Week of December 5, 2022
Communicating complex medical information to patients is a struggle. A few years back, I started telling stable patients that they were "boring me." Patients preferred the brevity and simplicity to wordier (though physiologically precise) comments like "your renal function and associated electrolyte, acid-base, anemia, and mineral bone disease parameters are not demonstrating significant or rapid change between the last visit and today." As I walk into the exam room, many of my patients now ask if they are boring (or worse, interesting). On Friday, after having this conversation again, I realized that my power as a physician has resulted in inadvertently training my population of patients to reverse the connotation of these two common words. I wonder if I missed the lesson of the Marvel universe and have irresponsibly used my power.
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Cases, hospitalizations, and ICU admissions are rising. Deaths are a lagging indicator and (based on more recent waves in other countries) may not increase as proportionally compared to previous waves.
N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
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If you read one thing this week, Eric Topol's summary of the latest wave should be it. Takeaways: elderly, immunocompromised, and those who have not received the latest bivalent boosters are at high risk for infection from the most prevalent strain BQ.1.1. Monoclonal antibodies are no longer effective. Paxlovid is underutilized - rebound infection aside. More data indicates Paxlovid benefits individuals across all age ranges and vaccination statuses.
https://erictopol.substack.com/p/the-new-covid-wave
Dr. Topol continues to advocate for nasal vaccines. A loyal reader shared a very detailed thread from a Canadian data scientist Jeff Gilchrist examining the Novovax COVID vaccine data in detail. The information is compelling.
https://twitter.com/jeffgilchrist/status/1597228107919826946
One last infectious disease-related discussion of note: the general pervasiveness of vaccine hesitancy leads to random outbreaks of other illnesses too. Dr. Eric Feigl-Ding (I find a bit alarmist at times) details an ongoing outbreak of measles(!!!) in Ohio. For reference, measles kills 1-2 out of every 1000 children affected, and 1/1000 children are left permanently disabled (blind or intellectually damaged).
https://twitter.com/DrEricDing/status/1598026844271693824
and
https://www.cdc.gov/globalhealth/newsroom/topics/measles/index.html
Vaccine hesitancy has other consequences too. Here is the latest data regarding variations in excess mortality by political affiliation in the U.S. "Between March 2020 and March 2021, excess death rates for Republicans were 1.6 percentage points higher than for Democrats. After April 2021 [with widespread COVID vaccine availability], the gap widened to 10.6 percentage points."
https://insights.som.yale.edu/insights/once-covid-vaccines-were-introduced-more-republicans-died-than-democrats
Medical Trends and Technology
The ethics of gene editing were back in the news this week. He Jiankui, a Chinese scientist imprisoned for manipulating embryos with CRISPR technology, appears to have restarted research. "In 2018 he announced that he [attempted to] altered the genetic makeup of IVF embryos to make them resistant to HIV - and started pregnancies with them." This week he posted to Twitter that he is reopening a lab.
https://www.statnews.com/2022/11/29/after-prison-crispr-babies-scientist-is-attempting-comeback/
Learning to use CRISPR (and related tools) is (and will be) one of the most impactful bioengineering technologies for the foreseeable future. Here are some interesting related articles:
CRISPR cancer trial success paves the way for personalized treatments
https://www.nature.com/articles/d41586-022-03676-7
and
Humans are late to the game:
CRISPR tools found in thousands of viruses could boost gene editing -
Phages probably picked up DNA-cutting systems from microbial hosts and might use them to fight other viruses.
https://www.nature.com/articles/d41586-022-03837-8
Infographics
The Chemistry of the World Cup: malachite, butane, and polyester, oh my!
https://twitter.com/Salters_Inst/status/1596095948454854656/photo/1
Things I learned this week
Adding to the long list of animals we should not attempt to bring back to life (a la Jurassic Park), I would include the recently discovered "duck-sized underwater-adapted velociraptor." Fossils of this species are the first documented non-avian water-adapted dinosaur. Meet Natovenator polydontus. Best not to feed the polydontus.
https://www.nature.com/articles/s42003-022-04119-9/figures/5
from
https://www.nature.com/articles/s42003-022-04119-9
Proteomics - studying patterns of proteins - is becoming an important tool in understanding history. Smithsonian magazine published two articles on the science and interpretation of proteins found in and on ancient documents and what those proteins can help us understand about the lives and worlds of our ancestors.
https://www.smithsonianmag.com/history/document-detectives-use-smudges-bloodstains-investigate-past-180980986/
and
https://www.smithsonianmag.com/science-nature/how-proteins-helped-scientists-read-between-lines-1630-plague-death-registry-180967811/
One day I will visit the Isle of Islay, Scotland, to visit distilleries that produce several of my favorite scotches. If I overindulge in said scotch and wander into the water, the Islay lifeboat service (part of the Royal Navy) would rescue me as they work the waters around the inner Hebrides. I also learned they have but one female coxswain. I hope I never have to meet Cara, though she seems lovely.
https://twitter.com/rnli/status/1595068553161748484
Clean hands and sharp minds,
Adam
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