Week of October 7, 2024
Last week, in an "oh by the way" moment ending a busy office appointment, one of my patients earnestly asked how to stockpile medications, stating that he "believes we were entering the end of times." My automatic thought was to ask (somewhat snarkily) why he was worried about managing chronic illness (with Ozempic and blood pressure medication) during a Rapture-like or similar apocalyptic event. On reflection, I was being unfair. In a more unhurried (and empathetic) moment, I should have better appreciated my patient's struggle with faith, science, mortality, and health. There is very little time during a typical appointment to address all this. And, yet, this person has long-standing skepticism about healthcare - which I suspect reflects some of these tensions. And though I addressed his question (only after I said something about a geriatric Mad Max roaming an apocalyptic wasteland for mobility scooter batteries and insulin needles), I realize I could have done better. These end-of-visit comments can be illuminating. At his next visit, I will have to find a way to thoughtfully explore this topic and better "meet him where he is."
FYI - When stored correctly, many pills have a multi-year shelf life (though injectable medications do not). However, it is variable by medication.
and
The "doorknob phenomenon" is well described in healthcare settings - "By definition, the doorknob phenomenon or doorknob statement occurs when patients wait until the last moment in the clinical encounter—often while the physician is grasping the doorknob to exit the examination room—to utter something that, not uncommonly, provides crucial information."
https://www.aafp.org/pubs/afp/issues/2018/0701/p52.html
Related: I recently finished Francis Collins' book The Road to Wisdom - he is the former NIH director (and human genome project researcher) who has written extensively about reconciling faith and science. It is worth reading.
https://www.goodreads.com/author/show/20100.Francis_S_Collins
and relinking from a few weeks ago:
https://erictopol.substack.com/p/francis-collins-on-truth-science
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COVID infection rates are trending back up. The year-over-year comparison dashboard, located in the top center row of the PMC19 dashboard, illustrates how this fall is turning out to be the highest infection rate since the Delta variant (but with fewer deaths, I suspect).
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
Let's do a week without COVID articles.
I will sneak in one H5N1 Avian flu story, though:
https://www.wired.com/story/us-loading-up-on-bird-flu-vaccine/
Medical Trends and Technology
John Burns-Murdoch, the Financial Times data guy, published an article on the population-level effects of Ozempic and similar GLP-1 drugs.
"In America and beyond, the dividends will be enormous. After smoking rates began falling, rates of lung cancer promptly peaked and then dropped precipitously, saving millions of lives. If obesity curves do now descend, rates of cardiometabolic disease and death should follow. More promising still, a growing number of trials find the addiction-suppressing mechanism of the same drugs can also reduce rates of alcohol misuse and even avert opioid overdoses."
https://www.ft.com/content/21bd0b9c-a3c4-4c7c-bc6e-7bb6c3556a56
and
https://x.com/jburnmurdoch/status/1842163184838250764
When biomedical technology and (bad? typical?) customer service collide - "Paralyzed Man Unable to Walk After Maker of His Powered Exoskeleton Tells Him It's Now Obsolete." [FYI - Neoscope is an online futurism and biotech aggregator employing the kinds of typefaces and in-line ads that make even the most dystopian vision of our future look jolly.]
https://futurism.com/neoscope/paralyzed-man-exoskeleton-too-old
Biology is always more complicated than we think. In the last month, I've seen some papers discussing research that recently discovered bacteria have defense mechanisms that create "free-floating" genes - genes not part of their known genome. These free-floating genes only activate when a virus infects the bacteria. There are many interesting implications of these findings: 1) there appear to be environmentally triggered pathways of unique protein synthesis in bacterial cells, and 2) there are multiple mechanisms for editing DNA and RNA in real-time (think more CRISPR-like tools). While geeky, this stuff is fascinating and demonstrates the extraordinary complexity of life. I've tried to pick several articles that explain what is going on:
https://x.com/stephentang23/status/1821641931174355072
and
https://www.fiercebiotech.com/research/first-scientists-discover-free-floating-bacterial-gene-challenges-cardinal-rules-biology
and
https://www.science.org/doi/10.1126/science.adq3977
Eric Topol offered a fantastic review of the science and insights in proteomics (the association between disease states and cellular/extracellular protein production). This post is an excellent state-of-the-art overview.
https://erictopol.substack.com/p/what-can-11000-proteins-in-our-blood
Infographics
The etymology of candy names. I had always assumed Baby Ruth was for Babe Ruth, not Grover Cleveland's daughter.
https://x.com/Rainmaker1973/status/1842587342672146847
Upon further research, this all may have been a naming-rights ploy. Ruth Cleveland passed away 17 years before Curtiss Candy produced the first Baby Ruth candy bar in the 1920s, at the peak of Babe Ruth's baseball career. Ruth sued and lost, however.
https://en.wikipedia.org/wiki/Ruth_Cleveland
and
https://casetext.com/case/george-h-ruth-candy-co-v-curtiss-candy
(more) Things I learned this week
There is so much beauty in a headline such as, "Potatoes are better than human blood for making space bricks." The seemingly illogical potato to human blood spectrum of material science, the assumption that we all know that "space bricks" are a thing, and the implication that we have simply been waiting for the outcome of research to decide which space bricks we want are amusing. And though I am (apparently) late to this blood-or-potato debate (the article is from 2023), many of the assumptions in that headline are on point. I wonder how much (and whose) blood is required to make space bricks (congratulations! You're going to Mars. But we only want you there for your parts.)
https://www.space.com/space-bricks-potato-starch-mars-moon
Growing up, my parents [gently] pressured me to be a lawyer or physician. As an adult, I've learned occupational happiness and fulfillment come in many forms. However, I may have missed my opportunity to become a competitive pumpkin farmer (and dreaming of growing the elusive 3000 lb pumpkin).
https://apple.news/AL1c-mUFJQmy160xZEN-rrQ
and
https://kdvr.com/news/outdoor-colorado/colorados-tightest-competition-pumpkin-growing/
and
I learned about The Great Pumpkin Commonwealth (GPC), whose mission is to "cultivate the hobby of growing giant pumpkins and other giant fruits throughout the world by establishing standards and regulations that ensure the quality of fruit, fairness of competition, recognition of achievement, fellowship, and education for all participating growers and weigh-off sites." I can only imagine the debates at subcommittee meetings attempting to align the proper parameters for measuring giant gourds. I missed the February 2024 convention in Belgium.
https://gpc1.org/kasterlee/
But the history of giant pumpkins was amusing. I can't believe we Americans let Canadians grow the first >1000 lb pumpkin in 1996—a travesty.
https://gpc1.org/history-of-pumpkin-growing/
Living with A.I.
Compared to trained physicians, GPT-4 better identifies and prioritizes possible diagnoses when presented with clinical vignettes. In this not yet peer-reviewed study, "resident and attending physicians with training in family medicine, internal medicine, or emergency medicine were randomized to access GPT-4 plus conventional diagnostic resources, or only conventional resources. Participants spent 60 minutes reviewing up to six clinical vignettes adapted from established diagnostic reasoning exams. [...] The availability of GPT-4 to physicians as a diagnostic aid did not significantly improve clinical reasoning compared to conventional resources. However, the LLM may improve components of clinical reasoning, such as efficiency. [However,] GPT-4 alone demonstrated higher performance than both physician groups, suggesting opportunities for further improvement in physician-AI collaboration in clinical practice."
https://www.medrxiv.org/content/10.1101/2024.03.12.24303785v1
More A.I. in support of biology:
"DrugChat is a multi-modal large language model (LLM) designed to predict molecule mechanisms and properties. The LLM analyzes the structure of an input molecule along with user queries to generate comprehensive, free-form predictions on drug indications, pharmacodynamics, and mechanisms of action.
https://www.biorxiv.org/content/10.1101/2024.09.29.615524v1
and
https://x.com/biologyaidaily/status/1841471045611749514
How about A.I. helping design novel antibodies for treating various illnesses?
https://www.nature.com/articles/s41401-024-01380-y
and
https://x.com/biologyaidaily/status/1841450212029833689
More! Here is an account from the creator of BindCraft, an AI-driven tool for designing molecules that bind to proteins for structural and synthetic biologists.
https://x.com/MartinPacesa
A.I. art of the week (A visual mashup of topics from the newsletter).
A giant bacterium, like E. coli, uses its flagella to type on a computer while manipulating test tubes. Other bacteria in the background are farming enormous pumpkins and candy bars growing on trees. Different bacteria are mixing a cement-like substance and building a brick house.
https://drive.google.com/file/d/1vJ21-KbmhSBmCXlaAcXFAvOLT3rdrhoS/view?usp=sharing
I enjoyed that DALL-E gave the giant E. Coli scientist glasses. So stereotypical.
Clean hands and sharp minds,
Adam
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