Week of November 14, 2022
Cable News re-entered my exam rooms last week. Two of the six patients I saw on Friday afternoon commented that the high costs of their pills were evidence of our government's failure to "fix" drug prices. Both directly referenced the bill that capped insulin prices for some Medicare part D and private insurance plans (and passed only by the House of Representatives less than 24 hours before their visits). Healthcare policy is complex and details matter (for instance, neither patient is on insulin). I should be prescribing more School House Rocks.
School House Rocks - I'm Just a Bill
https://www.youtube.com/watch?v=OgVKvqTItto
and
https://www.fiercehealthcare.com/payers/house-passes-bill-cap-insulin-copays-35-month-medicare-private-plans
and there is a lot more to the issue of drug pricing
https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/
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There are small increases in COVID case rates due to areas of high spread in the Southwest of the U.S. Data from western Europe also shows small increasing case rates. Deaths are still falling. French data (mentioned last week) hints that the latest Omicron variants (XBB and BQ.1.1) pathogenicity (plus increased population immunity) may yield lower hospitalizations and death rates compared to prior COVID surges.
see
https://erictopol.substack.com/p/an-optimistic-outlook
and
https://theconversation.com/xbb-and-bq-1-what-we-know-about-these-two-omicron-cousins-193591
N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
Financial Times Data
https://ig.ft.com/coronavirus-chart/?areas=eur&areas=usa&areas=e92000001&areasRegional=usny&areasRegional=usnm&areasRegional=uspr&areasRegional=usaz&areasRegional=usfl&areasRegional=usnd&cumulative=0&logScale=0&per100K=1&startDate=2021-09-01&values=deaths
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I found some articles discussing the cumulative and longer-term effects of COVID this week. The data suggests that each reinfection brings new risks for long COVID. In other words, keep getting boosters and consider Paxlovid if infected. And masks still work too.
Amongst 440,000 veterans, each episode of reinfection "further increased the risks of death, hospitalization, and sequelae in multiple organ systems in the acute and post-acute phase."
https://www.nature.com/articles/s41591-022-02051-3
Data from 46% of the German population demonstrated that significant Long Covid symptoms were present in adults, children, and adolescents. "In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the evidence on post-COVID-19 conditions in younger age groups and confirm previous results in adults."
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004122
Eric Topol offers a fantastic review of these articles.
https://erictopol.substack.com/p/covid-reinfections-and-long-covid
And to pile on to this topic (with Apple News links):
COVID-19 Is Still Messing Up Our Sleep. Here's How to Sleep Better
https://apple.news/ATuUhuB5pTR-iDxHXzOn9Aw
Covid-19 Infection Linked With Poor Cardiovascular Outcomes And Death
https://apple.news/ADmQ63h8oRwCIq7OCf0JSTw
One other article of note - there has been more analysis of the differences in schools that maintained vs. abandoned masking policies and how these policies overlap with socioeconomics.
https://www.nejm.org/doi/full/10.1056/NEJMoa2211029
Commentary
https://twitter.com/AbraarKaran/status/1590502179047374848
Medical Trends and Technology
Ethan Mollick, a Wharton School of Business professor, shared an interesting set of articles on the importance of sleep for a successful business leader. The data is striking.
https://twitter.com/emollick/status/1589620739388293120
Amongst the interesting takeaways:
1) Lack of makes you generate worse ideas
2) Lack of makes you think the bad ideas you develop are good
3) Getting boosts your mood, upping the mood of your startup
4) Lack of lowers your entrepreneurial ability
and
When people don't sleep enough, they:
-Become more abusive to their employees
-Help other people less
-Donate to charity less
Several people have recently brought this topic to my attention, and the book Why We Sleep is now on my to-read list.
https://www.goodreads.com/book/show/34466963-why-we-sleep
Infographics
I have an unfulfilled desire to spend more time on comparative evolutionary biology. How and when different biologic functions developed amongst the diverse creatures of the earth is fascinating.
I came across this fantastic infographic on the evolution of vision
https://twitter.com/markabelan/status/1589860716600643584/photo/1
from Mark Belan
https://twitter.com/markabelan/status/1589860716600643584
Here are the books that got me excited about this topic:
https://www.goodreads.com/book/show/223609.Cats_Paws_and_Catapults
and
https://www.goodreads.com/en/book/show/255735.Sensory_Exotica
Topics from the newsletter through the "eyes" of our A.I. Overlords!
(What is this section? - https://openai.com/dall-e-2/)
"Painting of emu in a tricorn hat writing on parchment with a quill pen"
https://labs.openai.com/s/4VmFJmqjhtn6h9TUP33ouckV
Things I learned this week
Call me nostalgic, but I am sad that today's world won't allow a simple farm girl to make Tik Toks with her emu. The New York Times conveyed a lot in a comprehensive article updating readers on the health of Emmanuel the Emu. Here are the themes I took away:
- Emmanuel did NOT have avian flu; he was "stressed."
- Taylor Blake, his human, is not setting a good example by kissing a sick Emu (Avian flu can jump species, and it was not clear Emmanuel did not have Avian flu initially.)
- Ms. Blake has a "complex" social media history.
- The article projects vague overtones of heavy-handed state intervention when describing the culling of chickens and ducks stricken with avian flu.
- There is a subtle sense of "othering" the "wild, migrating waterfowl that spend time in South America" and were the source of avian flu.
I am a big fan of nuanced reporting, and this article has it all (but for many wrong reasons). For the second time in four weeks, I found a favorite article about an emu.
https://www.nytimes.com/2022/10/28/style/emmanuel-emu-tiktok.htmls
I learned that November 2022 marks the 195th birthday of the friction match. Matches were invented in November 1827 by British Pharmacist John Walker, who never patented his invention. Early versions had a bug - "sometimes the burning sulfur coating would drop from the stick, damaging flooring or the user's clothing." Nevertheless, matches were quickly copied and sold as brands - "friction lights" and "Lucifers." And, (feeding the writings of Dickens and (later) Upton Sinclair) match factories were horrific venues of unsafe work generating chemical exposure (phossy jaw) amongst young women and child laborers.
https://www.smithsonianmag.com/smart-news/friction-matches-were-boon-those-lighting-firesnot-so-much-matchmakers-180967318/
and don't forget the medical article on "phossy jaw" (more precisely called phosphorus necrosis of the jaw).
https://www.rcseng.ac.uk/library-and-publications/library/blog/phossy-jaw-and-the-matchgirls/
Clean hands and sharp minds,
Adam
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