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Will COVID-19 Transform the Treatment of Dementia?

The 511

Back in the 20th century, we called 411 for information. Today, information’s aplenty, so you’re looking for something more. The 511 includes: 

  • 5 short paragraphs about medtech, biotech, or another science-y thing
  • 1 sentence for reflection (and maybe a laugh), and 
  • 1 track I’ve currently got in heavy rotation.

Alzheimer’s disease: it’s not just an elderly thing

A handful of recent studies of Alzheimer’s disease (AD) and dementia identifies key early-life factors associated with higher risk for dementia: “low educational level, midlife hypertension, midlife obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation.” Each of these factors has a social component, and their incidence varies by socioeconomic status and racialization. And the impact will not be cheap. Over the next 30 years, the healthcare costs for dementia are expected to be close to $8 trillion, with a “t.” After 200 failed drug trials in the past 30 years (many of which were beta-amyloid-and-tau-neurofibrillary-tangle centric), the NIH called on researchers in 2017 “to ensure that complex etiologies are captured for study.”

I’m with you. So there’s a COVID connection? 

Possibly. The response to the killing of George Floyd has reignited the abolitionist imaginary of thousands, perhaps millions, of Americans. The continued protests across the country reflect a critical demand akin to the core ethos of critical theory (those Frankfurt School cats): things could be otherwise. Things under close consideration include policing, universal health care, and tuition at public colleges and universities. New standards for early childhood care may be next, given the importance of brain development in early childhood.

“The brain develops most rapidly and is most plastic in the first 5 years of life. Strong early brain development supports more complex subsequent neuritic and intraneuronal connections and cognition, conferring lifelong advantage.” 

Sarah E. Tom, et al., Department of Neurology, Columbia University

The cost of a college education is one thing, but it pales in comparison to infant care: in most states, it costs more than public college tuition. It’s a primary barrier for 60% of parents seeking infant or toddler care.

Remind me: what’s “etiology”? 

Etiology (def.) — The study of causes, as in the causes of a disease.

New paradigms in the study and treatment of AD and dementia may better accommodate for the impact of genetics and environmental factors. Likewise, with the right structural incentives, researchers will reevaluate current biomarkers — and develop new ones — with equitable diagnostic effectiveness across racial lines. Compared to white Americans, African Americans are at increased risk of AD. And yet, most AD biomarker studies have included few African American participants, and a recent evaluation of a cerebrospinal fluid biomarker revealed different thresholds along racial lines.  

Advances in biomarkers for AD 

A new study describes the use of new blood tests for plasma p-tau217 as predictors of the presence of amyloid plaques. Researchers at Washington University School of Medicine in St. Louis showed that plasma assays for p-tau217 could be used as a screening tool and replace clinical use of costly PET imaging.

“I really think this is going to be a huge advance in Alzheimer’s disease. It’s almost like the first steps that blood tests for cholesterol in heart disease took back in the 1950s and ’60s.”

Howard Fillit, MD, of the Alzheimer’s Drug Discovery Foundation

As folks advocate for a more perfect union, let’s hope the related benefits of this development will be reaped in an equitable manner. Who knows? In the near future, maybe we’ll have canine-based assays for cancer and other diseases. No comment yet from the feline community.

5(1)1 — On leadership

“While now is a time to foster trust and delegate, [managers] don’t want [employees] debating about whether they should or shouldn’t do a major project. All that time questioning what to do will impact productivity … Managers should make the call on high-level priorities, so employees can focus on their best work.”

Julia Austin, Senior Lecturer, Harvard Business School (here)  

51(1) — In rotation

Part of me misses the work once entailed in finding new music, or even new old music. Most of me, though, finds great delight in finding something via three clicks — especially when it’s a cover song so delightful it might make you forget the original. 

Goodbye, Arctic Monkeys. Hello, Baby Charles.

Here’s Baby Charles’ “I Bet You Look Good on the Dance Floor.” 

If you like this stuff, and you know someone interested in health, leadership, and music, all mixed up with a dash of humor, please spread the word.

I’m also on this thing called Twitter (@randaldoane). 

While it may be a passing fad, drop me a note, if you like what you see.

Sources 

Association of Demographic and Socioeconomic Factors by Birth Cohort With Dementia Incidence

NIH Alzheimer’s Disease Center Recommendations 

Disentangling the Amyloid Pathways: A Mechanistic Approach to Etiology 

Child Care Aware of America’s 12th Annual Cost of Care Report Shows Child Care Outpaces Nearly All Other Family Expenses Nationwide 

Investing in Infant and Toddler Child Care to Strengthen Working Families

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757481?resultClick=3

The New Rules for Remote Work: Pandemic Edition

Baby Charles – Home

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Even algorithms need human consent

The 511 / November 26, 2020

For information in the 20th century, we called 411. The 511 includes: 

  • a handful of paragraphs about health tech or some other science-y thing
  • 1 sentence for reflection (and maybe a laugh), and 
  • 1 track I’ve currently got in heavy rotation.

Contact tracing and the question of trust

Celebrations across the country today will be muted, no doubt, due in large part to the pandemic and its recent surge. While the United States is not alone in this regard, let’s take quick stock of why, from New Mexico to Montana to Ohio and back again, the numbers continue to surge.

In “People proving to be weakest link for apps tracking COVID-19 exposure,” reporter Rae Ellen Bichell explores how, in Ireland and Switzerland, for example, more than 20% of their populations use a contact-tracing app. In the US, with the federal government’s laissez-faire approach to the pandemic, the response falls short of “patchwork”: that analogy suggests a connection of disparate elements. With only 12 states using phone-based, contact-tracing apps, it’s more of a scatter shot.

This uneven effort has all sorts of limitations that even the most crackerjack programmer cannot solve — namely, generalized doubt. People doubt it will matter. They doubt their privacy will be respected. They doubt the efficacy of government at multiple levels. So, either they don’t download the app or, if they do download the app, they don’t use it. In October, in North Dakota, Bichell notes, “about 90 people tested positive and received the codes required to alert their contacts. Only about 30% did so.”

Bloomberg Law, October 13, 2020.

The flipside of doubt is trust, which continues to be eroded in the US by partisan politics and media, and the White House especially. Nearly a year before the pandemic lockdown, Scientific American noted how “the Trump administration’s unprecedented record on science will harm people across the country, especially the most disenfranchised. While the sheer number of attacks on science is shocking, what a lack of science-informed policy means for our country is even more shocking.” Science only takes root in societies with healthy levels of trust. When politicians sow doubt in that soil, our shared sense of belonging, the balance between our freedoms and our responsibilities, wither and perish.

Harvard’s Julia Marcus, in a recent article in the New York Times, says more than she means about the recent surge of infections.

“Somebody says something, and somebody else says it, and then it just becomes truth,” said Julia Marcus, an infectious disease epidemiologist at Harvard University. “I worry about this narrative that doesn’t yet seem to be data-based.”

Small Gatherings Spread the Virus, but Are They Causing the Surge?,” New York Times, November 23, 2020

Enrollment in general, and for contact-tracing apps in particular, depends upon trust. Early adopters can create momentum, even across state lines, and build toward critical mass, “the percolation threshold,” or the tipping point. A favorite analogy for such developments is, of course, a viral pandemic.

Stay safe, and get that turkey to 165 degrees — Fahrenheit, of course. 🙂

5(1)1 — On life from a position of generosity and growth

““If you want to love what you do, abandon the passion mindset (“what can the world offer me?”) and instead adopt the craftsman mindset (“what can I offer the world?”).”

cal newport, from  So Good They Can’t Ignore You
51(1) — In rotation: Sly & and the Family Stone’s “Thank You (Falettinme Be Mice Elf Agin)”

I hope you, too, have reasons to offer a “Thank You” to your friends, your family, and your collective health today. Things do look grim, but, as Leonard Cohen notes, there’s a crack in everything. It’s how the light gets in. May this song add some sweetness and light to your day. Enjoy!

As you may know, Sly & the Family Stone weighed heavily on the imagination of rock critic Greil Marcus, and took up a sizeable section of his landmark book Mystery Train: Images of America in Rock’n’Roll Music (1975). I’ve written about that book, in an essay on Hamell on Trial, in case you’re interested.

Please share this post with someone you know who’s interested in health, leadership, and music.

I’m also on this thing called Twitter (@randaldoane). While it may be a passing fad, let’s connect, just in case it proves enduring.

If you want to talk about a grant proposal you’re working on, or a newsletter that needs more pop, drop me a line over here.

Cheers!

Sources

People proving to be weakest link for apps tracking COVID-19 exposure,” Rae Ellen Bichell, Kaiser Health News (in Fierce Biotech) | November 20, 2020. https://www.fiercebiotech.com/medtech/people-proving-to-be-weakest-link-for-apps-tracking-covid-exposure .

“The Trump Administration Has Attacked Science 100 Times … and Counting,” Scientific American, May 29, 2019. https://blogs.scientificamerican.com/observations/the-trump-administration-has-attacked-science-100-times-and-counting/ .

“Midwestern States Surge Toward Top of All-Time U.S. Covid Cases,” Bloomberg Law, October 13, 2020. https://news.bloomberglaw.com/coronavirus/midwestern-states-surge-toward-top-of-all-time-u-s-covid-cases.

Apoorva Mandavilli, “Small Gatherings Spread the Virus, but Are They Causing the Surge?,” New York Times, November 23, 2020. https://www.nytimes.com/2020/11/23/health/coronavirus-holiday-gatherings.html?searchResultPosition=1.

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Blood pressure on the go

The 511 / November 11, 2020

For information in the 20th century, we called 411. The 511 includes: 

  • a handful of paragraphs about health tech or some other science-y thing
  • 1 sentence for reflection (and maybe a laugh), and 
  • 1 track I’ve currently got in heavy rotation.

Take care of your heart! No pressure

As a DIY bike mechanic, I like to fix things that are broken. I even like to fix things that aren’t broken. Luckily, our doctors don’t tend to our health the way I tend to my bikes. And, for every check-up during my lifetime, two technologies remain unbroken: the stethoscope and the blood pressure cuff. If the blood pressure cuff is not broken, though, it’s not exactly comfortable either, and it’s been that way since 1881. (Thank you, Samuel Siegfried Karl von Basch.) In fact, it can be painful for kids, grown-ups, and seniors alike.

There is, as you might have guessed, another and considerably better way to measure blood pressure. At Blumio, a medtech start-up led by Oliver Shay and Catherine Liao, they are developing new wearable technologies based on a novel and brilliant idea:

Cuffless BP monitoring can be made possible with a pressure-less sensing modality that can capture arterial pressure waveform with the same sensitivity as applanation tonometry.

From https://www.blumio.com/science/

Let’s unpack that last phrase first. Applanation tonometry is about accuracy and sensitivity. It’s a test that measures the amount of pressure necessary to flatten a portion of your cornea, which allows your doctor to monitor your eyes for glaucoma. Blumio’s “pressure-less sensing modality” offers continuous monitoring of your blood pressure using a radar-based sensor. With precision medicine all the rage, along with too many Americans consumed by rage (do you really see that changing in 2021?), Blumio’s wearable sensor represents a major tech breakthrough to help Americans with their hypertension (1 in 3 adults) and cardiovascular disease (1 in 4 deaths: the leading cause of death in the US). Blumio provides real-time monitoring of the impact of alcohol, smoking, drugs, exercise and diet (finally!) on blood pressure.

“This contextualized information will ultimately provide insights into how behaviors, medicines, and other drugs impact blood pressure”: from the abstract of Blumio’s 2018 award from the NIH.

Dear reader: do you think that will be enough, say, to reverse the downward trend on American life expectancy? American life expectancy peaked in 2014, while the golden years of friendly neighbors to the north — and just about every other country where we have military personnel — continue to grow and grow.

Source: https://tinyurl.com/y3vuh2zj.

To be clear: I don’t expect the lovely folks at Blumio to be solely responsible for this task, for it’s clear who is responsible: we the people. As I write, of course, we as a country are less than a week removed from the calling of the 2020 election. Liberals, as well as members of Trump’s inner circle, have breathed a sigh of relief. Despite the administration’s constant assault on evidence-based protocols, science will rise again from the ashes.

Science, though, only thrives if its audience is paying attention. Yes, we’re all caught up in the distraction machine, but we also face duress due to policies — combined with market forces — that no longer work on behalf of millions of Americans. “Almost a third of working Americans currently have some kind of medical debt,” according to a recent report by Salary Report for NBC. “And about 28% of those who have an outstanding balance owe $10,000 or more on their bills.” That financial stress leads Americans to ration their healthcare. A full 33% of uninsured Americans — and even 8% of people with private health insurance — take their medicine on a drawn out schedule, rather than as prescribed.

With the expansion of the gig economy, and industry contraction during the pandemic, life for millions of Americans lacks the anchors of steady work, affordable insurance, and strong public education. “The infinite promise of American youth — a promise elaborately articulated by movies and advertisements and university prospectuses — has been an empty lie for so long,” notes novelist Zadie Smith, “that I notice my students joking about it with a black humor more appropriate to old men, to the veterans of wars.”

Her students, Smith notes, cling to their “writing style,” for they have so little else to fall back on. Does that same sense of being adrift characterize the political investments of adult Americans, too? Do we cling to our candidates and parties because everything else — including healthcare, especially — is fraught with contingency?

Should a Biden administration expand the reach of the Affordable Care Act and, in turn, reverse the curve of American life expectancy, maybe our next presidential election — and our politics in general — tax our cardiovascular health at a lower rate.

5(1)1 — On life from the vantage point of bike saddle

“When the spirits are low, when the day appears dark, when work becomes monotonous, when hope hardly seems worth having, just mount a bicycle and go out for a spin down the road, without thought on anything but the ride you are taking.”

Sir Arthur Conan Doyle (1859 – 1930), author of Sherlock Holmes
51(1) — In rotation: Portugal. The Man’s “Feel It Still”

“Feel It Still” celebrates 1966, a great year for rock’n’roll, and 1986, a great year for post-punk pop. My daughter has requested a household moratorium on this tune, but I can still share it with you. Enjoy!

FeelItStill.jpg

If you have a favorite remix of this tune, let me know!

If you like this stuff, and you know someone interested in health, leadership, and music, all mixed up with a dash of humor, please spread the word.

I’m also on this thing called Twitter (@randaldoane). While it may be a passing fad, drop me a note, if you like what you see.

If you want to talk about a grant proposal you’re working on, or a newsletter that needs more pop, drop me a line over here.

Cheers!

Sources

System and method for cardiovascular health monitoring. Patent application # US20190282106A1, United States. https://patents.google.com/patent/US20190282106A1/en.

“32% of American workers have medical debt—and over half have defaulted on it.” CNBC. February 13, 2020. https://www.cnbc.com/2020/02/13/one-third-of-american-workers-have-medical-debt-and-most-default.html

FEASIBILITY STUDY OF A NOVEL NONINVASIVE RF SENSOR FOR BLOOD PRESSURE MEASUREMENTS. NIH RePORT. 2018. https://projectreporter.nih.gov/project_info_description.cfm?aid=9679554&icde=0

“The Trump Administration Has Attacked Science 100 Times … and Counting,” Scientific American, May 29, 2019. https://blogs.scientificamerican.com/observations/the-trump-administration-has-attacked-science-100-times-and-counting/ .

“How does U.S. life expectancy compare to other countries?” KFF. https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/.

http://www.nytimes.com/2020/07/22/books/review-intimations-essays-zadie-smith.html

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Healthcare and the four freedoms

The 511

For information in the 20th century, we called 411. The 511 includes: 

  • a handful of paragraphs about health tech or some other science-y thing
  • 1 sentence for reflection (and maybe a laugh), and 
  • 1 track I’ve currently got in heavy rotation.

Talking with the SCOTUS about freedoms

And then there were nine. Justice Amy Coney Barrett gets some new threads for her wardrobe — just in time to determine the fate of the Affordable Care Act, it seems. Barrett, of course, made headlines when asked to list the five freedoms of the First Amendment: “Speech, religion, press, assembly … I don’t know — what am I missing?” Senator Ben Sasse tossed her the bone of “redress” of grievances. Here’s the full text:

First Amendment Rights - The Association for Women in Communications
The Constitution, from back in the day.

Great stuff, but let’s go bigger — namely, back to FDR’s State of the Union, 1941. The “Four Freedoms Speech” highlighted the freedoms of speech and worship (codified above), along with the freedoms from want and from fear. In this speech (full text here), FDR acknowledged that democracies in Europe were under assault and the US had an obligation to defend its allies. The freedom from want and the freedom from fear, respectively, appealed to the universal need — the human right — for economic security and freedom from aggression between nations.

Now it took awhile, but shortly after the close of the cold war, global poverty declined year over year for 25 years — until this year. War, of course, remains an all-too-steady feature of contemporary life.

I want to focus here on want as a key feature of American health disparities across racialized lines. For example: Black Americans aged 35 to 44 experience Covid-19 mortality rates that are nine times higher than their white counterparts. In pre-pandemic times, disparities in life expectancy were comparably frightful. “For COVID-19 to raise mortality as much as racial inequality does,” notes Elizabeth Wrigley-Field, “it would need to erase two to three decades of mortality progress for whites.”

Back to want and fear (in a more general sense): the two go hand-in-hand. The eight million Americans who have fallen below the poverty line since May (and, presumably, lost their employment-tied healthcare) have a right to be terrified. No pandemic-related relief is expected from Congress for another three weeks. (Recent studies indicate that over 114 million Americans lack health insurance or are underinsured.)

So … I’m just mapping out some parameters here, a series of threads to weave together in a future piece. These include:

  • the growing acceptance of Zoom-based education
  • the absurd level of debt incurred by students in medical school
  • the challenges faced by (and provisional solutions offered to) underrepresented groups in STEM disciplines in post-secondary education (here, to begin)
  • the decline in the number of Black male doctors in the US (here), and
  • community-driven solutions to health disparities (here)

And, since the AMA is the 7th biggest lobbyist in the country, I have an idea of how to pay for it. Thanks for checking this out.

5(1)1 — On the need for a renaissance of hope

The infinite promise of American youth — a promise elaborately articulated by movies and advertisements and university prospectuses — has been an empty lie for so long that I notice my students joking about it with a black humor more appropriate to old men, to the veterans of wars.”

Zadie smith, from intimations (2020)
51(1) — In rotation: Van Morrison’s “Astral Weeks”

When the colors of fall roll in and the wind turns brisk, I think more of Morrison’s Moondance than Astral Weeks. But this track (and nearly every track on the album) help lift the weight of this strange historical moment. Hail to the music that helps us to straighten our backbones and do what needs to be done. Here ya go.

Astral Weeks - Rolling Stone
Astral Weeks, 1968.

If you like this stuff, and you know someone interested in health, leadership, and music, all mixed up with a dash of humor, please spread the word.

I’m also on this thing called Twitter (@randaldoane). While it may be a passing fad, drop me a note, if you like what you see.

If you want to talk about a project with words, drop me a line over here.

Cheers!

Sources

Reducing achievement gaps in undergraduate general chemistry could lift underrepresented students into a “hyperpersistent zone” BY R. B. HARRIS, M. R. MACK, J. BRYANT, E. J. THEOBALD, S. FREEMAN, SCIENCE ADVANCES, 10 JUN 2020 : EAAZ5687 / https://advances.sciencemag.org/content/6/24/eaaz5687.full.

Elizabeth Wrigley-Field. US racial inequality may be as deadly as COVID-19. Proceedings of the National Academy of Sciences Sep 2020, 117 (36) 21854-21856;
DOI: https://doi.org/10.1073/pnas.2014750117.

Jamila Taylor. “Racism, Inequality, and Health Care for African Americans,” The Century Foundation, December 19, 2019. https://tcf.org/content/report/racism-inequality-health-care-african-americans.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425848/ doi: 10.17226/24624

Laurencin, Cato T, and Marsha Murray. “An American Crisis: the Lack of Black Men in Medicine.” Journal of racial and ethnic health disparities vol. 4,3 (2017): 317-321. doi:10.1007/s40615-017-0380-y

http://www.nytimes.com/2020/07/22/books/review-intimations-essays-zadie-smith.html

“Off the Ruling Class”: A Preview of my 10/22 Talk at CPL

Not the 511

So today’s a bit different: I’m using this blog entry to preview a talk I’m giving on 10/22.


Sign up here today to reserve your spot on 10/22 (reservation required).

The talk is based on an essay I wrote for Harper’s back in April, but expands its review of the three key elements of any given crime: motive, ability, and opportunity. In the 5-minute video below, I offer a sneak peek of the talk, with a review of an open letter, sent that fall, to campus newspapers at American colleges and universities by FBI director J. Edgar Hoover.

And yes, I have progressive lenses, which is why I hold my head at that weird angle. (Sorry for the couple of spots where the audio dips slightly.)

If you view the video via full screen, you can read the text pretty easily.

51(1) — In rotation: The Ramones’ “You Sound Like You’re Sick”

Ramones devotees celebrate the earliest LPs as the best, but I do have a soft spot for a bunch of tunes on this Phil-Spector-produced LP.

Here ya go. I hope you, of course, are in perfect health.

I’m also on this thing called Twitter (@randaldoane). Let’s connect!

If you want to talk about a project with words, drop me a line over here.

Cheers!

Sources

Open letter by J. Edgar Hoover (from the Nixon Library).

https://www.library.kent.edu/special-collections-and-archives/kenfour-notes-investigation

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