Week of October 16, 2023
A patient angry about co-pays (for a life-saving procedure), a second (immunosuppressed) patient subtly mocking me for wearing a mask in the exam room, and a third patient's hand-written patient note detailing the unaffordability of their medications, all punctuated last week's clinical office time. I often see the gap between ideal healthcare delivery and reality. Some days, I have fallen into that gap (and can't get up?).
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At the national level, hospitalizations are still falling.
Wastewater RNA concentrations are plateauing at levels higher than the summer, meaning we may see another rise in hospitalizations in the coming weeks. Either way, I suspect we will see a steady rate of coronavirus transmission heading into the holidays. The Inside Medicine aggregate COVID dashboard offers another view of this data.
The N.Y. Times COVID Tracker reflects only CDC-gathered hospital data. Hospitalization data are a (lagging) indicator.
https://www.nytimes.com/interactive/2023/us/covid-cases.html
Wastewater monitoring is more of a LEADING indicator.
The Inside Medicine COVID dashboard
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COVID articles
Dr. Eric Topol reviews the latest updates about intranasal COVID vaccines. There are 20+ nasal vaccines in development, and two are in phase 1 clinical trials.
https://erictopol.substack.com/p/covid-nasal-vaccines-get-a-boost
NBC News offered a thoughtful discussion about the declining use of Paxlovid despite offering protection against long COVID symptoms and, more immediately, hospitalizations.
Likewise, I learned that GoodRx, a national prescription medication discount program, offers a tracker for respiratory illness season, following year-over-year trends in Tamiflu, paxlovid, molnupiravir, and oral antibiotics fill rates (for flu, covid, and presumed bacterial respiratory illnesses, respectively).
https://www.goodrx.com/healthcare-access/research/flu-season-tracking-tamiflu-fills
Medical Trends and Technology
Amongst the vast array of wearable health data monitors, glucose monitoring is one of the most mature and valuable. I have observed a sharp increase in patients using wearable, continuous glucose monitors (CGMs) to manage their diabetes. Though targeted at medical professionals, this article offers a fantastic overview of the data, data use, and complexity of interpreting CGM output.
Before the pandemic, there was a belief that there was a significant difference in droplet vs. airborne virus transmission. However, that view has evolved. Flu, RSV, and many other respiratory illnesses exit infected individuals in a wide array of particle sizes (<5 to 100 microns), with very tiny particles (<5 microns) lingering for hours in the air. Science published the 2021 article with some fantastic illustrations. More recently, a group of physicians from Singapore published data on finding influenza A and B RNA in aerosolized particles. Yet another justification for wearing a mask when I see patients (even if they mock me).
Science article from 2021
https://www.science.org/doi/10.1126/science.abd9149
and
Infographic of the Week
Brains! Two overwhelming infographics that convey how complex the brain is without even having to read the text. These are great examples of a shock-and-awe infographic style. (Please note that I am not endorsing the author or website. I was just struck by how ineffective these complex infographics are at meaningfully conveying information.)
and
https://www.thehighestofthemountains.com/images/thehighestofthemountains_brain_map_135a-185px.jpg
Things I learned this week
I finished Malcolm Gladwell's 6-part Revisionist History podcast (Season 8) on gun control and firearms violence in the U.S. It is a fantastic deep dive into the history, data trends, and complexities behind the policy and public health crisis. I cannot say enough about his thought-provoking content and style. He rarely offers answers, but he knows how to ask questions.
https://www.pushkin.fm/podcasts/revisionist-history
Panda hugging
I learned there are paid panda-hugging jobs in China. The articles report that the salary was $32K in 2016 and requires one "to be at least 22 years old, have a basic knowledge of pandas, be able to write, and know how to take pictures."
https://www.boredpanda.com/hugger-panda-nanny-best-job-protection-research-center/
and
https://www.nbcnews.com/news/china/chinese-panda-sanctuary-search-panda-caretaker-n106181
Living with A.I.
I'm sure we'll see many more of this type of human vs. computer-generated studies shortly. Seventy-two (72) reviewers reviewed A.I.- and human-generated research abstracts, and 27 completed a survey and interviews to discuss their beliefs. [Despite] employing multiple rationales to judge texts, reviewers were largely unsuccessful in identifying A.I. versus human writing, with an overall accuracy rate of 38.9%.
https://www.sciencedirect.com/science/article/abs/pii/S2772766123000289
https://twitter.com/emollick/status/1712693602852163660
A.I. illustrated story art of the week
ChatGPT-4 now includes the ability to interact with DALL-E 3. Based on the above article about panda huggers, I prompted ChatGPT to write about a panda-hugging physician and illustrate the story. Imagine these tools used to generate custom, on-demand illustrated medical or cooking instructions.
Below is my first attempt at A.I. fiction with prompted pictures.
(You cannot yet share ChatGPT output with embedded pictures, so I copied the text and linked the pictures for this.)
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Dr. Xiao Lin, bamboo whisperer.
"Dr. Xiao Lin grew up in the bustling city of Chengdu, but his heart always belonged to the serene bamboo forests that skirted the city's edges. As a child, his grandmother told him tales of the majestic black and white creatures that roamed these forests, the giant pandas. She spoke of them as guardians of the forest, calling them the "Whisperers of the Bamboo.
Dr. Lin as a child:
https://drive.google.com/file/d/1UsTBg3UnoJYXOcykSL1c1DGWlET3ByUv/view?usp=drive_link
One summer, young Lin ventured deep into the bamboo forest on a quest fueled by his grandmother's tales. He encountered a young panda cub, lost and separated from its mother. With no experience but guided by instinct, Lin comforted the cub, using bamboo shoots to gain its trust. Together, they searched for and successfully reunited the cub with its mother. This profound experience left an indelible mark on Lin's heart.
Dr. Lin encountering the lost panda: https://drive.google.com/file/d/1Kbc9KxcobZFUb5_328kJjC4Mb4DYUZ-f/view?usp=drive_link
As he grew older, Lin's passion for pandas only intensified. He pursued a career in veterinary medicine, specializing in caring for these magnificent creatures. His unique approach, which combined scientific knowledge with the ancient tales and practices passed down from his grandmother, made him a pioneer in the field. Dr. Lin didn't just treat pandas; he understood them, communicated with them, and, most importantly, loved them deeply.
Dr. Lin as an adult:
https://drive.google.com/file/d/1wJfu2ULuMfCXpxQeXs5nazJmJeLBn7kF/view?usp=drive_link
and
Older Dr. Lin, an accomplished panda doctor:
https://drive.google.com/file/d/1dto1_Dp0Q__t15wQGxpTxEolBMHkYGJf/view?usp=drive_link
His clinic, situated in the heart of the bamboo forest, became a haven for pandas. They weren't just patients; they were his family. Dr. Lin became known as the "Panda Whisperer," echoing his grandmother's tales.
But his real motivation was more profound: a promise he had made to that lost cub years ago. He had vowed to dedicate his life to ensuring that no panda would ever feel lost or alone again."
Older Dr. Lin:
https://drive.google.com/file/d/1M2KAFWC6SNyh-Iyyj-8wwEgRiZvJhzSI/view?usp=drive_link
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Clean hands and sharp minds,
Adam
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