What Adam is Reading - Week of 4-4-22

Week of April 4, 2022

 

Last week, a clinic patient's question about an online dietary supplement for "kidney health" sparked a 25-minute conversation. In general, most patients do not need or benefit from nutritional supplements. Despite his stated "faith in me," the patient wanted to know "how I knew the supplement didn't offer him any benefits." Further conversation uncovered the patient's pandemic-driven doubts about healthcare due to mixed commentary on masking, treatments (read: Ivermectin and vitamin D), and "the many and well-publicized" vaccine complications. (To be clear - there are very few documented complications from the vaccine - the good far, far, far outweighs any side effects).

 I should not be surprised. Medical information is nuanced, ever-evolving, and often challenging to communicate with both accuracy and brevity. Mistrust is easy, pernicious, and oily, oozing into intellectual nooks and crannies. Medical uncertainties raised by cable news doctors, disconnected from the tenets of science, speaking of data without nuance, and dropping labels like "socialized medicine" are the intellectual equivalent of fracking for doubt and fear. And proving a negative (this supplement probably won't help and is a waste of money at best) is difficult to defend even without the mental oil spill of the pandemic's medical misinformation. 


And, of course, online supplements do not improve chronic kidney disease due to years of variably controlled diabetes, obesity, and (probably) sleep apnea.

 This article on the psychology of climate change data is an excellent parallel analysis of my office conversation this week:

https://www.psychologytoday.com/us/blog/psych-unseen/202204/why-dont-people-believe-in-climate-change

 

---- Latest Data

Case rates, hospitalizations, and death rates are still low. Wastewater data still demonstrates rising RNA quantities in some but not all localities. 

 

CDC Wastewater Surveillance tracker

https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance

 

N.Y. Times Tracker

https://www.nytimes.com/interactive/2021/us/covid-cases.html

 

Cases in the U.K., China, Australia, and elsewhere are plateauing.

Country Comparison from FT.com

https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=hkg&areas=chn&areas=jpn&areas=aus&areasRegional=usny&areasRegional=usla&areasRegional=usnv&areasRegional=usar&areasRegional=usks&areasRegional=usmo&cumulative=0&logScale=1&per100K=0&startDate=2021-06-01&values=cases

 

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The CDC wastewater data set is challenging to interpret. Changes in percentage changes are not easy to wrap one's head around. Focusing on one city may help. Boston wastewater data indicates an increasing prevalence of BA.2 RNA. 

https://twitter.com/j_g_allen/status/1510603977381011459 

Wastewater RNA sampling is a LEADING indicator. Don't throw the masks away yet.

 

A great example of nuanced data is the topic of a second booster. Dr. Eric Topol offered a fantastic review of the available studies on which patients most likely benefit from additional COVID vaccine doses - essentially older adults (> age 50) and the immunocompromised.

https://erictopol.substack.com/p/a-new-wave-and-a-new-booster

 

Dr. Jeremy Faust offered a roundup of studies regarding COVID this week. Articles reviewed include:

  • Protection of BA.1 antibodies against BA.2.
  • The use of convalescent plasma in avoiding hospitalizations due to COVID.
  • The use of Ivermectin in early COVID (didn't help anyone). 

https://insidemedicine.bulletin.com/this-week-in-covid-19-research-four-must-know-studies/

 

Science published a fantastic article touching on fact-based communication in the age of Twitter: "It can be difficult, for example, for scientists to be heard over the cacophony of messages on Twitter—some 500 million each day. And although some scientists have used the platform to elevate their online presence, that has rarely translated into concrete professional rewards. Eventually, the sizable Twitter followings some have built during the pandemic may fade. And in the meantime, some have suffered from their digital fame, attracting harsh personal attacks and threats of violence. Despite such challenges, many researchers believe that—like it or not—the pandemic has forever altered how certain scientists communicate with each other and the public."

https://www.science.org/content/article/twitter-transformed-science-communication-pandemic-will-last

 

Dr. Alasdair Munro sums up the difficulty in thinking about medical therapies in terms of cost/benefit

https://twitter.com/apsmunro/status/1510531457722335234

 

 

Random Medical Realities and Technologies

In response to requests for a broader range of medical and medical technology articles (thank you, survey respondents), here is an article discussing Bruce Willis and the announcement of his aphasia. When doctors see reports like this, sometimes you go digging; sometimes you let it go. But, aphasia is a symptom, not a disease.

https://insidemedicine.bulletin.com/aphasia-is-a-symptom-not-a-disease

 

And while we are on the nuances of data, check out epidemiologist Gideon M-K's blog on Vitamin D and COVID. It is a detailed review of a single, oft-cited study, but the way he parses the data is enlightening. His deep-dive is an excellent example of why critically reading medical literature can be time-consuming and requires a bit of expertise.

https://gidmk.medium.com/serious-data-issues-at-play-in-a-randomized-trial-of-vitamin-d-for-covid-19-65ee41a6194c

 

 

Infographics!

Batman! I remember the premiere of the 1989 Michael Keaton version very well. But Nothing will ever top Adam West from 1966 - "Hand me down the shark repellant bat spray."

https://www.youtube.com/watch?v=CJ-4jCS9ky8

This infographic is an excellent summary of the Batman movies.

https://public.tableau.com/app/profile/adedamola8122/viz/TheFacesofBatman/DataViz?publish=yes

 

 

Things I learned this week

 

Extreme Ironing (in which people take ironing boards to remote and odd locations to iron clothing) exists. Really.

https://en.wikipedia.org/wiki/Extreme_ironing

https://www.youtube.com/watch?v=7fd6NBQ8ego

and

https://www.youtube.com/watch?v=j1y4rsEVzYo

 

Scientists have observed numerous biological oddities around the Chornobyl nuclear power plant, including a black fungus that thrives on ionizing radiation. "The black fungi were not only growing [despite] radiation; they were changing and growing because of it." And, of course, if you launch said fungus into space, it can act as a shield against background radiation.

https://www.atlasobscura.com/articles/chernobyl-black-fungi-space

Fungus in Space! (not yet peer-reviewed)

https://www.biorxiv.org/content/10.1101/2020.07.16.205534v1.full.pdf

 

 

Clean hands and sharp minds, team

 

Adam

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