Last week, I attended a medical policy meeting, helping set Medicare payment rates for physicians and other healthcare providers. I have participated in this meeting three times a year since 2011. It is often tedious and filled with hours of debate over mundane minutia (for instance - how many linear feet of exam table paper or alcohol swabs should Medicare include as part of a level 4 outpatient medical office visit?). And yet, I often leave energized. The lobby and lunch conversations with like-minded physicians and policy experts are (another) reminder of how fortunate I am to know such a wide range of thoughtful humans, even if the thoughts sometimes focus on debating how many tongue depressors the typical patient requires in a 20-minute physician office appointment.
Interestingly, the committee meeting has its own Wikipedia page:
https://en.wikipedia.org/wiki/Specialty_Society_Relative_Value_Scale_Update_Committee
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Listen to a Google Notebook LM A.I.-generated podcast of the newsletter with two virtual "hosts."
The A.I. almost got things right - I do not personally partake in cold plunges, but I am amused that the A.I. thinks I do everything I write about. (And, it is clear the A.I. hosts still don't know they are A.I. I won't tell them if you don't.)
https://drive.google.com/file/d/11lYQZPnTR8SlSXMgaLMc9NVCk6dwbocx/view
About NotebookLM: https://blog.google/technology/ai/notebooklm-audio-overviews/
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Science and Technology Trends
I have been part of several conversations on the value of using saunas and partaking in cold plunges. While I have not read much about the physiologic impact of cold plunges, this thread and article reviewed by Dr. Nicholas Fabiano showed up in my X feed this week. "[Researchers] employed functional magnetic resonance imaging (fMRI) to identify clusters of [brain] networks coupled with behavioral changes after a 5 min cold-water immersion." "Participants felt more active, alert, attentive, proud, and inspired and less distressed and nervous after having a cold-water bath. The changes in positive emotions were associated with the coupling between brain areas involved in attention control, emotion, and self-regulation."
X Thread
https://x.com/ntfabiano/status/1880607121257250889
Article
https://www.mdpi.com/2079-7737/12/2/211
Claude Summary
https://claude.site/artifacts/522c9d72-0d78-4122-b49a-c61bee00ddac
My 8-15-22 issue with the data on sauna usage. (It is at the bottom of the newsletter.)
Bacterial nanotubes are "structures made of cell membrane that allow nutrients and resources to flow between two or more cells." Researchers from the University of Cordoba recently published findings demonstrating that ocean-borne photosynthetic single-cell organisms connect via nanotubules, apparently intermingling genomic information and maybe nutrients and other materials. The implication is single bacteria may be more part of interconnected communities than we traditionally thought. (This is an easy-to-read article about the research, FYI.)
https://www.quantamagazine.org/the-ocean-teems-with-networks-of-interconnected-bacteria-20250106/
Anti- Anti-Science Articles of Note
Last week, the FDA "banned" the food coloring red dye No. 3. I decided to dig into the available scientific data, which turned out to be confusing, making clear communication, much less action, difficult.
This Popular Science article highlights some of the confusion. In 1990, the FDA banned the dye from cosmetics but did not ban it as a food ingredient. (Safe to eat, but not safe to put on your face?) The article also provides a good overview of the history of Red No. 3. I also found a WaPo article from around the time discussing the politics and lobbying that yielded the cosmetics-only ban.
https://www.popsci.com/health/red-3-ban/
and
1989 Washington Post article:
Nevertheless, I was left wondering - what is the problem? What illnesses or outcomes are associated with Red No. 3? I found two extensive review articles looking at various food dyes. The better of the two is a metanalysis from 2012, which I summarized with Claude. Essentially, there is some data to suggest Red No. 3 confers a risk of DNA damage (i.e. risk of cancer) in lab animals. However, the studies cited in the metanalysis are not ideal – many used sample sizes of lab animals, variable dosing of those animals, and relatively short exposure times. In other words, despite these studies being the basis for the 1990 cosmetics ban, there are limited “compelling” data.
https://claude.site/artifacts/b217bdb6-00d1-482e-8b07-2ae1d3513c79
and the article
I also found an extremely detailed 2021 report from the California Office of Environmental Health Hazard Assessment detailing data about the health impact of food dyes. The 230+ page report is so extensive it exceeded Claude's summarization limits. ChatGPT was able to extract and summarize the relevant information and studies that informed the report. The 11 cited studies on Red No. 3, all imperfect animal or benchtop studies, demonstrated various unsavory effects, including cell damage, hyperactivity in mice, and diminished sperm counts in male rats. (Scroll to the bottom of the ChatGPT thread for the studies.)
https://chatgpt.com/share/678bf38b-eb08-8013-a70a-ae1bd1779788
The original report:
Here are my takeaways:
1) There is a paucity of robust data about the long-term impact of food dyes, including Red No. 3 in humans. In humans, the data that seemed to drive the ban are associative and related to the potential for cancer and behavioral impacts (i.e., the dye may exacerbate ADHD and similar attention-related symptoms).
2) The available data are concerning, but it is challenging to extrapolate benchtop and rodent data to humans - especially given the longer-term exposure of humans, highly variable person-to-person dosing, and many other confounding variables.
3) However, unlike fluoride (reviewed last week), I can find NO data on the nutrition benefits of food dyes (the value is aesthetic). Therefore, removing them has little downside (other than the costs incurred by the food manufacturers). See the FDA website on the history of food coloring additives: https://www.fda.gov/industry/color-additives/color-additives-history
4) Nuance reigns again – demonstrating how hard it is to build policy on imperfect science.
Living with A.I.
"The share of teens who say they use ChatGPT for their schoolwork has risen to 26%, according to a Pew Research Center survey of U.S. teens ages 13 to 17. That's up from 13% in 2023. Still, most teens (73%) have not used the chatbot in this way. Teens' use of ChatGPT for schoolwork increased across demographic groups."
"In Nature Communications study, researchers described using A.I. to create complicated electromagnetic structures and associated circuits in microchips based on the design parameters. What used to take weeks of highly skilled work can now be accomplished in hours. The A.I. behind the new system has produced strange new designs featuring unusual circuitry patterns. Kaushik Sengupta, the lead researcher, said the designs were unintuitive and unlikely to be developed by a human mind. But they frequently offer marked improvements over even the best standard chips."
Consumer-friendly article
https://techxplore.com/news/2025-01-ai-unveils-strange-chip-functionalities.html
and
Twitter discussion
https://x.com/8teapi/status/1878837038352581014
and
The Paper
https://www.nature.com/articles/s41467-024-54178-1
Infographics
I did not know Columbus disseminated chili peppers, which were not in many places of the world till the 1500s. Fascinating.
https://cornellbotanicgardens.org/wp-content/uploads/2018/11/map.layout.pdf
Things I learned this week
When penguins divorce, their whole colony feels their breakup.
"In good times, they largely stick with their partners, although there's often a bit of hanky-panky happening on the side." When a breeding pair separates after failing to achieve reproductive success, researchers discovered that chances of successful offspring with a new partner are often less than with previous partners, leading to population-level unintended consequences.
https://www.popsci.com/environment/penguin-divorce/
A meandering and random-fact-based lunchtime conversation amongst a mixed group of subspecialist physicians offered an interesting medical fact. An otolaryngologist (ear, nose, and throat doctor) taught me that melon allergies (like cantaloupe) are often a cross-reactive Oral Allergy Syndrome rather than a true allergy. Individuals who suffer from pollen allergies, particularly to ragweed, may also experience allergic reactions to cantaloupe due to cross-reactivity - their immune system "sees and reacts" to pollen and the fruit proteins similarly. Thus, the melon is a trigger, and the allergy is to ragweed. Sadly, it doesn't change the need to avoid melon or ragweed.
https://www.lafoodallergy.com/learn/allergic-to-cantaloupe-heres-what-you-need-to-know
A.I. art of the week (A visual mashup of topics from the newsletter, now using ChatGPT to summarize the newsletter, suggest prompts, and make the images)
It's a race to the bottom on the graphics this week:
"A dramatic Renaissance-style painting combining a futuristic microchip with intricate, angelic circuits designed in the style of Da Vinci, surrounded by penguins in emotional poses reminiscent of a divorce court. In the background, chili peppers sail tiny galleons on icy seas while a solemn Renaissance explorer points dramatically towards the horizon. The entire scene is infused with Michelangelo-style grandeur and detailed emotional expressions."
https://drive.google.com/file/d/1T4MNV9nt_OjCoyDkWDCxWDHM_jhEG8yt/view
Open A.I.'s Sora text-to-video interpretation of this prompt:
https://drive.google.com/file/d/1ic6MgCIeHr4dvWS_I8RaJiDfpd80gTkM/view
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Some insights from JP Weiland, a data scientist, and long-time COVID forecaster:
"[The fall] peak has definitely passed. Now I can overlay the observed data until January 8 (orange) over my Holiday Season Forecast from November 19 (green). Modeled numbers for January 17: 515,000 new infections/day ~1 in 65 currently infected. No region [in the U.S.] surpassed summer peak."
https://x.com/jpweiland/status/1880398194430943684
The Pandemic Mitigation Collaborative (PMC) website uses wastewater levels to forecast 4-week predictions of COVID rates.
based upon https://biobot.io/data/
Wastewater Scan offers a multi-organism wastewater dashboard with an excellent visual display of individual treatment plant-level data.
https://data.wastewaterscan.org/
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Clean hands and sharp minds team,
Adam