Week of February 17, 2025
By the fourth clinic patient last week, the phrase "logical fallacy Friday" was floating through my head. Multiple patients had multiple questions about "trusting medications" and the epistemology of my advice ("But how can you be sure this will work for me?"). I suspect social media and cable news themes were entering my exam room (again), amplifying my patients' baseline tendency toward a loss aversion and present-bias fallacies - essentially over-indexing on potential side effects and low-probability outcomes and under-valuing the benefits of treatment. ("So, you are saying if the drug works, I won't know since my kidneys will be stable, but I could have some other symptom? I don't know..."). When medical evidence is not trusted, faith in one's healthcare provider is the most significant care driver. Of course, building meaningful relationships in 15-20-minute appointment times is quite challenging.
Related:
Loss Aversion: https://thedecisionlab.com/biases/loss-aversion
Present Bias: https://www.behavioraleconomics.com/resources/mini-encyclopedia-of-be/present-bias/
Adam's discussion of this topic with ChatGPT highlights several strategies:
https://chatgpt.com/share/67b20a30-b820-8013-8f34-3f0cc4791c35
The undermining of vaccines by stoking these tendencies:
https://theunbiasedscipod.substack.com/p/will-vaccines-become-unavailable
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I ran out of time to make a podcast this week. My apologies.
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Science and Technology Trends
Scientists have engineered nasal bacteria (strains of Lactobacillus) to deliver drugs to the brain of mice, showing potential for treating obesity through appetite-suppressing hormones. This method effectively delivers drugs into the mouse body. Using bacteria for medical applications beyond the gut highlights the potential of the nasal microbiome as a pathway to the brain, bypassing barriers that typically limit drug accessibility.
https://smry.ai/https://www.nature.com/articles/d41586-025-00375-x
Dr. Topol reviewed the latest information on nasal spray COVID vaccines. "There are now six different programs with ongoing clinical trials in the United States to move Covid nasal vaccines forward, giving us multiple shots [at finding] at least one that's effective and safe." After describing where each vaccine's development stands, he summarizes the tech, political, and epidemiologic issues scientists face.
https://erictopol.substack.com/p/a-covid-nasal-vaccine-update
I used Gemini 2.0 Flash Thinking to create a Google Sheets summary table of the various vaccines and pull in information from the web for further comparison:
https://docs.google.com/spreadsheets/d/1A7LhH1E-8y9yxFNvQT5TQaGMggwet6y1uA9oriu8RJs/edit
Anti- Anti-Science Articles of Note
Two loyal readers recently asked me if exposure to cold weather can "cause" illness. After reviewing a series of articles, I found the best summation from Dr. Noc (Morgan McSweeney, a PhD scientist who has used social media to explain science and data for the last few years). His YouTube video elucidates the issue's nuances - cold temperatures do not cause illness, but benchtop (in vitro) data implies that cells of the nasal lining that experience temperatures <32°C (37° is normal body temperature) seem to mount a less robust biochemical anti-virus defense. In other words, cold temperatures may increase the likelihood of a more robust viral replication and infection for those in the early stages of a viral respiratory infection (think exposed but maybe not symptomatic). So, the available data suggests cold temperatures can play a role in "colds." However, the problem appears to be multifactorial and time-dependent - you need to have a viral exposure AND then prolonged cold temperatures around the same time.
Dr. NOC: Can cold weather make you catch a cold?
https://youtu.be/n1P6O6HQSyg
About Dr. Noc:
https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/93360
I found myself chatting with a new loyal reader about the benefits of saunas. In 2022, I wrote about the cardiovascular benefits - which are well documented (especially in Finnish populations who have the highest per capita sauna density in the world - 1 sauna for every 2 Finns!). However, my newfound loyal reader was talking about the "detoxification benefits" - the ability of saunas to induce sweating and remove "metals from the bloodstream." This comment evoked several questions (and a lot of skepticism). What heavy metals are in sweat? What is the maximal concentration of these metals per unit volume of sweat (in a person with typical exposure)? Is sweating a way to get rid of heavy metals? Let's dig in.
First, here is my prior writing about saunas.
http://www.whatadamisreading.com/2024/07/what-adam-is-reading-week-of-8-15-22.html
and here is a consumer summary of the data: https://www.uclahealth.org/news/article/benefits-sauna-bathing-heart-health
Bottom line: sauna use lowers CV risk.
The loyal reader sent a review article about heavy metal (cadmium, lead, arsenic, and mercury) content in sweat.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3312275/
Using Gemini Flash 2.0, I compiled a spreadsheet of typical ranges of Arsenic, Cadmium, Lead, and Mercury exposure (in the U.S.), the thresholds considered poisoning, and typical stool, urine, and sweat excretion rates.
https://docs.google.com/spreadsheets/d/1wHHAE8n3mRqQjzdJooySyNSjBa8Wqemq-iE6_hAEY3o/edit
So, what do I conclude from this?
- Sweat can contain small amounts of cadmium, lead, arsenic, and mercury.
- However, the amounts are so small per unit volume of sweat that you would have to spend a very long time in a sauna to truly "detoxify" (and you would probably dehydrate well before you cleanse your blood of these metals).
- Exposure to enough cadmium, lead, arsenic, or mercury that you need to "detoxify" spawns a bunch of other questions (like, who is trying to poison me? or should I call OSHA?)
- Use caution when laundering the workout clothing of individuals who work around high concentrations of lead, cadmium, arsenic, and mercury. More metals in the body means more metals excreted in sweat.
- Either way, Saunas are still associated with decreasing the risk of cardiovascular events, irrespective of any other potential benefits.
Bottom line: vague health concepts like "detoxifying" sound great but often are inconsistent with actual physiology.
Living with A.I.
Wired published Megan Farokhmanesh's explorations of various A.I. virtual dating apps (literally dating an A.I. bot). The article offers a variety of evaluation criteria and trade-offs (like the app that liked to role-play with the user but would intermittently still speak like a pirate). The most valuable takeaway is not to use A.I. dating apps and websites on your work computer, even if you are writing about A.I. dating apps for work.
https://www.wired.com/story/dating-ai-chatbot-partners-chatgpt-replika-flipped-chat-crushon/
Related - scholarly work entitled "Human–Robot Intimacy: Acceptance of Robots as Intimate Companions."
https://pmc.ncbi.nlm.nih.gov/articles/PMC11430707/
The A.I. Daily Brief offered an interesting episode reviewing recent data on which jobs are utilizing (and stand to be disrupted by) artificial intelligence. While the data needs a lot of caveats (for instance, some of the data is from anthropic and reflects who is using their free and first tier of paid versions), it is helpful to see how the job market is beginning to reflect the integration of these tools.
Episode: https://open.spotify.com/episode/00cQBCruYe9s8zf8QQPNOz?si=XvPWgXMyTMSF1xr15V76_Q
TLDR version - a Claude summary of the show transcript:
https://claude.site/artifacts/a6f5a3d7-ab56-4582-aa1a-c5967ca8c967
Infographics
I have recently shared several "coffee is not bad for you" articles. However, caffeine can be inappropriate for some people with specific ailments. I found this infographic on the (surprisingly variable) caffeine content in different brands of coffee.
https://www.flickr.com/photos/rtkrum/4266263806/sizes/h/
from
https://coolinfographics.com/blog/2010/1/11/the-caffeine-poster-how-much-caffeine-are-you-drinking-new-i.html?rq=coffee
Things I learned this week
My favorite headline from the week: "Kayaker Briefly Swallowed by Humpback Whale Off Chilean Patagonia." The fact that the kayaker survived the terrifying experience (there is a video and an interview) is fantastic. I wondered if such circumstances engender an odd sense of rejection. ("What, do I not taste good? Am I not good enough for a meal?").
https://ground.news/article/video-shows-humpback-whale-briefly-swallowing-kayaker-in-chile
My wife taught me the collective noun murmuration - a large group of starlings flying in a synchronized pattern, often in the shape of clouds, waves, or spheres. The story of James Crombie's now famous bird-shaped murmuration picture is impressive and lucky.
https://www.cnn.com/2025/02/13/style/james-crombie-starling-murmurations-snap
Last week, I wrote about the third and fourth xenotransplant recipients. A loyal reader reminded me about the background of the surgeon who performed the third xenotransplant (at NYU Langone in November 2024). Transplant surgeon Dr. Robert Montgomery is a heart transplant recipient himself (in 2018), and his story is remarkable. (Oddly, when he worked at Johns Hopkins, he shared the same hairdresser with my wife. Small world.) Here is a 2018 NYU Langone Health Center news article about Dr. Montgomery's medical history. He is, obviously, back to transplanting organs, including experimental xenotransplants.
https://nyulangone.org/news/node/13803
A.I. art of the week (A visual mashup of topics from the newsletter, now using ChatGPT to summarize the newsletter, suggest prompts, and make the images).
"An image in the style of mid-20th century American gothic style. A doctor and a giant humpback whale sit together in a kayak, floating on a calm river that winds through rolling midwestern fields. The doctor, dressed in early 20th-century attire, gestures thoughtfully while the whale listens with an expressive, almost human-like curiosity. Above them, glowing microscopic bacteria swirl playfully in the air, adding a surreal and scientific touch. The landscape is painted with warm golden sunlight casting long shadows over the idyllic countryside."
https://drive.google.com/file/d/1xD4ceEGi7Nq7qp_7XPXjVf0Tz0VRPhyD/view
I was reading about Grant Wood this week.
https://x.com/culturaltutor/status/1890024959281659908?s=42
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COVID levels are high but falling (1 in 67 people (on average) had COVID last week - 3-4 people on a 737-800 - my reference group size I am frequently stuck near for hours at a time). RSV, Norovirus, and influenza A also have high wastewater concentrations across the U.S.
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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-DaVita Inc-
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