Week of July 10, 2023
The gap between my clinical practice and my work in technology is a source of amusement and frustration. Seventeen years in practice, and my patients still record home data (home blood pressure and pulse logs, glucose readings, weights, etc.) on the back of junk mail, random scraps of paper, and (once) a yellowed 10-foot section of perforated dot matrix printer paper (with the holes on the side). In chronic disease management, the bottlenecks of extensive data analysis are frugality and the Luddite mindset of the patients (who could benefit the most). Of course, in a world of 15-minute office appointments and tiny exam rooms, unfolding a giant ream of perforated printer paper is not a Medicare-reimbursable care activity.
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The N.Y. Times COVID Tracker, based on only CDC-gathered hospital data (a surrogate (lagging) indicator), demonstrates fewer cases over the last 14 days.
https://www.nytimes.com/interactive/2023/us/covid-cases.html
Wastewater monitoring (more of a LEADING indicator) demonstrates stable virus concentrations nationally, with increasing quantities in New England and the Midwest.
Japan is seeing a significant spike in cases on Okinawa - with cases rising weekly for three months.
https://japannews.yomiuri.co.jp/society/coronavirus/20230708-121437/
and
https://www3.nhk.or.jp/nhkworld/en/news/20230707_34/
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COVID articles
The CDC may recommend adults get Flu + RSV + COVID vaccines simultaneously this fall. The NY Times does a good job describing the trade-offs. Is it better to spread out the vaccines (possibly more clinically effective) or better to increase the chances of more people getting all three vaccines? Lots of unknowns - and I am sure the vaccine hesitant will have lots to say on social media.
https://www.nytimes.com/2023/07/05/health/vaccines-rsv-covid-flu.html
The world's animals enjoyed the 2020 pandemic lockdown. We, humans, are disruptive to other species.
"Using GPS tracking data from 2300 individual mammals of 43 species, Tucker et al. documented changes in mammal movement patterns during the spring of 2020 compared with the previous year (see the Perspective by St. Clair and Raymond). In locations with strict lockdown policies, animals traveled longer distances during the lockdown period. In highly populated areas, mammals moved less frequently and were closer to roads than they were before the pandemic."
https://www.cbc.ca/news/canada/edmonton/animal-movement-gps-study-covid-1.6891448
and
https://www.science.org/doi/10.1126/science.abo6499
Medical Trends and Technology
Let's do a little basic science this week.
Dr. William Gibson offered a very easy-to-read Twitter tutorial on his most recent research - engineered molecules that can bind to and move various proteins to different parts of a cell. They demonstrate how this biotechnology can remove harmful proteins (like cancer-related proteins) from a cell's nucleus or move other proteins into the nucleus to upregulate DNA transcription (i.e., inducing a cell to make a desired protein). These data indicated the possibility of having medicines that offer precise control to turn genes on and off.
https://twitter.com/wgibson/status/1677409849695428608
and
https://www.biorxiv.org/content/10.1101/2023.07.07.548101v1
I continue to pay attention to articles on the microbiome.
The Microbiome's Influence on Substance Abuse and Treatment. (Or, there is data to suggest we are all just responding to the neurotransmitters (like dopamine) that the bacteria in our gut are stimulating or secreting.)
and
Altering the microbiome in immunosuppressed melanoma patients enhances response to treatment.
https://www.sciencedaily.com/releases/2023/07/230707111654.htm
Infographics
The biochemistry of sunburn. All skin can be burned by U.V. radiation, though the more melanin in the skin is more protective.
https://twitter.com/cenmag/status/1666832482711240707/photo/1
Things I learned this week
James Lind was an 18th-century Scottish physician who ran one of the first documented controlled clinical trials. He investigated treatments for scurvy - the consequence of Vitamin C deficiency. Scurvy was highly prevalent amongst British sailors in the 1700s and was associated with high morbidity and mortality. Not good if you are a superpower dependent on long-voyage sailing ships for force projection and commerce. Dr. Lind was a Royal Navy surgeon who decided to test the various anecdotal treatments for scurvy, the cause of which was unknown at the time.
"He took 12 men suffering from symptoms of scurvy, divided them into six groups, and treated [each pair with one of the common recommended, but unproven] remedies, including:
- a quart of cider a day
- 25 drops of the elixir of vitriol [dilute sulphuric acid!] three times a day
- half a pint of sea-water a day
- a nutmeg-sized paste of garlic, mustard seed, horse radish, balsam of Peru, and gum myrrh three times a day
- two spoonfuls of vinegar three times a day
- two oranges and one lemon a day
By the end of the first week, those on citrus fruits were well enough to nurse the others."
However, the lack of understanding of biochemistry and various other factors meant it took 50 years to fully implement citrus into the routine rations of British sailors. The BBC write-up is interesting and mirrors Dr. Joseph Lister's problems promulgating his Germ Theory in the 1840s (it only took 40 years to get most doctors to buy into routine antimicrobial practices).
https://www.bbc.com/news/uk-england-37320399
Read the original in the flowery prose of the 1750s with the letter "s" that appears like an "f" - called a long "s."
https://www.jameslindlibrary.org/lind-j-1753/
About the long "s."
https://www.livescience.com/65560-long-s-old-texts.html
Living with A.I.
Bertalan Meskó, director of the Medical Futurist Institute, recently offered insights on how A.I. will impact healthcare. While he does not acknowledge some boundaries (for instance, various legal, compliance, and privacy boundaries), his vision of technology driving personalized medicine is insightful.
https://www.pmlive.com/pharma_intelligence/AI_the_next_paradigm_shift_in_healthcare_1493764
Meskó's website photos make it look like he sees into the future.
ChatGPT, using the newly released code interpreter plug-in, can interpret external data, perform OCR work (reading text from scanned images), interpret messy data sets, copy data and video styles, generate video and images, and analyze large data sets. One can upload data and provide written instructions for the needed interpretation.
https://twitter.com/Saboo_Shubham_/status/1677900666050625538
and a deeper dive
https://docs.kanaries.net/articles/chatgpt-code-interpreter
A.I. art of the week
"a female physician, wrapped in dot matrix printer paper, floating in a pool filled with paper in the middle of a desert filled with old computers - fuji provia film; aperture 4.5, snoot flash on face"
Clean hands and sharp minds,
Adam
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