kottke.org posts about medicine
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 โ
spavis)
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 โ 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 โ 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)
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.
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.
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.”
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.
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.
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.
CTE (chronic traumatic encephalopathy), the degenerative brain disease that could dramatically change the way pro football is played in the future (if it’s played at all), can’t be identified in victims until after death. That makes it difficult to prove (or disprove) the connection between pro football, concussions, and death from CTE. But researchers have discovered a possible technique that could diagnose CTE in living patients.
Last year five retired N.F.L. players who were 45 years and older and suffered from mood swings, depression and cognitive problems were given PET, or positron emission tomography, scans. The authors of the study said those scans revealed tau protein deposits in their brains, a signature of C.T.E. While not definitive, the distribution of tau in the retired players was consistent with those found in the autopsies of players who had C.T.E.
If it’s actually possible, this could be huge. Many more players, current and former, can be tested and diagnosed and if CTE was found regularly and consistently, you’d think that insurance companies would flee from the NFL like rats leaving a sinking ship and football would have to adapt (to be more like soccer? flag football?) or die.
Tom Junod’s just-posted piece in Esquire is a good companion to the interview with former NFL star Jason Taylor. In it, Junod talks to several current NFL players about injuries and pain.
“The worst injury I’ve ever had on the field โ for my wife and kids, at least, and my mom and dad โ was an injury I got against the 49ers,” says Matt Hasselbeck. “Patrick Willis hit me as I was diving for the goal line. He hit me, and twenty minutes later I’m in an ambulance on my way to Stanford Medical. I’d broken a rib on the left and I’d broken a rib on the right. The rib on the right was right next to my aorta, and it was really dangerous for my health. I couldn’t breathe. It was like there was a weight on top of me. It’s a scary thing, because it feels like you’re drowning. I couldn’t breathe at all, and I got up off the field because it was a two-minute situation - I didn’t want the team to have to take a time-out. I tried to run off the field, and when the trainers met me they saw I was, like, purple in the face. And they immediately put me on the ground. Sometimes they’ll put you on the ground to evaluate you and sometimes to give the backup quarterback a chance to get loose. They put me on the ground because I was purple.”
That instinct - the instinct to run when you can’t breathe in order to save your team a time-out - is not one often encountered in civilian life. Indeed, it is one encountered almost exclusively in war, in which people’s lives, rather than simply their livelihoods, are at stake. Now, the NFL is replete with military symbolism, not to mention military pretensions. But the reality of injury is what makes it more than fantasy football, more than professional wrestling, more than an action movie, more than a video game played with moving parts who happen to be human. The reality of injury - and the phantasmagoric world of pain - is what makes it, legitimately, a blood sport. And it is what makes Dr. Yates, the Steelers’ team doctor, define his job simply and bluntly: “My job is to protect players from themselves.”
Junod adds, via Twitter:
Concussion: the global warming of the NFL. We feel bad about it. But what we really worry about is someone taking our football away.
Former NFL star Jason Taylor was so injured (and yet still playing every week) that for a period of two years, the 6’6” 240-pound linebacker couldn’t lift his kids into bed. So how did he play? Shots to kill the pain and then more shots to kill the pain of the first shots. And so on. Until he almost had to have his leg amputated.
The trainer rushed to Taylor’s house. Taylor thought he was overreacting. The trainer told him they were immediately going to the hospital. A test kit came out. Taylor’s blood pressure was so high that the doctors thought the test kit was faulty. Another test. Same crazy numbers. Doctors demanded immediate surgery. Taylor said absolutely not, that he wanted to call his wife and his agent and the famed Dr. James Andrews for a second opinion. Andrews also recommended surgery, and fast. Taylor said, fine, he’d fly out in owner Daniel Snyder’s private jet in the morning. Andrews said that was fine but that he’d have to cut off Taylor’s leg upon arrival. Taylor thought he was joking. Andrews wasn’t. Compartment syndrome. Muscle bleeds into the cavity, causing nerve damage. Two more hours, and Taylor would have had one fewer leg. Fans later sent him supportive notes about their own compartment syndrome, many of them in wheelchairs.
Taylor’s reaction?
“I was mad because I had to sit out three weeks,” he says. “I was hot.”
He had seven to nine inches of nerve damage.
“The things we do,” he explains. “Players play. It is who we are. We always think we can overcome.”
At the New Yorker, Reeves Wiedeman reminds us that the NFL is unlikely to change because so much of what happens with injuries is hidden from view.
As we watch a game that we know is dangerous, we soothe ourselves with the idea that these men must be aware of the risks, too; that they are being well compensated to take on those risks; and that, at least when they’re on the field, in front of the cameras, they are living the dream that we all craved as kids, and they’re having fun.
But what we can take from this story, and from the fact that, on the surface, this weekend’s games were filled with such excitement, is the fact that so much of football’s barbarism takes place beyond our vision and behind closed doors.
(thx, meg)
Flu season is here and it’s horrible. Jennifer Cain at Kicker has written a No-Nonsense, Non-Alarmist, Essential Guide to the Flu. The sections on how to tell the flu from other illnesses and what to do to avoid the flu are especially helpful.
There are four big telltale signs that can help you distinguish among a cold, a flu, norovirus and whooping cough:
#1. Fever equals flu. You might get a slight temperature from a cold, but if you’re really heating up, it’s probably the flu.
#2. Colds are mild and long lasting. Colds usually start with a sore throat, then progress to symptoms like a runny nose and congestion, followed by a cough that won’t go away. And they don’t usually cause fevers. Sometimes it can take up to 3 weeks to get rid of a cold entirely. The flu, though, tends to come on quickly all at once and be more intense, but it doesn’t linger. If you’re running a fever and your body aches and you can’t get out of bed and don’t feel like eating anything, it’s flu time.
Recent analysis by specialists shows that Junior Seau, the former stand-out NFL linebacker who committed suicide last year, suffered from chronic traumatic encephalopathy (CTE) at the time of his death. CTE is associated with repeated trauma to the head and has been found in many ex-NFL players, including a few that have committed suicide.
“I think it’s important for everyone to know that Junior did indeed suffer from CTE,” Gina Seau said. “It’s important that we take steps to help these players. We certainly don’t want to see anything like this happen again to any of our athletes.”
She said the family was told that Seau’s disease resulted from “a lot of head-to-head collisions over the course of 20 years of playing in the NFL. And that it gradually, you know, developed the deterioration of his brain and his ability to think logically.”
Experts caution that correlation is not causation, but as these incidents mount, the NFL is going to come under increasing pressure to act, causation or no.
Studies have long shown evidence of placebos doing something to help ill patients. Harvard Medical School’s Ted Kaptchuk is studying this effect to determine how and why it works.
Two weeks into Ted Kaptchuk’s first randomized clinical drug trial, nearly a third of his 270 subjects complained of awful side effects. All the patients had joined the study hoping to alleviate severe arm pain: carpal tunnel, tendinitis, chronic pain in the elbow, shoulder, wrist. In one part of the study, half the subjects received pain-reducing pills; the others were offered acupuncture treatments. And in both cases, people began to call in, saying they couldn’t get out of bed. The pills were making them sluggish, the needles caused swelling and redness; some patients’ pain ballooned to nightmarish levels. “The side effects were simply amazing,” Kaptchuk explains; curiously, they were exactly what patients had been warned their treatment might produce. But even more astounding, most of the other patients reported real relief, and those who received acupuncture felt even better than those on the anti-pain pill. These were exceptional findings: no one had ever proven that acupuncture worked better than painkillers. But Kaptchuk’s study didn’t prove it, either. The pills his team had given patients were actually made of cornstarch; the “acupuncture” needles were retractable shams that never pierced the skin. The study wasn’t aimed at comparing two treatments. It was designed to compare two fakes.
According to Google’s search tracking, this is the worst flu season in more than 6 years.
Google’s trends tend to follow the official CDC data closely and indeed the CDC concurs about the scope of the flu this year but their data is lagging behind Google’s by what looks like about 2 weeks. See also my post on how flu vaccines are made. (via @kellan)
In an op-ed piece for the NY Times, Dr. David Newman bears witness to the effects of gun violence he sees at his hospital.
I have sworn an oath to heal and to protect humans. Guns, invented to maim and destroy, are my natural enemy.
(via @ftrain)
We’ve spent the two dozen years putting computers in everything from our bodies to our cars. Now those devices increasingly have wireless connections to the outside world. Throw in a little lax security and the whole world becomes hackable.
Hospital equipment like external defibrillators and fetal monitors can at least be picked up, taken apart, or carted away. Implanted devices โ equipment surgically implanted into the body โ are vastly more difficult to remove but not all that much harder to attack.
You don’t even have to know anything about medical devices’ software to attack them remotely, Fu says. You simply have to call them repeatedly, waking them up so many times that they exhaust their batteries-a medical version of the online “denial of service” attack, in which botnets overwhelm Web sites with millions of phony messages. On a more complex level, pacemaker-subverter Barnaby Jack has been developing Electric Feel, software that scans for medical devices in crowds, compromising all within range. Although Jack emphasizes that Electric Feel “was created for research purposes, in the wrong hands it could have deadly consequences.” (A General Accounting Office report noted in August that Uncle Sam had never systematically analyzed medical devices for their hackability, and recommended that the F.D.A. take action.)
Denis Duthie was recently struck blind by vodka reacting poorly to his diabetes medication. Doctors in his native New Zealand thought he might have formaldehyde poisoning, which you can get from drinking methanol. The cure? More cowbell, er, ethanol. Since the hospital didn’t have enough medical ethanol for treatment, a nurse went to the liquor store for Johnnie Walker Black, which was then dripped directly into Duthie’s stomach.
It worked because the ethanol competed with the methanol and prevented it from being metabolised into harmful formaldehyde, which can cause blindness.
“There are two potential ways of doing it: one is to give intravenous ethanol through a drip, but that is not available in all hospitals. There is also nothing wrong with supplying that alcohol via the gastro-intestinal tract, which is what they’ve chosen to do in this circumstance, and that’s a well established treatment. If the patient’s awake they can just drink it.”
Science! No word on if Duthie had been eyeballing, butt-chugging, or using vodka tampons before going blind. (via @jamie_bear)
Ashlyn Blocker does not feel pain, a condition called ‘Congenital insensitivity to pain.’ Although she can feel pressure, and warm or cool, she can’t feel extreme heat or cold. In this profile in the NY Times Magazine, though, she seems like a relatively well-adjusted 13 year-old girl, which is a credit to her and her parents. Pretty fascinating story.
Tara and John weren’t completely comfortable leaving Ashlyn alone in the kitchen, but it was something they felt they had to do, a concession to her growing independence. They made a point of telling stories about how responsible she is, but every one came with a companion anecdote that was painful to hear. There was the time she burned the flesh off the palms of her hands when she was 2. John was using a pressure-washer in the driveway and left its motor running; in the moments that they took their eyes off her, Ashlyn walked over and put her hands on the muffler. When she lifted them up the skin was seared away. There was the one about the fire ants that swarmed her in the backyard, biting her over a hundred times while she looked at them and yelled: “Bugs! Bugs!” There was the time she broke her ankle and ran around on it for two days before her parents realized something was wrong. They told these stories as casually as they talked about Tristen’s softball games or their son Dereck’s golf skills, but it was clear they were still struggling after all these years with how to keep Ashlyn safe.
[…]
“It is an extraordinary disorder,” Woods said. “Boys die at a younger age because of more risky behavior. It’s quite interesting, because it makes you realize pain is there for a number of reasons, and one of them is to use your body correctly without damaging it and modulating what you do.”
Matter, a new publication that raised funds on Kickstarter, has launched and their first story is fantastic. Do No Harm by Anil Ananthaswamy profiles those suffering from Body Integrity Identity Disorder…people who believe that one or more of their limbs don’t belong to them and want them amputated.
Sitting at home in a small, somewhat rural American town not too far from the ocean, Patrick recalled the day his wife found out about his obsession. It was during the mid-’90s. As with almost all BIID sufferers, Patrick was fascinated with amputees, so he began downloading pictures of them off the Internet and printing them out. One day his wife was sitting in front of their computer, while Patrick sat in a wingback chair. She noticed a pile of printouts. They were images of men, but “completely clothed, no nudes or anything like that.” It was an awkward moment. “She was thinking that maybe I was gay,” Patrick recalls. “I must have been crimson.” Patrick asked her to take a closer look. She did, and soon realised that the men were all amputees.
Patrick told his wife that he had felt odd about his leg since he was four years old, a feeling that eventually grew into an all-consuming desire to be rid of it. It was a shock: they had been married for decades, and the revelation that he had been hiding something was hard to take. But his confession also brought relief. For more than four decades he had suffered alone. Growing up in small-town America, with conservative parents, in an era when “people didn’t believe in going and seeing mental health professionals,” Patrick was mystified by what he felt.
The last third of the piece, in which Ananthaswamy accompanies a BIID sufferer to have an amputation in Asia, was really difficult to read…powerful stuff. The piece is 99 cents for web/ePub/Kindle versions.
Ever since St. Vincent’s closed in 2010 (I walk past it every morning taking my son to school and they are ripping the shit out of the building to turn it into condos), lower Manhattan has been short more than a few hospital beds. In the aftermath of hurricane Sandy, Manhattan has been left with zero high-level trauma centers south of 68th Street.
Now, the nearest Level One trauma centers for residents of lower Manhattan aren’t all that close: New York Presbyterian/Weill Cornell Medical Center is on the Upper East Side at East 68th Street and St. Luke’s/Roosevelt Hospital is on the Upper West Side.
Officials say there’s no reason to think that, for now, trauma victims in lower Manhattan will be any worse off than those in other parts of the city. The response speed is still acceptable, they say. And if a trauma victim is in an immediately life-threatening situation, such as a traumatic cardiac arrest, ambulances bring them to the closest hospital, regardless of whether it’s a trauma center.
But the fear is that there won’t be enough surge capacity at other hospitals if there is a major disaster, or that overworked staff at other hospitals will grow fatigued under the load and patient care could suffer.
Well, I’m sure the free market will sort all of this out. (via @Atul_Gawande)
Uroscopy is the now obsolete practice of using the smell, taste, and color of urine to diagnose illness. There were even charts to help doctors and other healers identify different types of urine.
Many diseases affect metabolism and many changes in metabolism can be detected in the urine. For example, diabetics will excrete sugar in their urine โ sometimes enough sugar that it can be fermented into whisky. There are many other diseases that change the smell of a person’s urine, including the very descriptively named Maple Syrup Urine Disease or Sweaty Feet Syndrome, now much more likely to be diagnosed by electronic sensor arrays than actually tasting the urine.
(via edible geography)
Over the past few years, we’ve seen an endless parade of stories debunking the value of many of the products that line the shelves of our local pharmacies. Well, here’s a different kind of story. A massive study that included more than 15,000 men and lasted more than 13 years found that taking a daily multivitamin (in this case Centrum Silver) reduced the risk of cancer. It looks like there’s something to taking one multivitamin as opposed to swallowing high doses of individual vitamins.
Because of the frequent testing and safety measures, adult film stars are perhaps the world’s safest community, STD-wise. No one in the industry has been infected with HIV since 2004. Porn star Stoya explains:
The production manager printed out a copy of each performer’s page in the APHSS database. I signed my own copy and James’s, indicating that my results were mine and accurate and that I had seen James’s and was comfortable working with him and his clean test which had been taken less than 14 days prior. He did the same. Then the production manager performed an inspection. He looked in our mouths, at both sides of our hands, and at our genitals to make sure there were no visible sores or open wounds. There was another paper to sign stating that we have no sores or open wounds on or in our mouths, hands, and genitals and had been inspected. We also looked at each others genitals, mostly for fun but if either of us had seen (or smelled) something odd we would have called off the scene ourselves.
(via @claytoncubitt)
In No Evidence of Disease, Maciej Cegลowski writes about his girlfriend’s cervical cancer and the appearance of a new friend in her life, fellow cancer patient Stephanie. Except that, well, that’s not the whole story.
Cancer comes with an entourage: fear, loneliness, and isolation. Diane didn’t go to the makeup event expecting to make a new friend, but it was a way to get out of the house. She came home excited about having met Stephanie.
Stephanie was ten years younger than Diane. Her illness was acute myeloid leukemia (AML), a type of blood cancer in which cancerous precursor cells completely take over the bone marrow. Steph had gotten her diagnosis while studying abroad in Spain, and had been treated there long enough to put her into remission and send her home. Now her life was on hold, and the cancer was coming back.
Her long-term prognosis was poor. Steph was reticent in talking about it straight out, but after she and Diane became better friends, it became clear that she did not expect to survive a year. Her only hope lay in a difficult and risky transplant procedure. I couldn’t imagine having to face this at 23, but of course no one gets to make the choice.
Maciej is a great writer and this is a crazy-ass story and I don’t know exactly what you’re supposed to feel after reading this piece (sad? mad? defeated?), but you’ll definitely feel something. (via @sippey)
Using just the camera on your iPhone, the Cardiio app can accurately measure your heart rate. Here’s how it works:
Every time your heart beats, more blood is pumped into your face. This slight increase in blood volume causes more light to be absorbed, and hence less light is reflected from your face. Using sophisticated software, your iPhone’s front camera can track these tiny changes in reflected light that are not visible to the human eye and calculate your heart beat!
This video shows this process in action (with a short explanatory intro of the mathematical technique):
That is flat-out amazing. (via @delfuego)
Three people are HIV-free due to bone marrow transplants and that’s providing scientists with hope for a possible AIDS cure.
AIDS patients are susceptible to cancers, but they usually stop taking HIV drugs before receiving cancer treatment. “That allows the virus to come back and it infects their donor cells,” Kuritzkes said.
About 34 million people are infected with HIV, the virus that causes AIDS, globally; 25 million have died from it. While there’s no vaccine, cocktails of powerful antiviral drugs called antiretroviral therapy (ART) can keep the virus suppressed and keep patients healthy. No matter how long patients take ART, however, they are never cured. The virus lurks in the body and comes back if the drugs are stopped. Scientists want to flush out these so-called reservoirs and find a way to kill the virus for good.
Brown, and now these two other men, offer some real hope.
Dr. Timothy Henrich and colleagues at Brigham and Women’s Hospital launched a search about a year ago for HIV patients with leukemia or lymphoma who had received bone marrow stem cell transplants. Bone marrow is the body’s source of immune system cells that HIV infects and it’s a likely place to look for HIV’s reservoirs.
“If you took an HIV patient getting treated for various cancers, you can check the effect on the viral reservoirs of various cancer treatments,” Kuritzkes, who works with Henrich, said. They found the two patients by asking colleagues at Dana-Farber Cancer Institute in Boston which, like Brigham and Women’s, is associated with Harvard Medical School.
Both men had endured multiple rounds of treatment for lymphoma, both had stem cell treatments and both had stayed on their HIV drugs throughout. “They went through the transplants on therapy,” Kuritzkes said.
It turns out that was key.
“We found that immediately before the transplant and after the transplant, HIV DNA was in the cells. As the patients’ cells were replaced by the donor cells, the HIV DNA disappeared,” Kuritzkes said. The donor cells, it appears, killed off and replaced the infected cells. And the HIV drugs protected the donor cells while they did it.
The two men have been HIV-free for two years and three-and-a-half years, respectively. Another man who benefited from a bone marrow transplant from a donor whose immune cells resist HIV infection has been free of HIV for five years. (via @gavinpurcell)
A team in Boston is working on a method for injecting oxygen straight into a person’s bloodstream, which is faster than the more traditional method (you know, breathing).
Researchers led by Harvard Medical School’s John N. Kheir engineered tiny, gas-filled microparticles, which were about three micrometers in size and invisible to the naked eye. They used a device called a sonicator, which uses high-intensity sound waves, to produce a foamy liquid solution with microparticles that consist of a single layer of lipids that trap a tiny pocket of oxygen gas. They then injected the resulting mixture directly into the bloodstream of rabbits that were severely oxygen-deprived.
Within seconds, infusions of the microparticles restored the blood oxygen saturation of these mammals to near-normal levels. When the rabbits’ windpipes were completely blocked, the solution kept them alive for 15 minutes without a single breath and reduced the likelihood of cardiac arrest and organ injury.
More here and here.
Writing for The New England Journal of Medicine, Atul Gawande reviews the history of surgery. The utility and efficacy of surgical procedures increased sharply with the use of anesthesia and antiseptic practices.
Before anesthesia, the sounds of patients thrashing and screaming filled operating rooms. So, from the first use of surgical anesthesia, observers were struck by the stillness and silence. In London, Liston called ether anesthesia a “Yankee dodge” - having seen fads such as hypnotism come and go - but he tried it nonetheless, performing the first amputation with the use of anesthesia, in a 36-year-old butler with a septic knee, 2 months after the publication of Bigelow’s report. As the historian Richard Hollingham recounts, from the case records, a rubber tube was connected to a flask of ether gas, and the patient was told to breathe through it for 2 or 3 minutes. He became motionless and quiet. Throughout the procedure, he did not make a sound or even grimace. “When are you going to begin?” asked the patient a few moments later. He had felt nothing. “This Yankee dodge beats mesmerism hollow,” Liston exclaimed.
It would take a little while for surgeons to discover that the use of anesthesia allowed them time to be meticulous. Despite the advantages of anesthesia, Liston, like many other surgeons, proceeded in his usual lightning-quick and bloody way. Spectators in the operating-theater gallery would still get out their pocket watches to time him. The butler’s operation, for instance, took an astonishing 25 seconds from incision to wound closure. (Liston operated so fast that he once accidentally amputated an assistant’s fingers along with a patient’s leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.)
The New England Journal of Medicine recently reported on the 69 year-old man in the photo above. Constant sun exposure to one side of his face resulted in premature aging, though, the other side doesn’t look too bad for 69. The condition is called unilateral dermatoheliosis, which I think is Greek for make sure to wear sunblock.
The patient reported that he had driven a delivery truck for 28 years. Ultraviolet A (UVA) rays transmit through window glass, penetrating the epidermis and upper layers of dermis. Chronic UVA exposure can result in thickening of the epidermis and stratum corneum, as well as destruction of elastic fibers. This photoaging effect of UVA is contrasted with photocarcinogenesis.
(via gizmodo)
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