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Colorado has spent the last six years conducting a real life test to see if they could reduce the number of unwanted pregnancies and abortions. As the NYT’s Sabrina Tavernise explains, the results were stunning.
If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to.
While reading this otherwise excellent article written by US soccer player Christie Rampone, I discovered a type of diet I’d never heard of before, the blood type diet (italics mine).
Age and parenting make me think about longevity. I definitely believe one big reason for my longevity has to do with the dietary and fitness changes I made after being diagnosed with auto-immune conditions after giving birth to my youngest daughter Reece in 2011. For example, I’ve gone gluten-free and have started to eat to my blood-type. Also, a friend introduced me to a natural ingredient called EpiCor to help strengthen my immune system. I have taken EpiCor daily for the past three years and it has become a beneficial part of my daily routine of rest, recovery, working out, eating healthy, and being in airports and hotels more than my own house.
From Wikipedia, an overview of the diet:
The underlying theory of blood type diets is that people with different blood types digest lectins differently, and that if people eat food that is not compatible with their blood type, they will experience many health problems. On the other hand, if a person eats food that is compatible, they will be healthier.
That theory is, in turn, based on an assumption that each blood type represents a different evolutionary heritage. “Based on the ‘Blood-Type’ diet theory, group O is considered the ancestral blood group in humans so their optimal diet should resemble the high animal protein diets typical of the hunter-gatherer era. In contrast, those with group A should thrive on a vegetarian diet as this blood group was believed to have evolved when humans settled down into agrarian societies. Following the same rationale, individuals with blood group B are considered to benefit from consumption of dairy products because this blood group was believed to originate in nomadic tribes. Finally, individuals with an AB blood group are believed to benefit from a diet that is intermediate to those proposed for group A and group B.”
As you might have already guessed, there is no evidence that eating your blood type is beneficial nor do the claims of differing lectin digestion have scientific merit. Homeopathic nonsense.
Sam Peterman is a sophomore in high school near Buffalo who runs track. She also has a condition called neurocardiogenic syncope (NCS) that causes her to faint after every race she runs, right into the waiting arms of her father soon after she crosses the finish line.
Dr. Blair Grubb, a professor at the University of Toledo who has studied syncope extensively, characterized NCS in a 2005 article in The New England Journal of Medicine as the autonomic nervous system’s failure to keep blood pressure high enough to maintain consciousness.
Physical activity, he said, pools blood in the lower half of the body, reducing blood flow to the heart. In response, the heart pumps more vigorously. In people with NCS, the brain misreads that as high blood pressure and tries to lower the pressure, which leads to decreased blood flow to the brain and, thus, fainting.
Peterman often does not remember the ends of races — she blacked out the last 60 meters of a recent race — which has prompted her father to wonder why she faints after races and not during. See also No pain, possible gain. (via @atul_gawande)
This is an interesting theory about the Harry Potter series: the whole thing is about a mentally ill young boy (Harry) who is institutionalized by his parents (the Dursleys) in a mental institution (Hogwarts) and the contents of the books are Harry’s fantasy.
In the Harry Potter series, his parents are famous wizards, who were famous in all the world for their unparalleled love for the boy Harry, which set the whole series in motion, killing them and leaving the boy a scarred orphan. (This is a fantasy, crafted as the direct opposite of the way in which children usually end up scarred — through abuse and neglect.)
If we interpret the story as Harry’s fantasy, then the Dursleys are Harry’s real parents, and the Potters are imaginary. The Durselys either can’t cope with the increasingly-delusional boy living with them, or perhaps they are merely abusive, and it’s the abuse that’s making him delusional. In any event, the parent-figures constantly mistreat him, favor the brother, and inflict endless cruelty and humiliation on him. One day, Harry snaps, and Dudley (who is really Harry’s brother) is severely injured, in a way requiring repeated hospital treatments. (In the delusion, Harry imagines that a pig’s tail is magically grown from Dudley’s buttocks.) As a result of this incident, Harry is taken away to a “special school.”
Oh, this sounds fantastic: PBS is set to air a six-hour documentary series, Cancer: The Emperor of All Maladies, starting at the end of March. How have I not heard about this before today?
This “biography” of cancer covers its first documented appearances thousands of years ago through the epic battles in the 20th century to cure, control and conquer it, to a radical new understanding of its essence. The series also features the current status of cancer knowledge and treatment — the dawn of an era in which cancer may become a chronic or curable illness rather than its historic death sentence in some forms.
The series is based on Siddhartha Mukherjee’s The Emperor of All Maladies: A Biography of Cancer, which is one of the most interesting books I’ve read in the past few years. Ken Burns is executive producing and Barak Goodman is directing.
Thanks to Sarah Klein at Redglass Pictures for letting me know about this. Redglass created a pair of videos for the series featuring Terrence Howard and Ken Jeong talking about their experiences with cancer.
Update: All three parts of the series are available on the PBS site for the next two weeks or so.
Two years ago, Angelina Jolie wrote in the NY Times1 about her choice to have a preventive double mastectomy. Today, she is back with an update on her choice to have another elective preventive surgery, the removal of her ovaries and fallopian tubes.
Two weeks ago I got a call from my doctor with blood-test results. “Your CA-125 is normal,” he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. I have it every year because of my family history.
But that wasn’t all. He went on. “There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer.” I took a pause. “CA-125 has a 50 to 75 percent chance of missing ovarian cancer at early stages,” he said. He wanted me to see the surgeon immediately to check my ovaries.
I went through what I imagine thousands of other women have felt. I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren.
I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful.
I wrote a post on Jolie’s first article with more information about the genetic issues surrounding her choice.↩
The results of a major new trial, published in the New England Journal of Medicine, indicate that for children who are at risk of developing a peanut allergy, eating peanuts greatly reduces the chance of an allergy. This is pretty huge news.
All the babies were between 4 and 11 months old when they were enrolled, and all had either an egg allergy, severe eczema, or both-putting them at high risk of a peanut allergy down the road. Indeed, 98 of them were already heading in that direction: They tested positive for mild peanut sensitivity in a skin-prick test. This meant that these babies were already churning out antibodies to the peanut protein. Eating peanuts in the future could set off an allergic reaction.
The team divided the babies into two groups. Half were to avoid eating peanut products until they were 5 years old. The other half received at least 6 grams of peanut protein a week, spread across at least three meals, until they were 5 years old. Bamba was the preferred offering, though picky eaters who rejected it got smooth peanut butter.
Around the 5th birthdays of the trial subjects came the big test. The children consumed a larger peanut portion than they were used to in one sitting, and the results were clear-cut. Among 530 children who had had a negative skin-prick test when they were babies, 14% who avoided peanuts were allergic to them, compared with 2% of those who’d been eating them. In the even higher risk group, the children who were sensitized, 35% of the peanut-avoiders were allergic versus just over 10% of the peanut eaters.
Even if further studies confirm these results, will American parents start feeding their infants peanuts? I don’t know…there are lots of similarities to vaccines in play here.
Update: Somewhat related: children in developed countries might be growing up too clean, making them more likely to develop allergies.
The findings are the latest to support the “hygiene hypothesis,” a still-evolving proposition that’s been gaining momentum in recent years. The hypothesis basically suggests that people in developed countries are growing up way too clean because of a variety of trends, including the use of hand sanitizers and detergents, and spending too little time around animals.
As a result, children don’t tend to be exposed to as many bacteria and other microorganisms, and maybe that deprives their immune system of the chance to be trained to recognize microbial friend from foe.
That may make the immune system more likely to misfire and overreact in a way that leads to allergies, eczema and asthma, Hesselmar says.
(thx,paul)
Kellan Roberts died suddenly at 22. He had decided to be an organ donor and his heart went to a high school student from Minnesota, Connor Rabinowitz. After receiving the heart, Connor visited Kellan’s family in Seattle and met Kellan’s sister Erin. After a few years, Erin and Connor, well, just watch…this is a wonderful story well told.
Host Hank Green of the SciShow looks at the anti-vaccination movement from a scientific perspective: why are US parents growing less likely to vaccinate their children?
In psychology, the search for these explanations is called “Explanatory Attribution” and different people have different “explanatory styles”. Some people are more prone to blame themselves, while others search for an external event to blame. But one thing is clear: we are very bad at not blaming anything. It’s not surprising that parents of children with autism, especially parents who notice a sudden loss of previous development, will search for a possible cause. And when the most significant recent event in the health of the child was a vaccination, as can be said for many moments in the life of a young American, we might identify that as a potential cause and deem that link worthy of further examination.
Now this, is completely logical. The problem is that over a dozen peer-reviewed papers have found no correlation between autism and the MMR vaccine, or any other vaccine for that matter. And yet, when you Google vaccines and autism, a fair number of the results claim that there is a link between the two, and that that link is being covered up either by the government or by big corporations. A parent, already experiencing frustration with the medical community’s inability to tell them why this thing has happened to their child, will, on the internet, find a vibrant community of similarly frustrated people who share their values and experiences. These communities are full of anecdotes that draw connections between vaccines and autism. And so, unsurprisingly, some people become convinced that they have found the reason for their child’s disability.
Once their mind has been made up, confirmation bias sets in. Confirmation bias is simply our tendency to more readily, and with less scrutiny, accept information, anecdotes, and world views that confirm our existing beliefs. And, again, it is a completely normal thing that every person does. Indeed, trying to convince someone that a previously held belief is incorrect has been proven to actually increase their affinity for that idea. And so a community is born, and the safety of vaccines is called into question. And once the procedure for getting a vaccine goes from the doctor telling you that it is now time for a vaccine — and 99% of parents agreeing because that person went through medical school — to it being a question to ponder, vaccination rates will go down.
Administrators at Palm Desert High School in California have banned 66 students who never got measles vaccinations.
“I think some parents see it as a personal choice, like homeschooling. But when you choose not to vaccinate, you’re putting other children at risk.” From WaPo: Why this baby’s mom is so angry at the anti-vaxxers.
“I respect people’s choices about what to do with their kids, but if someone’s kid gets sick and gets my kid sick, too, that’s a problem.” A Marin County father has demanded that his district keep unvaccinated kids out of school.
Vox: How an Amish missionary caused 2014’s massive measles outbreak.
Bonus tweet: “If my kid can’t bring peanut butter to school, yours shouldn’t be able to bring preventable diseases.”
Molly Beauchemin is a dental health enthusiast. She talked to several dentists about what the current best practices are for keeping your teeth and gums as healthy as possible: The Truth About Your Smile.
Most people have heard a common criticism of hand sanitizer: using it too often makes you more vulnerable to sickness because it kills off even the beneficial germs that fight viruses like the cold and flu. The same is true for the bacteria in your mouth: mouthwash is so antiseptic that most dentists recommend you only use it if you are impaired or have an injury that prevents you from brushing. Otherwise, you risk killing off even the beneficial flora (yes, our mouths are disgusting wastelands of bacteria, but a lot of them are good guys) that help fight plaque and odor-causing bacteria.
I’ve been searching around for something like this for a few months. Dental hygiene, for me, is a set of mesofacts — I’m mired in the knowledge of my youth about how to brush, when to floss, etc. — but increasingly the kids would come home from the dentist with some new tidbit I’d never heard of before, like the thing about not rinsing the toothpaste out of your mouth after brushing. I have to say though, the oil pulling bit at the end sounds like a bunch of hokum.
Scientists have discovered the first promising new antibiotic in 25 years. And even better, says Ed Yong, is that the antibiotic in question is “resistant to resistance”.
A team of scientists led by Kim Lewis from Northeastern University have identified a new antibiotic called teixobactin, which kills some kinds of bacteria by preventing them from building their outer coats. They used it to successfully treat antibiotic-resistant infections in mice. And more importantly, when they tried to deliberately evolve strains of bacteria that resist the drug, they failed. Teixobactin appears resistant to resistance.
Bacteria will eventually develop ways of beating teixobactin — remember Orgel — but the team are optimistic that it will take decades rather than years for this to happen. That buys us time.
…and also that the process by which teixobactin was discovered is the real breakthrough:
Teixobactin isn’t even the most promising part of its own story. That honour falls on the iChip-the tool that the team used to discover the compound. Teixobactin is a fish; the iChip is the rod. Having the rod guarantees that we’ll get more fish-and we desperately need more.
Steven Brill has written a book about the making of the Affordable Care Act called America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System.
America’s Bitter Pill is Steven Brill’s much-anticipated, sweeping narrative of how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing — and failing to change — the rampant abuses in the healthcare industry. Brill probed the depths of our nation’s healthcare crisis in his trailblazing Time magazine Special Report, which won the 2014 National Magazine Award for Public Interest. Now he broadens his lens and delves deeper, pulling no punches and taking no prisoners.
Malcolm Gladwell has a review in the New Yorker this week.
Brill’s intention is to point out how and why Obamacare fell short of true reform. It did heroic work in broadening coverage and redistributing wealth from the haves to the have-nots. But, Brill says, it didn’t really restrain costs. It left incentives fundamentally misaligned. We needed major surgery. What we got was a Band-Aid.
I haven’t read his book yet, but I agree with Brill on one thing: the ACA1 did not go nearly far enough. Healthcare and health insurance are still a huge pain in the ass and still too expensive. My issues with healthcare particular to my situation are:
- As someone who is self-employed, insurance for me and my family is absurdly expensive. After the ACA was enacted, my insurance cost went up and the level of coverage went down. I’ve thought seriously about quitting my site and getting an actual job just to get good and affordable healthcare coverage.
- Doctors aren’t required to take any particular health insurance. So when I switched plans, as I had to when the ACA was enacted, finding insurance that fit our family’s particular set of doctors (regular docs, pediatrician, pediatric specialist that one of the kids has been seeing for a couple of years, OB/GYN, etc.) was almost impossible. We basically had one plan choice (not even through the ACA marketplace…see next item) or we had to start from scratch with new doctors.
- Many doctors don’t take the ACA plans. My doctor doesn’t take any of them and my kids’ doc only took a couple. And they’re explicit in accepting, say, United Healthcare’s regular plan but not their ACA plan, which underneath the hood is the exact same plan that costs the same and has the same benefits. It’s madness.
- The entire process is designed to be confusing so that insurance companies (and hospitals probably too) can make more money. I am an educated adult whose job is to read things so they make enough sense to tell others about them. That’s what I spend 8+ hours a day doing. And it took me weeks to get up to speed on all the options and pitfalls and gotchas of health insurance…and I still don’t know a whole lot about it. It is the most un-user-friendly thing I have ever encountered.
The ACA did do some great things, like making everyone eligible for health insurance and getting rid of the preexisting conditions bullshit, and that is fantastic…the “heroic work” mentioned by Gladwell. But the American healthcare system is still an absolute shambling embarrassment when you compare it to other countries around the world, even those in so-called “developing” or “third world” countries. And our political system is just not up to developing a proper plan, so I guess we’ll all just limp along as we have been. Guh.
I hate the word “Obamacare” and will not use it. It’s a derisive term that has been embraced for some reason by ACA/Obama supporters. It needlessly politicizes an already over-politicized issue. ↩
A major study conducted by the Harvard School of Public Health has found a significant link between autism and the exposure of the mother to high levels of air pollution during the third trimester of pregnancy.
Researchers focused on 1,767 children born from 1990 to 2002, including 245 diagnosed with autism. The design of the study and the results rule out many confounding measures that can create a bias, Weisskopf said. The researchers took into account socioeconomic factors that can influence exposure to pollution or play a role in whether a child is diagnosed with autism.
The fact that pollution caused problems only during pregnancy strengthened the findings, since it’s unlikely other factors would have changed markedly before or after those nine months, he said in a telephone interview.
The ultimate cause of autism remains a mystery in most cases, said Charis Eng, chairwoman of the Lerner Research Institute’s Genomic Medicine Institute at the Cleveland Clinic in Ohio. While the Harvard study isn’t definitive and the findings could be coincidental, it’s not likely given the large size and the precise results, she said in a telephone interview.
“The truth is there has to be gene and environmental interactions,” said Eng, who wasn’t involved in the study. “I suspect the fetus already had the weak autism spectrum disorder genes, and then the genes and the environment interacted.”
It would be a huge help (and I am not in any way being facetious about this) if Jenny McCarthy and all the other celebrity “vaccines cause autism” folks threw their weight behind cleaning up pollution the way they attacked vaccination. Redeem yourselves. (via @john_overholt)
In a series of tweets this morning, surgeon and author Atul Gawande called out the doctors who helped the CIA torture people.
1/The Senate CIA Torture Report reveals savage, immoral, utterly despicable practices by our govt. http://t.co/qZWUNtJSeU
— Atul Gawande (@Atul_Gawande) December 10, 20142/But the worst for me is to see the details of how doctors, psychologists, and others sworn to aid human beings made the torture possible.
— Atul Gawande (@Atul_Gawande) December 10, 20143/The torture could not proceed w/o medical supervision. The medical profession was deeply embedded in this inhumanity.
— Atul Gawande (@Atul_Gawande) December 10, 20144/It was doctors who devised the rectal infusions “as a means of behavior control.” (p100)
— Atul Gawande (@Atul_Gawande) December 10, 20145/Doctors suggested the water temperature for waterboarding and use of saline instead of free water to avoid water intoxication. (p86, 419)
— Atul Gawande (@Atul_Gawande) December 10, 20146/Doctors watched as stress positions inflicted pain, lacerations, and only stopped them when producing, e.g., shoulder dislocation (70)
— Atul Gawande (@Atul_Gawande) December 10, 20147/Psychologists, who were supposed to stop damaging interrogation, actually served as interrogators. (72)
— Atul Gawande (@Atul_Gawande) December 10, 20148/The Office of Medical Services provided consultation on when fractures and wounds were healed enough to resume torture. (p113)
— Atul Gawande (@Atul_Gawande) December 10, 20149/The Office of Medical Services wrote guidelines approving up to 3 waterboard sessions in 24 hours per prisoner. (p87)
— Atul Gawande (@Atul_Gawande) December 10, 201410/When torture caused Abu Zubaydah’s eyes to deteriorate, MDs only intervened to insure ability to see was saved to aid interrogation.(112)
— Atul Gawande (@Atul_Gawande) December 10, 201411/Doctors found prisoners with broken feet and still approved putting them into standing positions for up to 52 hours (p112)
— Atul Gawande (@Atul_Gawande) December 10, 201412/Doctors were long the medical conscience of the military. The worst occurred because gov’t medical leaders abdicated that role. (p87)
— Atul Gawande (@Atul_Gawande) December 10, 2014First do no harm.
Today’s Google Doodle honors Jonas Salk on what would have been his 100th birthday. Salk developed the first successful polio vaccine in 1955 and was hailed as a hero for it.
On April 12, 1955, Dr. Thomas Francis, Jr., of the University of Michigan, the monitor of the test results, “declared the vaccine to be safe and effective.” The announcement was made at the University of Michigan, exactly 10 years to the day after the death of President Roosevelt. Five hundred people, including 150 press, radio, and television reporters, filled the room; 16 television and newsreel cameras stood on a long platform at the back; and 54,000 physicians, sitting in movie theaters across the country, watched the broadcast on closed-circuit television. Eli Lilly and Company paid $250,000 to broadcast the event. Americans turned on their radios to hear the details, department stores set up loudspeakers, and judges suspended trials so that everyone in the courtroom could hear. Europeans listened on the Voice of America. Paul Offit writes about the event:
“The presentation was numbing, but the results were clear: the vaccine worked. Inside the auditorium Americans tearfully and joyfully embraced the results. By the time Thomas Francis stepped down from the podium, church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping. One shopkeeper painted a sign on his window: Thank you, Dr. Salk. ‘It was as if a war had ended’, one observer recalled.”
Because of Salk’s vaccine and subsequent vaccines, the US has been polio-free since 1979.
As Ebola enters a deepening relationship with the human species, the question of how it is mutating has significance for every person on earth.
From the front lines in West Africa to the genomics researchers who hope to control the outbreak, The New Yorker’s Richard Preston provides a detailed and interesting look at The Ebola Wars. Preston is the author of 1995’s The Hot Zone, the bestselling account of the first emergence of Ebola, which is back in the top 50 on Amazon.
Atul Gawande’s best selling Being Mortal is getting the Frontline treatment on PBS this January. Here’s the trailer:
Atul Gawande’s new book about medicine and death, Being Mortal, is out today. Two excerpts of the book are available online, The Best Possible Day:
I spoke with more than 200 people about their experiences with aging or serious illness, or dealing with a family member’s — many of them my own patients, some in my own family. I interviewed and shadowed front-line staff members in old age homes, palliative-care specialists, hospice workers, geriatricians, nursing home reformers, pioneers, and contrarians. And among the many things I learned, here are the two most fundamental.
First, in medicine and society, we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them. Hence the wide expert agreement that payment systems should enable health professionals to take sufficient time to have such discussions and tune care accordingly.
and No Risky Chances:
You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. These days are spent in institutions — nursing homes and intensive-care units — where regimented, anonymous routines cut us off from all the things that matter to us in life.
Too many books to read! Gotta make time for this one though.
Great piece about how Lufthansa cares for those who need medical attention while flying.
On a Lufthansa flight, making a public call for any medical professionals on the plane is a last resort. The airline prefers to be far more discreet. After all, does the whole plane always need to know that somebody on board is having a problem? To accomplish this, Lufthansa launched the Doctors on Board program for physicians.
Doctors on Board allows Lufthansa to identify doctors long before an emergency occurs. By doing this, the cabin crews can personally and discreetly summon the doctor if their skills are needed during a flight. In order to find doctors who could potentially participate in this program, the airline scoured the data from its Miles and More frequent flier program. By doing this, Lufthansa was able to identify 15,000 doctors who regularly fly the airline. Of those, 10,000 opted to join the program.
Participation in the Doctors on Board program carries with it several benefits. The doctors are issued a handbook about aviation medicine, as well as receiving news and information via both the internet and postal mailings. They are insured by Lufthansa for any care that they provide during a flight. They are also rewarded with 5,000 Miles and More award miles and a discount code for €50 off of their next flight, plus they receive a special bag tag identifying their participation in the program. Finally, they are given the opportunity to participate in a course on aviation medicine and on-board emergency handling, for which they are paid an additional fee.
This is real customer service: thoughtful, anticipatory, active, thorough. (via @marcprecipice)
When she was 33, Christine Hyung-Oak Lee had a stroke. It was not exactly a normal stroke and it ended up saving her life.
Our fridge was empty. I went to Andronico’s grocery store and browsed the aisles, a blur of colors and letters and shapes. What was it we needed? I wondered. I could not figure out how the pieces fit together, that I would need onions because we used onions for everything, that I would need bread for sandwiches, that I would need meat for a possible entree. They were shapes and colors and textures. That fleshy pink package was a fleshy pink rectangle. The countless numbers of canned soup and canned vegetables were mere metal cylinders.
I emerged with one thing: a jar of Muir Glen spaghetti sauce. I grabbed it because I had seen it before, because I could read the label. If it was something I could understand, it must be something I needed. I did not need spaghetti sauce.
I still do not remember how it is I paid, whether by cash or by debit or credit card. I do not remember swiping or handing over bills. I just remember blinking in the cold winter sun at my car in the parking lot. Holding a jar of spaghetti sauce.
And wondering how to get home. I did not know how to get home.
I got in the car and started driving. If I just drove, I thought, I would somehow get home.
Each time I thought about whether I needed to make a left turn or right or stop or go, I felt lost. I had no idea. And so I pressed on without thinking, while relying on intuition. Each time I stopped, I recognized landmarks - a tree or a house or a store. I knew I was getting closer to home, but I did not know how to continue.
Intuition carried me when logic and memory failed.
I made it home.
And then I thought, I need to get to a hospital.
I picked up the phone and then I asked myself, What is the phone number for 911?
I looked at the numeric keypad, and I could not figure out what number each shape represented. And what is the number for 911?
I thought perhaps I should try calling my husband. I could not remember his phone number, either. It did not occur to me to look for it in the contacts list on my BlackBerry, either.
I finally decided I would mash a bunch of numbers on the keypad and talk to whomever it was I dialed on the landline. I did not think about the fact that I did not know where I lived, but I punched in a set of numbers anyway.
“Hello,” a man said.
“Hi!” I said.
“Hi,” he said.
“Who is this?” I asked.
“This is A-,” he replied.
“Oh! I have been trying to reach you! I forgot your phone number and I didn’t know how to get ahold of you! I called this phone number, because it was in my fingers.”
Just go read the whole thing, what a great piece.
Hmm, this is interesting. Recent studies suggest that food allergies may be caused by the absense of certain intestinal bacteria…in part due to increased use of antibiotics in very young children.
Food allergies have increased about 50% in children since 1997. There are various theories explaining why. One is that the 21st century lifestyle, which includes a diet very different from our ancestors’, lots of antibiotic use, and even a rise in cesarean section deliveries, has profoundly changed the makeup of microbes in the gut of many people in developed countries. For example, the average child in the United States has taken three courses of antibiotics by the time he or she is 2 years old, says Martin Blaser, an infectious disease specialist and microbiologist at New York University in New York City. (See here for more on the reach of microbiome research these days.)
Cathryn Nagler, an immunologist at the University of Chicago in Illinois, has spent years probing links between the immune system, intestinal bacteria, and the onset of allergies. Back in 2004, she and her colleagues reported that wiping out gut bacteria in mice led to food allergies. Since then, Nagler has continued trying to understand which bacteria offer allergy protection and how they accomplish that.
Surgeon and New Yorker writer Atul Gawande has a new book about death coming out in October called Being Mortal.
Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.
Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person’s last weeks or months may be rich and dignified.
This piece Gawande wrote for the New Yorker in 2010 was probably the genesis of the book. I maintain a very short list of topics I’d like to write books about and death is one of them. Not from a macabre Vincent Price / Tim Burton perspective…more like this stuff. Dying is something that everyone has to deal with many times during the course of their life and few seem to have a handle on how to deal with it. That’s fascinating. Can’t wait to read Gawande’s book.
According to many psychiatrists and brain experts, about one in 10 autistic children sheds symptoms before adulthood. Duke researcher Geraldine Dawson explains that “there is this subgroup of kids who start out having autism and then, through the course of development, fully lose those symptoms.” Now they just have to figure out why. From the NYT Magazine: The Kids Who Beat Autism.
Journalist Miles O’Brien lost his left arm in February. He wrote about the experience and what he’s learned from it so far for New York magazine.
But here are two things you need to know about life after an arm amputation: First, your center of gravity changes dramatically when you are suddenly eight pounds lighter on one side of your body. Second, while my arm may be missing physically, it is there, just as it always has been, in my mind’s eye. I can feel every digit. I can even feel the watch that was always strapped to my left wrist. When I tripped, I reached reflexively to break my very real fall with my completely imaginary left hand. My fall was instead broken by my nose, and my nose was broken by my fall.
Lying on that sidewalk, moaning in pain, I reached the end of Denial River and flowed into the Sea of Doubt. It finally dawned on me in that instant that I was, indeed, handicapped. That may not be the term of choice these days — “differently abled” or “physically challenged” may be de rigueur — but as I touched my bloody face, feeling embedded chips of concrete in the wounds, “handicapped” sure seemed to fit.
The woman I was passing on the sidewalk when I fell took one look at me and cried out in panic to her husband: “My God, what’s happened to his arm?” “It’s gone,” I said. “But don’t worry, that didn’t happen today.”
O’Brien also mentions he’s tried mirror therapy pioneered by V.S. Ramachandran, which I’ve written about previously.
Measles cases in the U.S. just hit a two-decade high. In case you can’t already guess why, assistant surgeon general Dr. Anne Schuchat explains:
The current increase in measles cases is being driven by unvaccinated people.
From Aeon, Polio whack-a-mole:
The great allies of infectious diseases are no longer poverty, nor dirt, but the global anti-vaccination movement.
In a clinical trial at the Mayo Clinic, a woman with a type of blood cancer called myeloma was given an injection of measles virus large enough to innoculate 10 million people and has been “completely cleared” of her cancer.
So, as part of a two-patient clinical trial, doctors at the Mayo Clinic injected Erholtz with 100 billion units of the measles virus — enough to inoculate 10 million people.
Her doctor said they were entering the unknown.
Five minutes into the hour-long process, Erholtz got a terrible headache. Two hours later, she started shaking and vomiting. Her temperature hit 105 degrees, Stephen Russell, the lead researcher on the case, told The Washington Post early Thursday morning.
“Thirty-six hours after the virus infusion was finished, she told me, ‘Evan has started shrinking,’” Russell said. Over the next several weeks, the tumor on her forehead disappeared completely and, over time, the other tumors in her body did, too.
The cancer of the other person in the trial was unaffected and larger randomized trials still have to be performed, but this is encouraging news. Between this and the remission of cancer using HIV, it looks like viral therapy has a real shot at being a powerful weapon in fighting cancer.
Peter Bach, a cancer doctor, writes about losing his wife to cancer.
The streetlights in Buenos Aires are considerably dimmer than they are in New York, one of the many things I learned during my family’s six-month stay in Argentina. The front windshield of the rental car, aged and covered in the city’s grime, further obscured what little light came through. When we stopped at the first red light after leaving the hospital, I broke two of my most important marital promises. I started acting like my wife’s doctor, and I lied to her.
I had just taken the PET scan, the diagnostic X-ray test, out of its manila envelope. Raising the films up even to the low light overhead was enough for me to see what was happening inside her body. But when we drove on, I said, “I can’t tell; I can’t get my orientation. We have to wait to hear from your oncologist back home.” I’m a lung doctor, not an expert in these films, I feigned. But I had seen in an instant that the cancer had spread.
The last sentence here really got to me:
Our life together was gone, and carrying on without her was exactly that, without her. I was reminded of our friend Liz’s insight after she lost her husband to melanoma. She told me she had plenty of people to do things with, but nobody to do nothing with.
Bach’s discussion of treatment options reminded me of Siddhartha Mukherjee’s The Emperor of All Maladies, which is one of my favorite books of recent years. I was also reminded of how doctors die.
In 1988, India had over 200,000 cases of polio reported. For the past three years, they’ve had 0. At the end of this month, the WHO will announce the end of polio in India.
America experienced the height of polio in the 1940s and ’50s, when about 35,000 people became disabled every year. Fear and panic spread and parents were known to warn their children to not drink from public water fountains, avoid swimming pools and stay away from crowded public places like movie theaters. Perhaps the most famous case of polio in America was Franklin Delano Roosevelt, the first president with a significant physical disability.
The development of the Salk and Sabine vaccines helped lead to eradication of polio in the United States in 1979. In India, too, vaccination was critical.
“There were three keys to our success,” Kapur says. “Immunize, immunize and immunize.”
Three years ago, Kayla Montgomery was diagnosed with multiple sclerosis. Faced with the prospect of being confined to a wheelchair someday, Montgomery, one of the slower runners on her high school cross country team, told her coach she was short on time and wanted to run faster. Now she’s one of the fastest runners in the country and perhaps the MS has something to do with it.
Kayla Montgomery, 18, was found to have multiple sclerosis three years ago. Defying most logic, she has gone on to become one of the fastest young distance runners in the country — one who cannot stay on her feet after crossing the finish line.
Because M.S. blocks nerve signals from Montgomery’s legs to her brain, particularly as her body temperature increases, she can move at steady speeds that cause other runners pain she cannot sense, creating the peculiar circumstance in which the symptoms of a disease might confer an athletic advantage.
But intense exercise can also trigger weakness and instability; as Montgomery goes numb in races, she can continue moving forward as if on autopilot, but any disruption, like stopping, makes her lose control.
“When I finish, it feels like there’s nothing underneath me,” Montgomery said. “I start out feeling normal and then my legs gradually go numb. I’ve trained myself to think about other things while I race, to get through. But when I break the motion, I can’t control them and I fall.”
Montgomery’s story reminds me of ultra-endurance racer Jure Robic, particularly this bit in a NY Times profile:
Researchers, however, have long noted a link between neurological disorders and athletic potential. In the late 1800’s, the pioneering French doctor Philippe Tissie observed that phobias and epilepsy could be beneficial for athletic training. A few decades later, the German surgeon August Bier measured the spontaneous long jump of a mentally disturbed patient, noting that it compared favorably to the existing world record. These types of exertions seemed to defy the notion of built-in muscular limits and, Bier noted, were made possible by “powerful mental stimuli and the simultaneous elimination of inhibitions.”
Questions about the muscle-centered model came up again in 1989 when Canadian researchers published the results of an experiment called Operation Everest II, in which athletes did heavy exercise in altitude chambers. The athletes reached exhaustion despite the fact that their lactic-acid concentrations remained comfortably low. Fatigue, it seemed, might be caused by something else.
In 1999, three physiologists from the University of Cape Town Medical School in South Africa took the next step. They worked a group of cyclists to exhaustion during a 62-mile laboratory ride and measured, via electrodes, the percentage of leg muscles they were using at the fatigue limit. If standard theories were true, they reasoned, the body should recruit more muscle fibers as it approached exhaustion — a natural compensation for tired, weakening muscles.
Instead, the researchers observed the opposite result. As the riders approached complete fatigue, the percentage of active muscle fibers decreased, until they were using only about 30 percent. Even as the athletes felt they were giving their all, the reality was that more of their muscles were at rest. Was the brain purposely holding back the body?
“It was as if the brain was playing a trick on the body, to save it,” says Timothy Noakes, head of the Cape Town group. “Which makes a lot of sense, if you think about it. In fatigue, it only feels like we’re going to die. The actual physiological risks that fatigue represents are essentially trivial.”
Update: While still in middle school, thirteen-year-old Amaris Tyynismaa is putting up some of the best distance running times in the country against high school competition. And she does it in spite of, or perhaps, because of battling with Tourette syndrome since she was a little girl.
Some athletes with TS attribute near-magical powers to their condition. Tim Howard, the goalkeeper of last year’s U.S. World Cup soccer team, says that TS has given him vision and reflexes that other players simply don’t have. Famed physician Oliver Sacks once wrote about a ping-pong player whose abnormal quickness and ability to knock back unreturnable shots, he believed, had to be connected to TS. One reason is that people with Tourette’s also tend to have Obsessive Compulsive Disorder (Amaris included). They need to repeat behaviors-whether it’s preventing balls from going into the net or running improbably long distances-until they do it just right. “I’m not saying it’s a good thing to have,” Sacks told a reporter last year, “but if one has Tourette’s, there are advantages.” New research out of the University of Nottingham shows that the brains of TS patients are physically different from everyone else’s, transformed by years of operating under much greater than normal resistance and better at controlling the body.
Neurologists at the Tourette Syndrome Association aren’t quite ready to embrace a connection between TS and superior athleticism. They are more comfortable saying that people with TS often see their symptoms subside when they’re playing sports or otherwise engaged in something that focuses their attention away from the urge to tic.
Soccer quieted the noise in Amaris’ head. After taking up the game, she began to tic less off the field. She did better in school. She talked more. Actually, she talked a lot, like she does now. In her last game in England, she scored three goals and the other kids lifted her up on their shoulders and carried her around. She would have had a major problem with that just months before-too many germs-but she loved it.
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