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kottke.org posts about medicine

Anxious about anxiety

I hope that by posting this article about anxiety here, I will feel less anxious about having to read it for tips on how to reduce my extremely high levels of current stress and anxiety.

It doesn’t solve the riddle, either, but that’s not Stossel’s fault. It’s because anxiety of the kind he is afflicted with is not a riddle. It’s an illness. There is therefore nothing, except in the medical sense, to solve. That’s not what Stossel wants to believe, though. He has an idea that more is at stake. He thinks that there is a metaphysics of anxiety. “To grapple with and understand anxiety,” he says, “is, in some sense, to grapple with and understand the human condition.”

Hmm, it’s not working.


World map of vaccine-preventable outbreaks

World map of vaccine-preventable outbreaks

From the Council on Foreign Relations, a world map showing outbreaks of diseases that can be prevented by vaccines. (via @jopearl)


What happens when you don’t get vaccinated

Amy Parker grew up with super health-conscious parents who provided her with a healthy diet and active lifestyle. But they also didn’t vaccinate her and she was sick all the time as a kid.

As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox. In my 20s I got precancerous HPV and spent six months of my life wondering how I was going to tell my two children under the age of 7 that Mummy might have cancer before it was safely removed.

This is the part that really gets to me: Parker wasn’t vaccinated but was given so many antibiotics for her childhood illnesses that she became immune to them! [Hair-tearing-out noise]

My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got so many illnesses requiring treatment with antibiotics that I developed a resistance to them, which led me to be hospitalized with penicillin-resistant quinsy at age 21 — you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.

Update: Slate has corrected the passage above, taking out the part about Parker’s resistance to antibiotics. It now reads:

My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got many illnesses requiring treatment with antibiotics. I developed penicillin-resistant quinsy at age 21 — you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.

People do not develop antibiotic resistance, microorganisms do. I regret the idiotic error and tearing out my hair. (thx @chrismize)


Scenes from a stroke

Diana Hardeman is 30, healthy, and has no history of past medical issues. A few days before Christmas, she had a stroke.

My right arm seemed no longer a part of my body. I couldn’t control it; it was limp at my side, like the worst dead arm you can imagine, but completely out of nowhere. My boyfriend was just coming to check on what time we are leaving and I exited the bathroom, slumped on the ground, and told him what was going on. Except I didn’t. I couldn’t. What I was saying in my head came out as gibberish. I could not get words out of my mouth. I felt stupid, even laughing at myself, saying, “It’s ok, it’s ok” to him, thinking it might just go away. But then the reminder that something was wrong set in again. In a whisper, I finally got out the words “call my dad.” He did. My parents happened to be right outside and my father, a physician, ran up the stairs to find us. When he saw me stuttering and holding my dead arm, he called for an ambulance. By now I was crying, perhaps in hysterics, as the numbness had seeped from my arm to my whole right side. I then calmed, stopped tying to speak, as it was frustrating and pointless, and looked into my boyfriend’s eyes saying to him with mine, I may not walk again. I may die, somewhat acquiescing to whatever it was that was happening to me. I caught myself, though, and thought, No, that can’t happen, I gotta fight it, and kicked off my boots to try to move legs and focused my mind on, well, not dying.

Hardeman also posted the original unedited version of her story written during recovery. Its less-than-flowing prose bears the mark of a semi-functioning arm and brain.

In case you don’t know me, Hi. Im Diana. I’m a 30 year old lady. Itallerthan your average girl, thinner tha your average girl, and and active than your average girl. Yeah I run an ice crea business for a living, but like to thing I’m healthier than your average girl too. No priorn medical history. Nothing.

 my first ever ride in an ambulance was uneventful - the hops;ital is a 5 minute drive from my folks’ house. By now I had somehow regained some ability to sspeak and answered the EMT’s incessant questionsining. still stuumbling over my words, even laughin at my mstakes.

Found this via the Kickstarter for Hardeman’s ice cream company.

Update: The NY Times just covered torn arteries, which was the cause of Hardeman’s stroke.


The search for a blockbuster insomnia drug

Merck is working on a new insomnia drug that they claim has few of the sometimes nasty side effects of other drugs like Ambien. Ian Parker reports for the New Yorker.

If the Merck scientists succeeded at the F.D.A., they would be the first to bring an orexin-related drug to market. “It’s an amazing achievement,” Richard Hargreaves, the fourth colleague at the Hilton, said. “Everyone should be really proud.” But, he added, “my worry is that a new mechanism is being evaluated on the science of an old mechanism.”

“With Ambien, you’ve got a drug that’s got basically only onset,” Renger said, dismissively. That is, it sends you to sleep but might not keep you asleep. “Suvorexant has the onset, but it has the great maintenance, especially in the last third of the night, where other drugs fail.” And even though suvorexant keeps working longer than Ambien, suvorexant patients don’t feel groggier afterward, as you might expect. Impassioned, Renger imagined himself addressing the F.D.A.: “Why aren’t you giving this a chance?”

“Drugs usually have some side effects,” Schoepp said. “It’s all benefit-risk.” He added, “There is some dose where suvorexant will be ultimately safe-because nothing will happen. If you go low enough, it becomes homeopathic.”

They stood to go to their rooms. Schoepp murmured, “I’d love to take it right now.”


The surge to end polio

From Wired’s Matthieu Aikins: The Surge.

In 1988 there were 350,000 cases of polio worldwide. Last year there were 223. But getting all the way to zero will mean spending billions of dollars, penetrating the most remote regions of the globe, and facing down Taliban militants to get to the last unprotected children on earth.

See also: Imagining a post-antibiotics future.


More former NFL stars have head troubles

Hall of Famer Tony Dorsett is among a growing group of former NFL players who have been diagnosed with diseases caused by years of head trauma and other injuries.

The former Cowboys running back, now 59, said that when he took his Oct. 21 flight from Dallas to Los Angeles for testing, he repeatedly struggled to remember why he was aboard the plane and where he was going. Such episodes, he said, are commonplace when he travels.

Dorsett said he also gets lost when he drives his two youngest daughters, ages 15 and 10, to their soccer and volleyball games.

“I’ve got to take them to places that I’ve been going to for many, many, many years, and then I don’t know how to get there,” he said.

The 1976 Heisman Trophy winner and eighth all-time leading NFL rusher said he has trouble controlling his emotions and is prone to outbursts at his wife and daughters.

“It’s painful, man, for my daughters to say they’re scared of me.” After a long pause, he tearfully reiterated, “It’s painful.”

And I missed this last year, but former Bears QB Jim McMahon is suffering from early-stage dementia.

In an interview with Fox affiliate WFLD-TV, aired Wednesday, the 53-year-old McMahon says he knows where he’s going when in an airport. But when he meets people, “I’m asking two minutes later, ‘Who was that?’

“When my friends call and leave me a message … I’ll read it and delete it before I respond and then I forget who called and left me a message.”

McMahon says he is not worried about his mind withering away. He says he still reads a lot and is doing other things to keep his mind active. However, he said he doesn’t know whether he is getting worse.

These stories are just going to keep coming. Perhaps a true tipping point will come when one of the league’s past megastars is dianosed with CTE…if Brett Favre or Dan Marino or John Elway or Troy Aikman or Ray Lewis or any of the other former players that appear regularly on NFL game broadcasts announces he has CTE or dementia, maybe then the league will take real action? Or not? (via df)

Update: Former NFL player Kevin Turner died at 46 in March and his doctors say he had “advanced CTE” from repeated head trauma.

“This is not ALS; this is CTE,” McKee said. “The severity of Mr. Turner’s CTE was extraordinary and unprecedented for an athlete who died in his 40s.”

Turner died in March at age 46. He had spoken of his certainty that his declining physical state leading to his death was due to his football career. Doctors said they believed he had such advanced CTE because he endured decades of head traumas while playing football.


CDC official: we’ve reached “the end of antibiotics”

In an interview accompanying a Frontline episode on drug-resistant bacteria, an associate director for the CDC, Dr. Arjun Srinivasan, says that “we’re in the post-antibiotic era”.

The more you use an antibiotic, the more you expose a bacteria to an antibiotic, the greater the likelihood that resistance to that antibiotic is going to develop. So the more antibiotics we put into people, we put into the environment, we put into livestock, the more opportunities we create for these bacteria to become resistant. …We also know that we’ve greatly overused antibiotics and in overusing these antibiotics, we have set ourselves up for the scenario that we find ourselves in now, where we’re running out of antibiotics.

We are quickly running out of therapies to treat some of these infections that previously had been eminently treatable. There are bacteria that we encounter, particularly in health-care settings, that are resistant to nearly all — or, in some cases, all — the antibiotics that we have available to us, and we are thus entering an era that people have talked about for a long time.

For a long time, there have been newspaper stories and covers of magazines that talked about “The end of antibiotics, question mark?” Well, now I would say you can change the title to “The end of antibiotics, period.”

We’re here. We’re in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t.

You know how when you first hear a joke it’s the funniest thing ever and then you hear it a second time and it’s less funny and then a third, fourth, and fifth times and it just keeps getting less and less funny until you’re not laughing at all and it actually becomes annoying? That’s how antibiotics work across the entire human population. And if Dr. Srinivasan is correct, we’re transitioning into the not laughing stage and the annoying stage where lots of people start dying can’t be far behind (unless we get some new jokes/treatments).

Yesterday, Mark Sample tweeted about disasters, low-points, and chronic trauma:

“Low point” is the term for when the worst part of a disaster has come to pass. Our disasters increasingly have no low point.

After the low point of a disaster is reached, things begin to get better. When there is no clear low point, society endures chronic trauma.

Disasters with no clear low point: global warming, mass extinction, colony collapse disorder, ocean acidification, Fukushima.

To which I would add: drug-resistant infectious diseases. (via digg)


League of Denial

League of Denial, the Frontline documentary on the NFL and concussions, is available online for anyone to watch for free.


NFL deliberately campaigned against science regarding head injuries

According to an upcoming book by ESPN reporters Mark Fainaru-Wada and Steve Fainaru, the NFL “conducted a two-decade campaign to deny a growing body of scientific research that showed a link between playing football and brain damage”.

Excerpts published Wednesday by ESPN The Magazine and Sports Illustrated from the book, “League of Denial: The NFL, Concussions and the Battle for Truth,” report that the NFL used its power and resources to discredit independent scientists and their work; that the league cited research data that minimized the dangers of concussions while emphasizing the league’s own flawed research; and that league executives employed an aggressive public relations strategy designed to keep the public unaware of what league executives really knew about the effects of playing the game.

Excerpts of the book are available from ESPN The Magazine and Sports Illustrated. An episode of Frontline based in part on the book airs next week. Interestingly, ESPN was collaborating with Frontline on this program, but they pulled out of it in August.


“Vaccines. And Now My Kids Don’t Die.”

What if there were a new class of wonder drugs for children that prevented some of the worst diseases in history with very limited side effects…would you take them? Some people don’t “trust” that wacky “science” though.

What’s so confounding is that many of the parents requesting exemptions for their children cite specious, disproven fears — such as that the vaccine could cause autism — many of which were based on a fraudulent, retracted study or fringe research published in non-peer-reviewed journals. And the rest of the country hasn’t been as successful as Massachusetts in containing measles infections. Earlier this year, an intentionally unvaccinated 17-year-old from Brooklyn, New York, was infected with measles while on a trip to the United Kingdom. Because he lived in a community with a large number of other deliberately unvaccinated children, the virus quickly spread. By the time the outbreak was contained, 58 people had been infected — making it the largest outbreak in the country in more than 15 years. Nationwide, the Centers for Disease Control and Prevention reported 159 total cases between January and August, which puts 2013 on track to record the most domestic measles infections since the disease was declared eliminated from the United States in 2000.

Declared eliminated! [Hair-tearing-out noise]


How to Beat Jet Lag

In the 1980s, Charles Ehret developed an antidote to jet lag called The Argonne Anti-Jet-Lag-Diet.

After experimenting on protozoa, rats, and his eight children, Ehret recommended that the international traveler, in the several days before his flight, alternate days of feasting with days of very light eating. Come the flight, the traveler would nibble sparsely until eating a big breakfast at about 7:30 a.m. in his new time zone — no matter that it was still 1:30 a.m. in the old time zone or that the airline wasn’t serving breakfast until 10:00 a.m. His reward would be little or no jet lag.

The diet was adopted by US government agencies and other groups as well as Ronald Reagan, but it difficult to stick to. Recently, researchers in Boston have devised a simpler anti-jet lag remedy:

The international traveler, they counsel, can avoid jet lag by simply not eating for twelve to sixteen hours before breakfast time in the new time zone-at which point, as in Ehret’s diet, he should break his fast. Since most of us go twelve to sixteen hours between dinner and breakfast anyway, the abstention is a small hardship.

According to the Harvard team, the fast works because our bodies have, in addition to our circadian clock, a second clock that might be thought of as a food clock or, perhaps better, a master clock. When food is scarce, this master clock suspends the circadian clock and commands the body to sleep much less than normally. Only after the body starts eating again does the master clock switch the circadian clock back on.

Totally trying this the next time I have to travel, although the Advil PM/melatonin combination my doctor suggested worked really well for me on my trip to New Zealand. (via @genmon)


Area man brews own beer in gut

A Texas man was getting drunk without drinking alcohol and his doctors think they figured out why: brewer’s yeast in his in gut was brewing beer and making the man intoxicated.

The patient had an infection with Saccharomyces cerevisiae, Cordell says. So when he ate or drank a bunch of starch — a bagel, pasta or even a soda — the yeast fermented the sugars into ethanol, and he would get drunk. Essentially, he was brewing beer in his own gut. Cordell and McCarthy reported the case of “auto-brewery syndrome” a few months ago in the International Journal of Clinical Medicine.

Some clever entrepreneur will undoubtedly turn this syndrome into a product…the market opportunity for a pill that allows you to get drunk on spaghetti *and* be the owner/operator of your own microbrewery is too large to ignore. (via ★interesting)


Fast ideas vs slow ideas

Using a pair of medical innovations as an example, Atul Gawande writes about why different kinds of innovations spread at different speeds and how you might be able to speed up the “slow ideas”.

This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt-these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.

The global problem of death in childbirth is a pressing example. Every year, three hundred thousand mothers and more than six million children die around the time of birth, largely in poorer countries. Most of these deaths are due to events that occur during or shortly after delivery. A mother may hemorrhage. She or her baby may suffer an infection. Many babies can’t take their first breath without assistance, and newborns, especially those born small, have trouble regulating their body temperature after birth. Simple, lifesaving solutions have been known for decades. They just haven’t spread.

If you’re interested, Gawande wrote extensively on anesthesia and antiseptics in The New England Journal of Medicine.


Are Viral Cat Videos Actually Viral?

Or rather, protozoan? Toxoplasma gondii is a protozoan parasite which is transmitted from rodents to cats through a crafty mechanism…it makes mice attracted to the smell of cat urine. Mouse goes near cat, cat eats mouse, T. gondii has a new host. From cats, the parasite can jump into humans, where it may be responsible for all sorts of nastiness:

Well, the behavioral influence plays out in a number of strange ways. Toxoplasma infection in humans has been associated with everything from slowed reaction times to a fondness toward cat urine — to more extreme behaviors such as depression and even schizophrenia. And here’s the kicker: Two different research groups have independently shown that Toxo-infected individuals are three to four times as likely of being killed in car accidents due to reckless driving.

And maybe makes us want to invent networking technology and share cool links? In this five-minute talk, Kevin Slavin cleverly connects viral media with T. gondii:

That video was so good, I watched the whole thing twice.


Mozart had weird ears

Here’s a watercolor drawing by Wolfgang Amadeus Mozart of his ear compared to an ordinary ear1:

Mozart's Ear

“Mozart Ear” has become a medical catch-all term for deformed ears (for instance). Deformed or not2, the ear clearly didn’t have any negative effect on his musical ear. (via @DavidGrann)

[1] The note accompanying the drawing at Harvard’s Houghton Library reads:

Mozart, Wolfgang Amadeus, 1756-1791. Mein Ohr [und] ein gewöhnliches Ohr [My ear and an ordinary ear] : drawing, [n.p., n.d.] Water-color drawing; [n.p, n.d] 1 drawing : watercolor on paper

The “mein” is crossed out and “Mozart” is written in its place in another hand. With this is Fr. Jelinck’s A.D.s., Salzburg, 1879 Sept. 19, certifying that this is by Mozart.

[2] It’s stated elsewhere that the ear is actually that of Mozart’s son, which would be slightly more plausible than Mozart drawing his own ear.


There’s a HIV morning-after pill?

Yes, and there’s also $20 over-the-counter test for HIV that gives results in 20 minutes.

Two recent developments could make these conversations less awkward, or even render them moot. But they also raise troubling questions about promiscuity and responsibility that are reminiscent of debates from the 1980s.

The first development was the approval, last summer, by the Food and Drug Administration of an over-the-counter rapid-response at-home H.I.V. test kit. The test, called OraQuick and available nationwide since October, gives results 20 minutes after a cheek swab. The second is the increasing availability of PEP and of pre-exposure prophylaxis, or PrEP.

PEP - the medication I am taking - has been called the H.I.V. morning-after pill, and PrEP, to follow the analogy, is akin to birth control. A study in the British medical journal The Lancet this month found that drug-injecting addicts who took PrEP were half as likely to become infected with H.I.V. as those who did not; other studies have shown that the drug reduces transmission of the virus from mother to child, and transmission among both gay men and heterosexuals.


Near death, near life experience

For his first piece written as a staff writer for GQ in 1995, the magazine’s editor urged Andrew Corsello to write about the time he almost died of a mysterious liver failure.

Wednesday, August 31, the next day. Sicker, bewildered. In my office chair quaking with exertion, like a car with its accelerator and brake simultaneously floored. My breathing’s all wrong-the sharp, uneven gasps of an overworked dog. When I lumber off to the can, the urine is purple and oily looking. At three minutes after one, Doc Mike calls with the blood results. “Stop whatever you’re doing,” he orders. “Get in here now.”

Corsello won the 2007 National Magazine Award for his story, The Other Side of Hate.


Bionic men and women walk among us

For The Verge, Russell Brandom writes about the increasing use of neural implants to control the symptoms of a variety of diseases, from depression to Parkinson’s to dystonia.

The results are as reliable as flipping a light switch, but even after decades of testing, no one knows exactly why it works. Dr. Kaplitt, the surgeon who installed Rebecca Serdans’ implant, explains it by likening the brain to a collection of electrical circuits. A disorder like dystonia is a failure of those circuits. When you install a brain stimulation device, “it’s presumably blocking abnormal information from getting from one part of the brain to another, or normalizing that information.” But Kaplitt is the first to acknowledge that this is just a theory. “The mechanism by which brain stimulation works is still somewhat unclear and controversial.”

But the lingering questions haven’t slowed down research. There are already patents that would use brain stimulation implants to enhance memory or prevent stuttering, to cure anorexia or bring a person to orgasm. Experimental studies use the device to treat Alzheimer’s disease and drug addiction. Those circuits aren’t as well understood as the circuits governing movement disorders, but the principle is no different. Once you’ve got a line into the circuitry of the brain, Parkinson’s is just the beginning.

Last week I featured a video of a man with Parkinson’s who has a brain pacemaker that allows him to function normally.


No Parkinson’s with the flip of a switch

Andrew Johnson has been diagnosed with Early Onset Parkinson’s Disease and recently underwent deep brain stimulation (DBS) surgery to implant a brain pacemaker that supplies his brain with regular and reliable electrical pulses. In this incredible video, Johnson turns the pacemaker off and you can see the effect that DBS has had on his life.

Understatement of the year at the end of the video. Wow. Johnson writes about his experience with Parkinson’s on his site, Young and Shaky. (thx, eamon)


Medical school in blog form

Why go to medical school when you can just read this Medical School tumblr blog? Includes posts on open heart surgery, sickle cell anemia, and a simple suturing demonstration:


America is bad for your health

“Give me your tired, your poor, your huddled masses yearning to breathe free.” And I’ll give them heart disease, high blood pressure, diabetes, and a shorter lifespan. A growing body of research suggests that there is often a high health toll when it comes to coming to America.

A growing body of mortality research on immigrants has shown that the longer they live in this country, the worse their rates of heart disease, high blood pressure and diabetes. And while their American-born children may have more money, they tend to live shorter lives than the parents.

The pattern goes against any notion that moving to America improves every aspect of life. It also demonstrates that at least in terms of health, worries about assimilation for the country’s 11 million illegal immigrants are mistaken. In fact, it is happening all too quickly.


Angelina Jolie had a preventive double mastectomy

In this morning’s NY Times, Angelina Jolie writes about her decision to have a preventive double mastectomy to hopefully ward off cancer.

My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.

We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.

It happens that just last night I read about the BRCA-1 gene in Siddhartha Mukhergee’s excellent biography of cancer, The Emperor of All Maladies. This part is right near the end of the book:

Like cancer prevention, cancer screening will also be reinvigorated by the molecular understanding of cancer. Indeed, it has already been. The discovery of the BRCA genes for breast cancer epitomizes the integration of cancer screening and cancer genetics. In the mid-1990s, building on the prior decade’s advances, researchers isolated two related genes, BRCA-1 and BRCA-2, that vastly increase the risk of developing breast cancer. A woman with an inherited mutation in BRCA-1 has a 50 to 80 percent chance of developing breast cancer in her lifetime (the gene also increases the risk for ovarian cancer), about three to five times the normal risk. Today, testing for this gene mutation has been integrated into prevention efforts. Women found positive for a mutation in the two genes are screened more intensively using more sensitive imaging techniques such as breast MRI. Women with BRCA mutations might choose to take the drug tamoxifen to prevent breast cancer, a strategy shown effective in clinical trials. Or, perhaps most radically, women with BRCA mutations might choose a prophylactic mastectomy of both breasts and ovaries before cancer develops, another strategy that dramatically decreases the chances of developing breast cancer.

Radical is an understatement…what a tough and brave decision to make. Again from the book, I liked this woman’s take on it:

An Israeli woman with a BRCA-1 mutation who chose this strategy after developing cancer in one breast told me that at least part of her choice was symbolic. “I am rejecting cancer from my body,” she said. “My breasts had become no more to me than a site for my cancer. They were of no more use to me. They harmed my body, my survival. I went to the surgeon and asked him to remove them.”

The genetic testing company 23andme screens for three common types of mutation in the BRCA1 or BRCA2 genes:

Five to 10 percent of breast cancers occur in women with a genetic predisposition for the disease, usually due to mutations in either the BRCA1 or BRCA2 genes. These mutations greatly increase not only the risk for breast cancer in women, but also the risk for ovarian cancer in women as well as prostate and breast cancer among men. Hundreds of cancer-associated BRCA1 and BRCA2 mutations have been documented, but three specific BRCA mutations are worthy of note because they are responsible for a substantial fraction of hereditary breast cancers and ovarian cancers among women with Ashkenazi Jewish ancestry. The three mutations have also been found in individuals not known to have Ashkenazi Jewish ancestry, but such cases are rare.

23andme testing kits are only $99.

Update: Two things. First, and I hope this isn’t actually necessary because you are all intelligent people who can read things and make up your own minds, but let me just state for the official record that you should never never never never NEVER take medical advice, inferred or otherwise, from celebrities or bloggers. Come on, seriously. If you’re concerned, go see a doctor.

Two: I have no idea what the $99 23andme test covers with regard to BRCA1 and BRCA2 gene mutations beyond what the company states. The most comprehensive test for BRCA1 and BRCA2 mutations was developed by a company called Myriad Genetics and costs about $3000. Myriad has patented the genes, a decision that has been sharply criticized and is currently being decided by the Supreme Court.

But many doctors, patients and scientists aren’t happy with the situation.

Some are offended by the very notion that a private company can own a patent based on a gene that was invented not by researchers in a lab but by Mother Nature. Every single cell in every single person has copies of the BRCA1 and BRCA2 genes.

Myriad officials say they deserves the patent because they invested a great deal of money to figure out the sequence and develop “synthetic molecules” based on that sequence that can be used to test the variants in a patient.

“We think it is right for a company to be able to own its discoveries, earn back its investment, and make a reasonable profit,” the company wrote on its blog.

I do know the 23andme test covers something related to the BRCA1 and BRCA2 mutations…a friend of a friend did the 23andme test, tested positive for the BRCA1 mutation, and decided to have a preventive double mastectomy after consulting her doctor and further tests. (thx, mark, allison, and ★spavis)


Anti-vaccine mom changes mind

An article from a mother who was anti-vaccine until her daughter (and then the rest of the family) got the whooping cough. And still she feels “funny” about vaccination.

And yet I still wondered about that list of things that I would now, I suppose, have to surrender to and immunise my child against. Polio, for one — a couple of my parents’ pensioner friends still carry the limp left by their childhood polio, but none of my friends do, because it isn’t around any more. And diphtheria — what was that, even? I knew it had killed one of Queen Victoria’s daughters, but that wasn’t our reality.

The reason it wasn’t our reality was, of course, due to a continuous programme of immunisation. Duh. Diphtheria is a disease that still kills one in five infants it meets, even if they get treatment, their necks swelling up until they can no longer breathe. I have now seen a picture of a child whose neck was ravaged by diphtheria, bloated like a foie gras goose about to burst. I wish I could unsee it.

Duh, indeed. This anti-vaccination nonsense is an instance in which the public’s lack of knowledge about how science works (and not just their lack of recall of scientific facts) is truly harmful. (via @CharlesCMann)


Stretching before exercise considered harmful

Or at least unbeneficial. A comprehensive study out of Croatia complements other evidence that stretching your muscles before exercise results in less strength, power, and performance than if you hadn’t stretched.

The numbers, especially for competitive athletes, are sobering. According to their calculations, static stretching reduces strength in the stretched muscles by almost 5.5 percent, with the impact increasing in people who hold individual stretches for 90 seconds or more. While the effect is reduced somewhat when people’s stretches last less than 45 seconds, stretched muscles are, in general, substantially less strong.

They also are less powerful, with power being a measure of the muscle’s ability to produce force during contractions, according to Goran Markovic, a professor of kinesiology at the University of Zagreb and the study’s senior author. In Dr. Markovic and his colleagues’ re-analysis of past data, they determined that muscle power generally falls by about 2 percent after stretching.

And as a result, they found, explosive muscular performance also drops off significantly, by as much as 2.8 percent. That means that someone trying to burst from the starting blocks, blast out a ballistic first tennis serve, clean and jerk a laden barbell, block a basketball shot, or even tick off a fleet opening mile in a marathon will be ill served by stretching first. Their performance after warming up with stretching is likely to be worse than if they hadn’t warmed up at all.


The quick rise of cigarette smoking

I’m currently reading The Emperor of All Maladies: A Biography of Cancer (which is excellent) and I’m up to the chapters on prevention, specifically the prevention of lung cancer through reduction of cigarette smoking. I had no idea cigarette smoking was so uncommon in the US as recently as 1870…but we caught up quickly.

In 1870, the per capita consumption in America was less than one cigarette per year. A mere thirty years later, Americans were consuming 3.5 billion cigarettes and 6 billion cigars every year. By 1953, the average annual consumption of cigarettes had reached thirty-five hundred per person. On average, an adult American smoked ten cigarettes every day, an average Englishman twelve, and a Scotsman nearly twenty.

For some context on that 3500/yr per person number (and the unbelievable 7000/yr Scottish rate), the current rate in the US is around 1000/yr and the highest current rate in the world is in Serbia at almost 2900/yr per person.


Search data finds unknown drug side effects

Whenever I start to feel sick, I hit the Internet and start searching for more information about my symptoms. When a doctor writes me a prescription and I start feeling something unexpected, I search the web for side effects. And I’m not the only one whose first instinct is to turn my head and search. So many of us have adopted this behavior that researchers are gathering valuable information by studying our search queries and “have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.”


Possible cure for pediatric HIV

A baby in Mississippi may have been cured of HIV by an early treatment of standard HIV drugs.

After starting on treatment, the baby’s immune system responded and tests showed diminishing levels of the virus until it was undetectable 29 days after birth. Ten months later, when the baby returned to the hospital (her mother stopped bringing her, without explanation) the researchers tested her again for HIV and found no sign of the virus. It appeared she had been functionally cured.


What can hospitals learn from The Cheesecake Factory?

From back in August, Atul Gawande visits a Cheesecake Factory and wonders if the combination of “quality control, cost control, and innovation” achieved by chain restaurants can offer lessons to hospitals and other health care organizations.

The company’s target last year was at least 97.5-per-cent efficiency: the managers aimed at throwing away no more than 2.5 per cent of the groceries they bought, without running out. This seemed to me an absurd target. Achieving it would require knowing in advance almost exactly how many customers would be coming in and what they were going to want, then insuring that the cooks didn’t spill or toss or waste anything. Yet this is precisely what the organization has learned to do. The chain-restaurant industry has produced a field of computer analytics known as “guest forecasting.”

“We have forecasting models based on historical data-the trend of the past six weeks and also the trend of the previous year,” Gordon told me. “The predictability of the business has become astounding.” The company has even learned how to make adjustments for the weather or for scheduled events like playoff games that keep people at home.

A computer program known as Net Chef showed Luz that for this one restaurant food costs accounted for 28.73 per cent of expenses the previous week. It also showed exactly how many chicken breasts were ordered that week ($1,614 worth), the volume sold, the volume on hand, and how much of last week’s order had been wasted (three dollars’ worth). Chain production requires control, and they’d figured out how to achieve it on a mass scale.

As a doctor, I found such control alien-possibly from a hostile planet. We don’t have patient forecasting in my office, push-button waste monitoring, or such stringent, hour-by-hour oversight of the work we do, and we don’t want to. I asked Luz if he had ever thought about the contrast when he went to see a doctor. We were standing amid the bustle of the kitchen, and the look on his face shifted before he answered.

“I have,” he said. His mother was seventy-eight. She had early Alzheimer’s disease, and required a caretaker at home. Getting her adequate medical care was, he said, a constant battle.

This piece was on several best-of-the-year longreads lists and deservedly so. But the Factory’s 3000-calorie plate of pasta will probably not help the state of American health care.


Junior Seau’s family sues NFL over concussions

The deceased former NFL player’s family joins more than 6000 people who have sued the NFL over head injuries in the past few years.

“We were saddened to learn that Junior, a loving father and teammate, suffered from CTE,” the family said in a statement released to the AP. “While Junior always expected to have aches and pains from his playing days, none of us ever fathomed that he would suffer a debilitating brain disease that would cause him to leave us too soon.

“We know this lawsuit will not bring back Junior. But it will send a message that the NFL needs to care for its former players, acknowledge its decades of deception on the issue of head injuries and player safety, and make the game safer for future generations.”

Plaintiffs are listed as Gina Seau, Junior’s ex-wife; Junior’s children Tyler, Sydney, Jake and Hunter, and Bette Hoffman, trustee of Seau’s estate.

The lawsuit accuses the league of glorifying the violence in pro football, and creating the impression that delivering big hits “is a badge of courage which does not seriously threaten one’s health.”

It singles out NFL Films and some of its videos for promoting the brutality of the game.

Seau is a pretty boldfaced name…I wonder what effect this will have on public perception, etc.