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Carphology by A Fo Ben

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Broader healthcare provision lowers mortality

All the recent discussions in the USA about the benefits of extending medical care to every single person have prompted many opinions on such an approach. With the NHS free-at-the-point-of-care ethos, medical professionals from the UK have been accused of inherent bias on the subject. Some states in the USA have already increased Medicaid eligibility, leading the way to a more universal system. A recent study in these US states in the 5 years before and after this decision showed significantly reduced all-cause mortality of 6.1% between the two time periods. Perhaps unsurprisingly, the greatest improvements were in poorer areas and in the elderly population. These striking results remind us that the NHS model is still an ideal worth aspiring to.

NEJM 2012;367:1025–34

Brewed potato speech

The economic downturn may be driving more people towards home brewing, but a recent report from Utah makes for sobering reading. Eight maximum security inmates were enjoying ‘pruno’—a batch of illicit potato-based hooch—when one developed dysphagia, diplopia and progressive weakness within 12 h of consumption. All eight prisoners were hospitalised; three needed mechanical ventilation. Food-borne botulism poisoning was diagnosed. All received heptavalent botulinum antitoxin, an investigational new drug; there were no deaths. The outbreak was traced to a rogue baked potato stored at ambient temperature for an undetermined number of weeks in a sealed plastic bag, peeled by fingernails and fermented in this bag for several days before being distributed to other inmates.

Morb Mortal Wkly Rep 2012;61:782–4

Gender bias alive and well in academia

The idea that women are under-represented in science is not new. Despite extensive evidence that there is no inherent sex difference in aptitude, there have been only small advances to increase the number of women, particularly at higher levels. A recent US study investigated the effect of candidate gender on senior academics’ decision making when rating CVs for an appointment for a hypothetical laboratory manager position. The academics were not aware of the purpose of the study. Despite identical CVs, female candidates were consistently considered less competent than their male counterparts; were rated as less deserving of career mentorship; and worthy of a lower starting salary. The gender of the academic making the decision had no bearing on these opinions. It is not clear whether there are similar biases in applications for more clinical positions, but this is a timely reminder of the importance of challenging our unconscious stereotyping.

PNAS 2012;109:16474–9

Genius is 1% location and 99% mastication

While studying the population effect of dietary flavonoids and cognitive function, Franz Messerli stumbled across the strong correlation (figure 1) between the number of Nobel laureates for every 10 million persons in a given country, and chocolate consumption from three sources (Chocosuisse, Theobroma and Caobisco). Indeed, when Sweden is excluded (an outlier because of Nobel's nationality) the choco-correlation is even stronger. Forget state-sponsored sport to improve a nation's standing: the Chinese will quickly realise that a country needs only to step up chocolate consumption by 0.4 kg per capita per year to increase its Nobel laureate count by 1.

Figure 1

Correlation between countries' annual per capita chocolate consumption and the number of Nobel laureates per 10 million population.

N Engl J Med 2012;367:1562–4

Handy MRI's tennis dream

The question of how much awareness a patient in a persistent vegetative state (PVS) retains has long been important for clinicians and researchers alike. Functional MRI, a tool used to address almost every neuroscience question including how much activity there is in the brain of a dead salmon (Carphology passim), has recently been put to rather better use to address this question. Patients in the MR scanner are asked to imagine either walking around their house or playing tennis to give yes/no responses to questions asked. Although most were unable to respond, some gave accurate responses, even demonstrating formation of memories since the onset of their PVS. Although the technique currently requires expensive and specialist equipment, smaller brain-computer interfaces are developing fast, and it may not be too long before patients can interact with the environment again, at least at some level.

NEJM 2010;362:579–89


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