Quick dip: Bonobo teeth, flu vaccines, death-of-midlist 3.0, death of the uninsured, and gory films

Eric Michael Johnson contemplates the hearts, minds, teeth, and claws of bonobos and other primates.
Tara Smith explains why she’ll be getting her kids their (seasonal) flu vaccines. Revere does likewise
Daniel Menaker, former honcho at Random House, defends the midlist. (Where was he when my book was getting so much push?)
Just in case you missed it, lack of insurance is killing 45,000 people a year (Times) in the U.S. This doesn’t include preventable deaths among the underinsured (like yours truly, who is sitting on some surgery that he’d rather put behind him). You can download the actual study here.
And Wired — can we overstate the value of the Wired Science crew? — has a great post about old surgical films from the 1930s. Silent. Fascinating. Not for the squeamish. This is also valuable simply for calling attention to the Wellcome Center’s YouTube channel, “digitising medical history.”

Much ado about swine flu


The swine flu triage tent at Dell’s Children’s Medical Center, in Austin, Texas
photo: Ralph Barerra, Austin American-Statesman

I can’t keep up with the flu news. (If you want to, best single bet — the wide net — is Avian Flu Diary.) But as the World Health Organisation meets in Hong-Kong to discuss, among other things, swine flu, here are a couple that make good follow-ups to my Slate piece on how adjuvants gobble up vaccine antigen supply:
WHO pushes for worldwide swine flu vaccinations (hoping to vaccinate 3 billion) — despite that overall supply will fall short .
The U.S. (and some other developed countries) agree to donate 10 percent of their supply to the effort.
The first reports of vaccine trials in children give mixed results: kids 10-17 seem (like adults in the first two trials reported) to respond well to the vaccine, with most developing antibody responses likely to confer immunity; but kids under 10 do not, and will probably require two doses spaced some time apart. This probably means most kids under 10 will be vulnerable to the virus for longer. For both this news and a meta-look at how unevenly it is reported, see Effect Measure’s post of this morning.
NB: Slate’s Jack Shafer has a nice piece echoing Effect Measure’s beef about the press being too upbeat on H1N1.
And if you don’t think this could get bad, consider that even at this early stage, Dell’s Chidren’s Medical Center, in Austin, is so swamped with flu patients that it has set up triage tents — and is suffering staffing shortages in the ER.
I’ve received a fair amount of mail about my Slate piece. (See Slate’s Fray for a taste of the range.) I hope to finish a post following up more substantially soon.

Misdiagnosing the live and the dead

“One in six patients ‘wrongly diagnosed by NHS doctors’,” shouts the Daily Mail (via EvidenceMatters. This should not surprise us: Autopsies have been finding a similar percentage of misdiagnosis among the dead for decades. Doctors will always miss some diagnoses. Progress is a matter of ever narrowing the list of things doctors miss — so the other problems can be diagnosed and treated, letting the patients live longer (till they did of something incurable — or something we still haven’t learned to diagnose. Learn to properly diagnose, say, appendicitis, and you can save the life of a10-year-old (as I was when I had my appendix out) and let him die decades later of old age, something incurable — or something the doctor misses then.
Hard to accept that doctors miss things. They always will. The shame is that they so often miss things and then bury the mistakes — as they do now about 10-15% of the time. Doing so removes the opportunity to learn from the mistake and save the patient from the same one.

Caleb Crain sums up the MSMer’s Media 2.0 anxiety

In the intro to his self-published (on Lulu.com) collection of blog posts, The Wreck of the Henry Clay, New Yorker contributor Caleb Crain sums up nicely the anxieties shared by at least one other writer-with-blogging-addon about blogging, and, by extension, about self-publishing books. Which I may just do myself soon — a collection — because I CAN. Ellipses are mine.

I came to blogging … as a veteran of print…. [and so] came to blogging nervous about losing what footing I had there… The quandary: If I wanted to communicate an important discovery, shouldn’t I write it up formally, either for money (i.e., journalism) or prestige( scholarship)? If a discover wasn’t worth these rewards, was a casual communication of it worth risking my reputation, such as it was, for accuracy and deliberation?… To speculate beyond one’s area of expertise, based on no more than intuition and a few pieces of evidence, which happened to be new to oneself but not might be to specialists — wasn’t that a recipe for broadcasting one’s ignorance? And at the pit of my stomach, as I contemplated my efforts to make a living as a freelancer, lay another question: Would my editors continue to buy the cow if I was dispensing the milk for free on my blog?

This last question, Crain notes, turns out to be a good one.

Do check this out.

Posted via web from David Dobbs’s Somatic Marker

To boost or not to boost, or how our H1N1 vaccines will leave millions naked

My latest piece for Slate examines the unsettling consequences of the United States’ choice of swine flu vaccines.
The good news about these vaccines is that, to judge by the first vaccine trial results, published last week, they appear to work fast, safely — and at about a half to a quarter of the doses that the CDC expected. This means we effectively have about two to four times as many vaccines as we had figured we would. Since we ordered 195 million doses, we could vaccinate damn near the whole country.

If the fast-tracking efforts continue to work and the flu peaks closer to Christmas than Columbus Day, this robust and effective vaccine supply stands to sharply check swine flu in the United States, saving anywhere from a few thousand to 50,000 lives.

That’s the good news. The bad news?

But what if we could save two to four times that many lives by vaccinating another 200 million to 300 million people worldwide?
Well, we could have—but the United States effectively decided not to do so when it ordered its vaccine supply. Back in May, many other countries ordered swine flu vaccines that include boosters, called adjuvants, that reduce by half or more the amount of antigen (the imposter or inactivated infectious agent) a vaccine requires to be effective. The United States, however, ordered almost all of its doses in the nonadjuvant, or unboosted, form—an older model of vaccine, considered the U.S. standard, that uses more antigen but creates vaccines that are (at least theoretically) safer. That safety, however, comes at the cost of exhausting the precious antigen supplies much faster — and leaving hundreds of millions elsewhere unvaccinated.

Altogether, I conclude,

if the virus retains its present, relatively “mild” course—killing about as many as the seasonal flu but more heavily concentrated on adults under 60, especially the sick and the pregnant—this could mean some 20,000 to 50,000 deaths.

It’s not pretty, and it’s not simple. For the full range of complications (well, as full as I can make it in about 1000 words), check out the whole story.
You’ll also want to check out some of the posts that drew this problem and some of its many wrinkles to my attention. Foremost is a great post from Revere at Effect Measure, who serves as a peerless — and peerlessly passionate and informed — guide to things infectious, especially flu. Close behind is Columbia University virologist Vincent Racaniello, who keeps a blog, and some great links and podcasts, at his Virology Blog.

Could the Baucus plan bouncback all the way to single-payer?

A couple observers — one on Olbermann, one in a biz publication — think Baucus's plan is so bad, and his dead-end path so disastrous, that it could generate a response that includes either a robust public option or even (longer-term) a single-payer plan. 

From The 5 Must-Read Takes of Health Care Bill From Baucus at the Atlantic Wire

A 'Gift' for Insurance Industries … And Maybe for the Public Option?  On Countdown with Keith Olbermann, Wendell Potter, the former Vice President of Corporate Communications at health insurance company CIGNA, said the bill was so favorable to his former employers that it "looked at first like it might have been written by the lobbyists and the lawyers for the health insurance industry," except that "I don't think they would have been quite this audacious." But here's the flip side: the public option "is not dead," he observed, and "there may be so much outrage and pushback to this bill that it may give the public option a new lease on life."


Republicans: Take This While You Can. Vote Baucus. Joe Weisenthal is another that has taken the plan apart at length. Calling the bill "already DOA," he advised Republicans, as a "strategic move," to throw their weight behind Baucus's proposal even though "it goes against Republican philosophy." Why? "Eventually, if current trends persist, it's going to be easy to get a single-payer, universal healthcare bill passed, the likes of which is favored by the far left. … The Baucus plan," on the other hand, "is far from ideal, but if it passes, it's likely that government-run health insurance will be dead." It "would take us down a totally different path."

Posted via email from David Dobbs’s Somatic Marker

Does Tamiflu resistant swine flu virus really spread less well? Not so fast, says Revere

For a while that seemed to hold true. The biology seemed sound and all was very reassuring. Then, suddenly, in the 2007-2008 flu season the H1N1 seasonal influenza (not the swine flu H1N1) developed Tamiflu resistance and in a remarkably short time almost all of the H1N1 seasonal flu was resistant to Tamiflu.

via scienceblogs.com

Posted via web from David Dobbs’s Somatic Marker

Daily dip: jellyfish, snow leopards, dinos, PTSD, more conservative anatomy, et alia

OK. Animals first, then everybody else.

(Other) Animals

Want Your Own Dinosaur? Place Your Bids

Jellyfish numbers rise  My son and I saw this last year when we were at the EuroScience conference (highly recomennded) in Barcelona (ditto). The beaches had warnings of whole rafts of these. Determined to get wet in the Med, I dipped my toes.

Forget Apple, Here’s the Real Snow Leopard

Everybody else

Top soldiers denounce torture.

Earlier Model of Human Brain’s Energy Usage Underestimated Its Efficiency Covered heavily, but maybe you missed it.

Alison Bass, whose book “Side Effects” just won the National Assn of Science Writers Science-in-Society Award, explains Why doctors are still “crazy” about antidepressants

“A cadre of people who understand the science” or how it’s about time medicine studied information transfer as well as Southwest Airlines does. 

Hendrik Hertzberg draws the anatomy of the conservative organism

Pentagon is treating troops for PTSD, but experts say measurements … – Stars and Stripes

“In a vast military organization obsessed with metrics and measuring every
aspect of its performance, experts say there is one glaring gap: The Pentagon
has no system in place to evaluate whether its downrange crisis interventions
are actually working.”

This is shocking and somehow unsurprising. The VA has been treating vets for PTSD for 35 years — but lacks good information on which treatments work best or worst and why.