Week of June 6
(No email next week due to vacation)
By the seventeenth minute of a recent patient appointment, the voice in my head screamed that I was not obligated to defend Dr. Fauci or vaccine manufacturers. The (notably civil) discussion strayed far from "why the booster is right for you" (where the "you" in my exam room has chronic kidney disease and a cornucopia of comorbidities). Many months into a world of COVID, I still feel a visceral urgency (almost compelled) to lay out the data and uphold (what I see) as a struggle for intellectual integrity. But for all the parallels between these patient conversations and Don Quixote (man vs. society, tilting at windmills, etc.), the articles I found this week reinforced the importance and complexity of being intellectually honest. Maybe I am in the "you think what you read" feedback loop?
---- Latest Data
Case rates and deaths were down over the last week. Hospitalizations and test positivity rates are still rising. I continue to see anecdotal data that unreported positive cases (diagnosed by home-based antigen tests) are common and there is a higher prevalence of COVID than the data below represent.
N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
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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I have been reminding my patients, most of whom are over age 50 and immunocompromised/chronically ill, to get their boosters (doubly so in light of the data above). The CDC has an interactive booster decision tree to help educate about booster eligibility.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html
It pairs nicely with their update on the value of boosters in protecting against infection or re-infection.
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
The NY Times published an interesting article about the complexities of masks during the pandemic. Here is the crux - masks protect people who wear them correctly. But because mandates don't enforce correct mask-wearing, population-level data imply masks do not work. Or put more succinctly by the article, "It is simultaneously true that masks work and mask mandates do not work."
https://www.nytimes.com/2022/05/31/briefing/masks-mandates-us-covid.html
On April 18, 2020, I wrote in-depth about a problematic study by Stanford professor John Ioannidis.
see http://www.whatadamisreading.com/2020/04/what-adam-is-reading-4-18.html
Sadly, Dr. Ioannidis has spent most of the pandemic publicly downplaying the severity of COVID and supporting unfounded treatments. In the most recent episode of Michael Lewis' podcast Against the Rules, he covers not only the paper I wrote about in 2020 but does a great job highlighting the logical (and ethical) failures of some doctors during the pandemic. If (like me) you are interested in the center of the Venn diagram representing data, logical fallacies, and health care systems, you must listen to this 35-minute podcast. (As an aside, the podcast interviews data scientists who found even more flaws in the study than initially apparent.)
https://www.pushkin.fm/podcasts/against-the-rules/the-person-who-knows
One last item on intellectual integrity: authors of a widely publicized study linking ivermectin to lower COVID mortality have retracted their work. The authors stated that wide-scale misinterpretation might "harm patients."
https://retractionwatch.com/2022/06/03/widely-touted-abstract-on-ivermectin-and-covid-19-retracted/
Random Medical Technology and Realities
The possibilities of gene editing via CRISPR are both fantastic and scary. I found an article on the unexpected data associated with knocking out the receptors of the hormone AVP in hamsters. The hypothesis (based on prior research) was the hamsters would be more docile and friendly when their brains could no longer respond to AVP (the hormone receptor was genetically made inactive). The hamsters turned out to be more aggressive. A UK tabloid picked up the story and made the narrative melodramatic. My conclusions: The biochemistry of social behaviors is complex. Gene editing is a powerful tool that comes with responsibility. (Isn't that the entire theme of the Marvel cinematic universe?). Genetically altered angry hamsters make for titillating newspaper headlines.
Study
https://www.pnas.org/doi/10.1073/pnas.2121037119
Contrast the study to the Daily Mail article - "Scientists accidentally create super-vicious HAMSTERS in a lab after gene editing experiment goes wrong and makes aggressive rodents chase, bite and pin each other down."
https://www.dailymail.co.uk/news/article-10884147/Vicious-hamsters-bred-lab-accident.html
About CRISPR
https://www.yourgenome.org/facts/what-is-crispr-cas9
Though not medical per se, this article seemed to be an apropos follow-on to the mutant hamster story: "Roving Packs of Robot Dogs Are Coming to the Moon." Or, put in more precise language, several organizations have suggested using robot dogs to examine the moon in response to a European Space Agency challenge looking for novel ways to explore and map the lunar surface. Words matter.
https://www.thedailybeast.com/roving-packs-of-robot-dogs-are-coming-to-the-moon
Infographics!
Medicinal and industrial uses of dandelions
https://www.compoundchem.com/2022/05/26/dandelion/
I do not advocate eating dandelions for health reasons. However, both Goodyear and Continental are working on scaling dandelion rubber for tires:
https://continentaltire.com/learn/continental-constructing-tires-dandelions-0
and
https://continentaltire.com/learn/five-fun-facts-about-dandelion-tires
Things I learned this week
Thanks to Apple TV+'s Prehistoric Planet, I learned that 70 million years ago, amongst the many large and remarkable creatures that roamed the Earth, 17-inch toads named Beelzebufo ampinga were wandering the swamps of (what is now) Madagascar. They were large enough to eat juvenile dinosaurs, which was depicted in the program. I felt some empathy for the dinosaur getting eaten by the toad - I see it as a little humiliating. (Toads are certainly not my first choice of an animal by which to be eaten.) Of course, I suppose I should also consider the toad's name Beelzebufo - a portmanteau of the name Beelzebub and bufo (Latin for "toad"). Maybe being eaten by a "devil toad" is more dignified?
https://en.wikipedia.org/wiki/Beelzebufo
Beelzebufo was featured in a 2008 N.Y. times article as well.
https://www.nytimes.com/2008/02/19/science/18frog.html
review of Prehistoric Planet
https://www.theguardian.com/tv-and-radio/2022/may/23/apple-tv-prehistoric-planet-review-youll-genuinely-think-youre-watching-real-dinosaurs
And in a move to pander to my large audience of Coloradans, I offer this recent Atlas Obscura article on "How to Eat Like a 19th Century Colorado Gold Miner." Sheep's feet with Picante sauce may be at an upcoming team dinner, now that I know what traditional Denver dining entails.
https://www.atlasobscura.com/articles/eat-like-a-gold-miner
And lastly, on the theme of intellectual integrity, I learned that 1) The Weekly World News is still alive - on social media. And 2) they are publishing on topics of high importance, such as the setbacks in the "Birds Aren't Real" movement.
https://twitter.com/weeklyworldnews/status/1532417129382805505
(for context https://www.cbsnews.com/news/birds-arent-real-origin-60-minutes-2022-05-01/)
Clean hands and sharp minds, team
Adam
Next week, I will be on a family vacation. Expect the next email on June 20.
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