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Posts Tagged ‘health

“God loveth the clean”*…

The history of ordinary things can be fascinating while offering insight into our immediate future. We’ve previously noted how artificial ice and assorted refrigeration/cooling technologies helped change demographics in the American South. Recent news from the Census Bureau confirms this trend as northern states like Michigan and New York lost population while the south, Texas and Florida in particular, gained. But the history of the ordinary can be hidden by ubiquity, tedium, and general disinterest. Unnoticed until they cry out for attention. Today’s Tedium is looking at the history of New York City restaurant inspections and the variety of ways restaurants cope. (And yes, the pandemic has certainly had an impact.)

There is no shortage of great New Yorkers, the people that helped shape the city and its culture. How one measures impact can vary. The wealthy and influential find their names on street signs, convention centers, and airports. A year into the COVID-19 pandemic, however, there is a renewed appreciation for those that helped lay the foundation for the city’s hospitals and medical care. In this regard, there are few New Yorkers greater than Dr. Sigismund Goldwater. 

A graduate of Columbia University and NYU medical school, Dr. Goldwater was a recognized authority in hospital construction. Among the numerous posts he held over a distinguished career included Superintendent at Mount Sinai Hospital, president of the American Conference on Hospital Service, and vice president of the New York Academy of Medicine. In recognition of his career and experience, he was appointed City Commissioner of Hospitals from 1934 to 1940. During his administration, Dr. Goldwater oversaw the construction of 25 new hospital buildings. His Times obituary credits him with adding more than 5,000 hospital beds to city capacity.

While his work in hospital administration and construction helped lay the foundation for New York City as a world-class center for health care, Dr. Goldwater has a legacy a bit more meaningful to modern restaurateurs. In 1914, Mayor John Purroy Mitchel was newly elected and in need of a health commissioner. His first choice, Dr. Goldwater, didn’t really want the job but finally acquiesced on the strong insistence of his predecessor. 

About six months after taking over the role, now Health Commissioner Goldwater announced a couple of general initiatives in public transportation and dining to ensure general cleanliness, pointing out to the Times that, “…the Sanitary Code at present did not call for regular inspection as in the case of bakeries and meat markets.” His solution was to require permits and require commercial restaurants to be inspected on an annual basis.

Public health, especially regarding sanitary food handling practices, had grabbed media attention in the early 20th century in part to Upton Sinclair’s The Jungle. Sinclair, an investigative journalist, went undercover to detail the working conditions in meat packing facilities. His account of rat infested factories and spoiled meat products shipped to consumers provoked outrage. Unfortunately for Sinclair, who was trying to shed light on the conditions of workers, readers were incensed to learn what was in their food. By 1905, the federal government had passed legislation to create what would become the Food and Drug Administration (FDA).

Another unique circumstance that kept food safety in the minds of New Yorkers was the terrible tale of Mary Mallon, better known as Typhoid Mary. A private cook that was also an asymptomatic carrier of typhoid, Mary Mallon became infamous for her condition, the number of people she infected, and her refusal to cooperate with safety guidelines. [See here]

There was another reason for the attention Mary Mallon received, explains Claire Stewart, a chef and hospitality management professor at the New York City College of Technology. “Typhoid was considered a disease of the poor and associated with immigrants and overcrowded tenements,” she said. “Mary Mallon spent a lot of her career cooking for wealthy people, so her bringing typhoid to the upper classes caused a lot of alarm.”

Still, by the time Dr. Goldwater became health commissioner, New York City had yet to regulate restaurants, creating a range of dining experiences and anxiety about the status of any given kitchen.

One concerned citizen wrote to the Times in a letter titled, “We Need Dainty Waiters.”, “In these days of pure food laws and Boards of Health… I would like to ask what assurance, if any, has the public that in our hotels, restaurants, and clubs proper supervision over their employes is exercised so as to insure us a fair degree of cleanliness on the part of those who handle the food we are to eat? This inquiry is prompted by occurrences coming under the personal observation of the writer, showing that employes in so-called high-class hotels, clubs, and restaurants are often guilty of practices which would not be tolerated in our own homes. One large restaurant in this city requires its waiters to pass an inspection by a manicure before they are allowed to handle food for its patrons.”

After Dr. Goldwater noted that other cities had also adopted regular restaurant inspections, and noting the potential for additional revenue via fines and permit fees, the city agreed. Now they just had to get some 15,000 owners and operators to comply. Should be easy, right?…

The wacky and surprising history of NYC restaurant inspections (and by extension, that same system in other cities). That letter grade is a lot more effective than you might think: “The Letter in the Window.” By Andrew Egan, in Ernie Smith’s (@ShortFormErnie) ever-illuminating newsletter Tedium (@readtedium).

* Francis Bacon

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As we wash our hands, we might recall that it was on this date in 1913 that Gideon Sundback was granted a patent on the first modern zipper. While he did well with his invention for several decades, he and his western competitors were overtaken in the mid-20th century by YKK.

Most checked chefs pants still have buttons.

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“If locusts are ravenous sociopaths, cicadas are more like frat boys – clumsy, loud, and obsessed with sex”*…

… and they are, themselves, the object of other species’ obsessions…

This spring’s emergence of periodical cicadas in the eastern U.S. will make more than a buzz. Their bodies—which will number in the billions—will also create an unparalleled food fest for legions of small would-be predators, including many birds and mammals. But some animals may benefit more than others, and any boost predator populations get from the coming buffet of winged insects will likely be short-lived, researchers say.

Tiny chickadees and mice have been known to wrestle these chunky bugs for a quick snack. Raptors, fish, spiders, snakes and turtles will gulp them down when given the chance. Captive zoo animals, such as meerkats, monitor lizards and sloth bears, will do so as well if the insects show up in their enclosure. Observers have even reported seeing domestic cats trap two cicadas at once, one under each forepaw.

This spring, three species of cicadas (collectively referred to as Brood X or Brood 10) will crawl out of the ground where they have spent the previous 17 years. They will coat the limbs and leaves of trees, sing, mate, lay eggs and then die. Uneaten corpses and body parts will add nutrients to the soil, bolstering the ecosystem and its denizens long after the boisterous insects disappear. But the famous periodicity of cicada broods can set some predators up for feast-then-famine scenarios—population booms followed by food insecurity and then sudden drops in numbers.

“In response to this superabundance of food, a lot of the predator populations have outrageously good years,” says Richard Karban, a University of California, Davis, entomologist who studies periodical cicadas. “But then the next year, and in the intervening years, there’s no food for them, so their populations crash again.”

Predators could be part of the reason that these slow-flying, defenseless and colorful cicadas emerge periodically instead of perennially. Over millennia, synchronized periodic emergences as a dense mob could have led to higher adult survival rates. Thus, the insects evolved to adopt their unusual life cycle—most of which is spent feeding underground—explains University of Connecticut evolutionary biologist and ecologist Chris Simon, who studies cicadas. “The predators are really important in driving the whole story,” she says. The success of the species effectively banks on sheer volume…

Most bird species do not travel to take advantage of cicada emergences… They live and eat in the same areas year after year, picking off the insects opportunistically instead of traveling to the cicada motherlode… cuckoos are an exception: they migrate to take advantage of insect outbreaks all over the country…

Despite all the eager predators, the life-cycle gamble on high-volume emergences pays off for periodical cicadas. Most survive predation to mate and then drop dead to the forest floor. But even if they go uneaten, their ecosystem impact does not stop there. Cicada bodies contain about 10 percent nitrogen, which is more than the concentration found in dead leaves and other typical forest litter, says Louie Yang, a University of California, Davis, entomologist, who studies resource pulses and phenological shifts. Plants such as American bellflowers will take up the nitrogen from the dead cicadas, and herbivorous mammals and insects will selectively feed on the higher-nitrogen fertilized leaves, he adds.

Patterns such as this one illustrate the ecological lens that periodical cicadas can provide on biological communities and evolutionary timelines. “I love the reciprocity of the whole system,” Yang says. “I think this kind of stuff happens all the time, but it’s usually hard to see. When these pulse events happen, it makes it really obvious—we can see that pulse pass through the system.”…

Billions of emerging insects will likely trigger predator population surges: “Brood X Cicadas Could Cause a Bird Baby Boom.”

Oh, and given climate change, 17-year cicadas could become 13-year cicadas: “The cicadas are coming. And they’re changing dramatically.”

* Catherine Price, 101 Places Not to See Before You Die

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As we bear the buzz, we might recall that it was on this date in 1923 that insulin became publicly available for use by diabetics. Frederick Banting had discovered insulin in 1921, and refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. He and his co-inventors, James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it.

Today, Banting and his colleagues would be spinning in their graves: Their drug, which many of the 30 million Americans with diabetes rely on, has become the poster child for pharmaceutical price gouging.

The cost of the four most popular types of insulin has tripled over the past decade, and the out-of-pocket prescription costs patients now face have doubled. By 2016, the average price per month rose to $450 — and costs continue to rise, so much so that as many as one in four people with diabetes are now skimping on or skipping lifesaving doses

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Written by LW

April 15, 2021 at 1:01 am

“To sleep: perchance to dream: ay, there’s the rub”*…

I’m not the first person to note that our understanding of ourselves and our society is heavily influenced by technological change – think of how we analogized biological and social functions to clockwork, then steam engines, then computers.

I used to think that this was just a way of understanding how we get stuff hilariously wrong – think of Taylor’s Scientific Management, how its grounding in mechanical systems inflicted such cruelty on workers whom Taylor demanded ape those mechanisms.

But just as interesting is how our technological metaphors illuminate our understanding of ourselves and our society: because there ARE ways in which clockwork, steam power and digital computers resemble bodies and social structures.

Any lens that brings either into sharper focus opens the possibility of making our lives better, sometimes much better.

Bodies and societies are important, poorly understood and deeply mysterious.

Take sleep. Sleep is very weird.

Once a day, we fall unconscious. We are largely paralyzed, insensate, vulnerable, and we spend hours and hours having incredibly bizarre hallucinations, most of which we can’t remember upon waking. That is (objectively) super weird.

But sleep is nearly universal in the animal kingdom, and dreaming is incredibly common too. A lot of different models have been proposed to explain our nightly hallucinatory comas, and while they had some explanatory power, they also had glaring deficits.

Thankfully, we’ve got a new hot technology to provide a new metaphor for dreaming: machine learning through deep neural networks.

DNNs, of course, are a machine learning technique that comes from our theories about how animal learning works at a biological, neural level.

So perhaps it’s unsurprising that DNN – based on how we think brains work – has stimulated new hypotheses on how brains work!

Erik P Hoel is a Tufts University neuroscientist. He’s a proponent of something called the Overfitted Brain Hypothesis (OBH).

To understand OBH, you first have to understand how overfitting works in machine learning: “overfitting” is what happens when a statistical model overgeneralizes.

For example, if Tinder photos of queer men are highly correlated with a certain camera angle, then a researcher might claim to have trained a “gaydar model” that “can predict sexual orientation from faces.”

That’s overfitting (and researchers who do this are assholes).

Overfitting is a big problem in ML: if all the training pics of Republicans come from rallies in Phoenix, the model might decide that suntans are correlated with Republican politics – and then make bad guesses about the politics of subjects in photos from LA or Miami.

To combat overfitting, ML researchers sometimes inject noise into the training data, as an effort to break up these spurious correlations.

And that’s what Hoel thinks are brains are doing while we sleep: injecting noisy “training data” into our conceptions of the universe so we aren’t led astray by overgeneralization.

Overfitting is a real problem for people (another word for “overfitting” is “prejudice”)…

Sleeping, dreaming, and the importance of a nightly dose of irrationality– Corey Doctorow (@doctorow) explains: “Dreaming and overfitting,” from his ever-illuminating newsletter, Pluralistic. Eminently worthy of reading in full.

(Image above: Gontzal García del CañoCC BY-NC-SA, modified)

* Shakespeare, Hamlet

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As we nod off, we might send fully-oxygenated birthday greetings to Corneille Jean François Heymans; he was born on this date in 1892. A physiologist, he won the Nobel Prize for Physiology or Medicine in 1938 for showing how blood pressure and the oxygen content of the blood are measured by the body and transmitted to the brain via the nerves and not by the blood itself, as had previously been believed.

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“What is research but a blind date with knowledge?”*…

Science at work: a fascinating interactive visualization of every paper ever published in Nature.

Will Harvey

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As we interpret influence, we might spare a thought for Neil Arnott; he died on this date in 1874. A physician and inventor, he created one of the first forms of the waterbed, the Arnott waterbed for the comfort of patients during prolonged illness. He also invented the economical Arnott stove (which he called a thermometer-stove), which featured a self-regulating fire. And in 1852, he won the Rumford Medal for the construction of the smokeless fire grate, as well as other improvements to ventilation and heating.

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Written by LW

March 2, 2021 at 1:01 am

“You’re mugging old ladies every bit as much if you pinch their pension fund”*…

Who benefits from the commercial biomedical research and development (R&D)? Patients-consumers and investors-shareholders have traditionally been viewed as two distinct groups with conflicting interests: shareholders seek maximum profits, patients – maximum clinical benefit. However, what happens when patients are the shareholders?…

Adding investments by governmentally-mandated retirement schemes, central and promotional banks, and sovereign wealth funds to tax-derived governmental financing shows that the majority of biomedical R&D funding is public in origin. Despite this, even in the high-income countries patients can be denied access to effective treatments due to their high cost. Since these costs are set by the drug development firms that are owned in substantial part by the retirement accounts of said patients, the complex financial architecture of biomedical R&D may be inconsistent with the objectives of the ultimate beneficiaries…

It has been estimated that of the total $265 billion spent annually on biomedical research worldwide, over a third – $103 billion comes from public sources. Nevertheless, as public input capital is allocated predominantly into early stage research, nearly all output – medicines – is ultimately brought to the market by private firms. Importantly, these firms are not independent agents. They have owners-shareholders to report to. Until the end of the previous century the major type of owners-shareholders were individual households. At the turn of the millennium, however, they have been displaced by institutional investors, the largest of which are public retirements schemes or quasi-public funds, such as occupational pensions.

First, government money underwrites the basic R&D that goes into drug discovery and development, then public pension monies fund the private companies that bring those drugs to market. As the private companies are solving for highest profits, as opposed to optimal public health, those drugs are often priced out of the reach of the very people whose pension contributions funded their development. Drugs “priced out of reach” is certainly not a new phenomenon; AIDS drugs (to take one example) were priced by Western pharma companies at prices that rendered them inaccessible to most citizens of low-income countries in Africa and Asia. The pensioners in wealthy nations were, effectively, living off of the misery of those in poorer companies.

But the dynamic has continued, deepened– and come home to roost. Now patients in high-income countries are denied access to effective treatments due to their high cost, while these costs are being set by the drug development firms, owned in substantial part by the retirement accounts of those same patients, and benefiting from direct and indirect governmental support.

Investing in one’s own misery– the painful irony of pharma funding: “Pension and state funds dominating biomedical R&D investment: fiduciary duty and public health.”

[Image above: source]

* Ben Elton, Meltdown

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As we untangle unintended consequences, we might send healthy birthday greetings to Charles Value Chapin; he was born on this date in 1856. A physician and epidemiologist, he was a pioneer in American public health. He co-founded in first bacteriological laboratory in the U.S. (in 1888) in Providence, were he was Superintendent of Health– a position he held for 48 years. In 1910, he established Providence City Hospital where infectious disease carriers could be isolated under aseptic nursing conditions; his success inspired similar health control measures throughout the U.S. A professor (at Brown) and prolific writer, his impact on health policy and practice was so broad that he was hailed as “the Dean of City Public Health Officials.”

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