Inside Medicine: Five on Friday (April 26, 2024).

This week in medicine, what I'm thinking about, etc. You know, an actual newsletter.

Apr 26, 2024

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!

If you value this feature—and Inside Medicine in general…

Here we go…

Item 1. Emergency care is on the line at the Supreme Court.

The Supreme Court heard oral arguments regarding an Idaho abortion restriction that tests the limits of EMTALA; EMTALA is the federal law that requires ERs to treat and stabilize all life, limb, and organ-threatening conditions regardless of ability to pay or other factors. Basically the situation is this: if the pregnant woman’s life is in imminent danger, medically necessary abortions can legally proceed. At issue is when a pregnancy (or condition that affects it) becomes a threat to the pregnant woman’s life, limb, or organs. So, if the pregnant woman is in danger but the risk of death is not immediate, what can doctors do?

If that sounds like an uncomfortable liminal space in which to practice emergency medicine to you, then we agree. As an ER doctor, I can’t imagine having to think about these issues in real time. It’s crazy. As I always say, EMTALA is our mandate and our mission. It reminds me to do the right thing for the patient in front of me, regardless of anything else. Laws that weaken EMTALA make it harder for frontline ER doctors to practice.

Meanwhile, the AP found that some people are being turned away for care, apparently in light of abortion restrictions.

This is just bad.

Item 2: Bird flu makes it into commercial products.

The FDA announced that traces of H5N1 (“bird flu”) have been found in commercial milk in the US. These fragments are not dangerous to people, but the information implies three things to me. First, that our tests are pretty good these days but we have not been using them enough. Second, pasteurization works (I would not be drinking unpasteurized milk, if I were you). The detected fragments are not a danger to human health, but that’s in part due to safety mechanisms (including pasteurization). Third, the amount of H5N1 circulating in animals may be higher than scientists have been able to detect so far. That could portend a higher likelihood of human infections. In fact, apparently one in five milk samples in the US shows signs of bird flu exposure.

So far the only human case in the US during this outbreak has been mild. But we don’t know how the virus would affect the average person, nor those with serious health risks.

Item 3. Science, the pandemic, and politics.

There are reasonable conversations to be had about the origins of SARS-CoV-2. While I think (based on some genetic analyses and studies of the Wuhan market, rather than government hearsay) that this virus jumped to humans from an animal, anything is possible. My point is that the question itself is not off limits.

What bothers me is that there seems to be a political agenda among many who believe that Covid-19 came from a lab leak in Wuhan. That is, this viewpoint aligns with a point of view that wants to blame China (or US government funding) for the pandemic. (They’d be a bit more credible to me if their agenda was to make sure that good science was being done while adhering to the most rigorous of safety protocols; those concerns never seem to get mentioned. Instead we just get a lot of finger pointing.)

On the other side, there are those who worry that scientists have been too resistant to the very possibility of a lab leak. Those people are worried that top tier medical journals were unduly influenced by political pressure.

This week, editor-in-chief of Science Dr. Holden Thorp (and Inside Medicine subscriber who I interviewed here in the past) gave testimony to Congress on these issues. He described his experience at the helm of one of the world’s top scientific peer review journals. I found his comments to be compelling and transparent. Did the scientific community respond perfectly to Covid-19? Certainly not. Does he see evidence that top tier journals acted in bad faith or were inappropriately pressured to push one side of an argument? No. I encourage you to read or watch his testimony to Congress.

Item 4: Alcohol Awareness Month.

April is Alcohol Awareness Month. Here is a resource with information on underage drinking and the effects of alcohol on the brain.

We all know that drinking and driving is behind thousands of deaths per year. You probably also know that alcohol-related deaths increased during the pandemic. (They have decreased in the last couple of years, but are still above pre-pandemic levels). But alcohol use disorders (AUD) also affect health in countless ways. One that I often see in the ER is that those with AUD are much less likely to take their medications as prescribed.

While most people enjoy a bit of alcohol without serious adverse effects, there’s no person who should drink more than they do now, and many who should cut back or quit altogether.

Item 5. Poll of the Week results.

Last week, I asked you whether you liked the Five on Friday format. You do! 98% of voters said to keep this feature coming rather than to break it up into smaller posts. Thanks for the feedback.

Item 5a. Poll of the Week for this week! Since it is alcohol awareness month, I’ll ask you about your own use. Now, this is purely a question about frequency, not amount. There are some people who drink weekly and have a serious problem because of how much they consume, and some who drink daily who do not have a serious problem because of how little they consume. So, this purely a question of “how often.” Lastly, I can’t see your individual responses (nor can anyone), so please be honest!

Whatever your answer, please do not drive while intoxicated.

That said….

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?

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