Week of Jan 29, 2024
Thanks to a workout-related low back strain, my Friday clinic was marked by a painful gait and patients asking if I was okay. While accompanying an 86-year-old patient to the front desk, I found myself eyeing his rolling walker. I don't recall facing a back-pain-driven ethical quandary before. However, given my discomfort, I seriously contemplated stealing the man's assistive device - at that moment, the office hallway felt very long, and there was only one walker between the two of us.
I'm now feeling better, but I can see why moments of desperation undermine social norms. There are plenty of good articles on situational ethics in times of scarcity.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780626/
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Hospitalization rates are still rising, but the rate of rise may be plateauing. Wastewater RNA concentrations are falling in all areas of the U.S.
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.
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COVID articles
U.K. researchers published data demonstrating pronounced cognitive slowing in people with long COVID symptoms as compared to age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest post-COVID syndrome-related symptoms.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00013-0/fulltext#secsectitle0140
and
https://twitter.com/EricTopol/status/1750587367771996591
Related to the above, I have seen a series of articles questioning the role of COVID in post-pandemic disinhibited behaviors, such as increased aggression or risk-taking, and data demonstrating increased risky driving and accidents. As I have previously written, I would be surprised if coronavirus is the only virus with the potential for long-term organ (including brain) damage. Our post-COVID sample size is so large that population-level trends may be more evident.
https://www.nytimes.com/2024/01/10/magazine/dangerous-driving.html
and
https://twitter.com/JGrantGlover/status/1750626444546355592
Beijing University of Technology engineers looked at the impact of N95 masking + improved ventilation on COVID transmission in college classrooms. Their data demonstrated that infection risk in students wearing N95 respirators is reduced by 96%. When the classroom's fresh air per capita is 24m3/h/person, the virus exposure can be decreased by 81.1 % compared to the more typical per capita fresh air volume of 1.02 m3/h/person.
https://www.sciencedirect.com/science/article/abs/pii/S0048969724004819
and
Discussion of this data has stoked intermittent comments from the "masks are a violation of my rights" crowd on the platform formally known as Twitter.
https://twitter.com/drseanmullen/status/1751289630580707611?s=42&t=cHtDhpWgAdi0UhIayqsoag
Medical Trends and Technology
GLP-1s (Ozempic and related medications) were back in the news. New data demonstrates the drugs reduce inflammation in various parts of the body, raising the prospect this class of drugs offers a broader range of benefits against diseases such as Parkinson's and Alzheimer's.
https://www.nature.com/articles/d41586-024-00118-4
Walking and standing desk workers of the world unite!
"In this cohort study involving 481,688 individuals over a mean follow-up period of 12.85 years, individuals who predominantly engaged in sitting at work exhibited a higher risk of mortality from all causes (16%) and cardiovascular disease (34%) compared with those who predominantly did not sit, even after adjusting for sex, age, education, smoking, drinking, and body mass index. Individuals who predominantly sit at work would need to engage in an additional 15 to 30 minutes of physical activity per day to mitigate this increased risk and reach the same level of risk as individuals who predominantly do not sit at work."
For full disclosure, I have owned and used a walking desk since 2013.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814094
Sin taxes (taxing tobacco, alcohol, sugar, and fat) shape behavior. Recent data from cities taxing high-sugar beverages showed decreased consumption since 2018, correlating to the increased pricing. https://jamanetwork.com/journals/jama/fullarticle/2814394
and
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2813506
You will recall that the organization "Affordable Groceries for All" (funded by the American Beverage Association) seems uniquely focused on opposing soda taxes (and not so much on helping lower the prices of other consumables).
https://affordablegroceriesforall.com/
Infographics
I found an enlightening infographic about the origin story of various color names. I direct your attention to porcelain.
https://twitter.com/etymology_nerd/status/1630565192483631106/photo/1
Things I learned this week
Social media has some merits - for instance, a quick tutorial about the painter Zinaida Serebriakova exemplifies the notion that art is so often a reflection of political, scientific, and cultural change.
https://twitter.com/culturaltutor/status/1751370825599463754
In contrast to the merits of social media mentioned above, I also learned that a photographer trained (using Skinnerian conditioning) two rats to take photographs of themselves. The artist saw the whole project as a metaphor for the dopamine reward we humans get from social media. Apropos of the article, the headline 'Rats Taking Selfies' was all it took to get me to click. [I am a sucker for articles that combine animals, technology, and human-like behaviors. My family no longer allows me to talk about training dogs to use word buttons; I'm sure they will be thrilled to hear about rodents taking selfies.]
I visited the Internet Archive's library of 1940s instructional films for schools and libraries. It is a fantastic look at the prevailing social norms and ideals of a mid-20th century America. The 10-minute films are unironically hokey and dated but a lot of fun. Did viewers from the 1940s think they were as stilted as they seem now? By the way, I did not find any films about when it is okay to steal walkers from the elderly.
https://archive.org/details/coronet_instructional_videos
A few of the many available:
What to do on a Date
https://archive.org/details/0248_What_to_Do_on_a_Date_E01668_19_40_42_00
Communism
https://archive.org/details/3177_Communism_02_10_39_20
What about Juvenile Delinquency?
https://archive.org/details/WhatAbou1955
Perhaps the most excellent short film ever made about the Dewey Decimal system - an analog relational database (for those that may not have had "Library Science" in elementary school).
https://archive.org/details/0044LibraryOrganization20110400
Living with A.I.
The likelihood of physicians trusting AI-driven clinical support tools increases when LLM responses also include the reasoning behind the answer. This notion seems obvious, but the linked article offers a fantastic discussion of why LLMs (and black-box A.I.) engender distrust.
https://www.nature.com/articles/s41746-024-01010-1
The more time I spend exploring A.I., the more I realize the most significant value comes from learning to use LLMs as an extension of one's problem-solving and ideation efforts. I found a Twitter discussion linking to recent papers offering a perspective on this topic.
https://twitter.com/emollick/status/1751353615334146460
A.I. art of the week
A side view of a physician in a white coat on a treadmill desk walking with a walker. Put flames on the walker's legs.
https://drive.google.com/file/d/1Xec4l_BOHdzB0US2yfOOzcxmt6fI-J-c/view?usp=sharing
Another entertaining variation:
https://drive.google.com/file/d/1wk8mA81N2f9TtS-wzFKJxfDKBqcPTX90/view?usp=sharing
Clean hands and sharp minds, team
Adam
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