Vol. 133 October 1, 2015 What Year Is This? 1984??

October 1, 2015


“Have you seen the video? You must see the video?” -Carly Fiorina on CNN


I must admit that the Republican Presidential debates have been occasionally entertaining as the non-Trumps gradually reveal a little of their own personalities in trying to counter his H-U-G-E one. But sometimes the posturing for a sound bite or a differentiating headline has so grossly distorted the facts that alarm bells go off in my head. Wait, you say, isn’t that normal for a political campaign? Of course it is, but as a physician I can’t help but cringe watching rabid political attacks based on distorted, misleading, and even deliberately misstated “medical information”.

“Planned Parenthood is profiting from selling baby parts obtained from abortions”.

  1. The 1988 Fetal Tissue Transplantation Panel, appointed by President Reagan, after reviewing decades of research stated that there was no evidence that the possible use of fetal tissue for medical research had ever helped persuade a woman to have an abortion.
  2. Only a few Planned Parenthood affiliates in three Western states have arrangements to provide fetal tissue from abortions to researchers.
  3. Permission for donation of fetal tissue cannot be sought from a woman until after she has decided to end the pregnancy.
  4. By law, the fetal tissue can not be sold for profit. A sum of $30 to $100 may be reimbursed to the health care providers/facility (not to Planned Parenthood, not to the patient) to cover costs of tissue recovery.
  5. By law, there is no federal reimbursement for the abortion procedure itself.
  6. Use of the unique characteristics of fetal tissue has allowed successful research for decades in the development of life-saving , disease-preventing vaccines. “Virtually every person in the country has benefitted from research using fetal tissue.” (1)

“Use of fetal tissue is unethical.”

  1. Just today the pediatric neurosurgeon running for President answered a question in New Hampshire about Planned Parenthood with, “Tearing babies apart? Is that what you mean? The medical ethics of selling body parts and manipulating babies in order to preserve certain body parts? It’s illegal.” Besides mixing “legal’ in with “ethical’, two different concepts, Dr. Carson has also apparently forgotten that he participated in a 1992 medical research study using tissue from aborted fetuses. (2)
  2. “The research use of fetal remains is ethical.” said Reagan’s 1988 panel.
  3. The Committee on Pro-Life Activities of the National Conference of Bishops has written “it may not be wrong in principle for someone unconnected with an abortion to make use of fetal organ from an unborn child who died as a result of an abortion.” (3)

“Planned Parenthood is in the abortion business.”

  1. Three per cent (3%) of the 10.6 million services delivered annually by Planned Parenthood were related to abortion procedures in 2014. That does represent over 320,000 abortions, so I can understand why believers in “zero abortions” might be upset, but Planned Parenthood services are much broader:
    42% for sexually transmitted disease tests (including HIV tests),
    34% for contraception services,
    11% for pregnancy tests,
    and 9% for cancer screening and prevention.
  2. “The inconsistent or incorrect use of contraception accounts for nearly half of unintended pregnancies and half of those end in abortion.” (4)
  3.  78% of the people served lived at or below the 150% federal poverty level.
  4. “We strongly support Planned Parenthood not only for its efforts to channel fetal tissue into important medical research but also for its other work as one of the country’s largest providers of healthcare for women, especially poor women.” (5)

“Have you seen the video? You must see the video?” -Carly Fiorina on CNN

  1. The Video” of Planned Parenthood physicians describing how they obtained fetal tissue is a heavily and deceptively edited compilation of 30 months of taping obtained by actors who misrepresented themselves and asked leading questions.
  2. “The Other Video” and pictures of a bucket of dead baby parts being sorted out by a technician has nothing to do with Planned Parenthood and is from “stock footage” from an anti-abortion organization.

I have no association with Planned Parenthood, and I am not an advocate of abortion as “a means of contraception”.
I am dismayed when information about a major health care provider and a valuable medical research resource is so distorted in such a believable fashion for political means.

In New Hampshire Dr. Carson decried political correctness and likened it to “group-think in Nazi Germany”.  In our present state of political polarization, demand for political correctness, a discouraged middle-class, growing fear of foreigners and scapegoating of immigrants, and even a popular, narcissistic candidate with a distinctive hair style, could “It” happen here?

1.  NEJM 373:10, September 3, 2015 , p.890
2.  Boston Globe, Oct. 1, 2015, B4
3.  Biomedical Politics 1991
4.  Guttmacher Institute 2014
5.  Editors of the NEJM, Sept. 3, 2015



Vol. 132 September 15, 2015 BUGS: Can’t Live Without Them, Can’t Live With Some of Them

September 16, 2015


 “Germs make us sick, but everyone focusses on the harm.
And it’s not that simple, because without most of these organisms,
we could not survive.”
– Martin Blaser, MD; Professor of Microbiology, NYU School of Medicine

Bacteria (bugs) on and in our body outnumber our own cells by about 10 to 1. They only comprise 1-3% of our total body mass or up to about 3 pounds. but they essentially make life possible, as well as occasionally cause us great harm. That bacterial crowd, with its companions of fungus, protozoa  other one-celled critters, is called a microbiome (“microbes that share our body space”). We inherit about 23,000 genes from our parents. Our microbiome contains 4 MILLION, and they are always working.

The National Microbiome Project funded by NIH for $115 million and completed in 2012 confirmed many associations between our bacteria and both health and illness. By our bacteria I mean “our” bacteria. Each person develops a unique microbiome starting with maternal bacteria received during birth. By age three years our microbiome is stable, but can be altered by antibiotics, what we eat, and sanitation practices. The “microbiome fingerprint” of an individual’s stool is distinct and can correctly identify a second stool from that same individual a month later 80% of the time.

Most of the bacteria we live with reside in our intestines. Roughly 70-80% of our feces is made up of bacteria living peacefully in our gut helping us to digest food, absorb sugar, protecting us from auto-immune disease, and maybe even to communicate with our brain. Certain groups of gut bacteria in mice have been shown to affect the blood-brain barrier, to make it more open, “to leak”, which has spurred some researchers to study the effect of gut bacteria on mental health. Associations between obesity, diabetes, and auto-immune diseases like Crohn’s and Irritable Bowel Syndrome (IBS) and the gut microbiome in laboratory mice have already been made.

Some gut bacteria in mice have been found to have two different, interchangeable physical shapes which can sense the environment (the kind of food passing by) and change from one shape to the other, just like a silicon chip. Crohn’s disease was long thought to be an infections disease, but is now considered a non-infectious inflammatory disease. In fact, the absence of one particular bacteria in mice reproduces Crohn’s disease symptoms in them. Human clinical researcher of the microbiome is flourishing.

Balance within our microbiome is important. Clostridium difficile, a pathogen when it overgrows in our gut when competing bacteria are knocked out by prolonged use of antibiotics, can cause debilitating diarrhea, dehydration, malnutrition, and even death. “Clostridial clusters”, a group of non-pathogens, on the other hand can detect sugar in the gut, increase insulin sensitivity, and may protect against the development of diabetes. The recently developed treatment of performing fecal transplants from healthy people to patients with C. difficile infections might be more readily accepted if we called them “microbiome transplants”.

What’s New?
Antibacterial soaps containing triclorsan have been found to be no more antibacterial than soap and water after 40 years of study reviewed by the FDA. Because of recent concerns about the effect of triclorsan on hormone levels and the growth of drug-resistant bacteria in lab animals, the FDA will require manufacturers to prove that their anti-bacterial soap or cleanser is better than soap and water or change its claims or cease its sale by 2016. Anti-bacterial solutions (Purell) are effective because they contain alcohol.

A recent study of the treatment of acute appendicitis with antibiotics alone (24 hours of high dose IV and then 10 days of oral antibiotics) has shown that in selected cases that non-operative treatment is as successful as surgical treatment. Long-term follow-up of these patients remains to be done.

The microbiome of the subway was studied in 2013 by Weill Cornell Medical School investigators who collected and analyzed hundreds of DNA samples from the underbelly of New York City. The good news is that very few samples had the DNA of disease-causing bacteria, and only 1% was identifiable as human bacterial DNA. The more striking fact is that “48% of the DNA found did not match any known organism”. Now, the investigators say that’s because our databases of genomes are incomplete, but I think that there is a Stephen King novel waiting to be written there.

1.  Scientific American, June 2012,, The Ultimate Social Network, Jennifer Ackerman
2.  Scientific American, Feb, 2015, Innovations In, The Microbiome
3.  Weill Cornell Medicine, Vol. 14, No. 1
4.  New Yorker, Oct. 22, 2012 p.32, “Germs Are Us” by Michael Specter
5.  Microbes can be used to identify individuals, Boston Globe, May 18,2015, B4

Vol. 131 September 1, 2015 Current, Recurrent Controversies

September 1, 2015


“Anachron’s Law:
There is no myth which is so irrational that no one will believe it.
Anachron’s Corollary:
There is no truth which is so obvious that everyone will accept it.”
George Hammond

“How Much Is That Pill In The Window?”:
It costs either $2.6 BILLION or $1.4 BILLION to develop a new drug depending on which report you believe… the Tufts Center for the Study of Drug Development (supported in large part by drug companies) or Jeffery Avorn, MD of the Division of Pharmacoepidemiology and Pharmoeconomics of Harvard Medical School. The discrepancy is important since the high price of drugs is becoming a hot topic in this pre-election year. Read this NEJM article to get a glimpse of the smoke and mirrors used in such calculations (how to calculate capital costs?, what is a “self-originated” drug?, how much of R&D costs are covered by public tax money (NIH grants)?, what are R&D and what are marketing costs?, etc.). (1)

  • 80% of new compounds fail to meet expectations and are abandoned during development. This, of course, raises the calculated cost of developing the successful ones.
  • Both reports agree that the time required for new drug approval by the FDA has decreased to the point where it as fast as, or faster than other countries.

“Gadar” is faulty :
Ten years of research has not appreciably advanced our understanding of what makes people gay according to a “state-of-the-art” review of research into sexual orientation held every five years in a remote location. This year’s conference was held at the University of Lethbridge in Western Canada. The sharp dichotomy between nature (genetics) versus nurture (cultural) causes, the focus of numerous “twin studies” in many countries over many years, has been significantly blurred. The search for the “gay gene” has been tempered by the realization that at least 150 genes are involved in determining “something as simple as your height.” (2)

A new concept, the “environment of the womb”, has recently received greater research interest, but data remains inconclusive. The “environment of the womb” swirls with all sorts of different, and changing, levels of hormones and proteins for 9 months, and researchers  continue to look for its effects on the fetus – “epigenetics”. “Genes are the ingredients of grandma’s apple pie. Epigenetics is the recipe of how she actually makes it.” (2)

The scarce support of sexual orientation research is due in large part to societal controversies  (hence the remote locations for conferences to reduce easy access for “Spotlight Investigative Teams” roaming for hot topics). I wonder if such research is even worth it at all. Any research conclusion will likely be ignored by those people with the strongest negative opinions about sexual orientation because many have clearly shown no acceptance of scientific evidence about anything.

“Low-T” is another manufactured diagnosis:
Despite the lack of scientific evidence showing any benefits, 2.2 million men were prescribed testosterone in 2013 for “age-related hypogonadism”, a brand new diagnosis limited to aging men and apparently coined in response to a demand for testosterone prescriptions. Most of the men are 40 to 64 years old, and one-third of them had never had their actual testosterone blood level checked prior to the prescription. The authors of this report suggest that direct-to-consumer marketing for the improvement of “low-T symptoms” is a major reason for this wide-spread, increasing usage. The FDA has identified a “weak signal” that testosterone usage has adverse cardiac effects, and is concerned … so they have… “recommended some drug label revisions”. (3)

“Lingering Lyme”:
The CDC notes that one in five patients treated for Lyme disease may develop a persistent syndrome of fatigue and other symptoms known as “post-treatment Lyme syndrome”, and no one knows what causes it. It is NOT cured by continuous long-term antibiotics. There is new laboratory animal evidence that some of the organisms causing Lyme go into a “dormant state” when under antibiotic attack. They are NOT resistant to the antibiotic. The cell metabolism function that is attacked by the antibiotic just shuts down temporarily when the antibiotic is present, and so the organism survives. The researchers found that reintroducing the same antibiotic in the lab animal after a time off antibiotics subsequently killed these “persister” organisms. This is a new direction of inquiry in Lyme disease, but not everyone believes in “persisters” and “pulsed antibiotics”. They won’t believe, and shouldn’t, until all four of Koch’s postulates  for establishing a link between a disease and an organism are met. (4)

“Water, Water Everywhere…but not needed”:
The persistent myth that 8 glasses of water will keep you healthy was apparently initiated by readers of a 1945 Food and Nutrition Board recommendation that people need 2.5 liters of water a day. BUT, the readers ignored the next sentence that read “most of that quantity is contained in prepared food” … like fruits, vegetables, juice, coffee, tea, and even beer. Prospective studies have failed to find any benefit on skin elasticity, kidney function, “healthy appearance”, disease-free state, or mortality in those healthy people who increase their water intake. A recent study using a urine osmolality of 800 mOsm/kg (a measure of concentration) as the “normal” value in children concluded that more than half of 4,000 symptom-free, healthy children were “dehydrated”! It would seem that we should throw that particular “normal” standard out the window … or at least into the crapper. (5) Water is good for you, but, let’s face it, you really don’t need take a water bottle with you in the car when you go to pick up the mail.

1. “The $2.6 Billion Pill – Methodologic and Policy Considerations”, Jeffery Avorn, MD, NEJM 372;20, May 14, 2015 .
2. “What Makes People Gay?- Revisited” , Neil Swidey, Boston Globe Magazine, August 23, 2015,
3. “Testosterone and ‘Age-Related Hypogonadism’ – FDA Concerns”, NEJM 378;8, Aug 20, 2015
4. “Lingering Lyme”, Scientific American, Sept. 2015, pg.17
5. “The Persistent Health Myth of 8 Glasses of Water A Day”, Aaron J. Carroll, MD, NY Times, Aug. 25, 2015, pg. A3

Vol. 130 August 1, 2015 Medical Diagnosing Websites

July 31, 2015


Have you ever gone on the internet
to seek a diagnosis for your symptoms?


Fifty million people did so on iTriage last year. Healthline.com

gets 6.5 million visits a month. WebMD’s “symptom tracker” gets 4 million visits a month.

Are they any good at making a diagnosis for you? Do they give good triage advice?

A recent study by Harvard Medical School faculty says “not too bad”, BUT “seeker beware”. (1)
There is significant accuracy variability between the websites. The authors identified 143 websites offering diagnoses in response to symptoms entered by the user. They submitted 45 standard sets of symptoms from “patients looking for a diagnosis” (entered by non-professionals) to each of the 43 websites directed at general medicine/primary care “symptom tracking”. The “patient’s” symptoms entered were in one of three categories (unlabeled and unknown to the website): 1) symptoms require urgent medical evaluation, 2) symptoms should be evaluated by a medical professional by appointment, and 3) self-care without medical evaluation is all that is recommended (the classic medical triage decision tree).

On average, half of the websites listed the correct diagnosis first. 58% listed the correct diagnosis in the top three. However, the range of correct number of #1 diagnoses varied from 5% to 50% between websites. Not unlike a medical professional’s diagnostic decision-making, the software on these websites correctly identified common diseases more frequently than uncommon ones. (The old medical student saw is true: “When you hear hoofbeats think of horses, not zebras.”)

A more comforting result of the study was that 80% of the symptoms needing urgent evaluation and care were identified correctly. The flip side was that two-thirds of the patients that could have been served well by self-care alone were instructed to seek a medical evaluation. As one web-designer physician remarked, “We try to neither unduly alarm nor inappropriately reassurance users.” The software behind the triage advice on these websites (“should I see a doctor or not”) is highly risk-adverse in suggesting so many medical evaluations for minor symptoms. This may not prove so useful to people using the websites to avoid a visit and the payment of a deductible.

The triage accuracy was comparable to that found in studies of nurse practitioner telephone triage which ran about 60-70% compliant with physician in-person recommendations. Of course, the symptom tracking websites do lack perceptions of patient anxiety, tone of voice, urgency of speech, and other subtle, but important clues (especially to pediatricians), of the nature of the situation. Perhaps as a practicing pediatrician I put too much stock in those kind of clues in assessing a patient by telephone, but I suspect that they do improve the person-to-person triage decision-making. At least, the symptom tracking websites were better than just entering symptoms into a Google.

Which symptom tracking website was the best? DocResponse.com got the highest score, but offers no pediatric content. Healthychildren.com by the American Academy of Pediatrics is the site to go to for that. MEDoctor had the worst results. e-Patient Dave, a respected non-medical patient care advocate, recommends trying 2 or 3 websites with the same symptoms.

The traffic to these kind of websites and their popularity with patients may spawn a new word in the lexicon of medical practice; “cyberchondriac”

1. BMJ 2015:351, July 8, 2015

Vol. 129 July 15, 2015 Update on FDA & Sunscreens and Bath Salts

July 15, 2015



“Herbal incense” may sound organic,
but it sure ain’t good for you.


Sunscreens (1)
Previous blogs have noted that the FDA has limited authority over and regulations for sunscreens, but it does have some. Despite “the common wisdom” that the FDA is slow to approve new prescription drugs, its approval process is generally faster than Europe’s and in 2014 the FDA approved the highest number of new drugs in 18 years – 41 products. (1)

Over-the-counter (OTC) products like sunscreens are regulated by a different process using the standard:  “ generally recognized as safe and effective”. But, in 2014 the FDA declined to permit use of 8 new ingredients in sunscreens even though they have been in use in Europe for 5 years. It cited lack of safety studies, gaps in data, and reports of adverse events. This action prompted an understandable, if   a bit of an over-the-top reaction, from the Wall Street Journal calling to “strip the sunscreen police of all powers over the stuff.”

It is obvious that the FDA has mixed, and unfunded, responsibilities for review of OTC products. A new law, the Sunscreen Innovation Act of 2014 (only in America could we come up with a name like that), tried to clarify the situation, but no new resources were allocated to implement it. In the meantime both the FDA and the CDC continue their efforts to discourage use of tanning beds and promote prevention measures against melanoma which claim 10,000 deaths a year in the U.S.

Synthetic Cannabinoids (SC) (2)

Synthetic cannabinoids (SC) arrived in the U.S. from Europe in 2008 as herbal incense, spice, and bath salts “not for human consumption”. Since 2011 the DEA has placed over 40 SCs into Schedule I of controlled substances which means they are obtainable only by prescription. The problem is that manufacturers of these SCs merely change one or more chemical bonding group or a single chemical chain and the new compound falls outside such a regulation. The compounds are easily obtained on the internet for use in e-cigarettes or are added to energy drinks. They are still labeled “not for human consumption”, and may even carry the assurance that the product “contains no regulated compounds”.

Widespread distribution and marketing have led to recent clusters of serious illness and even deaths, particularly among the young and inexperienced users. Many users reported that they used SCs in order to get high without risking a positive drug test. SCs are NOT detected by the usual urine or blood lab tests, have no available antidote, and can produce serious symptoms which are not readily identifiable as symptoms specific to SC toxicity. Some users have died before reaching an emergency department.

The number of adverse events is increasing. During a two month period in early 2015 Mississippi reported 1200 SC-related visits to the ER and 17 deaths. One reason for this uptick may be the distribution of novel SC compounds that are easily and rapidly synthesized and marketed in response to regulatory actions. They can have new, unknown effects resulting in idiosyncratic toxicity such as delirium, seizures, psychosis, kidney failure, hallucinations, coma, and death.

Ninety-one per cent of users interviewed in one study inhaled vaporized SCs from refillable e-cigarette cartridges. E-cigarettes seem to be garnering more very bad “unintended consequences” than originally predicted by its advocates.

1. NEJM July 9, 2015, pg. 101; A Spotlight on Sunscreen Regulation; J.A. Sharfstein, MD, Johns Hopkins School of Public Health
2. NEJM July 9, 2015, pg. 103, Synthetic Cannabinoids – Related Illnesses and Deaths, DEA, CDC, and University of California

Vol. 128 July 1, 2015 Obamacare is Five Years Old. Can It Walk and Talk?

July 1, 2015


“From a historical perspective,
5 years is a very short time.
Many of the key insurance provisions have been
in effect only since October 2013.” (1)

Now that the Supreme Court has decided that a key provision in the Affordable Care Act of 2010, the federal subsidy of health insurance for eligible citizens, is legal, the infancy of Obamacare is over. It looks like it is here to stay. How is the toddler doing? What has it done? Luckily, The Commonwealth Fund just published a summary of ACA effects so far. (1)

The Commonwealth Fund is a private foundation formed in 1918 with Harkness family money made from the early oil business, (Shell Oil).

“The Commonwealth Fund has sought to be a catalyst for change by identifying promising practices and contributing to solutions that could help the United States achieve a high-performance health system. The Fund’s role has been to establish a base of scientific evidence on what works, mobilize talented people to transform health care organizations, and collaborate with organizations that share its concerns. The Fund’s work has always focused particularly on the challenges vulnerable populations face in receiving high-quality, safe, compassionate, coordinated, and efficiently delivered care.”

This health-care-focussed fund and think tank reports that it is too early to see many benefits of the ACA, but lists some of its immediate, observable effects.

Access to care:

  • 7.0 to 16.4 million young adults from chronically uncovered populations ( hispanics, blacks, and those with low incomes) have gained health insurance coverage since 2010 (different survey methods and timing cause the difference in results).
  • 11.7 million Americans selected a health plan through the health insurance marketplaces established by the ACA. 87% of those people were eligible for federal subsidies of premiums.
  • 10.8 million additional Americans have enrolled in Medicaid since the ACA was passed.
  • 3 million previously uninsured young Americans have gained coverage through the ACA extension of dependent coverage to age 26.
  • 8-12 million Americans have benefitted from the ACA’s regulation that prevents insurers from discriminating against people with preexisting conditions.
  • 75% of those newly insured seeking appointments with primary care or specialist physicians have secured one within 4 weeks or less.

Delivery-System Reform:
“ The law constitutes one of the most aggressive efforts in the history of the nation to address the problems of the health care delivery system through funding many divergent experiments though lacking a coherent strategy.” (1)  The Commonwealth Fund report lumped the efforts into four categories.

1. Changes in Payments:
Reduce readmissions – There are 150,000 per year fewer Medicare hospital readmissions within 30 days of discharge partly attributed to ACA financial penalties to hospitals with higher than expected readmission rates.
Reduce hospital-acquired conditions – ACA financial penalties to hospitals in the highest quarter of avoidable hospital-acquired conditions may have helped the composite rates for those to drop by 17% from 2010 to 2013.
Pay for Performance – ACA payment incentives to hospitals and physicians to improve their performance on various cost and quality measures: “too early to tell”.
Bundled payments – This departure from fee-for-service reimbursement pays the hospital, the physician, and post-hospital services with a single payment for a procedure or condition. 7000 providers have signed up for it, but it is “too early to tell”.

2. Changes in the Organization of Health Care Delivery:
Accountable Care Organizations (ACOs) – An ACO is an organization of physicians and hospitals formed to improve the integration and coordination of ambulatory, inpatient, and post-acute services for a defined population of Medicare beneficiaries. 405 ACOs are participating in a program that allows them to keep a portion of any cost savings they can generate without degrading quality. Although the pilot program of about a dozen Pioneer ACOs “saved” $385 million in the first two years, it is “too early to tell” if the others will have a postive effect.
Primary Care Transformation – A pilot program to reduce costs and improve quality in primary care has shown a $14 per month cost reduction per Medicare enrollee and less emergency room visits and hospitalizations in the 2.5 million patients participating in its first year, but it is “too early to tell”.

3. Changes in Workforce Policy:
The effects of increased primary care reimbursement for Medicaid patient services, increased National Health Service Crops scholarships for practicing in underserved areas, and establishment of a National Health Care Workforce Commission (but remains to be funded by Congress) are all “too early to tell”.

4. Increase Innovation in Health Care Delivery:
The Center for Medicare and Medicaid Innovation (CMMI) was funded at $1 billion a year for 10 years to undertake a wide variety of experiments in improving quality for patients and reducing the 43% share of national health costs now paid by the government.

  • Commonwealth Fund says: CMMI is perhaps the most promising of the ACA efforts, but “way too early to tell”.
  • The CMMI itself reports it has launched 26 “demonstration models” of cost reduction and quality improvement. The Pioneer ACOs mentioned above is the first model “to meet the statutory criteria for expansion”.(2)
  • A separate report from Weil Cornell Medical College Department of Healthcare Policy and Research states that to date the CMMI has spent only one-third of its $10 billion, that it seems to be slow in distributing data from its experiments to participating organizations, and that it is hampered, as most quality improvement efforts are, by the lack of consensus on what constitutes “ improved quality”. So it is “too early to tell” (2)

Wow, that is definitely more than you may have ever wanted to know about the ACA so far!
It is certainly more than I can remember.
It is clear that Obamacare does have a lifetime before it.
As that lifetime unfolds one can only hope that responsible adults will guide it through its future developmental stages.

Bottom line: carry a small laminated copy of this blog in your pocket or purse to pull out when engaged … embroiled, …immersed, …or even entangled in any discussion about Obamacare, which will continue, even if Hilary renames it.

Remember, Medicare was just as controversial when first passed. One governor that opposed Medicare actually mobilized his state’s National Guard the day Medicare was passed in fear of the hordes of newly insured people that he expected to overwhelm emergency room departments.

1. NEJM June 18, 2015;  The Affordable Care Act at Five Years
2. NEJM May 21, 2015;  Assessing the CMS Innovation Center

Vol. 126 June 15, 2015 New Ways to Identify Individuals

June 15, 2015

hub“Getting to know you,
“Getting to know all about you …”

– Anna, from The King and I

Our concern about “privacy” springs from the awareness of the many ways that new technology can let other people learn about us and identify us; gleaning info from the net, monitoring phone activity, screening videos from ubiquitous security cameras, or even being photographed by a drone. It is not like we need to read about another technology people can use “to get to know us”, to identify us, whether we like it or not. Well, read on dear reader.

Individuals can now be identified by their intestinal microbes, their bacteria, like they can be identified by their fingerprints. The pattern of types and amounts of microbes in feces apparently varies by individual, and researchers at the Harvard School of Public Health were able to correctly identify which stool sample came from which person 80% of the time. We all have our own specific, consistent microbial “stool print” that remains fixed over months and even a year. No one is certain whether it is genetics, or diet, or just happenstance, but our gut flora, our intestinal microbe community, remains fairly consistent and is different for each individual. These “microbial fingerprints”, if known in the 1920’s, sure would have added another meaning to the name “Bugs Moran”.

Stool microbial fingerprints are not as reliable as DNA match-ups, and we will learn much more about that when the case of the “devious defecator” goes to trial this month in Atlanta, Georgia. The case is a result of the mysterious periodic appearances of human feces in a retail food warehouse. Laborious, traditional detective work by the employer narrowed the suspects down to two men. Each was asked for, and consented to, a mouth swab for DNA to compare with the DNA in the feces piles. Neither man was a match, so no action was taken, BUT a judge has decided that the men’s suit against the employer can go forward to a jury trial on damages ( “ridicule, embarrassment, and humiliation” ) under GINA.

GINA (Genetic Information Nondiscrimination Act)  was passed seven years ago to prevent employers and insurers from using genetic information to avoid hiring people who have genes that increase the risk of them developing a costly disease. Under this law the employer cannot ask for or buy genetic information. Even though no information on disease risk was sought or obtained in this case, the judge ruled that “a genetic test is a genetic test is a genetic test”, and the case could go to trial. In other words, “Any genetic test done to embarrass or harm an individual violates federal law”. (1).  So, “s**t happens”, and now they can tell that it’s your s**t, but your employer may not be able to do anything about it.

Meanwhile back in Boston, Harvard researchers have developed a $25, single-drop-of- blood test that can identify which of 1000 strains of 206 viruses an individual has contracted in his or her lifetime. People from different countries (U.S., South Africa, Thailand, and Peru) had different “viral fingerprints”, presumably from different exposures. If the researchers can identify your country by a viral pattern, one can only wonder how precise an identification tool this might become with 1000 x 206 data points. The test takes months to complete and is available now only as a research tool, but the patent is pending. (Virscan)

So, as we watch technology advance from fingerprint identification to bacterial, viral, and DNA “prints” as new ways for others “ to get to know us”, it is natural to ask, “Can ‘energy prints’ be far behind?”

1. NY Times June 2,2015, D6

%d bloggers like this: