Got a fabella?

The fabella is a small bone located in a tendon behind the knee (note the tiny bone at ther ear of the femur head).

This bone virtually disappeared over the course of human revolution, but it’s making a comeback. Looking at 21,000 studies of the knee spanning the past 150 years, researchers found that the fabella is three times more common than it was in 1918. In that year, just 11 percent of the world population had the bone. Last year, it was present in 39 percent of us.

It’s true that the average human body is taller and heavier than it was in 1918, resulting in longer shinbones and larger calf muscles—changes that put the knee under increasing pressure. But nobody knows what the fabella is supposed to do or why it’s making a comeback. In old world monkeys, it played a role in knee muscle mechanics. But in humans it’s anybody’s guess. As one scientist said, “perhaps the fabella will soon be known as the appendix of the skeleton.”

There’s definitely a down side to having this bone. It can cause knee pain. People with osteoarthritis in their knees are about twice as likely to have this bone than those who do not have arthritis. It can also create additional challenges for knee replacement surgery.

I’ve got some knee x-rays hanging around somewhere. I’m going to check them out.

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Primed for smallpox

Small pox was a horrible disease: fever, vomiting, rash, pustules, unslakable thirst, swelling, death. If you survived, you were left horribly scarred and possibly blind. Most people don’t know that the first person who advocated inoculating people against the disease was an English noblewoman, Lady Mary Wortley Montagu (born 1689). Smallpox was the biggest killer of her time. It killed her brother and nearly killed her. It happened that, on a trip to Turkey in 1717, she observed old women taking some pus from a smallpox sufferer and, using a needle, scratching a bit of it into a child’s skin. The children inoculated this way would have a mild case for a few days, then recover and never get the pox again. Before she left Turkey, Lady Mary had one of the women inoculate her own son in this way.

After returning to England, she tried convincing physicians of the inoculation idea, but they, of course, were disdainful. Nevertheless, she talked one physician into inoculating her daughter, who was three at the time. The procedure went well. After a time, Lady Mary succeeded in convincing a few more physicians to give it a try (actually, experimenting on prisoners). The rest, of course, is history, except that a physician named Edward Jenner, noting that milkmaids never got smallpox, figured out that inoculating people with cowpox was safer and more effective than inoculating with smallpox. Of course, Jenner gets the credit for the vaccination idea. Incidentally, the term, vaccination, comes from the latin word vacca, for cow. (In case you've forgotten, being inoculated with small doses of virus primes your immune system such that it can quickly attack an invader it "remembers.")

Today there is no smallpox. Not a single case on earth since the 1970s. Thanks to vaccinations, it’s been wiped out. Except, that is, for one mishap. In 1978, Janet Parker, a photographer in Birmingham, England, got smallpox after taking photographs of tissues and organs for doctors’ files. Somehow, she’d come into contact with samples that were supposed to have been locked away. Other people caught it from her. Parker died. Within a few years of her death all lab stocks of smallpox virus in the world were destroyed except for some samples kept in two tightly locked-down laboratories, one in the US and one in Russia.

Since the Parker incident in 1978, no one has had smallpox. In the US, routine smallpox vaccinations for every child were discontinued in 1971 and only a small fraction of humans are immune to it (old people who had it and survived).  Today the only samples of the smallpox virus are kept in two tightly locked-down labs, one at the CDC in Atlanta, and one in Russia. 

After 9/11 the US started a crash program to stockpile millions of doses of the smallpox vaccine. Gotta watch out for those Russians.

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Measles

I remember when I had the measles. I don’t remember the sickness part. What I remember is staying in bed in my parents’ bedroom because it was darker than mine. You were supposed to stay in a dark room with the shades pulled down. The disease left me with the loss of half my hearing in my left ear (listening to a phone with my left ear is pretty much useless). Many weren’t so lucky.

I was born in 1936. The measles vaccine was introduced in 1963. My kids were all vaccinated (the oldest was born in 1959). Measles became a reportable disease beginning in 1912. In the first decade of reporting, an average of 6,000 measles-related deaths were reported each year.

By 2000, the U.S. had eliminated measles, meaning that for one year no one had been infected. Now, as you know, measles has made a comeback, thanks to the reluctance of parents to have their children vaccinated (“vaccine hesitancy”). (The notion that measles vaccine causes autism has been thoroughly debunked.) According to the CDC, nearly 700 cases of measles has been confirmed in the US this year, more than any year since the disease was eradicated. World-wide, it claims more than 100,000 lives each year.

 Measles is a highly contagious disease, being transmitted primarily by tiny respiratory droplets that can remain viable in the air for up to two hours. Each person with measles may go on to infect 9 to 18 others. Plus, if you’re not immune and have been exposed, you have a 90% chance of contracting the disease.  Because measles is so contagious, near-perfect vaccination coverage (herd immunity of 93 to 95%) is needed to protect against a measles resurgence. Vaccine hesitancy has been identified by the World Health Organization as one of the top 10 threats to global health and is a serious hurdle to the global eradication of measles.

I guess you have to be old to appreciate the value of vaccinations. For one thing, most of us old people knew someone who either died from or was crippled by polio. Maybe polio will be the next disease resurgence.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Infectious-disease specialist shortage

Because of the increasing prevalence of “superbugs”—drug-resistant bacteria and fungi—it behooves us to have experts who know how to diagnose and treat infections caused by these organisms. But such experts are in short supply. According to the National Resident Matching Program, training spots for infectious-disease specialists go unfilled. Between 2009 and 2017 training positions dropped by more than 40 percent. It’s because this specialty does not pay well. While infectious disease specialists care for some of the most complicated illnesses in the health care system, their pay can be even worse than that of a general practitioner!

The specialty is poorly paid because of the way our insurance system reimburses doctors. Doctors are paid on the basis of the thousands of services that doctors provide—services as lowly as taking blood pressure, but of course also including surgery and everything else. Each service has a code and each code represents a monetary value. In the words of one doctor, “the formula prioritizes invasive procedures over intellectual expertise.” Infectious-disease doctors don’t do procedures: they consult. That consultation can include speaking with the primary care doctors and specialists, reviewing x-rays, and examining cells—all non-paying activities. Infectious-disease specialists are often the only medical people who not only know how to identify the disease-causing pathogens, but also know which of the new antibiotics to use. When such specialists aren’t available, doctors just wing it.

I read an account of a teen-age boy who became terribly ill with a myriad of symptoms, including painful and swollen testicles. Because he was traveling with his family, he went to lots of different doctors and hospitals in the US and Europe. None could diagnose his problem. Most gave him antibiotics. Finally, back home, he saw an infectious-disease specialist. It turns out he had dengue fever, which he’d contracted from a mosquito in Hawaii. Dengue fever is caused by a virus which, as you know, is unaffected by antibiotics. Everyone had been winging it.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.