Tuesday, October 8, 2024

Morning Rounds: Physics Nobel, Hurricane Helene, and “Make America Healthy Again”

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Good morning! We’ve got a lot of news to share today, including another dispatch from Drew on the Nobels. Let’s get to it.

Physics Nobel goes to pioneers of machine learning

John Hopfield of Princeton University and Geoffrey Hinton of the University of Toronto, two researchers behind the development of machine learning, won the Nobel Prize in physics on Tuesday. The Nobel committee cited their “foundational discoveries and inventions that enable machine learning with artificial neural networks.”

In announcing the prize, the Nobel committee described Hopfield and Hinton’s work as not just helping advance research across different fields of physics — from material science to particle physics to astrophysics — but as something that was already changing daily life, with technology including facial recognition and language translation building off of the research.

Ellen Moons, the chair of the Nobel’s physics committee, also pointed to the applications in medicine, saying that “machine learning can aid humans in making faster and more reliable decisions, for instance, when diagnosing medical conditions.”

But Moons also nodded to the thorny questions that such a powerful technology has prompted. “Its rapid development has also raised concerns about our future,” she said.

More here from Drew.

Position matters: Measuring blood pressure the wrong way can lead to overdiagnosis

When you’ve made it to your doctor’s exam room, are you sitting on the paper-covered table when your blood pressure is taken? If so, they’re doing it wrong. You should be seated in a chair with your arm supported on a desk or other surface, keeping the cuff aligned with your heart. Monday’s study in JAMA Internal Medicine tells us measurements taken with patients’ arms in their laps or hanging by their sides overestimated blood pressure by as much as 4 mm Hg for the top number (systolic, or when blood pumps) number and almost 7 mm Hg for the bottom number (diastolic, or when the heart rests between beats).

Those higher numbers, compared to recommended arm positions, may not seem very big, and the study enrolled only 133 participants. But the authors estimate that improper arm position could mean 16% of U.S. adults, or 40 million Americans, would be mistakenly diagnosed with hypertension using a cutoff of 140 mmHg and higher, and 22%, or 54 million people, would be misclassified using the lower cutoff of 130 mmHg. That could make the difference between a prescription for a hypertension-lowering medication or a recommendation to make lifestyle-only changes. — Liz Cooney 

Can life expectancy keep going up?

If I was born in 1870, I probably would have died at the age I am now — 30 years young (thank you). Needless to say, people live a lot longer now than they used to, and generally, those in wealthy countries live even longer than those in poorer ones. But there may be a limit to how much time on earth wealth can provide. A study published yesterday in Nature Aging argues that “humanity’s battle for a long life has largely been accomplished.”

That message stands in stark contrast to what some of the longevity field’s most vocal proponents say about how lifestyle and diet changes could allow people to live as long as 150 to 180 years. Researchers analyzed data from 1990 to 2019 in the eight countries with the longest-lived populations, as well as the United States and Hong Kong. Increases in life expectancy slowed in all of these populations. And when the authors modeled a scenario in which life expectancy reaches 110, they found it would require curing most major causes of death today. Read more from STAT’s Jonathan Wosen.

The forces behind the GOP push to ‘Make America Healthy Again’

At a recent roundtable on Capitol Hill, newcomer siblings Calley and Casey Means had seats next to longtime favorites on the political right like psychologist and renowned beef-eater Jordan Peterson. Outside the event, the siblings buzz in the same orbit as even bigger names: Tucker Carlson, Joe Rogan, Robert F. Kennedy Jr., and even former President Donald Trump.

So who are the Meanses? The shortest answer is that Calley, 39, is a startup founder, while his sister Casey, 37, is an M.D. The full picture is more complicated. As burgeoning conservative media figures, they’re working to build a “Make America Healthy Again” identity for the Republican party. Trump is prioritizing the epidemic of chronic disease, Calley Means told STAT’s Isa Cueto in an exclusive interview. And in public appearances, they emphasize how polluted health care, government, and science have all become with perverse financial incentives. Their messages tend to activate conservative anxieties about personal freedoms, family values, and institutional corruption.

I asked Isa how she heard about the Meanses, and why she decided to write about them. “It just seemed like they kept popping up all over the place, and were propelling a conversation about chronic disease — and the big systemic issues underlying illness — that people were actually fired up about,” she said. “It was also fascinating to me how the Meanses were taking traditionally left-leaning ideas, like Food Is Medicine, and flipping them into GOP priorities. Like a total political ouroboros.”

Read more in Isa’s profile.

HIV in breast milk: Is undetectable still untransmittable?

When it comes to transmitting HIV through sex, the science has long been clear: If the virus is undetectable, then it’s untransmittable. But does that also apply to people who want to breastfeed? For mothers taking antiretroviral therapy, the risk of transmitting HIV to babies through breast milk is extremely low, but not exactly zero. In lower-income countries, the risk of transmission has long been seen as secondary to the benefits of breastfeeding. But in high-income countries, where safe formula and clean water are readily available, guidelines have been more cautious, advising avoidance of breastfeeding altogether.

A study published yesterday in the Annals of Internal Medicine contributes important evidence as the first to examine viral load in breast milk from people with long-term viral suppression.

Researchers collected breast milk from three cisgender women: an HIV-positive patient who maintained undetectable viral loads without medication for nine years, another HIV-positive patient who was on antiretrovirals with undetectable viral loads for five years, and one without HIV. The team detected no RNA copies of HIV in either woman with HIV, and extremely low levels of DNA copies.

Here’s what it means: There was no evidence of an intact virus, or of a virus that was strong enough to replicate and infect cells. While the small study wasn’t specifically designed to assess transmission risk, the data supports revising recommendations on infant feeding in high- resource settings, according to an editorial that accompanied the study. 

Hospital lobby calls for national emergency over IV shortage

Hurricane Helene killed more than 230 people when it tore through the Southeast U.S. just over a week ago. The storm also shut down an IV manufacturing plant in Marion, North Carolina, that’s responsible for about 60% of the IV solutions for the U.S. As the company, Baxter, deals with the damage, the American Hospital Association is asking the Biden administration to declare a shortage of IV solutions and invoke national emergency powers to ease the crisis.

It’s unclear how long it will take for the Marion plant to get back up and running. Some hospitals have already declared internal shortages and restricted IV use, and as Hurricane Milton barrels toward central Florida, another IV manufacturing plant is in its current path. Read more from STAT’s Brittany Trang.

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