Inside Medicine: Five on Friday (April 19, 2024).
This week in medicine, what I'm thinking about, etc. You know, an actual newsletter.
We are back with “Five on Friday", the feature where Inside Medicine behaves like an actual medical/health/science newsletter. Below are the top-of-mind things that I’m thinking about right now. Also, please vote in the poll at the end! (The poll is about whether you like the “Five on Friday” format. I need to know what you think!)
If you value this feature—and Inside Medicine in general…
Here we go…
Item 1. WHO liberalizes its definition of “airborne” in response to Covid.
Early in 2020, a debate broke out in the scientific community: Was SARS-CoV-2, the virus that causes Covid-19 “airborne”? The emerging data suggested that the virus could spread through the air. But, the virus didn’t have all of the characteristics of some “truly” airborne viruses like tuberculosis. My take was that this would all have to be hashed out by experts and that, in the meantime, we could assume that Covid-19 was “airborne enough” to spread in that manner in key settings.
Finally, the WHO has decided to settle the debate by simply changing the definition of airborne to make it more inclusive. There are real benefits to this change. But what I really want to see is a better understanding of what makes the virus more likely to stay afloat. Usually things like temperature and humidity play a role. I’m sure that’s the case here—but to what extent it alters the infectious potential of a room which has housed a Covid-19 patient? I think that remains unknown.
Item 2: RSV and cardiovascular disease go hand-in-hand.
If you’ve read Inside Medicine for a while, you probably know that I strongly believe that a lot of the damage that viruses like Covid-19 cause comes by way of exacerbating underlying chronic medical conditions. “Tip-over” hospitalizations occur when someone gets Covid-19, which in turns exacerbates their heart condition. These hospitalizations are not “incidental”; they are caused by SARS-CoV-2 infection.
But I’ve also said that SARS-CoV-2 is hardly alone in this. We’ve long known that flu does this. So, now we are looking elsewhere in the world of important pathogens. New research shows an impressive correlation between RSV-related hospitalizations and worsening cardiac conditions. While the new study in JAMA Internal Medicine was not designed to answer the chicken-or-egg question, it’s quite likely that RSV infections are responsible for many cardiac-related hospitalizations and complications. Viruses, in case you haven’t noticed, are bad!
Item 3. Should MDs and DOs merge?
Time was the MDs were the doctors you associate with hospitals and typical medical care, while those with the DO (Doctor of Osteopathy) were not. (More on that here.) Over time, these two academic pathways have increasingly merged. Some of the best docs I know came be physicians through the DO pathway. However, there are still some hospitals and academic programs that harbor antiquated views on this. A great story in MedPage Today by Cheryl Clark looks at whether MDs and DOs should continue to have separate licensing boards. For people who think that the MD/DO pathways no longer need to be distinct, one obstacle may be the governing bodies controlling the system. If the two pathways towards becoming a physician were to essentially merge, some of these powerful organizations might become redundant.
Item 4: National Feet Week.
Folks, it is National Feet Week. As an ER doctor, let me tell you this: Your feet say more about you than almost any other part of your body. In some cases, it’s obvious; if you have diabetes, problems often first show up as vascular problems in the toes, for example. But in other subtle ways, foot-related health is a window into your overall wellbeing and disease vulnerability. Think about mobility. It turns out that the ability to clip one’s own toenails has some of the strongest predictive power for identifying older people not at risk of having a fall. So, do yourself a favor and get a podiatrist. They may save you a trip to the ER, pun intended.
Item 5. Poll of the Week results.
Last week, I asked you about eclipses!
Item 5a. Poll of the Week for this week! Time for a check-in on this weekly feature, “Five on Friday.” I’ve been enjoying doing this format, but just wanted to see what you think. Now, I realize that those of you who have read this far are likely to represent a subgroup of Inside Medicine readers who probably appreciate this format…but…
Thanks for chiming in.
That’s it. Your “Friday Five!”
Feedback! Do you like the “Five on Friday” format? Have any ideas for next week’s Poll of the Week? Any great articles you read elsewhere that you want to share with the Inside Medicine community? Other musings or thoughts?
Please contribute to the Comments!
I didn't take the poll, because there's no nuance - it's not a question of format, but of the content. Some of the pieces would be fine separately and could use longer discussion; others are fine as short takes. But they're all interesting! (I particularly liked the one on feet as predictive markers - at 80, I still cut my toenails, so that was very encouraging.)
"Viruses, in case you haven’t noticed, are bad!"
Jeremy, I try to not be a pedant all the time but I really think this one needs comment. If there weren't many viruses out there helping (curating, culling and modifying and influencing in many ways) you, and your gut biome and your skin flora etc, would be soon dead, and would in any case never have evolved to your current lofty, excellent substack writing status. That some viruses are broadly detrimental, yes. Blanket bad? no. We could equally say that humans are bad, (... or even perhaps that ER doctors are bad... but then we would NEVER say that would we!)
A tiny fraction of all viruses sometimes have some nasty effects on humans, sometimes very nasty.
I understand that modifiers/qualifiers make for less punchy and more difficult to read text, but its a complex world out there and blanket statements lead to misunderstandings. Please.
That said, as always, thank you.