to be meticulous. Despite the advantages of anesthesia, Liston, like many other surgeons, proceeded in his usual lightning-quick and bloody way. Spectators in the operating-theater gallery would still get out their pocket watches to time him. The butler's operation, for instance, took an astonishing 25 seconds from incision to wound closure. (Liston operated so fast that he once accidentally amputated an assistant's fingers along with a patient's leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.)
The New England Journal of Medicine recently reported on the 69 year-old man in the photo above. Constant sun exposure to one side of his face resulted in premature aging, though, the other side doesn't look too bad for 69. The condition is called unilateral dermatoheliosis, which I think is Greek for make sure to wear sunblock.
The patient reported that he had driven a delivery truck for 28 years. Ultraviolet A (UVA) rays transmit through window glass, penetrating the epidermis and upper layers of dermis. Chronic UVA exposure can result in thickening of the epidermis and stratum corneum, as well as destruction of elastic fibers. This photoaging effect of UVA is contrasted with photocarcinogenesis.
In June 2007 Jenny McCarthy began promoting anti-vaccination rhetoric. Because of her celebrity status she has appeared on several television shows and has published multiple books advising parents not to vaccinate their children. This has led to an increase in the number of vaccine preventable illnesses as well as an increase in the number of vaccine preventable deaths.
Indigo children is a term used to describe children who are believed to possess special, unusual and sometimes supernatural traits or abilities. The term is pseudoscientific. The idea is based on New Age concepts developed in the 1970s by Nancy Ann Tappe and further developed by Jan Tober and Lee Carroll. The concept of indigo children gained popular interest with the publication of a series of books in the late 1990s and the release of several films in the following decade. A variety of books, conferences and related materials have been created surrounding belief in the idea of indigo children and their nature and abilities. The interpretations of these beliefs range from their being the next stage in human evolution, in some cases possessing paranormal abilities such as telepathy, to the belief that they are more empathic and creative than their peers.
Alive Inside is a documentary that follows social worker Dan Cohen as he discovers that music can "awaken" people suffering from degenerative memory loss (Alzheimer's, etc.). Here's a clip in which a man goes from a near-coma state to talking about his favorite songs after listening to music for awhile on headphones.
Frank Bruni, who was the food critic at the NY Times for five years, was recently diagnosed with gout. Since his diagnosis, he's had to cut back on much of his previous food and drink favorites.
You never really quite appreciate just what a cornucopia of food alternatives exists -- just how many culinary directions you can set off in -- until a few are cut off and you're forced to re-route yourself. That's a lesson that people with celiac disease and with diabetes have learned. It's what vegetarians have long asserted. And it's what gout is teaching me. In diet books, the word "substitution" comes across as some pathetic euphemism for "sacrifice" and "compromise," a positive-spin noun born of negative circumstances. But substitution is indeed a plausible course, and not necessarily a punitive one. At breakfast, oatmeal thickened with a heaping tablespoon of peanut butter can provide the same wicked indulgence that pork sausage does. At dinnertime, chicken prepared with care and ingenuity can go a long way toward replacing lamb, and the right kind of omelet can be wholly satisfying.
Somehow the conversation turns to Margaret Thatcher. Somehow Margaret Thatcher becomes a recurring topic. Somehow Margaret Thatcher becomes our go-to sexual depressant. Somehow Margaret Thatcher ends up sitting naked on a suburban fence, legs swinging and twirling a top hat. Occasionally Reagan makes an appearance, too. There's a lot of glitter involved. I invoke the former Prime Minister whenever I need to cool off. For emergency purposes only.
And the videophonic stress was even worse if you were at all vain. I.e. if you worried at all about how you looked. As in to other people. Which all kidding aside who doesn't. Good old aural telephone calls could be fielded without makeup, toupee, surgical prostheses, etc. Even without clothes, if that sort of thing rattled your saber. But for the image-conscious, there was of course no answer-as-you-are informality about visual-video telephone calls, which consumers began to see were less like having the good old phone ring than having the doorbell ring and having to throw on clothes and attach prostheses and do hair-checks in the foyer mirror before answering the door.
"Patients come in with their iPhones and show me how they look on [Apple's video calling application] FaceTime," says Dr. Sigal. "The angle at which the phone is held, with the caller looking downward into the camera, really captures any heaviness, fullness and sagging of the face and neck. People say 'I never knew I looked like that! I need to do something!' I've started calling it the 'FaceTime Facelift' effect. And we've developed procedures to specifically address it."
The parasite, which is excreted by cats in their feces, is called Toxoplasma gondii (T. gondii or Toxo for short) and is the microbe that causes toxoplasmosis-the reason pregnant women are told to avoid cats' litter boxes. Since the 1920s, doctors have recognized that a woman who becomes infected during pregnancy can transmit the disease to the fetus, in some cases resulting in severe brain damage or death. T. gondii is also a major threat to people with weakened immunity: in the early days of the AIDS epidemic, before good antiretroviral drugs were developed, it was to blame for the dementia that afflicted many patients at the disease's end stage. Healthy children and adults, however, usually experience nothing worse than brief flu-like symptoms before quickly fighting off the protozoan, which thereafter lies dormant inside brain cells-or at least that's the standard medical wisdom.
But if Flegr is right, the "latent" parasite may be quietly tweaking the connections between our neurons, changing our response to frightening situations, our trust in others, how outgoing we are, and even our preference for certain scents. And that's not all. He also believes that the organism contributes to car crashes, suicides, and mental disorders such as schizophrenia. When you add up all the different ways it can harm us, says Flegr, "Toxoplasma might even kill as many people as malaria, or at least a million people a year."
For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven't yet been fully vaccinated.
In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. "I lost a lot more sleep than I usually do" worrying about the situation, he said.
"You feel badly about losing a nice family from the practice," added Dr. LaReau, but families who refused to vaccinate their kids were told that "this is going to be a difficult relationship without this core part of pediatrics." Some families chose to go elsewhere while others agreed to have their kids inoculated.
This slow death march could easily take 10 to 15 years. Imagine the timeline. A couple more college players -- or worse, high schoolers -- commit suicide with autopsies showing CTE. A jury makes a huge award of $20 million to a family. A class-action suit shapes up with real legs, the NFL keeps changing its rules, but it turns out that less than concussion levels of constant head contact still produce CTE. Technological solutions (new helmets, pads) are tried and they fail to solve the problem. Soon high schools decide it isn't worth it. The Ivy League quits football, then California shuts down its participation, busting up the Pac-12. Then the Big Ten calls it quits, followed by the East Coast schools. Now it's mainly a regional sport in the southeast and Texas/Oklahoma. The socioeconomic picture of a football player becomes more homogeneous: poor, weak home life, poorly educated. Ford and Chevy pull their advertising, as does IBM and eventually the beer companies.
It's not a frequent topic of discussion, but doctors die, too. And they don't die like the rest of us. What's unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don't want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They've talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen-that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that's what happens if CPR is done right).
People don't know how to die anymore...advances in technology and medicine have lulled us into believing we can fix anything that's wrong with our bodies, pain and expense be damned. And sometimes we can and do, and it's that "what if" that makes it so difficult when thinking about what to do.
The first report of a zolpidem [aka Ambien] awakening came from South Africa, in 1999. A patient named Louis Viljoen, who, three years before, was declared vegetative after he was hit by a truck, had taken to clawing at his mattress during the night. Thinking he was suffering from insomnia, his family doctor suggested zolpidem to help him sleep. But 20 minutes after his mother ground the tablet up and fed it to him through a straw, Viljoen began to stir. His eyes, which normally wandered the room, vacant and unfocused, flickered with the light of consciousness. And then he began to talk (his first words were "Hello, Mummy"), and move (he could control his limbs and facial muscles). A few hours later he became unresponsive. But the next day, and for many days after that, zolpidem revived him, a few hours at a time.
Here was a case worthy of Hollywood: three years was well past the point at which doctors would expect any sort of spontaneous recovery. Viljoen awoke with the ability to speak in complete sentences. Not only did he recognize his mother, but he also recognized the voices of people who had spoken to him only when he was apparently vegetative. He remembered nothing of the mysterious realm he kept receding back into. When doctors asked him what it was like to slip away, he said he felt no changes at all. But he could recall conversations from the previous day's awakening, along with bits and pieces of his former life: his favorite rugby team, specific matches he attended, players that he rooted for and against. As time passed, his cognition improved. He could laugh at jokes, and his awakenings stretched from a few hours to entire days. Eventually, he no longer needed zolpidem.
Sour candy is sour because of the acidity level. The Minnesota Dental Association has compiled a chart listing several popular sour candies, all of which are acidic enough to cause tooth enamel loss and some of which are almost as acidic as battery acid! Here's part of the chart:
Update: I meant to add that the ph scale is logarithmic (like the Richter scale) so that a pH of 3.0 is 10 times more acidic than a pH of 4.0. That means that even the pH 1.6 & 1.8 candies on the list aren't quite battery acid, but it also means that a pH 2.0 candy has 100x more acidity than is required to cause enamel loss, not just 2x.
This is good news in the fight against malaria, which kills almost 800,000 people annually (that's a San Francisco, every single year).
An experimental vaccine from GlaxoSmithKline halved the risk of African children getting malaria in a major clinical trial, making it likely to become the world's first shot against the deadly disease.
Final-stage trial data released on Tuesday showed it gave protection against clinical and severe malaria in five- to 17-month-olds in Africa, where the mosquito-borne disease kills hundreds of thousands of children a year.
"These data bring us to the cusp of having the world's first malaria vaccine," said Andrew Witty, chief executive of the British drugmaker that developed the vaccine along with the nonprofit PATH Malaria Vaccine Initiative (MVI).
While hailing an unprecedented achievement, Witty, malaria scientists and global health experts stressed that the vaccine, known as RTS,S or Mosquirix, was no quick fix for eradicating malaria. The new shot is less effective against the disease than other vaccines are against common infections such as polio and measles.
GlaxoSmithKline has previously stated that they will sell the vaccine for cost + a 5% markup that will be put back into tropical disease research.
Internet sensation Amit Gupta was recently diagnosed with leukemia and needs a bone marrow transplant. Problem is that he needs a transplant from someone of South Asian descent.
To aid him in his fight, Amit is going to need a bone marrow transfusion. Unlike blood transfusions, finding a genetic match for bone marrow that his body will accept is no easy task. The national bone marrow registry has 9.5 million records on file, yet the chances of someone from South Asian descent of finding a match are only 1 in 20,000.
This is where we come in. We're going to destroy those odds.
How? By finding and registering as many people of South Asian descent as we possibly can.
Tests are easy -- a simple swab of the cheek. If someone is determined to be a match, that person would have to be willing to undergo an outpatient procedure in which marrow is extracted from bones in the back by a special needle. It's not a fun procedure, but it's not dangerous either. And doing it could save a life.
This crazy-experimental therapy uses a modified HIV virus to attack cancer cells in humans. Only three people have tried this therapy for chronic lymphocytic leukemia; two are in complete remission and one showed improvement.
Doctors removed a billion of his T-cells -- a type of white blood cell that fights viruses and tumors -- and gave them new genes that would program the cells to attack his cancer. Then the altered cells were dripped back into Mr. Ludwig's veins.
At first, nothing happened. But after 10 days, hell broke loose in his hospital room. He began shaking with chills. His temperature shot up. His blood pressure shot down. He became so ill that doctors moved him into intensive care and warned that he might die. His family gathered at the hospital, fearing the worst.
A few weeks later, the fevers were gone. And so was the leukemia.
There was no trace of it anywhere -- no leukemic cells in his blood or bone marrow, no more bulging lymph nodes on his CT scan. His doctors calculated that the treatment had killed off two pounds of cancer cells.
A year later, Mr. Ludwig is still in complete remission. Before, there were days when he could barely get out of bed; now, he plays golf and does yard work.
The team begins by injecting a solution containing carefully chosen nanoparticles into the skin. This leaves no visible mark, but the nanoparticles will fluoresce when exposed to a target molecule, such as sodium or glucose. A modified iPhone then tracks changes in the level of fluorescence, which indicates the amount of sodium or glucose present. Clark presented this work at the BioMethods Boston conference at Harvard Medical School last week.
The tattoos were originally designed as a way around the finger-prick bloodletting that is the standard technique for measuring glucose levels in those with diabetes. But Clark says they could be used to track many things besides glucose and sodium, offering a simpler, less painful, and more accurate way for many people to track many important biomarkers.
Dudley Clendinen has ALS, aka Lou Gehrig's disease, and has a short time to live. Which is fine by him; he's got a plan.
There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months' difference. It retails for about $14,000 a year. That doesn't seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.
No, thank you. I hate being a drag. I don't think I'll stick around for the back half of Lou.
I think it's important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don't talk about how to die. We act as if facing death weren't one of life's greatest, most absorbing thrills and challenges. Believe me, it is. This is not dull. But we have to be able to see doctors and machines, medical and insurance systems, family and friends and religions as informative - not governing - in order to be free.
And that's the point. This is not about one particular disease or even about Death. It's about Life, when you know there's not much left. That is the weird blessing of Lou. There is no escape, and nothing much to do. It's liberating.
Two million patients pick up infections in American hospitals, most because someone didn't follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It's like no one's in charge-because no one is. The public's experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it's pit crews people need.
Players who began their careers knowing the likely costs to their knees and shoulders are only now learning about the cognitive risks, too. After years of denying or discrediting evidence of football's impact on the brain -- from C.T.E. in deceased players to an increasing number of retirees found to have dementia or other memory-related disease -- the N.F.L. has spent the last year addressing the issue, mostly through changes in concussion management and playing rules.
Duerson sent text messages to his family before he shot himself specifically requesting that his brain be examined for damage, two people aware of the messages said. Another person close to Duerson, who spoke on the condition of anonymity, said that Duerson had commented to him in recent months that he might have C.T.E., an incurable disease linked to depression, impaired impulse control and cognitive decline.
"Let's do the E.R.-visit game," he went on. "This is a fun one." He sorted the patients by number of visits, much as Jeff Brenner had done for Camden. In this employed population, the No. 1 patient was a twenty-five-year-old woman. In the past ten months, she'd had twenty-nine E.R. visits, fifty-one doctor's office visits, and a hospital admission.
"I can actually drill into these claims," he said, squinting at the screen. "All these claims here are migraine, migraine, migraine, migraine, headache, headache, headache." For a twenty-five-year-old with her profile, he said, medical payments for the previous ten months would be expected to total twenty-eight hundred dollars. Her actual payments came to more than fifty-two thousand dollars -- for "headaches."
Was she a drug seeker? He pulled up her prescription profile, looking for narcotic prescriptions. Instead, he found prescriptions for insulin (she was apparently diabetic) and imipramine, an anti-migraine treatment. Gunn was struck by how faithfully she filled her prescriptions. She hadn't missed a single renewal -- "which is actually interesting," he said. That's not what you usually find at the extreme of the cost curve.
The story now became clear to him. She suffered from terrible migraines. She took her medicine, but it wasn't working. When the headaches got bad, she'd go to the emergency room or to urgent care. The doctors would do CT and MRI scans, satisfy themselves that she didn't have a brain tumor or an aneurysm, give her a narcotic injection to stop the headache temporarily, maybe renew her imipramine prescription, and send her home, only to have her return a couple of weeks later and see whoever the next doctor on duty was. She wasn't getting what she needed for adequate migraine care -- a primary physician taking her in hand, trying different medications in a systematic way, and figuring out how to better keep her headaches at bay.