Week of September 16, 2024
During my clinical office hours last week, several patients (upon learning both our kids are now in college) offered suggestions on child-free trips and adventures for my wife and me - day trips, restaurants, and travel. And though I said I did not think we were ready for the Viking cruise (a common suggestion from my mostly older patients), the fact that my wife and I received our Novavax vaccines together at lunchtime on Saturday and then used coupons to buy a few things at CVS suggests otherwise. While I am unsure what the exact benchmark for "you are now ready for a Viking cruise" is, a Saturday outing for joint healthcare coupled with coupon-driven purchases feels like we are on our way. At least we didn't eat dinner at 4:30 PM.
(BY THE WAY - I strongly encourage most people to get the updated COVID shots. Unless your doctor tells you otherwise, I suggest receiving the flu vaccine in early October, a few weeks before Thanksgiving and peak flu season.)
https://www.verywellhealth.com/how-long-does-a-flu-shot-last-770538
**I am traveling through next weekend and may not write another newsletter until the week of September 30.
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COVID infection rates continue to fall. Last week, COVID prevalence was 1 in 41 Americans, down from 1 in 34 the first week in September.
The Pandemic Mitigation Collaborative (PMC) website uses wastewater levels to forecast 4-week predictions of COVID rates.
https://pmc19.com/data/
based upon https://biobot.io/data/
Wastewater Scan offers a multi-organism wastewater dashboard with an excellent visual display of individual treatment plant-level data.
https://data.wastewaterscan.org/
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COVID articles
The XEC variant of COVID is now appearing in the U.S. after German health authorities identified it a few weeks ago.
https://www.msn.com/en-us/health/other/covid-19-new-xec-strain-just-getting-started-sparks-concern-amid-summer-wave-of-us-cases/ar-AA1qaNKV
"[This] paper shows that [when schools install air filters], cleaner air increases student test performance by 20% - the same impact as smaller class sizes or intense tutoring."
https://x.com/emollick/status/1834064552977203567
Similar to this 2004 paper indicating improved air filtration (or at least decreasing indoor pollution) improved office worker efficiency and performance. [The article is pay-walled, so abstract only.)
https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0668.2004.00278.x
Nature published an in-vitro (meaning cells in a dish - not in live people or animals) Australian study looking at the protection offered by various nasal sprays against viral infections. It is an imperfect study (for example, the Australian saline nasal spray manufacturer designed and paid for it). Their data demonstrates that saline and other (iodine or related) nasal sprays can act as antiviral barriers for human respiratory cells. However, they argue that ONLY the saline sprays (compared to others) do not inhibit the "normal functioning" of nasal mucosa cells.
Whether it turns out that saline, iodine, or other sprays are "best," there is a small, imperfect body of data across numerous studies that nasal sprays have a role in minimizing viral infections - with very little expense and very few side effects.
https://x.com/atranscendedman/status/1834681255494844716?s=42
and
https://www.nature.com/articles/s41598-024-72262-w
and
Look at the articles in this brief PubMed search on nasal sprays:
https://pubmed.ncbi.nlm.nih.gov/?term=nasal+spray+virus
Medical Trends and Technology
Eric Topol interviewed former NIH director Francis Collins, the latest scientist, to write a book on understanding scientific data and the notion of "truth." Collins' book comes out later this month, but the interview is worth listening to.
"[In the book, I offer a framework for addressing] a lot of the problems we have right now where somebody says, well, that might be true for you, but it's not true for me, that's fine if you're talking about an opinion, like whether that movie was good or not. But it's not fine if it's about a fact, like the fact that climate change is real and that human activity is the main contributor to the fact that we've warmed up dramatically since 1950. I'm sorry, that's just true. It doesn't care how you feel about it; it's just true. The zone of "established facts" is where I think we have to re-anchor ourselves again when something's in that place. I'm sorry, you can't just decide you don't like it, but in our current climate, and maybe postmodernism has crept in all kinds of ways we're not aware of, the idea that there is such a thing as objective truth even seems to be questioned in some people's minds. And that is the path towards a terrible future if we can't decide that we have, as Jonathan Rauch calls it, a constitution of knowledge that we can depend on."
https://open.substack.com/pub/erictopol/p/francis-collins-on-truth-science
I highly doubt there is a wrong time to compare and contrast the pathophysiology of bed bugs, scabies, and body lice. Reading this article will arm you with fascinating facts and knowledge deployable at Thanksgiving and holiday parties (especially powerful if your listeners are wearing bulky, itchy sweaters.)
https://jamanetwork.com/journals/jama/fullarticle/2823413?guestAccessKey=43146fe6-1eb8-43ec-9616-1756ee720ad2&utm_source=twitter&utm_medium=social_jamaderm&utm_term=14611458870&utm_campaign=content_max&linkId=583582515
Here is an interesting set of articles I explored this week - several studies examining the link between mouthwash use and other medical ailments, such as diabetes and hypertension. The proposed mechanism seems to be that killing oral bacteria (part of the body's microbiome) decreases certain chemicals those bacteria excrete, including nitric oxide. Nitric oxide (NO) is a vasodilator (dilates arteries and veins), and therefore, lower levels of NO may lead to high blood pressure. While I would not use this data to advise patients to avoid mouthwash use, it is a fascinating relationship that speaks to the many unknowns of the microbiome.
https://pubmed.ncbi.nlm.nih.gov/31709856/
https://pubmed.ncbi.nlm.nih.gov/?term=mouthwash+nitric+oxide
Infographics
September 13 was both a Friday and International Chocolate Day. I hope no one had bad luck with chocolate on Friday.
https://x.com/compoundchem/status/1834599992880681314/photo/1
and
Why Friday the 13th is considered an unlucky day.
https://www.npr.org/2024/09/13/nx-s1-5103766/beware-its-friday-the-13th-dont-say-we-didnt-warn-you
Things I learned this week
Bob Ross, my favorite painter and the godfather of ASMR, had a son, Steve, who also paints and, at times, has taught painting. Bob's son may be a better landscape artist than Bob.
https://people.com/parents/all-about-steve-ross-bob-ross-son/
and
https://steverossart.com/
Steve's agent and painting school partner, Bram, runs a Ross-ian style painting YouTube channel. Sadly, Bram does not deliver the soothing Bob Ross signature baritone whisper voice
https://steverossart.com/paint-with-bram
I learned about Shopping Cart theory, a meme-derived ethical measure "which posits that one's willingness to return a shopping cart [to the storefront or cart corral] is a test of self-governing behavior and moral character.
https://en.wikipedia.org/wiki/Shopping_cart_theory
and a more in-depth review of the cultural impact of the shopping cart:
https://daily.jstor.org/free-wheeling-shopping-carts-and-culture-and-culture/
Living with A.I.
I am back to reading Wharton professor Ethan Mollick's blog. In early August, he previewed Apple's AI-powered Siri, which was introduced in the iPhone 16 last week. He contrasts Apple's A.I. with the Open A.I.'s emotion-rich speaking. “Apple's [limited A.I.] approach is not just a technical one but a philosophical decision. It carries risks. It is unpredictable. It hallucinates. It has the potential for misuse. It is not always private. So, Apple decided to reduce the danger of misuse or error. They have turned Siri into a Copilot. These sorts of Copilots appear in many products - very narrow A.I. systems designed to help with specific tasks. In doing so, they hide Large Language Models' weirder, riskier, and more powerful aspects. Copilots can be helpful, but they are unlikely to lead to leaps in productivity or change how we work because they are constrained. Power trades off with security."
https://www.oneusefulthing.org/p/on-speaking-to-ai
I continue to find value in listening to the A.I. Daily Brief podcast. Friday's episode on ChatGPT o1 offered a quick and thoughtful description of how to test the latest features - including looking at problems through differential tokenization and offering more contemplative responses. Imagine if you had a quantum computer offering infinite tokenization from which to derive answers.
https://open.spotify.com/episode/5pdmqQpUz3vNGdSz1pmj7t?si=yOfoy5gCQDeKwMScnAhmxA
A.I. art of the week (A visual mashup of topics from the newsletter).
What I wanted:
Generate a picture of a Bob Ross-like painter painting a landscape filled with large nasal spray bottles, shopping carts, chocolate bars, and Jason from the Friday the 13th movies series.
Alas, OpenAI is very concerned about hockey masks and Bob Ross. Thanks to content restrictions, what I had to settle for:
Generate an image of a large-haired landscape painter painting a landscape filled with large nasal spray bottles, shopping carts, and chocolate bars.
https://drive.google.com/file/d/1kZnAXbKxVej-UUDh_PH6EX66lTpYO-1y/view?usp=sharing
Clean hands and sharp minds,
Adam
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