Forge Friday Roundup - September 3, 2021

September 3, 2021

In today’s Roundup: cluster trial reports on masking; the mathematical limits of gradient descent; key leaders depart FDA vaccine division; clinical trial brings link between alcohol and atrial fibrillation into sharper focus; some states dial back COVID data collection and reporting; “Zoom dysmorphia” fuels personal appearance discontents; Bayesian approaches for feature selection; “long-haul” COVID patients still seeking answers; US needs national clinical trials infrastructure to cope with public health emergencies; much more:


  • This now-viral tweet by @ddoniolvalcroze, which includes a picture of a handwritten manuscript page of Russia author Fyodor Dostoevsky’s masterpiece The Brothers Karamazov will have every editor who ever gave vent to muttered exasperation about an author’s disorderly manuscript saying, “I take it all back.”
  • Duke palliative care physician and cartoon artist Nathan Gray has published a new set of drawings that provide an, er, idiosyncratic vision of medical terminology.


Black and white photograph showing open staircase from the side with shadows underneath. Image credit: Callum Wale/Unsplash
Image credit: Callum Wale/Unsplash
  • “…despite this widespread usefulness, researchers have never fully understood which situations the algorithm struggles with most. Now, a research paper explains it, establishing that gradient descent, at heart, tackles a fundamentally difficult computational problem. The work's result places limits on the type of performance researchers can expect from the technique in particular applications.” At Nautilus, Nick Thieme covers recent work that establishes limitations to the applicability of widely used machine-learning technique, an algorithm known as gradient descent.
  • “A key problem with feature selection methods is they do not inform the analysis of the set of features for which we don’t know enough to select or reject them. The following approximate Bayesian procedure may help in this regard, and expose whether the sample size is adequate for the task.” At his Data Methods Discourse page, statistician Frank Harrell has opened a discussion topic on the use of a Bayesian procedure for selecting variables or features of interest, a procedure that avoids some of the limitations associated with LASSO regression methods.
  • At Kaiser Health News, Andy Miller reports on a potentially troubling phenomenon: even as COVID cases and hospitalizations surge as the delta variant spreads, some states, particularly ones in the South, are dialing back on the frequency and extent of their COVID data reporting.
  • “Visiting a page kicks off a bidding process where hundreds of advertisers are simultaneously sent data like an IP address, a device ID, the visitor’s interests, demographics, and location. The advertisers use this data to determine how much they’d like to pay to show an ad to that visitor, but even if they don’t make the winning bid, they have already captured what may be a lot of personal information.”  In an essay for The Markup, Alfred Ng takes a close look at what it really means when a tech company asserts that they “do not sell your personal data.”
  • Another day, another big hack: the Boston Globe reports that the venerable Boston Public Library has been hit with a ransomware attack that has disabled a significant portion of its computer network (H/T @PearlIF).
  • “The findings from this randomized clinical trial indicate that individuals increase physical activity more when they have a role in selecting their goals and when the target goals are implemented immediately.” A study published today in JAMA Cardiology by Patel and colleagues presents findings from the ENGAGE randomized trial, which evaluated a “gamified” intervention designed to increase levels of physical activity in economically disadvantaged persons who were at higher risk of cardiovascular problems.
  • “Facebook may have spent a lot of time and effort putting it together, but Ethan Zuckerman, who runs the Initiative for Digital Public Infrastructure at the University of Massachusetts in Amherst and is the former founder and director of the MIT Media Lab, said that the main conclusion he came to after reading the report was how flawed the methodology was, since most of the top posts appeared to be spam.” Facebook’s recent “transparency” report comes in for some scathing criticism, as Mathew Ingram documents at Columbia Journalism Review.
  • The preprint server service bioRxiv has announced a new tool that allows readers to sign up for automated alerts for new publications in topic areas of particular interest.


  • “Doctors have long suspected a link between alcohol and atrial fibrillation, but until now, they did not have definitive evidence that alcohol could cause arrhythmias. The new study is among the most rigorous to date: The researchers recruited 100 people with a history of atrial fibrillation and tracked them intensely for four weeks, monitoring their alcohol intake and their cardiac rhythms in real time.” The New York Times’ Anahad O’Connor reports on findings from a study by Marcus and colleagues, recently published in the Annals of Internal Medicine, that used a variety of methods (including electronic devices) to establish a clear link between alcohol consumption and incidents of a kind of heart arrhythmia called atrial fibrillation.
  • “…we found that mask distribution, role modeling, and promotion in a LMIC [low/middle income country] setting increased  mask-wearing  and  physical  distancing,  leading  to  lower  illness,  particularly  in  older adults. We find stronger support for the use of surgical masks than cloth masks to prevent COVID-19. Whether people with respiratory symptoms should generally wear masks to prevent respiratory virus transmission—including for viruses other than SARS-CoV-2—is an important area for future research.” A preprint by Abaluck and colleagues reports findings from a large cluster-randomized study that examined the effects of community-based masking programs in Bangladesh.
    Nighttime photograph showing shoreline waves glowing bright blue from bioluminescence. A man stands in the waves in silhouette with arms raised. Image credit: Trevor McKinnon/Unsplash
    Image credit: Trevor McKinnon/Unsplash
  • “Now, scientists report that ocean bioluminescence can be so intense and massive in scale that satellites orbiting five hundred miles high can see glowing mats of microorganisms as they materialize in the seas. Last month in the journal Scientific Reports, eight investigators told of finding a luminous patch south of Java in 2019 that grew to be larger than the combined areas of Vermont, New Hampshire, Massachusetts, Rhode Island and Connecticut.” The New York Times’ William J. Broad reports on new research that reveals vast tracts of ocean may be glowing from bioluminescent organisms.
  • “Only a quarter of countries worldwide have a national policy, strategy or plan for supporting people with dementia and their families....At the same time, the number of people living with dementia is growing according to the report: WHO estimates that more than 55 million people (8.1 % of women and 5.4% of men over 65 years) are living with dementia. This number is estimated to rise to 78 million by 2030 and to 139 million by 2050. A new report out this week from the World Health Organization surveys global shortfalls in dementia care and failures to prepare for an increasing incidence of the condition.
  • “Despite long-haulers’ fight for recognition, any discussion of the pandemic still largely revolves around two extremes—good health at one end, and hospitalization or death at the other. This ignores the hinterland of disability that lies in between, where millions of people are already stuck, and where many more may end up. The coronavirus is here to stay, and even as vaccines diminish the threat of hospitalization and death, we don’t know yet how well they will protect against the disability of long COVID.” At The Atlantic, Ed Yong revisits the phenomenon of “long COVID” – and the growing frustration of patients trying to grapple the longer-term implications of the still poorly understood condition.
  • “The researchers found that modern individuals grew faster than ancient ones. An analysis of organic materials in the clams’ shells suggests that modern clams are ingesting pollution-derived particles called nitrates, which fertilize symbiotic algae that live in the molluscs’ cells, providing the animals with extra fuel. Milder winters and a decline in seasonal storms could also have boosted the clams’ growth.” While the onrush of climate change is undoubtedly a disaster for humans and a great many other species, it’s turned out to be a bonus – for the time being, anyway – for giant clams in the Red Sea, as Nature reports.
  • “Russia’s Sputnik V vaccine is holding up well against the Delta variant, a paper posted yesterday on the preprint server medRxiv shows. The study of nearly 14,000 people showed the two-dose vaccine reduces the risk of hospitalization with COVID-19 by 81% and helped prevent severe lung injury.” Science Insider’s Olga Dobrovidova reports that the Russian Sputnik V vaccine appears to confer protection against serious outcomes resulting from infection with the COVID delta variant.
  • “In older patients with hypertension, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events than standard treatment with a target of 130 to less than 150 mm Hg.” In a paper published in the New England Journal of Medicine, Zhang and colleagues report results from a randomized trial (the STEP Study) that evaluated the use of intensive blood-pressure control as a means of reducing cardiovascular risk in patients with high blood pressure.
  • “A key advantage of knowing the correlates of protection is potentially enabling the approval of future vaccines. The vaccines that are available now went through a slog of clinical trials involving tens of thousands of people. But with vaccines increasingly available, it’s harder to enlist volunteers to participate in a study in which they might receive a placebo. Most people would instead choose to get a shot they know works.” STAT News’ Andrew Joseph probes a question that has assume a particular urgency of late: just how well protected against COVID are vaccinated persons, and how can “correlates of protection” potentially speed clinical trials and regulatory approvals of vaccines to come.


Mirror fragments reflecting different angles of a scene, centered on a person sitting with downturned gaze. Image credit: Erik Eastman/Unsplash
Image credit: Erik Eastman/Unsplash
  • “During the pandemic, the fun house mirror of Zoom twisted the images being reflected back to us, and at the same time, although trapped inside, we were still bombarded with edited images on social media and on television. These factors combined had a damaging impact on self-perception, anxiety and mental health – and it’s not going away.” A malaise for our era, certainly: in an article for Wired UK, Amit Katwala introduces readers to “Zoom dysmorphia,” in which unflattering camera representations during videoconference (often due to the distorting effects of camera lens geometry) are having real-world impacts on people’s psychological well-being.
  • “Although the pandemic is still not over and new surprises await scientific exploration, we should begin to learn from this crisis and prepare for the next one. Crises are likely to increase in frequency in the coming years, requiring more rapid cycles of scientific and technological innovation to solve them….To meet these future challenges, we need strategies that both strengthen peer review and radically decrease review times. Therefore, we advocate for the formation of rapid-review boards and scheduled reviews.” A viewpoint article by Urban and colleagues published in the journal Bioscience outlines some ways that scientific communication may need to change to accommodate an accelerating pace of medical and climate-change-related crises.
  • “Rimel recalls a particularly tough time right after her brother had to be hospitalized. Even then, family members were repeating conspiracy theories on social media and bragging about not wearing masks, Rimel says….Some of the same people who attended Dixon's funeral are still sharing misinformation related to COVID-19 online, says another sister, Jennifer Dixon.” As if the raw suffering imposed by COVID wasn’t enough, disease denialism, fueled by misinformation and conspiracy theories, exacts a further toll on families, as this NPR story by Brett Sholtis demonstrates.
  • “The doctors often stand in lab coats and use simplified medical jargon, lending an air of authority. They often take advantage of a ready audience online by livestreaming news conferences, and keep interest alive by promising new evidence that will expose corruption and support their arguments.” What, if anything, should be done to sanction physicians who deliberately spread medical misinformation? The New York Times’ Davey Alba and Sheera Frenkel explore the question as misinformation continues to accelerate the extent of harm being done by the COVID delta variant.
  • “Controlling for a number of covariates (number of citable papers published by the author; presence of international authors; number of co-authors; degree of the professor's specialization), the average increase in the number of self-citations per paper following introduction of the national scientific accreditation (ASN) is of 9.5%. The increase is common to all disciplines and academic ranks, albeit with diverse magnitude.” An Italian study by Abramo and colleagues published in the Journal of Informetrics shows an increase in self-citation across multiple academic disciplines after the creation of a citation-based incentive program.
  • “The difference between me and the Covid-19 anti-vaxxers is that I was lucky enough to be an anti-vaxxer when there was no pandemic. If I keep that perspective in mind, then the quiet outreach I’ve been doing to nudge Covid anti-vaxxers to get the shot can feel like a small form of penance.” A “First Opinion” article at STAT News by Craig Idlebrook offers some first-hand perspective on vaccine denialism – and how it can be effectively countered.
  • “It’s worth noting here: Studies have shown that assigning free reading for homework ― allowing students to read whatever books they want ― does improve their academic performance. But a little free reading is a world away from bulging backpacks full of coursework ― or additional online assignments after hours of Zoom schoolwork….Because of COVID, even longtime proponents of homework are advocating for a more sensible, pandemic-considerate workload for kids.” An article at Huffington Post UK by Brittany Wong that questions the wisdom of assigning grade-school homework during a still-active pandemic includes perspective from Duke’s Harris Cooper.


  • “The report recommended that Black doctors see only Black patients, and that they should focus on areas like hygiene, calling it “dangerous” for them to specialize in other parts of the profession. Flexner said the white medical field should offer Black patients care as a moral imperative, but also because it was necessary to prevent them from transmitting diseases to white people. Integration, seen as medically dangerous, was out of the question.” An infographic and accompanying historical essay by Anna Flagg at the New York Times’ Upshot blog traces the connections between the current “mortality gap” experienced by Black Americans and an early 20th-century report on American medical education whose effects are still reverberating today (H/T @uche_blackstock).
    Black and white photograph showing a pair of hands holding a jigsaw puzzle piece, with other pieces (out of focus) scattered on a table. Image credit: Benjamin Zanatta/Unsplash
    Image credit: Benjamin Zanatta/Unsplash
  • “The US has a distributed system for the conduct of clinical research in which investigators are able to pursue studies without much central coordination….In normal times, this decentralized process serves science well….But in a crisis, resources for conducting research are scarce. Clinicians do not have time to run multiple, rigorous studies, and enrolling patients in a setting where clinicians are delivering emergency care can be difficult. When COVID-19 struck, the uncoordinated system for clinical research meant that many of the most important clinical questions did not get addressed in a timely manner.” In a viewpoint article for JAMA Health Forum, former FDA Commissioner Scott Gottlieb makes the case for developing a national infrastructure for conducting urgent clinical trials in public health emergencies.
  • “The current approach that relies on determining payments for each type of digital interaction is destined to fail because such interactions aren’t distinct services that can be easily differentiated. Unless we move rapidly toward capitated models, the health care system will continue to deliver suboptimal, non–patient-centered care that fails to harness the potential of the technology that exists all around us.” An editorial published in the New England Journal of Medicine by Julia Adler-Milstein and Ateev Mehrotra indicts the current U.S. fee-for-service system for paying for medical care acting as a drag on the full potential of digital health.
  • “Two of the FDA’s most senior vaccine leaders are exiting from their positions, raising fresh questions about the Biden administration and the way that it’s sidelined the FDA….The bombshell announcement comes at a particularly crucial moment, as boosters and children’s shots are being weighed by the regulator. The departures also come as the administration has recently jumped ahead of the FDA’s reviews of booster shots, announcing that they might be available by the week of Sept. 20.” Endpoint News’ Zachary Brennan breaks some startling news: two senior FDA leaders who have overseen the agency’s vaccine evaluation program are resigning, apparently as a result of disagreements about the role of other federal health agencies in the FDA decision-making process.
  • “A nursing home is too expensive; or, because of ongoing staffing shortages, there aren’t even open beds in the area. Over the past year and a half, many have also deemed them too risky because of Covid-19 concerns. In-home care seems more complicated, but it’s almost always what the care recipient wants, especially if it means the ability to stay in their own home. So the family decides to make it work, without a real understanding of the often-invisible costs that will quickly begin to accumulate.”  An eye-opening article at Vox by Anne Helen Petersen illuminates the enormous costs of long-term eldercare lying in wait for may unsuspecting families.
  • “The Ohio lawsuit makes reference to the Front Line Covid-19 Critical Care Alliance, a nonprofit of which Wagshul is listed as a founding physician. The organization touts Ivermectin as both a preventative and treatment for COVID-19. Its “How To Get Ivermectin” section includes prices and locations of pharmacies that will supply it, from Afghanistan to Fort Lauderdale to Pennsylvania to Sao Paulo, Brazil.” A mind-boggling story from the Ohio Capital Journal’s Jake Zuckerman details a recent judicial decision in which a hospital in Cincinnati was ordered to supply an ICU patient with ivermectin to treat COVID symptoms, despite the lack of any evidence supporting the use of the antiparasitic therapy for that purpose (clinical trials of ivermectin for the treatment of COVID are ongoing, but no high-quality study has reported findings yet).