What we should look at is the clinical outcomes of these trials, including against the variant. That’s something we should care about and we can interpret. And there, it’s been non-stop good news if you look at the right metric. For most of these trials, our “endpoint” has been things like any disease, however minor, even sniffles. Even when we look at “severe” disease, it isn’t what most of us think of as severe: hospitalization, ICU, ventilation and such. So what’s the news there? Since the beginning of the trials, all trials, there has not been a single death or hospitalization among people vaccinated. Not one. Zero. Not for Moderna, not for Pfizer/BioNTech, not for Oxford/AstraZeneca, not for Sputnik, not for J&J, not for Novavax.

“We’re telling you that no one should be out here because it’s dangerous, but we’re sending you out there and we’re not giving out any masks.” --- The bus driver, who declined to be named for fear of losing her job, is one of hundreds of thousands of Brooklynites still working essential jobs, even as the borough is hit hard by the coronavirus. Twenty-eight percent of New York City’s essential workers live in Brooklyn — the most in any borough — and the vast majority of them are people of color. In Brooklyn, the number of deaths outpaced those in Queens on Sunday. Brooklyn has more than 2,606 confirmed COVID-19 deaths and 865 “probable” COVID-19 deaths, according to NYC data released April 19.

Older black people are more likely to die of the virus that their white counterparts – among those lost are prominent black pastors, performers and civil rights activists. --- Coronavirus has claimed more than 45,000 lives in the US as of Tuesday – especially those of older Americans, who represent 91% of all Covid-19 deaths. Within that vulnerable population, older black people are more likely to die of the virus than their white counterparts. And among those lost are prominent black pastors, performers, and practitioners who lived through struggles for civil and cultural rights in their communities.

How social media, FaceTune, and plastic surgery created a single, cyborgian look. --- Then the celebrity doctor came in, giving off the intensity of a surgeon and the focus of a glassblower. I said to him, too, that I was just interested in looking better, and wanted to know what an expert would recommend. I showed him one of my filtered Snapchat photos. He glanced at it, nodded, and said, “Let me show you what we could do.” He took a photo of my face on his phone and projected it onto a TV screen on the wall. “I like to use FaceTune,” he said, tapping and dragging. Within a few seconds, my face was shaped to match the Snapchat photo. He took another picture of me, in profile, and FaceTuned the chin again. I had a heart-shaped face, and visible cheekbones. All of this was achievable, he said, with chin filler, cheek filler, and perhaps an ultrasound procedure that would dissolve the fat in the lower half of my cheeks—or we could use Botox to paralyze and shrink my masseter muscles. […] What did it mean, I wondered, that I have spent so much of my life attempting to perform well in circumstances where an unaltered female face is aberrant? How had I been changed by an era in which ordinary humans receive daily metrics that appear to quantify how our personalities and our physical selves are performing on the market? What was the logical end of this escalating back-and-forth between digital and physical improvement?

The gun debate would change in an instant if Americans witnessed the horrors that trauma surgeons confront every day. --- Goldberg jumped in. “As a country,” Goldberg said, “we lost our teachable moment.” She started talking about the 2012 murder of 20 schoolchildren and six adults at Sandy Hook Elementary School. Goldberg said that if people had been shown the autopsy photos of the kids, the gun debate would have been transformed. “The fact that not a single one of those kids was able to be transported to a hospital, tells me that they were not just dead, but really really really really dead. Ten-year-old kids, riddled with bullets, dead as doornails.” Her voice rose. She said people have to confront the physical reality of gun violence without the polite filters. “The country won’t be ready for it, but that’s what needs to happen. That’s the only chance at all for this to ever be reversed.” She dropped back into a softer register. “Nobody gives two shits about the black people in North Philadelphia if nobody gives two craps about the white kids in Sandy Hook. … I thought white little kids getting shot would make people care. Nope. They didn’t care. Anderson Cooper was up there. They set up shop. And then the public outrage fades.” […] There’s no medical reason for a patient to be in a hospital longer than necessary. The point was the ridiculousness of the situation. A woman gets shot through no fault of her own, she comes to the hospital scared, and if she’s OK, Goldberg says, “It’s like, here, take a little Band-Aid.” The woman goes home, and for everyone else in the city, it’s as though the shooting never happened. It changes no policy. It motivates no law. In a perverse way, the more efficiently Goldberg does her job inside the hospital, the more invisible gun violence becomes everywhere else. Which is why she pours so much of herself into the outreach programs, the scientific studies and any other method she has of finding control and making the problem visible.

Is there a dietary treatment for multiple sclerosis? And if so, why is the medical establishment ignoring published academic research that started in the 1950s proving it? --- Clinical research evolved the way it did for sound reasons, but the new standards came, as innovations will, with complications of their own. It’s easy—and tempting, given the profits involved—to paint all this as the corporate conspiracy of Big Pharma, but the real problem is rooted in something else. We’re in the middle of a generalized epistemological failure brought on by a too-narrow understanding of “proof.” We’re in thrall to the tyranny of data. This deeper problem both weakens our clinical research institutions, and makes them vulnerable to charlatans and profiteers. […] In Montreal, Roy Swank made observations, took measurements, and then constructed an argument about multiple sclerosis which, while it cannot be proved, may yet be useful. But by narrowing the field of “proof” or reliable information to include only that which can be supplied by the results of randomized controlled trials, people like Dr. F. have lost the ability to evaluate the worth of a useful argument like Swank’s, let alone construct one. The growing intensity of commercial and regulatory pressures on scientific research has worsened the rhetorical climate still further. This is the source of our epistemological catastrophe in both the medical profession, and in the broader scientific community.

The more we are able to accept the decay of the body after death, the easier it becomes to accept the decay of the body before death.

Like superheroes, each pain reliever has its own set of strengths and weaknesses.

A $3 squirt of CBD oil on your ice cream or coffee? Probably right around 10 mg. You’d need 30 times that amount to get to the levels at which researchers have found stress-relieving results. […] it wouldn’t be fair to say that 5 or even 20 mg of CBD oil in your coffee is proven to do nothing; that hasn’t been proven. It’s more accurate to say that 20 mg of CBD oil in your coffee has never been proven to do much of anything, and related research indicates that’s probably way too low of a dose to have any measurable effect. […] One study found that placebos sometimes work even when the subject knows it’s a placebo. Another, using that same public speaking setup that CBD studies have used, found that anxiety treatments are particularly susceptible to the placebo effect, with 40 percent of placebo-treated patients showing a decrease in anxiety symptoms while tasked with speaking to a crowd. So is it possible that despite all this anecdotal evidence, low-dose CBD is a placebo? Sure, because, say it with me: We don’t know anything about CBD. […] There are big companies and small companies, companies that provide elaborate chemical charts and companies that have no online presence at all. There are companies that run their goods — either as raw materials or as consumer-stage final products — through lab tests. There are those that say they do but provide no information on what the labs found or which labs tested their products. Everyone wants a piece of CBD, and nobody is watching. Remember: There’s no regulation by the FDA or anyone else. […] In 2016, the FDA tested several “CBD oils,” ultimately issuing warnings to eight companies. Some of those oils were found to contain no or barely any CBD, and many contained illegal quantities of THC. […] CBD, though wildly understudied, is not bullshit. In fact, the FDA just approved its very first cannabis-derived drug, a CBD-based epilepsy treatment called Epidiolex. The dosage for Epidiolex starts at around 2.5 mg/kg and is increased to 5 mg/kg, so a 150-pound adult would settle onto a dose of just over 340 mg per day, though the diseases it targets start in childhood. Even some of the claims made by recreational CBD sellers aren’t bullshit, in the abstract. CBD really does show some anti-inflammatory properties. It really does have anxiolytic effects, in certain situations. Of course, it’s the scammy nature of herbal supplements that a seller can say something like “CBD has been indicated to reduce anxiety” (a true statement!), even though the actual product you’ve got in your hand has never been indicated to do so. Nutmeg, for example, will act as a dangerous psychoactive drug at high levels, but it would be deranged to put “scientific research has shown that nutmeg can get you high as hell” on a pumpkin spice latte. It’s correct, but it’s also incredibly misleading. We don’t know how CBD affects the brain in any kind of depth. We don’t know which doses and delivery methods are best for different outcomes. We don’t know how CBD interacts with most other drugs or foods. We don’t know the differences between the effects of isolates and full-spectrum preparations. We don’t even know how many cannabinoids there are. California, for what it’s worth, seems aware and concerned about this whole thing. But a lack of data does not hinder capitalism; it is, rather, a huge help. When nobody knows anything, you can say — or imply — anything. More importantly, you can sell everything.

100 years ago doctors had little credibility.  A education reformer's report remarkably reformed medical education and physicians' professionalism.  In the last thirty years this credibility has been eroded by financial ties between doctors and the drug companies.  Is it time for another Flexner Report. […] It's not enough to have doctors' payments from drug companies listed on some website. In every waiting room, patients should be able to read clear signs indicating doctors' payments received from companies and the specific drugs and products involved. In the long term medical research and academia must find a better way to separate their work from their sponsors' money. A general research fund of drug company money directed by an independent board has been suggested but seems unlikely given the profit driven priorities of the drug industry.

This is an amazing piece. Robert Kirkbride, a descendent of famed physician and asylum architect Thomas Story Kirkbride, told CityLab in a 2015 interview that “Buildings didn’t commit people. People committed people. But it’s easier to blame buildings than human behavior.” This is accurate. But buildings are also assets, and their value gets determined, in part, by the residue of the human actions that took place within them. It isn’t just lead paint and asbestos that a building like this has to reckon with; it’s the cruel history it can represent. And yet people don’t really seem to “blame buildings,” as far as I can tell. The opposite: architecture is the thing that redeems them. As they are sanitized, loss in the past becomes gain the developer, in the present, speculating on the future. [...] Architecture matters. Buildings reflect who we think we are, and who we want to be; in this redevelopment, we’re invited to imagine ourselves as people who treat the most vulnerable among us with care and tenderness. To those who cannot be repaired we would give ethereal, pastoral beauty; what God could not provide through the bounty of nature, we would give, in the spirit of brotherhood for our fellow man. In this way, in this place, we stake a claim to the legacy of those who eased suffering; we claim we are people glad to marshal our wealth in compassionate acts.

Rebecca Skloot article on veterinarians who treat fish, as field evolves to meet demands of pet owners; number of households that keep fish is about 13.9 million, and there are nearly 2,000 vets to serve them.

Perhaps we need to ask our patients how they would design their ideal emergency department. Has anyone thought to do that? I know they would like caring, kind, compassionate staff. Staff who are not carrying serious emotional damage with them to work and back every day. It would be good for all of us to get this right. And soon.

Now researchers at the Massachusetts Institute of Technology have devised a radical new approach to brain imaging that reveals what past studies had missed. By mathematically analyzing scans of the auditory cortex and grouping clusters of brain cells with similar activation patterns, the scientists have identified neural pathways that react almost exclusively to the sound of music — any music. It may be Bach, bluegrass, hip-hop, big band, sitar or Julie Andrews. A listener may relish the sampled genre or revile it. No matter. When a musical passage is played, a distinct set of neurons tucked inside a furrow of a listener’s auditory cortex will fire in response. Other sounds, by contrast — a dog barking, a car skidding, a toilet flushing — leave the musical circuits unmoved.

Experts recommend people stay on antidepressants for four to nine months after remission, but some keep taking them for years.

For any discoveries that Murphy makes, the road ahead is paved with obstacles. Safety testing, animal testing, and then finally, the hope that a drug company and its investors can be persuaded to gamble hundreds of millions on the chemical passing the multiple stages of human clinical trials, before it can be turned into an over-the-counter product. The odds seem slim, but with the annual global mortality rate from antibiotic resistance predicted to hit 10 million in the next 35 years, scientists remain hopeful that the politicians will come to better agreements on how to finance antibiotic development. The question is, will they get around to doing so before it’s too late?

On fibrodysplasia ossificans progressiva.

Governor Romney has repeatedly promised that on his first day in office he will work to repeal Obamacare. Insurance companies will again be free to deny my family coverage for whatever reasons they see fit. The Ryan budget which Governor Romney plans to enact as president includes enormous cuts to Medicaid. A vote for the Romney/Ryan ticket is a vote to completely destroy the financial security and medical safety of my child and family. If you are planning on voting for him I’m sure that you are doing it for other reasons but these will be the consequences of that decision. You may not like hearing it but it’s the truth. A vote for Romney/Ryan is a vote that will hurt hardworking Americans like me and my family.

the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized.

This 10,000-rpm, no-pulse artificial heart doesn't resemble an organic heart--and might be all the better for it.

‘When it comes to IVF, in-vitro fertilization, nothing is normal. Your world is upside-down. Your doctor compliments your wife on her monkeys. Then, when every dollar and exertion has gone toward a single hour of hope, it begins to snow.’

Worth looking into, perhaps.

A ton of scientific studies are flat-out wrong. And most of it doesn't really matter anyway. "‘Science is a noble endeavor, but it’s also a low-yield endeavor,’ he says. ‘I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.’"

"Your Guide to Quackery, Health Fraud, and Intelligent Decisions"

"Atul Gawande gave the commencement speech at Stanford’s School of Medicine last week. Here is what he told the graduating class." On the need for building interconnected systems of care in medicine, rather than a hodgepodge of specialists not communicating with each other.

"ClearRx is a trademark for a design for prescription drug packaging, designed by design student Deborah Adler as a thesis project and adopted by Target Corporation (with refinements by industrial designer Klaus Rosburg) for use in their in-store pharmacies." Very well done.

Good story, personal writing from one of the more entertaining and interesting blogs out there. (And four tracks from the new Andrew Bird album.)

Green, simple healthcare. "Our packaging is made from 100% recycled materials and it is compostable, which means one day, it will probably become a part of a large tree. Maybe you can cut down that tree and make it into a speedboat."

From the US National Library of Medicine, a huge collection of free, public-domain images from anatomical atlases. A great wealth of material. Wish it were designed better and that the books were all scanned rather than some photographed.

A good collection of information.