Vol. 194 June 1, 2018 Some DOs and DON’Ts

June 1, 2018

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Avoid fried meats which anger up the blood.
-Satchel Paige’s Guide to Good Living


DON’T drink alcohol
 Really?? I thought red wine prolonged your life by preventing certain types of heart disease. That IS the current wisdom. It is thought to be the compound reservatrol that provides that benefit. If you believe that then eat lots of grape skins, peanuts, and blueberries for their reservatrol.

A Lancet Journal study of 600,000 current  high-income European drinkers suggests that the threshold for an increased risk of cardiovascular disease is LESS than previously thought. The U.S. Dietary Guidelines, based on previous studies, state that one glass of wine daily for women and two glasses daily men is carries no risk and might even be beneficial. This Lancet study suggests that the threshold of increased risk of death from cardiovascular disease is just one glass a day, regardless of gender. Reviewers of the study remark that such guidelines are not very helpful for individuals. Remembering that obesity kills more people than alcohol is helpful for the context. But, alcohol deaths are still more common than opioid deaths. About one-third of driving fatalities involve alcohol-impaired drivers. In one study 40% of convicted killers said they were under the influence of alcohol when they committed homicide. About 25% of suicides are alcohol related. So, again, as they say on Fox radio news, “We report. You decide.”

DO measure your PAS (Prostate-Specific-Antigen) if your 55-69 years old.
DON’T measure it if you’re 70 or older.
This is a more neutral update of the 2012 U.S. Preventative Services Task Force recommendation against PAS testing because of studies showing overly aggressive diagnostic testing and treatment of low risk patients based on the PAS level. Nowadays “active surveillance” rather than “aggressive treatment” has become the norm as has “shared decision-making” ( the fancy label for discussing the results and management options with your primary physician).

DON’T smoke marijuana if breast-feeding.
A very small study (8 women from Denver, … from where else but?) had their breast milk analyzed for THC at different times after smoking a standard joint. Calculations showed that about 2.5% of the inhaled dose was ingested by the infants. The THC levels in the breast milk were highest in the 1 and 2-hour post-joint breast milk samples . The 20 minute and 4 hour post-joint samples were one-half that. Those breast milk levels are very low, would not cause any apparent change in the infant’s behavior, but the effect of any exposure of cannabis to the developing brain is unknown. No THC metabolites were found in the breast milk.

DO consider liquid nicotine for e-cigarettes as dangerous for toddlers.
One quarter of the nearly 9000 children under 6 years old that got into liquid nicotine meant for e-cigarettes during 2012-2017 had significant clinical effects from the ingestion. Many states, but not all, have legislated child-proof packaging of the liquid nicotine as a result.

DO use the right words for childhood obesity.
Apparently Latino children are more apt to be obese than non-Latino children. A study has shown that those children and parents prefer the words,”unhealthy weight” and “too much weight for the child’s health”. DON’T use “chubby”, “fat”, gordo”, or “muy gordo”. The words “high BMI” and “overweight” were judged to be not motivating in BOTH languages. I guess words DO matter.

DO ignore baby formula marketing pitches.
If you don’t breast feed your infant, then DO use any cow’s milk formula. All the cow’s milk formula’s with added iron are the same nutritionally. DON’T be led astray by marketing ploys like “added amino acids”, “probiotics added”, ” more digestible protein”, etc. The global baby milk formula market is close to $62.5 billion. The only beneficial added ingredient to formula is iron.  Most babies do very well on whatever cow’s milk formula you give them.  Some special infants may need special formulas, but it is a small number. Vegetarians and babies with galactosemia can use soy-milk formula. Otherwise, all infants are “of course, above average” and can thrive on what ever cow’s milk with iron formula you buy for them.

DO reconsider your child’s allergy to penicillin.
Formal allergy testing of 100 children making an ER visit and labeled as “allergic to penicillin” revealed that 0% (nada) of those children with previous low-risk symptoms of penicillin allergy were actually allergic to penicillin. In a follow-up of those children one year later, 60% of them had been given penicillin treatment without incident or allergic reaction symptoms. The estimated savings from using penicillin instead of the higher priced non-penicillin antibiotics for all of the 6700 patients who visit that ER annually with a diagnosis of penicillin allergy was $192,000.

DON’T spend your money for SPF over 30 in sunscreens.
An SPF of 15 blocks 94% of UVB rays. SPF 30 blocks 96%. SPF 40 blocks 97%. None of the usual sunscreens available in the U.S. block the UVA rays which penetrate deeper in the skin and cause aging of the skin. The FDA continues its years-long study of UVA blocking sunscreens already available in Europe. DO put on the sunscreen 30 minutes before going out in the sun to allow its ingredients to activate the skin, and re-apply 20 minutes after exposure to the sun.

and finally . . .

 Avoid running at all times.
DON’T look back. Something might be gaining on you.
– Satchel Paige’s Guide To Good Living


Vol. 193 May 15, 2018 Antibiotics are Beneficial: A Reminder

May 15, 2018

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A disease outbreak anywhere is a risk everywhere.”
-Dr. Tom Frieden, Director U.S. CDC


We read a lot about the dangers of using too many antibiotics. The popularity of “organic foods” is due in part to their claim to be from “antibiotic-free” animals and plants. Concern about the increasing antibiotic resistance of germs due to antibiotic overuse is real as is frequently described in scientific journals as well as the general press. Why, then, would the New England Journal of Medicine publish an article describing the benefits of random, mass distribution of an oral antibiotic to nearly 100,000 children who had no symptoms or diagnosis! Maybe because that effort reduced the death rate of children aged 1-5 months by 25%!

As you’ll remember in my last blog,  I was impressed by Bill Gate’s knowledge of the medical literature because during his presentation he cited this antibiotic clinical trial which had been published that very same week. Well, full disclosure, he knew about the study because his foundation funded it! This study is the kind of innovative medical study related to global health that the Bill & Melinda Gates Foundation supports. I think it is worthwhile to review the details of the study, if just to remind us that antibiotics are good, that medical science advances on the shoulders of previous work, and that sometimes simple answers, like putting iodine into salt or fluoride into water, can prevent a whole lot of disease.

Previous studies in sub-Saharan Africa showed that blindness caused by trachoma, an infectious disease, could be reduced markedly through the mass distribution of an oral antibiotic, azithromycin. Other studies suggested that the same antibiotic could prevent other infectious deaths like malaria, infectious diarrhea, and pneumonia. It is known that azithromycin affects the transmission of infectious disease, so that treatment of one person might have benefits on others in the same community. The data in two of these studies of trachoma prevention in Ethiopia suggested that mass distribution of azithromycin “might” reduce childhood deaths. Since death (after the neonatal period) is a relatively rare event, even in these settings, the trial had to be conducted in a large population. Hence the need for a large grant to carry it out.

A single dose of oral azithromycin was given to 97,047 children aged from 1 month to 5 years in three African countries during a twice-yearly census. 93,191 children in different communities of the same countries were given a placebo. Over the two-year study the “treated” children received 4 oral doses of azithromycin, each about 6 months apart. Children were identified by the name of the head of the household and GPS coordinates of their location for subsequent censuses. Approval for the study was obtained from 9 ethics committees in 6 countries (3 in the US, 1 in the UK, and 2 in Africa).

The average reduction of annual death rates of children receiving a single dose of the antibiotic every 6 months was 13.5% . Children aged 1 month to 5 months receiving the antibiotic had a mortality rate reduction of 25%. At the conclusion of the trial all the children in the communities of Niger, which has one of the highest child mortality rates in the world and a mortality rate reduction of 18% for all ages in this study, were offered treatment with azithromycin.

This study is a beautiful example of the testing of a simple hypothesis, generated by the results of previous work, using innovative methods, requiring a large population for validity,  and implemented by a multi-national team of medical scientists with a large grant from a private foundation that resulted in clear benefits for better global health.

I, for one, am happy to trumpet some good news about antibiotics and this example of “medical research for all” at its best.

Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa, NEJM 378;17, April 26, 2018





Vol. 192 May 1, 2018 Infections Going Viral

May 1, 2018

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“World conditions are ripe for a pandemic like the 1918 influenza epidemic, but we, the U.S. and the world, are not prepared to fight it.” – Bill Gates, April 27, 2018

Ten experts (three of them had British accents, so they were particularly believable) agreed with Bill Gates when he presented this warning in the 2018 Shattuck Lecture at the Massachusetts Medical Society Annual Meeting in Boston last week.

The 1918 influenza virus first appeared in the U.S. in New York City and within just 5 weeks it had spread across the country to California resulting in 670,000 U.S. deaths. As you know, the flu virus changes every year and we can’t start making a vaccine until we recognize and identify “this year’s mutation”. It then takes months to produce, distribute, and administer a vaccine, so consequently our flu vaccine is always playing catch up. Since 1918 we have developed anti-viral medicines and a number of different antibiotics to combat influenza complications, so a repeat of such a lethal flu epidemic is today considered unlikely.

But it is the other viruses, the “novel viruses”, that concern the experts at this conference. For instance, 1000 “novel” viruses from different species which could potentially cross over to humans and cause significant disease have been identified over the past 8 years . Of these 1000 “novel” viruses, 891 are brand new, never before identified. Advances in genomic sequencing allow the specific identification of potentially pathogenic mutations, but as one speaker noted it has taken the U.S. Weather Service over 50 years to build a data base that allows “reasonably good” weather forecasts, so our ability to forecast the effects of new virus diseases is considered to be woefully rudimentary. (1)

We will probably receive the earliest warning signs of any new epidemic from mining the “digital exhaust” of our social networks, “flu near you” apps, crowd sourcing of symptom reporting, net-connected thermometers. upticks in certain prescriptions, volunteered Alexa conversations, Google search statistics, bot-driven AI, and locations of Uber-delivered medicines. (2)

The reasons the world is ripe for an infectious pandemic are: increasing population, increasing urbanization in developing countries, continued poverty that promotes inter-species living, routine rapid travel between countries, increasing frequency of natural disasters due to climate change, plus potential bioterrorism. Several speakers used a military preparedness metaphor, consciously using the verb “fight” and the noun “war”. For example, “If we knew our enemy was developing a new military weapon we would be throwing all sorts of resources at analyzing what the threat is, how to detect it at the earliest possible moment, how to defend against it, and how to deal with its effects if deployed. We should be doing the same for future infectious disease epidemics, and we are not.” (3)

Bill Gates was most impressive with his command of diverse, seemingly obscure facts like the per cent change of Uganda’s GDP, the identifying numbers of a new unnamed TB antibiotic, the three viruses that could mimic Ebola, and that in a recent study 4 almost random doses per year of the antibiotic zithromax reduced childhood mortality in developing countries by 50% in 2 years! He remains a man of vision as well , made it clear that the Bill & Melinda Gates Foundation would continue its support of innovative health and education efforts, and describes himself as an optimist. He nonchalantly reported that his foundation had just granted $12 million seed money to a group working with Glaxo (stock-pickers take notice) to develop a universal flu vaccine, one that would be effective against all flu virus mutations. (Such a universal flu vaccine was the #1 fervent wish of the Deputy Director of the CDC when asked for her hopes for the next ten years.(4))

 Our pandemic preparedness is not just a task for the medical/clinical sciences nor just for “new” technology.  The “old” technologies of anthropology and the fine art of negotiation were vital to a successful defense against Ebola. It was not until we recognized the cultural traditions of burial rituals of some African tribes, and persuaded them to change them, that we were able to contain the Ebola epidemic. (5)

Pandemic preparedness is not only a multi-disciplinary effort. It must also be political. Even as science advances, there must be the political will to deploy the resources before a pandemic attack . Of course, “urgent” often trumps even important “long term” needs in politics, but a pandemic is the equivalent of a war. By the time the battle is raging it can be too late to effectively marshal all the troops and equipment necessary to win. (3)

The consensus of the conference was: “The U.S. should continue to be the leader in global health security.”

1. Joanna Mazet, DVM, MPVM, PhD, Professor of Medicine, University of California, Davis
2. John Brownstein, PhD, Chief Innovation Officer, Professor of Medicine, Boston Children’s Hospital
3. Jeremy Farrar, OBE, FRCP, FRS, Director, Wellcome Trust
4. Anne Schuchat, MD, Principal Deputy director, CDC
5. Mark Gordon, Esq. Co-Founder Vantage Partners

Vol. 191 April 15, 2018 The Gun Violence Epidemic

April 15, 2018

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“EPIDEMIC” continues to be a common catch word for headlines. Apparently we have lots of epidemics; the flu, HIV, opioid, Zika, gun violence, etc. We spend a lot of tax money investigating and containing epidemics. . . . Oh, . . . all except for that last one: gun violence.

Why is that? In 1996 the Communicable Disease Center (CDC), our federal bulwark against harmful epidemics, was expressly instructed by Congress NOT to study anything related to guns, i.e. don’t give research grants, don’t establish data bases to track events, and don’t sic the EIS on the gun violence epidemic. In one of his rare Executive Orders President Obama instructed the CDC in 2012 to resume their gun violence research and asked Congress to allocate $10 million dollars for that purpose. Congress never did.

EIS stands for the Epidemic Intelligence Service, a division of the CDC. It has a stellar reputation for laser-focussed field analysis of incipient epidemics to guide early actions to contain them, to reduce any harm to people. Just last week the CDC launched an investigation into a cluster of 53 new HIV cases in Lowell, MA. (In 2007 Boston had a “cluster” of 92 gun-related homicides.) Ironically, the CDC remains hamstrung in any effort to collect and analyze data on the gun violence epidemic at a time when it is asking the general public to participate in identifying any other kind of potential epidemic via internet “crowd sourcing” .

The CDC does keep mortality statistics and issues an annual report of causes of death for each state. The difference of gun-related death rates  between states is huge, and  no one really knows why. Massachusetts had the lowest number of gun-related deaths in 2016: 3.4 deaths per 100,000 population, or 242 gun-related deaths in Massachusetts that year. Texas, Florida, and California had 3,353, 2,704, and 3,184 gun-related deaths respectively that same year. Those three states also had the most suicide deaths and the most accident-related deaths of all the states. That’s interesting, but those rates may not be related in any way to each other . Food for thought? Too bad the CDC can’t collect more data on gun deaths.

A gun is the harmful agent in this epidemic just as a virus is the harmful agent in the AIDS epidemic. True, human behavior is the cause for both of the epidemics spreading, but while we are developing a HIV vaccine we have implemented effective measures to contain the epidemic with “safe sex” campaigns, identification of risk factors, pre-natal treatment of HIV-positive pregnant women, early treatment of exposed newborns, and development of successful medical treatments. All of this was accomplished with the support of the CDC and NIH. Why not provide government support for similar interim steps to reduce the gun violence epidemic? Medical societies and many citizen groups have picked up the “safe gun” banner. Why hasn’t the federal government done so?

One answer is, of course, money. The NRA contributed money to 205 House members (189 Republicans and 16 Democrats) and 42 Senators (35 Republicans and 4 Democrats) in 2012. The Democratic Senator that got the most NRA money got less than the 41 Republicans above him or her on the list. 95 of the top 100 NRA money receivers in the House were Republicans. Most analysts actually consider this as “chump change” ($5,000-10,000 per Congressman) compared to the $18.6 million that the NRA spent on NRA-favorable candidates in the 2012 elections. Analysts speculate that the money buys “allegiance” rather than “influence” (whatever that means). We all know it buys lots of “thoughts and prayers.”

Another answer may be that there are more guns than people in the U.S. It is as if everyone had AIDS, or as if HIV- infected people considered it their constitutional right to do anything with it they wished to. We as a nation did a lot to reduce the harm of HIV without abolishing the HIV virus. Why can’t we take the same approach to gun violence? We could do quite a bit without abolishing guns if we could do research about how guns are spread, how they are used for harm (In fact, 50% of gun deaths are suicides), how we could reduce harmful use (electronic signatures, smart guns, trigger locks, no multiple cartridge magazine, etc.).

The significant reduction of auto accidents deaths was accomplished by multiple means (seat belts, car seat regulations, air bags, electronic sensors, changes in car manufacture, speed limit regulations, etc,) and not by abolishing cars or drivers’ licenses. With better data perhaps we could take effective action to reduce the gun death epidemic.

Claritin:gun cartoon

Vol. 190 April 1, 2018 Back To The Future

April 1, 2018

Hub thumbnail 2015On April 1st I have always published an April Fools Day blog; blogs that were clearly outrageous, but just believable enough to fool a few people. This year is different. The daily broadcasted “fake news”, and real news, is so outrageous and often almost believable that anything I could conjure up would pale by comparison. Besides, it would be very difficult for me to match the parody standards of Stephen Colbert, Samantha Bee, Trevor Noah, and SNL and their room full of writers. So today’s blog will present some fun facts from the past. They are true, and could, perhaps, give us a tiny bit of comfort in remembering past turmoil as ironic glimpses or even premonitions of the future that we now endure.

“What You Can Do About Today’s Hospital Costs”
             “Like everything else, the cost of being sick or hurt has gone up sharply. These skyrocketing medical costs have put millions of Americans in a dangerous spot, because their health insurance is no longer enough to pay the bills. So even though they have some protection, an illness or accident could cost them hundreds or thousands of dollars out of their own pockets. It could put them deep in debt for years to come. . . When you get sick or hurt, these plans pay you generous cash benefits that are tax free!”
– Look Magazine 7/29/1969, an ad from Bankers Insurance Co. for a Medicare gap policy when hospital stays were “$59-A-Day”. (see Hubslist March 2010)

Campaign Contributions to Members of Congress
               “The American Medical Political Action Committee (AMPAC), the political arm of the American Medical Association (AMA), contributed $2.4 million to candidates for Congress during the 1989-1990 campaign and $2.9million during the 1991-1992 campaign. . . . The AMPAC tended to support political conservatives, who tended to vote against the AMA positions on public health issues [like tobacco sale restrictions, handgun control, and repeal of the abortion “gag rule”] but who backed the AMA on political and economic issues.”
– January 6, 1994, New England Journal of Medicine Special Article, 330: 1, pg.32-37 (see Hubslist August 2009 )

A Short History of Medicine
“Doctor, I have an earache.”
2000 B.C. – “Here, eat this root.”
1000 B.C. – “That root is heathen, say this prayer.”
1850 A.D. – “That payer is superstition, drink this potion.”
1940 A.D. – ” That potion is snake oil, swallow this pill.”
1985 A.D. – “That pill is ineffective, take this antibiotic.”
2000 A.D. – ” That antibiotic is artificial. Here, eat this root.”
2020 A.D. – “That root is expensive. Here, put this warm oil in your ear.”
– February 7, 2000 from the internet, [We will read a lot more about placebo effect
in the next few years.] (see Hubslist2009)

My Palm Pilot
“I have discovered that my Palm Pilot was endowed by its creator with certain inalienable rights to do e-mail, check stocks, book travel arrangements, and browse the Web. But I have merely used it as a Rolodex and a date book. . . . I have had the creepy feeling that I’m not living up to the expectations of any kind of my new technology. . . . A recent Wall Street journal article warned us of the onslaught of more such gizmos. . . .I resist spending an enormous amount of time forming relationships with technology that I know from experience is likely to leave me. . . .In the same amount of time, Americans can either figure out their new software or their new tax package. . . .Every day we get more tools to do things that we don’t really want to do but feel dumb for not learning to do.”
– Ellen Goodman, April 1999, Boston Globe (see Hubslist December 2013        )

Before Emoticon Icons
:-)))   laughing out loud
:’-(   crying
:-II   angry
:-@   screaming
{ }   hug
:-*)   kiss
– 2001 from the internet.

Dilbert Explains Stock Investing
“First, employees provide valuable data.
A manager refines the data.
The CEO gives ‘visibility’ to analysis.
Accountants publish bad news in footnotes using a combination of nanotechnology and gibberish.
Discount brokerage firms tell you that you’re smart.
Investors present their own research on TV programs.”

– Dilbert by Scott Adams, May 2, 2004

As an encore. . .  a “blast from the past” in biblical verse to once again remind us that “nothing changes while everything changes”.

Lamentations of the Father

“Hear me, O my children, for the bills they kill me. I pay and pay again, even to the twelfth time in a year, and yet again they mount higher than ever before. For our health, that we may be covered, I give six hundred and twenty talents twelve times in a year; but even this covers not the fifteen hundred deductible for each member of the family within a calendar year. And yet for ordinary visits we still are not covered, nor for many medicines, nor for the teeth within our mouths. . . .  And when the month of taxes comes, I will decry the wrong and unfairness of it, and mourn with wine and ashtrays, and rend my receipts. And you shall remember that I am that I am: before, after, and until you are twenty-one. Hear me then, and avoid me in my wrath, O children of me.”
– Ian Frazier 1999, “Household Principles”

Hubslist plugger cartoon 3:18                                                -1994



Vol. 189 March 15, 2018 Future Medical Breakthroughs

March 15, 2018

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Some predictions from the internet (“fake news?”) and some from investors ( “real news?”)


This first set of predictions, though reported on the internet, is from an interview with the CEO of Mercedes Benz who listed Tesla, Google, Apple, and Amazon as his current competitors, not other auto companies.

The Tricorder X price will be announced this year:  “There are companies who will build a medical device (called the “Tricorder” from Star Trek) that works with your phone, which takes your retina scan, your blood sample, and you can breathe into it. It then analyses 54 biomarkers that will identify nearly any disease.  It will be cheap, so in a few years everyone on this planet will have access to world-class medical analysis, nearly for free.  Goodbye, medical establishment.”

3D printing:  “The price of the cheapest 3D printer came down from $18,000 to $400 within 10 years.  In the same time, it became 100 times faster.  [3D medical devices like heart valve replacements are already being used in some major medical centers] All major shoe companies have already started 3D printing shoes.”

Alternative protein source:  “There are several startups that will bring insect protein to the market shortly. It contains more protein than meat.   It will be labeled as “alternative protein source” (because most people still reject the idea of eating insects).”

“All in” on smart phones:  “If it doesn’t work with your phone, forget the idea. There is an app called “moodies” which can already tell in which mood you’re in.  [MGH is currently testing such an app’s ability to accurately monitor cell phone self-reported feelings by high-risk psychiatric patients, so that any imminent suicide action can be identified and treated.] By 2020 there will be apps that can tell by your facial expressions, if you are lying.  [Current face-recognition programs at airports already are used to spot “potential terrorists”.] Imagine a political debate where it’s being displayed when they’re telling the truth and when they’re not.”

Longevity:  “Right now, the average life span increases by 3 months per year. Four years ago, the [U.S.} life span used to be 79 years, now it’s 80 years. The increase itself is increasing and by 2036, there will be more than one year increase per year.   So, we all might live for a long time, probably way more than 100.”

That’s it for the “pie in the sky” walk, but it’s money that talks. Where is it going?

Lab-cultured burgers
Edible animal protein that is brewed from animal stem cells in a bioreactor has passed the “taste test” for beef, chicken, fish, and duck, so that “this potentially trillion-dollar market opportunity” has attracted several Venture Capitalist funds. MosaMeat, the creator of the first “clean burger”, has received millions of dollars of VC investments. “The biggest challenge is taking what’s in the lab and making it commercially viable.” A pound of Memphis Meat costs about $2,400 to produce in the lab. That is about $600 for a Quarter Pounder. The company aim is to get it down to $5 – a true Value Meal. (Wired March 2018, pg.15)

Surgery-free biopsies looking for cancer
The detection of cancer cells circulating in our blood by identifying bits of cancer DNA shed into our blood by tumors is already used to “personalize” (i.e. adjust type of chemotherapy agents) in patients already diagnosed with cancer.  VC’s are currently investing billions (yes, that is a “b”) in several companies that are racing to develop DNA and genome-sequencing identification technics to detect tiny, currently non-suspected cancers in healthy people, all from a simple non-invasive blood sample.  The hope is to make an even earlier diagnosis of cancer. “Liquid biopsy detection” is still years away from being patient-ready, but it is not lack of money that is blocking sight of these “blood unicorns”; it is basic biology. (Wired, February 2018, pg. 16)

“Transparent Larry” guides robotic operation on real Larry
Larry Samrr (there should be a terminal “t” in his last name, but there isn’t) is an astrophysicist and astronomer at the University of California Davis who has been keeping precise records of his intake, energy output, and excretions (another output measure) for years. That data along with periodic MRIs, frequent blood and stool analyses, annual colonoscopies (real and virtual), and complete DNA sequencing (genome identification) data has been entered into a super computer at the California Institute for Telecommunications and Information Technology, (Calit2).  The super computer produces a constantly-updated 3D image of Larry’s insides, “Transparent Larry.” The computer made the diagnosis of Crohn’s disease in Larry way before clinical symptoms appeared. In 2016 it guided the removal of a diseased portion of his colon. The “Larry Transparent” image was fed directly into a da Vinci Xi robot his surgeon was using. It reduced the operation duration by about an hour. “Experimenting with fancy new technology is not always a surgeon’s top priority.” It helped that Larry’s surgeon was from a family of engineers and was immediately intrigued by “Transparent Larry”. (The Atlantic, March 2018, pg.28)

Nanoinfusions of DNA to regenerate, restore, and reprogram cells
Cells can be reprogrammed to do different functions by injecting them with different mixtures of DNA, RNA, and proteins, usually delivered by a virus. Such a method can produce indiscriminate immune responses to the virus, unintended injection into non-target cells, and other undesirable effects. Scientists have developed a tiny electronic chip (“nanochip”) that creates holes by electric current in only a portion of a mouse cell surface, so that a reprogramming mixture can be inserted at a precise dose  without “upsetting” the entire cell (“nanotransfection”). In mice this has allowed skin cells to build new blood vessels to help heal a damaged limb and to restore brain cells damaged by a stroke. “Human trials may begin in a year.” (Scientific American, December 2017, pg. 20)

I see by the old clock on the wall that I have run out of time (I seem to be about an hour late everywhere I go this week for some reason), so I can’t go on about other future medical breakthroughs in wearables, probiotics, medical marijuana, robotics, cryptocurrencies for your health insurance plan, obesity control, understanding teens’ brains, and, of course, many, many more apps.

Vol. 188 March 1, 2018 St. Valentine’s Day Massacre #2

March 1, 2018

Hub thumbnail 2015St. Valentine’s Day Massacre,
Chicago, Ill. 1929:
7 gangsters killed.

St. Valentine’s Day Massacre, Parkland, Fla. 2018:
17 kids & staff killed.

Firearm safety is a public health issue”
-Massachusetts Medical Society, February 2018

The 1929 massacre was partly responsible for the 1934 Illinois and 1935 Federal laws regulating machine guns. The laws actually did NOT ban the guns, They taxed them! The tax was $200 (about equivalent of $8000 today) and the annual license to own one was also very expensive. It effectively doubled the price of a tommy gun, the gangsters favorite. In 1986 the sale of fully automatic guns was prohibited by federal law “except those already existing in owners hands” that were grandfathered in. (1)

This year’s St. Valentine’s Day Massacre was the 30th mass shooting (more than 4 victims) in 2018 . . . so far. It was also the 17th time a gun had been fired on school grounds in 2018 . . . so far. AND on February 14, 2018 there were 28 additional gun deaths elsewhere in our country. (2)

Just to numb your brain with some more statistics (I know, I know . . .your eyes are already glazed over having read these numbers or others like them so many times), but during the period of 2009-2013 there were 722 per year firearm-related injuries Massachusetts, a state well-know nothing for its extensive of gun regulations . When you subtract the average of 121 suicides per year and 187 unintentional injuries per year some might say, “Only half are homicides. What’s the big push against gun violence.?”

And that’s when you can reframe the conversation into “gun safety”, not gun banning, not gun restrictions. That is the tack the medical profession is taking, and it might prove to be less confrontational to vested interests and more successful than other efforts.  Gun safety measures target preventing ALL of the 722 annual gun injuries. (pun intended).

The American Academy of Pediatrics strongly recommended a few years ago that pediatricians ask about gun safety as part of their usual assessments of household risks during a well visit; i.e. “If you have guns in the house,are they stored safe from the access of children?” One response was Florida legislature passing a law making it a crime for a physician to ask a patient or parent about gun ownership. The law was rescinded by the US Court of Appeals after the AMA brought suit.

In the same Feb. 24 2018 newspaper that Trump called for the arming of school teachers the Associated Press reported that 9,070 pupils (1 in 105 students) had to be physically restrained in Massachusetts school during the 2016-2017 school year.   244 of those incidents resulted in an injury to student or staff. Nationally the U.S. Education Department estimates that figure of physical restraint is at least 22,000 incidences per year. So, let’s just throw a gun into THAT equation! (CCT Feb. 24, 2018)

A relevant model of effective action is the decrease in auto fatalities by passing multiple laws and regulations, technological advances, and public education (Seat belts, airbags, speed limits, car cameras, etc.)

Smart gun technology  now exists to make guns safe, but they would still allow the owner to “repel any invaders of his house . . . or country”,  and might cut the number of gun injuries by 50%. Reducing mass homicides would require more regulation of automatic guns.

Organized Medicine’s new recommendations are to focus on gun safety.
1. Physicians should talk to their patients and families about gun accessibility, storage, and safety in the home.

2. The CDC should be allowed to conduct gun violence research (collect and analyze data)  like in any other public health epidemic.

3. Increase federally funded research on this “urgent health care crisis” of gun violence.

Many physicians belong to the NRA, “and that’s OK”. A physician friend of mine from Massachusetts was interviewing for a medical license by a physician panel in New Mexico. The chairwoman, noting his home state, asked him if he knew about gun control in New Mexico. He pleaded ignorance, and she responded, “A steady hand. Would you like an application to the NRA?”



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