Consulo Indicium - 12/20/21

Information for your Consideration… 

A Call To Action – In case you missed it, everyone needs to review the editorial submitted by Victor J. Dzau, MD, in the December 2, 2021 issue of the New England Journal of Medicine on “Decarbonizing the U.S. Health Sector – A Call to Action”. While we are (rightfully) consumed by all things Covid, we also need to simultaneously step back from the crisis of the day to check the horizon for the looming crisis of tomorrow. The authors point to the fact that the health sector is “…responsible for an estimated 8.5% of national carbon emissions.” Derived from operations, energy production and, supply chain sources. Furthermore, the USA health sector represents 25% of the global health sector's contribution to greenhouse gas emissions. The glaring statistic from the editorial is that the supply chain for health care represents 80% of the entire footprint – so, we know where we need to focus our time and energy for getting the biggest bang for the buck. Now, all of this is important – if you think we are facing global climate change. If you happen to believe it’s a hoax – well…let’s not go there.

Aid On The Way – The HHS Health Resources and Services Administration will be releasing $9B in COVID-19 financial assistance in the coming month to all 50 states, the 8 territories and, Washington, DC. The intent is to provide financial aid to hospitals and physicians. The allocation for each of the states is listed here.  

Oy Vey, Omicron Spreads – The web is burning up with news about the Omicron variant and its spread – and, it’s all due to genetic shift. It’s the latest hot topic (as of this writing) about the spread clearly shown by the new variant. It has disseminated throughout the populace at a much faster rate than the original Covid-19 or the Delta variant. In fact, federal officials from the Centers for Disease Control (CDC) issued a briefing that outlines a dramatic increase in infections upwards of a “sevenfold in a single week”. So, my advice is: 1) continue to mask, 2) get boosted – if you’re eligible; and, 3) stay away from large group settings where the risk of spread will no doubt be higher. In other words, be prudent!

On the last point, I received a Twitter text from my Associate Editor reporting that a small group of 11 completely vaccinated/masked/boosted attended a small social party. Of the participants, 7 have now tested positive for Covid. Just be aware that it’s not a “study” but a social media report and, ominous nonetheless. It’s especially ominous for the health care delivery systems where stressed workers are reaching their limit with more to come in January 2022.

Always Consider The Data Source – One of the dilemmas in the current pandemic is that “reports” on the pandemic are coming from all sorts of quarters – some reliable and reputable and others fabricated and fallacious. A recent report from Harvard University reviewed the results of the Delphi/Facebook survey of over 250,000 people on their rate of vaccination last spring. At the time, the data sets were reporting statistically minimalist margins of error which raised the confidence of the researchers on the validity of the findings. However, when the CDC did a retroactive review of the data sets, they came up with an entirely different assessment.

In fact, the Delphi-Facebook study overestimated the uptake of vaccination by respondents by 17%. But, it was not just the Facebook crowd. At about the same time, the Census Bureau reported the Household Pulse Survey on the same issue and it was found to be overestimating vaccination by 14%. Hmmm? Why?

After a comprehensive review by statisticians from Harvard, Stanford and, Oxford, it was determined that the study findings were the result of the “big data paradox.” It’s where there is a large set of respondents but where the answers are less than forthcoming. An example is the Clinton-Trump polls for the Presidential election which famously predicted a Clinton win. However, in retrospect, many of the Trump voters responded with “undecided” or offered a “nonresponse”. So, despite a large data set, the results were wrong.

The original report in Nature concluded with the following assessment: “The larger the data size, the surer we fool ourselves when we fail to account for bias in data collection…” Going a step further, Xiao-Li Meng, Ph.D., the Whipple V.N. Jones Professor of Statistics at Harvard observed that “A biased big data survey can be worse than no survey at all.” Agreed! It sends us off in incorrect directions leading to unintended consequences. Researchers are warning that there is an increasing tendency to weigh data “quantity” higher than data “quality”.

We need to be on guard when new “data” is reported. In particular, I’ve become very skeptical of social media sources. Despite the fact that these sources contain massive amounts of data, it is too frequently non-replicable or skewed with the big data paradox. So, beware!! It’s something I frequently share with my professional counterparts who are quoting findings on Facebook, Twitter, etc. (See above 😊). Finally, let me just say that I tend to rely upon the reviewed literature rather than unvalidated reports. It’s a safer place to hang out…

Some “Sort Of” Positive News – In a separate report from the CDC on infant mortality, the “overall infant mortality rates have continued to improve over the last 14 years…” But, disparities continue. Black babies die twice as often and the rate of improvement for White babies is faster resulting in a widening of the gap! Specific death rates per 1000 for the various racial groups in America were: Whites, 4.49; Blacks, 10.60; Pacific Islanders and Native Hawaiians, 8.19; Native Americans and Alaska Natives, 7.87; and Asians, 3.38. There’s clearly work to be done to narrow the gap.

Good News For Coffee Consumers – It is my personal quest to validate the value of coffee as an adjunct to anybody’s diet for any purpose (SEE above note on “…Consider The Data Source”). As a mega-consumer of coffee, I’m alert to studies showing the benefits of coffee. The latest is a real research study from Australia published in the Frontiers in Aging Neuroscience that revealed a higher coffee intake appeared to slow the accumulation of amyloid protein – the substance that seems to be the core problem in the slow progression of Alzheimer’s disease. Coffee was also associated with higher executive function and better attention span – something my wife would like for me to keep at peak values 😊.

In other reports in a study published online in PLOS Medicine, coffee or tea was associated with reduced risk for stroke and dementia. Ironically, the biggest benefit was associated with consuming both beverages. The investigators found that drinking 2-3 cups of coffee and 2-3 cups of tea per day exhibited a 30% decrease in the incidence of stroke and a 28% lower risk for dementia versus those who did not imbibe. The study was particularly interesting because prior studies have rarely evaluated the consumption of both types of caffeine intake. Individuals were identified from the UK Biobank and participated in the study for a median of more than 11 years. The study was funded by the National Natural Science Foundation of China with no relevant financial relationships reported by the authors. A full text of the article including all of the details, check here. So, the lesson for me is that I had better start drinking more tea…

Long Haul Covid Cases Continue To Increase – One of the problems that has been pushed out of the media spotlight is the specter of Long Covid. A variable percentage of people can experience variable multiorgan effects or autoimmune conditions over a variable period of time extending from weeks to months and perhaps years following a Covid-19 illness. We are at the beginning of this phenomenon which seems to attack healthy cells in the body by mistake and causes tissue damage and inflammation or outright tissue damage to various parts of the body. At the present time, the phenomenon is referred to as multisystem inflammatory syndrome (MIS) following a COVID-19 infection. The most common COVID long-haul persistent symptoms often include brain fog, fatigue, headaches, loss of smell, dizziness, and shortness of breath, among others. Check here for a more comprehensive list of symptoms or, simply type in “Long Haul Covid” into your browser. 

Autism On The Increase – But, Why? The CDC released a report in early December noting that the rate of autism among children appears to be on the increase. The most recent data comes from a 2018 analysis which showed that 1 in 44 eight-year-old USA children was diagnosed with autism. That’s a fairly dramatic increase from the 1 in 54 children from just two years earlier in 2016. There are several problems with extrapolating the data; however. First, only 11 states were included in the reporting database. And, second, the method of identifying “autism” does not appear to be standardized.  Those were just two areas of concern identified in a short read of the reports… Also, the question of “Why?” is left hanging…

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