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Disease superspreaders and the new coronavirus

Coronavirus — characterized by the halo of protein spikes that surround each individual virus particle — is the family that gave birth to SARS. Today, there's a new coronavirus stalking humans, especially in the Middle East. Scientists have documented 16 infections, and 10 fatalities. The good news is that there are probably lots of non-serious infections that aren't being reported, meaning the fatality rate probably isn't as high as it looks. Also, this coronavirus seems to have trouble spreading from person to person. But, in regards to that last factor, it's important to pay attention to a detail from the SARS outbreak that we still don't totally understand. Turns out, a handful of people were responsible for most of those infections. The Canadian Press' Helen Branswell writes about superspreaders and the scientists trying to understand how individuals can alter the course of an outbreak. (BTW: If you don't follow Helen Branswell on Twitter, you're missing some of the best infectious disease reporting out there.)

Independent midwives to march in London today to protest impending shutdown of indie midwifery

There are apparently no insurers in the UK willing to extend cover to independent midwives, and so independent midwives and their clients operate in an insurance-free zone, which is risky, but it was apparently a risk everyone was willing to take. However, a new EU regulation mandates that midwives operate with insurance, and once that regulation is implemented locally, it will end the practice of independent midwifery in the UK unless there's some drastic action to create an insurance policy to which independent midwives may subscribe.

We had our daughter at home with an NHS midwife, and it was wonderful. Not everyone is lucky enough to live in the cachement of a hospital with midwives who'll help mothers deliver at home (especially now as NHS budgets are being slashed to ribbons across the country). If this rule comes to pass in the UK without any insurance fix, having a baby safely at home will become effectively illegal for families across the country.

A silent protest is scheduled for today at the House of Commons:

This campaign continues with a Silent Protest and march in Westminster on Monday 25 March, from 11am, to lobby Government to protect women's right to choose their maternity care and find a solution to the issues raised by an EU Directive.

Independent Midwives are registered midwives who have chosen to work outside the NHS to be able to offer continuous care and support to women who choose it. This is the kind of autonomous midwifery that you see in the hugely popular programme “Call the Midwife”. Nowadays it is mostly only independent midwives who are able to provide what David Cameron once called “gold standard care”. Due to staff shortages and budgetary pressures very few NHS Trusts are able to provide this kind of care.

Sally Randle is an independent midwife in Bristol, offering local women an alternative to NHS care. Sally says, “I was lucky enough to practise this way in the NHS in London, but local maternity services did not provide this way of working. I decided to become an independent midwife so I could continue this rewarding work. I love my job; I don't even mind getting up in the night to go out to a birth because I know the family well and feel privileged to be involved in this amazing time in their lives”.

I can't figure out why insurers can't sort this out. The actuarial data set is robust and well-established. The potential liability, though high, is calculable. If you can get insurance to juggle machetes in Covent Garden (high potential liability, small data set, massive individual variation), why the hell can't indie midwives get cover?

Silent Protest and March (Thanks, William!)

The other problem with fake vaccine scares

It's not just that bad information on the "dangers" of vaccines is working to reduce the number of children getting vaccines — a fact that affects herd immunity. Now, there's evidence that the fake scares (and efforts to debunk them) are getting in the way of scientists publishing real evidence about actual problems with certain vaccines. These aren't the kind of broad "vaccines are poison" claims you're familiar with. Instead, we're talking about legitimate science documenting side effects that are usually very rare, but still have an impact on certain subsets of the population and need to be addressed. Maggie

Why "cancer clusters" are so hard to confirm

This excerpt from the new book, Toms River by Dan Fagin, has me instantly intrigued. The book is about one of the rare places where scientists were able to prove that not only was there a cluster of cancer cases, but that those cases could be linked to a cause. The excerpt explains why this is such a rare thing. Turns out, just because it looks like a town has more cancers than it should, doesn't mean that's always what's going on. Maggie

Grapefruit + prescription drug = overdose

There are 44 prescription drugs on the market today that should never be combined with grapefruit. That's because the sour fruit (and some other, closely related, kinds of citrus) contain chemical compounds called furanocoumarins that prevent your body from metabolizing certain prescription drugs. Essentially, the grapefruit creates an artificial overdose where one tablet packs the power (and side effects) of 20. The CBC has a full list of the drugs, which includes cancer drugs, cholesterol-lowering drugs, and drugs to treat problems of the urinary tract. Wikipedia has more about why this interaction happens. Maggie

Dr. Google proves himself somewhat useful

Googling what ails you sounds like a good and empowering idea — until you run into barren fields of Yahoo Answers, swamps of misinformation peddled by charlatans, and orchards of seemingly useful sites that yield only the bitter fruit of tiny bits of information you have already read 5000 times already. But, it turns out that Dr. Google can actually be good for something. At The New York Times, John Markoff reports on a study that found Google search data could be used to discover and track previously unreported side-effects of common medications. Maggie

Exergen Temporal Artery Thermometer

I like the Exergen TemporalScanner because with a gentle stroke of the forehead, I can get a person’s temperatureaccurately and almost instantly — without having to stick something in their ear, mouth, or any other orifice. I can even check a child’s temperature while they sleep. It’s very easy to use — but do read the instructions to get the right swipe motion.

The device takes 1,000 readings per second, selects the most accurate among them, and adjusts for room temperature to give you the temperature of the temporal artery (near the temple) — which is an earlier signal of disease than rectal temperature. This temporal artery thermometer is more accurate than ear thermometers and is less affected by the sources of error that can make oral or underarm temperatures misleading. (However, for many purposes, temperature precision isn’t that important. Just knowing whether there is a fever or not is far more important than knowing the temp within a few tenths of a degree. And often fever is helpful, anyway.) But accurate thermometer readings can bring great peace of mind.

I use one of these at our home and carry one with me everywhere in my pediatrician doctor’s bag. -- Alan Greene, MD

Exergen Temporal Artery Thermometer $31

FDA approves 3D-printed replacement skulls

The FDA has approved OsteoFab, "a cranial maxillo-facial (CMF) plate for skull reconstruction which can be used to replace up to 75% of the skull." Cory

The legacy of Fukushima

At Time, Bryan Walsh reports on two pieces of news coming out of the aftermath of the Fukushima nuclear disaster. First, the World Health Organization has released estimates of the health effects on the plant's workers, the people who were involved in shutting it down, and the local residents who lived closest to the plant when it went into meltdown. These people will have an increased risk of leukemia, thyroid cancers, and cancer, in general. But the increase isn't as large as you might have feared. Walsh does a very good job of breaking down the statistics, here. The second bit of news is, unfortunately, not so good. In Germany, which decided to phase out nuclear power in the wake of Fukushima, coal power is on the rise. And it's rising faster than the increase in renewable energy. Maggie

Antibiotics and gut health

I finally got around to reading Carl Zimmer's highly-recommended National Geographic article about antibiotics and their effect on our microbiome, the "100 trillion microbes that live in our healthy bodies."

Scientists are only now beginning to get answers to those questions. In a paper just published online in the journal Gut, Andres Moya of the University of Valencia and his colleagues took an unprecedented look at a microbiome weathering a storm of antibiotics. The microbiome belonged to a 68-year-old man who had developed an infection in his pacemaker. A two-week course of antbiotics cleared it up nicely. Over the course of his treatment, Moya and his colleagues collected stool samples from the man every few days, and then six weeks afterwards. They identified the species in the stool, as well as the genes that the bacteria switched on and off.

What’s most striking about Moya’s study is how the entire microbiome responded to the antibiotics as if it was under a biochemical mortar attack. The bacteria started producing defenses to keep the deadly molecules from getting inside them. To get rid of the drugs that did get inside them, they produced pumps to blast them back out. Meanwhile, the entire microbiome powered down its metabolism. This is probably a good strategy for enduring antibiotics, which typically attack the molecules that bacteria use to grow. As the bacteria shut down, they had a direct effect on their host: they stopped making vitamins and carrying out other metabolic tasks.

When You Swallow A Grenade

From Seizure to Surgery: first-person account of what it's like to have a brain tumor

Jess Hill has published the second part of a three-part series on what it’s like to have a brain tumor diagnosed, then surgically removed. Read: Magical Realism: From Seizure to Surgery. The earlier installment is here. Xeni

Scientists tell Gawker, "It's probably okay to eat your own poop"

They aren't saying you should do it. There's really no reason to. (Even fecal transplants are done in a much less disgusting manner.) But if, for whatever reason, you were to ingest your own poop, you probably won't get sick and die from it. Somebody else's poop, on the other hand, is more risky. So, glad we got that cleared up. Maggie

Tortured junk-food pushers bare all


A long, investigative feature on junk food, health and the processed food industry in yesterday's NYT consists primarily of interviews with tortured and semi-tortured junk food scientists and execs who have perfected the art of getting you to eat food that makes you sick. It's quite a read:

Eventually, a line of the trays, appropriately called Maxed Out, was released that had as many as nine grams of saturated fat, or nearly an entire day’s recommended maximum for kids, with up to two-thirds of the max for sodium and 13 teaspoons of sugar.

When I asked Geoffrey Bible, former C.E.O. of Philip Morris, about this shift toward more salt, sugar and fat in meals for kids, he smiled and noted that even in its earliest incarnation, Lunchables was held up for criticism. “One article said something like, ‘If you take Lunchables apart, the most healthy item in it is the napkin.’ ”

Well, they did have a good bit of fat, I offered. “You bet,” he said. “Plus cookies.”

The prevailing attitude among the company’s food managers — through the 1990s, at least, before obesity became a more pressing concern — was one of supply and demand. “People could point to these things and say, ‘They’ve got too much sugar, they’ve got too much salt,’ ” Bible said. “Well, that’s what the consumer wants, and we’re not putting a gun to their head to eat it. That’s what they want. If we give them less, they’ll buy less, and the competitor will get our market. So you’re sort of trapped.” (Bible would later press Kraft to reconsider its reliance on salt, sugar and fat.)

Here's another good bit:

To get a better feel for their work, I called on Steven Witherly, a food scientist who wrote a fascinating guide for industry insiders titled, “Why Humans Like Junk Food.” I brought him two shopping bags filled with a variety of chips to taste. He zeroed right in on the Cheetos. “This,” Witherly said, “is one of the most marvelously constructed foods on the planet, in terms of pure pleasure.” He ticked off a dozen attributes of the Cheetos that make the brain say more. But the one he focused on most was the puff’s uncanny ability to melt in the mouth. “It’s called vanishing caloric density,” Witherly said. “If something melts down quickly, your brain thinks that there’s no calories in it . . . you can just keep eating it forever.”

The Extraordinary Science of Addictive Junk Food [NYT/Michael Moss]

(Image: Snakes?, a Creative Commons Attribution (2.0) image from reallynuts's photostream)

Shoe shiner donates $200K in tips

After 32 years shining shoes at Pittsburgh's Children's Hospital, Albert Lexie amassed $200,000 in tips—and paid it right into a fund for sick kids whose families cannot afford medical costs. [WTAE] Rob

Illustrated guide to insanity, 1883


"Types of insanity, an illustrated guide in the physical diagnosis of mental disease" from 1883 is not just a frightening look at the inhumane treatment of people with mental health problems in the 19th century, it's also full of sensitive charcoal portraits of inmates in various asylums, along with their tragic personal histories: "X______ has been melancholic for some years, and the disease is drifting into dementia."

Types of insanity, an illustrated guide in the physical diagnosis of mental disease [with manuscript notes] (1883) (via Retronaut)