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Health

A Virus That Can Cause Polio-Like Paralysis in Children Has Returned

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A virus that can rarely cause a polio-like paralysis in children has resurfaced in the U.S. after mostly disappearing during the covid-19 pandemic. The Centers for Disease Control and Prevention reports that it has spotted a surge of cases linked to enterovirus D-68. Based on recent past outbreaks, officials expect that a small percentage of these cases will develop a serious neurological condition known as acute flaccid myelitis.

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Over the weekend, the CDC issued a health advisory concerning EV-D68. Since August 2022, doctors and hospitals in several parts of the country have notified the agency of an increase of severe respiratory illness cases and hospitalizations among children caused by two groups of viruses: rhinoviruses and enteroviruses. Further testing has shown that some of these cases were caused by EV-D68, and the CDC’s own surveillance data has shown a higher proportion of respiratory illnesses tied to the virus this summer compared to the past three years.

EV-D68 is one of many viruses that usually cause a mild common cold, mostly in children. However, it’s become apparent in recent years that the infection can sometimes trigger AFM. The virus is a cousin of the poliovirus, which has long been known to cause a similar paralytic condition in about 0.1% of victims. And it’s suspected that EV-D68 has recently mutated in some way that makes it more similar to polio and thus more likely to cause AFM, though it is still a rare complication.

The primary symptoms of AFM are sudden limb weakness, and some will also experience facial weakness, slurred speech, and pain along their limbs and back. In the most severe cases, people can develop a life-threatening paralysis that causes respiratory failure, while others may develop permanent paralysis.

There are probably several causes of AFM, including other enteroviruses, but the spike in cases seen since at least 2014 is closely connected to outbreaks of EV-D68 in particular. These outbreaks of EV-D68 and AFM had occurred every two years on schedule during the past decade, likely as a result of population immunity falling low enough for large groups of children to catch it all at once. But this pattern, which would have predicted another AFM outbreak in 2020, changed once the covid-19 pandemic arrived.

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While mostly everyone has contracted covid-19 by now, much of the world took precautions during the first years of the pandemic to avoid unnecessary social and physical contact. These efforts may have only slowed down the spread of the highly contagious coronavirus, but they were more effective at curbing the transmission of many other, less-contagious infections, EV-D68 included. It’s only recently that many garden variety germs have begun to storm back in frequency, and experts have warned that EV-D68 would eventually follow suit as well. The virus tends to be seasonal, arriving in the summer, just as it has now.

There have been nearly 700 confirmed cases of AFM documented by the CDC since 2014, when the agency began formally tracking it. During past outbreak years, there were around 150 to 200 cases of AFM. So far, only 13 cases have been reported in 2022. But the condition typically appears weeks after the initial symptoms of a common cold, and past outbreaks of AFM have similarly followed outbreaks of EV-D68. In its advisory, the CDC calls for doctors to be on the lookout for the condition and notes that “increased vigilance for AFM in the coming weeks will be essential.”

The actual poliovirus has made something of an unwelcome return in the U.S. this summer. In July, a young New York resident developed paralytic polio, and the virus has since been found in the state’s wastewater, indicating the potential for further spread. The virus may not spread very far, thanks to a highly effective vaccine and a high vaccination rate (over 92% nationwide), but it remains a danger to the unvaccinated, and its return could imperil the global effort to eradicate polio as a human disease.

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Health

How Many Steps You Really Need to Take Each Day, According to Science?

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The more you walk, the lower your risk of all-cause and cancer mortality, according to a new study, with the benefits leveling out once you reach 10,000 steps per day. So clearly, that is the number of steps to aim for—or is it?

Studies that compare health outcomes to step counts sound pretty compelling, because these days we all have step counters on our wrists or in our pockets. A step count number also sounds very concrete and precise: 10,000 steps equals health and happiness, and it gets measured for us automatically. Cool.

But already, I bet you’ve noticed some major caveats. Our bodies are messy meat machines, not neat step counters. If exercise is what matters, wouldn’t a cyclist have a lower step count than a runner, yet be just as healthy? For that matter, couldn’t a walker and a runner end up with similar step counts despite doing very different intensities of exercise that likely have different effects on the body?

On the other hand, there are some ways that step counts are a good way of tracking activity, so I don’t want to dismiss the idea entirely, even though I’m skeptical of how sharp a picture it provides. Step counts are higher for people who move around more in daily life (“incidental” activity, it’s sometimes called) even if they don’t do a lot of structured exercise. The steps are also counted automatically: You might not remember whether you were doing yard work for 20 minutes or 45, but your tracker probably has a good idea of how many steps you took.

There’s a further set of caveats: These studies are usually observational. They tell us that people who take more steps per day tend to be healthier. But is it cause or effect? People who are in poor health may have less energy to run errands and go for daily walks. And people who use wheelchairs or other mobility aids probably aren’t clocking step counts even when they do.

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With that in mind, here are some step counts published in recent research, alongside some of their caveats.

For all-cause mortality and cancer mortality

This study found that the people who took 10,000 steps had lower risk than those who took 8,000, who in turn had lower risk than those who took 6,000, and so on. Step counts above 10,000 seemed to have a similar risk as 10,000. In other words, if this represents a true and causal relationship—which we can’t be sure of—increasing from 10,000 to 12,000 wouldn’t change your risk of cancer or death.

The 78,500 people tracked were from the UK, aged 40- to 79, and 97% white.

For dementia

This study found that participants’ risk of dementia decreased the more steps they got in, up to 9,800 per day, similar to the above study. (It was also conducted by the same team and drew from the same pool of subjects.) They also note that people who took 3,800 steps had about half the reduced risk of people who took 9,800, so perhaps that lower number would be a good target if you’re currently more sedentary. That said, this was also an observational study, and most of the participants were a bit young to start developing dementia.

For all-cause mortality in elderly women

This study found a reduced risk of death from any cause in women who took 4,400 steps compared to those who took 2,700 steps per day. More was better, up to about 7,500 steps, after which the chance of dying seemed to level off. Step count numbers come from quartiles: the 25% of people with the lowest step counts averaged around 2,700.

The participants were 16,741 women with an average age of 72. They come from the Women’s Health Study, which began as a 1990’s trial of aspirin and vitamins for prevention of heart disease and cancer. The participants are 95% white and most are nurses.

For mortality in middle-aged people

This study compared steps per day to the risk of death in middle age (41 to 65). It found that people who took more than 7,000 steps had a 50% to 70% reduced risk of mortality compared to people who took fewer than 7,000 steps per day. This number was chosen as a cutoff because it is the number that the American College of Sports Medicine estimates as a 30-minute walk each day plus a small amount of non-exercise activity.

The 2,110 participants were 57% women, 42% Black, and were followed for an average of about 11 years after the study.

For arterial stiffness

Stiffening arteries are a component of cardiovascular disease. This systematic review found that increasing steps by 2,000 per day seems to reduce arterial stiffness by about the same amount as starting a structured exercise program. The categories compared in the analysis ranged from those who took less than 5,000 steps to those who took more than 10,000. The authors write: “In layman’s terms, these findings suggest that some physical activity is better than none, but also that more is better than less.”

The results come from 20 previous studies. Most were cross-sectional (comparing groups of people based on how many steps they take) but a few were randomized controlled trials or prospective studies.

For diabetes risk in Latinx adults

This study found that each 1,000 steps more per day was associated with a 2% reduced risk of diabetes. People who took 10,000 to 12,000 steps per day had an 18% lower risk compared to those who took fewer than 5,000 steps per day.

The study participants were 6,634 Hispanic and Latino adults, half of them female, with an average age of 39.

For all-cause mortality, but at different ages

This study is interesting because it breaks down the results by age group. Data from 15 studies suggests that mortality decreases with more steps up to 6,000-8,000 steps for people aged 60 and up, but that the equivalent in younger adults is 8,000-10,000.

What do we make of all this?

I think it would be a mistake to take these top-line results completely at face value. Can you reduce your risk of death by a certain percentage just by deliberately walking a few thousand more steps per day? Nearly all of these studies compared people who already walked different amounts, rather than tasking groups of people with increasing their step counts and seeing how their health changed.

But the results do suggest that healthier people tend to have step counts that are toward the higher end of the typical range. In pretty much all of these studies (and others in this research area), people who take, say, 8,000 steps tend to be in a lower risk category than those who take, say, 2,000. So if you’re currently pretty sedentary, getting your step count up might be worth a try, even if there is no specific study saying you have to meet such-and-such number.

It’s also interesting, I think, to see that there’s no specific optimal number that these studies have identified, even though we like to talk about these studies in specifics. It’s not like you need to get to 10,000 because something different will happen than if you got 9,500.

The curves on the graphs in these papers tend to level off somewhere in the high four digits, but estimates also get less certain there because there just aren’t very many people who get more steps than this. A person who routinely gets 25,000 steps per day, for example, is just off the charts. They might be super fit, or they might have an active job that works them harder than they can easily recover from; these studies aren’t designed to tease out the difference.

The bottom line, then, is probably what you would have assumed even before checking the numbers: if you sit around a lot, moving more will probably be good for you. And if you want specific guidance, you can go with the good old 150+ minutes of exercise per week guideline, or follow the various guidelines from government projects that recommend 8,500 steps per day (U.S. presidential challenge), 7,000 to 10,000 (U.K.’s national obesity forum), or 8,000 to 10,000 (Japan).

  

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Health

Exclusive: Medical journals broaden inquiry into potential heart research misconduct

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WASHINGTON, Sept 13 (Reuters) – Three medical journals recently launched independent investigations of possible data manipulation in heart studies led by Temple University researchers, Reuters has learned, adding new scrutiny to a misconduct inquiry by the university and the U.S. government.

The Journal of Molecular and Cellular Cardiology and the Journal of Biological Chemistry are investigating five papers authored by Temple scientists, the journals told Reuters.

A third journal owned by the Journal of American College of Cardiology (JACC), last month retracted a paper by Temple researchers on its website after determining that there was evidence of data manipulation. The retracted paper had originally concluded that the widely-used blood thinner, Xarelto, could have a healing effect on hearts.

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“We are committed to preserving the integrity of the scholarly record,” Elsevier, which owns the Journal of Molecular and Cellular Cardiology and publishes the two other journals on behalf of medical societies, said in a statement to Reuters.

Philadelphia-based Temple began its own inquiry in September 2020 at the request of the U.S. Office of Research Integrity (ORI), which oversees misconduct investigations into federally funded research, according to a lawsuit filed by one of the researchers.

The Temple investigation involves 15 papers published between 2008 and 2020 and supported by grants from the U.S. National Institutes of Health, according to the court records. Nine of the studies were supervised by Abdel Karim Sabri, a professor at Temple’s Cardiovascular Research Center.

His colleague Steven Houser, senior associate dean of research at Temple and former president of the American Heart Association, is listed as an author on five studies supervised by Sabri. Houser was also involved in four additional papers under scrutiny.

Houser sued in federal court last year to stop the university’s inquiry, saying Temple sought to discredit him and steal his discoveries.

Houser “has not engaged in scientific or other misconduct, has not falsified data, and has not participated in any bad acts with any other scientist or academic,” Houser’s lawyer, Christopher Ezold, said in a statement to Reuters. Houser helped review and edit the text portions of the Sabri-supervised studies and did not provide or analyze the data, Ezold said.

A Temple spokesperson said the university is “aware of the allegations and is reviewing them.” He would not comment further or discuss interactions with medical journals. ORI also declined comment. Sabri and Houser did not respond to questions.

Several research experts said that Houser, as one of multiple co-authors, cannot be assumed to be involved in potential misconduct. The ultimate responsibility for a study usually lies with the supervising scientist and any researcher who contributed the specific data under scrutiny.

EXPRESSION OF CONCERN

The probes highlight concerns over potential fabrication in medical research and the federal funds supporting it. A Reuters investigation published in June found that the NIH spent hundreds of millions of dollars on heart stem cell research despite fraud allegations against several leading scientists in the field.

The Temple inquiry also reveals a lack of consensus within the scientific community over how such concerns should be communicated, to prevent potentially bad science from informing future work and funding, according to half a dozen research experts interviewed by Reuters.

Temple did not notify the medical journals that it was conducting an inquiry at the request of the U.S. government agency, the journals told Reuters. They said that they began their inquiries independently.

Xarelto’s manufacturer, the Janssen Pharmaceuticals division of Johnson & Johnson (JNJ.N), also told Reuters the supervising researchers at Temple did not notify the company about the investigation or the retraction by the JACC journal, though two of its employees were listed as co-authors on the paper. Janssen said their contribution to the paper was not questioned in the retraction.

In some misconduct inquiries, universities have notified scientific journals that an investigation is underway. That has allowed journals to issue an “expression of concern” about specific studies, telling readers that there may be reason to question the results. If there is a finding of data manipulation, the journals would be expected to retract the paper.

None of the journals that published the papers under scrutiny by Temple have issued expressions of concern. They would not comment to Reuters as to why they decided not to.

“It’s murky because of a lack of resources for these investigations, there’s no standardization worldwide,” said Arthur Caplan, head of medical ethics at New York University’s Grossman School of Medicine.

Other journals are not scrutinizing the Temple researchers’ work. Five papers flagged by ORI were published in the AHA journals Circulation, Circulation: Heart Failure, and Circulation Research, where Houser is a senior advisory editor.

The AHA said it had not been notified by the U.S. agency or by Temple about their inquiry, and that it does not view itself as responsible for investigating further. The AHA said it had issued a correction of data on one paper at the authors’ request. The paper was the sole study under scrutiny that listed Houser as supervising researcher.

“The American Heart Association is not a regulatory body or agency,” the AHA said in a statement to Reuters.

FEDERAL FUNDING

Researchers and their institutions can be forced to return federal funding that supported work tainted by data manipulation.

Houser has received nearly $40 million in NIH funding and Sabri has received nearly $10 million since 2000, according to a Reuters analysis of NIH grants. Houser’s lawyer said that none of his NIH funding supported the papers supervised by Sabri.

The JACC journal said in its retraction of the Xarelto research that it launched its investigation after receiving a complaint from a reader. In response, the researchers issued a correction of some image data in the paper, which was supervised by Sabri and which listed Houser as an author.

However, the journal said that the correction raised further concerns, prompting it to hire an unidentified outside expert to review them.

According to the retraction notice, the expert evaluation found evidence of manipulation in seven images using a technique known as Western blot, which determines concentrations of a specific protein in cells or tissues under different experimental conditions. As a result, the journal said its ethics board voted to retract the paper.

NIH, ORI and Temple declined to comment on whether Temple would be required to return any federal funding of the work retracted by the JACC publication.

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Reporting by Marisa Taylor and Brad Heath; Editing by Michele Gershberg and Edward Tobin

Our Standards: The Thomson Reuters Trust Principles.

Brad Heath

Thomson Reuters

Washington-based reporter covering criminal justice, law and more and a graduate of Georgetown University Law Center and member of the Virginia bar.

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Science

Cloud labs and remote research aren’t the future of science – they’re here | Medical research

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It’s 1am on the west coast of America, but the Emerald Cloud Lab, just south of San Francisco, is still busy. Here, more than 100 items of high-end bioscience equipment whirr away on workbenches largely unmanned, 24 hours a day and seven days a week, performing experiments for researchers from around the world. I’m “visiting” via the camera on a chest-high telepresence robot, being driven round the 1,400 sq metre (15,000 sq ft) lab by Emerald’s CEO, Brian Frezza, who is also sitting at home. There are no actual scientists anywhere, just a few staff in blue coats quietly following instructions from screens on their trolleys, ensuring the instruments are loaded with reagents and samples.

Cloud labs mean anybody, anywhere can conduct experiments by remote control, using nothing more than their web browser. Experiments are programmed through a subscription-based online interface – software then coordinates robots and automated scientific instruments to perform the experiment and process the data. Friday night is Emerald’s busiest time of the week, as scientists schedule experiments to run while they relax with their families over the weekend.

There are still some things robots can’t do, for example lifting giant carboys (containers for liquids) or unwrapping samples sent by mail, and there are a few instruments that just can’t be automated. Hence the people in blue coats, who look a little like pickers in an Amazon warehouse. It turns out that they are, in fact, mostly former Amazon employees.

Emerald originally employed scientists and lab technicians to help the facility run smoothly, but they were creatively stifled with so little to do. Poaching Amazon employees has turned out to be an improvement. “We pay them twice what they were getting at Amazon to do something way more fulfilling than stuffing toilet paper into boxes,” says Frezza. “You’re keeping someone’s drug-discovery experiment running at full speed.”

Further south in the San Francisco Bay Area are two more cloud labs, run by the company Strateos. Racks of gleaming life science instruments – incubators, mixers, mass spectrometers, PCR machines – sit humming inside large Perspex boxes known as workcells. The setup is arguably even more futuristic than at Emerald. Here, reagents and samples whizz to the correct workcell on hi-tech magnetic conveyor belts and are gently loaded into place by dextrous robot arms. Researchers’ experiments are “delocalised”, as Strateos’s executive director of operations, Marc Siladi, puts it.

The Emerald Cloud Lab in South San Francisco. The laboratories are equipped with more than 200 types of scientific instrument that can be controlled remotely from a software ‘command centre’. Photograph: Emerald Cloud

Automation in science is nothing new, especially in fields such as molecular biology, where much of the experimental work involves the laborious and repetitive transfer of tiny quantities of liquid from one vial to another. The disruption caused by the pandemic also encouraged a number of specialist facilities to develop ways to operate their equipment remotely. (The beams of the UK’s powerful Diamond Light Source, for example, a particle accelerator that generates ultra-high energy radiation to investigate matter, can now be operated by users from anywhere in the world.) And outsourcing difficult or time-consuming elements of the experimental process is not new either.

But Emerald and Strateos are different – these are the world’s first laboratories that in theory allow anyone with a laptop and credit card to “pay and play” with the entire reagent inventory and suite of instrumentation available in a world-class research facility. The appeal of this approach became obvious during the pandemic, when many researchers were unable to visit their own labs in person; the founders of cloud labs say this is the future of life science.

The most obvious benefit is productivity: researchers can conduct several experiments at once and queue them up to run overnight or while they do other things. “Our pro-users, they’ll do the work of 10 scientists in a traditional lab,” says Frezza. “They’ll crank ridiculous numbers.”

There’s no time spent setting up and tearing down equipment, cleaning up, maintaining and fixing instruments or replenishing stock. Arctoris, a remote-operated drug discovery lab in Oxfordshire, says its platform has completed projects for pharmaceutical companies in 24 hours that might take at least a week in a traditional setting. Instead of pipetting for hours each day, researchers can spend more time thinking, reading, and analysing results with colleagues.

Scientists at Pittsburgh’s Carnegie Mellon University were so impressed by what staff and students could do at the Emerald Cloud Lab – one researcher managed to recreate years of his PhD experimentation in a matter of weeks – that they recently asked the company to build another one, just for them.

With a year’s worth of access to a cloud lab often costing less than the price of a single piece of high-end lab equipment, the dean of Carnegie Mellon’s college of science, Rebecca Doerge, says the model could be transformational. “I’m not interested in just changing science at Carnegie Mellon. I’m interested in changing the process of science worldwide,” she says of the new facility in Pittsburgh. “We all have colleagues in under-resourced places that can’t do the science that they’re capable of just because they don’t have enough money. So with an internet connection and access to a cloud lab, this is a game-changer.”

A Strateos smart lab in San Diego. The company claims to have ‘reimagined the laboratory as a smart data generation centre’. Photograph: Strateos

Doerge, a statistician turned science administrator, is also excited about removing variation and human error from experimental work. There will be no scientists based at the new 1,500 sq metre (16,000 sq ft) site, just half a dozen technicians helping the place run 24 hours a day. “People still go to wet labs and they still stand there and they make mistakes. I don’t think that everything is automatable in science, I’m not saying that. I’m just saying that the repetitive stuff, once you learn it, you don’t need to stand there and do it over and over and over again.”

Scientists such as Doerge believe the precision of remote-operated labs could help fix what has become known as science’s “reproducibility crisis” – the worrying revelation that the results of troves of published research can’t be replicated when different groups of scientists follow the same methods exactly. Plugging an experiment into a browser to be performed by robots forces researchers to translate the exact details of every step into unambiguous code. For example, what once might have been described in a scientific paper as “mix the samples” becomes detailed computer instructions for a certain machine to mix at a certain number of rotations a minute for a certain time. Other factors that could affect the result, such as the ambient temperature at the time, are captured in the metadata.

As Doerge has encouraged more and more research – and even teaching – at Carnegie Mellon to be transferred to the remote labs, not all of her colleagues have been supportive. Many scientists think that working alongside colleagues at the bench and the sights and sounds of experimentation are what help generate exciting ideas and happy accidents. Others have concerns about the quality of data produced in labs they’ve never set foot in. “‘If I don’t see it with my own eyes, it doesn’t exist’ – I’ve heard that from some of the senior faculty members,” says Doerge. “It’s a mindset shift for sure.”

Some experts believe that making access to sophisticated labs this easy is a potential biosecurity or bioterrorism threat. In theory, small groups or even individuals with no research experience could use a cloud lab to start performing complex biological experiments. “The labs are saying they only work with trusted partners, but of course they are very keen to open their market,” says Dr Filippa Lentzos, an expert in biological risk and biosecurity at King’s College London. “Even though we must remember most people come from a good place, there are some pretty crazy people out there too. Barriers are most definitely coming down if you want to deliberately do something harmful.”

Cloud labs say that they review all scheduled experiments and have systems to flag or reject any that appear illegal or dangerous. Plus, they argue, the complete digitisation of everything happening in the lab actually makes it easier to record and monitor what people are doing than in a traditional lab.

Paul Freemont, co-founder of the UK Innovation and Knowledge Centre for Synthetic Biology, has helped develop several highly automated labs in the UK, including a robotic platform that was able to conduct more than 1,000 Covid tests a day early in the pandemic. He is not sure that remote-operated labs are yet “mature” enough to replicate what is available to scientists who set up their own automated equipment. “I like the concept and think this is the way science is going to go. It would work if we had all the necessary protocols and workflows that a biologist might need, but I think that’s not currently available to the level of complexity and detail that one needs.”

Scientists from Carnegie Mellon university. The institution has asked Emerald to build it a dedicated cloud lab. Photograph: Tim Kaulen/Carnegie Mellon University

Freemont also has concerns about scientists not truly understanding or engaging with the software or the hardware that generates their data. “You have to have the next generation of scientists understand how to build all this infrastructure themselves and how to work with it – you have to have some hands-on experience, surely. The potential for a few labs or big private companies to monopolise that understanding – I don’t think would be very healthy.”

Despite these concerns, the appetite for cloud science is growing. Emerald is expanding capacity to keep up with demand, mostly from pharmaceutical companies and biotech startups. Strateos is working with the US research agency Darpa to study in detail how its facilities can improve reproducibility and efficiency of previous experiments and the company is also licensing its software so that other institutions can convert their facilities.

In future, cloud labs may even decide what experiments to do themselves. As Google’s DeepMind platform has recently proved, machine-learning tools can now gobble up decades’ worth of data and spit out answers to questions that would take scientists many years to solve with physical inquiry. Pharmaceutical companies are increasingly using these tools to simulate molecular interactions in their search for new drugs. Data generated through cloud labs – which translate biology into an information technology – would only make these tools more powerful. Combining all these technologies could one day lead to systems that can develop theories and physically test them without human input.

Already, some advanced Emerald Cloud Lab users have developed algorithms that adjust the parameters or direction of the next experiment based on their own data analysis. “It’s kind of wild stuff, very futuristic,” says Frezza.

All this means scientists are the latest profession to ask what the move towards automation and AI means for the future. Could more traditional research scientists one day find themselves out of a job? It’s unlikely – after all, we’ll always need people to prioritise which questions need answering and develop new ways to answer them. But the days of sitting at a bench in a white coat and gloves beside the flame of a Bunsen burner may soon be a thing of the past – the era of the robot researcher is coming.

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Health

Poor Dental Health Linked to Greater Dementia Risk: Meta-Analysis

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A healthy mouth may just help keep the brain healthy as well, new research out this week suggests. The study, a broad review of the existing evidence, found that poor dental health was linked to a later higher risk of cognitive decline and dementia. This increased risk was especially apparent for those missing some or all of their teeth.

Many studies have indicated that the health of our teeth and gums can influence the body elsewhere, including the brain. But other studies have been less conclusive, and there remains much uncertain about the strength and direction of this relationship. It’s possible, for instance, that the link can be explained by people developing poor dental health as a result of their early dementia, instead of the other way around—an example of something scientists call reverse causality.

In new research by a team from the University of Eastern Finland, they sought to conduct an updated meta-analysis of the evidence so far, one that would try to account for these gaps in knowledge. They collected and analyzed 47 longitudinal studies that tracked people’s oral and brain health over time, looking specifically at those who hadn’t been diagnosed with dementia at the start of the study.

Ultimately, they found that people with poor oral health were 23% more likely to eventually develop some amount of cognitive decline, and 21% more likely to develop dementia. And of the various measures of oral health studied, they also found that tooth loss in particular was independently associated with cognitive decline and dementia.

“Poor periodontal health and tooth loss appear to increase the risk of both cognitive decline and dementia,” the authors wrote in their paper, published Thursday in the Journal of the American Geriatrics Society.

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They caution that the evidence they examined is still limited and has many caveats, so it’s hard to draw firm conclusions. Many of the studies looked at different groups of people (some only included people over 65) or tracked them for different periods of time, while others may have had methodological problems in their design. But the authors say theirs is the largest review of its kind to date. They also tried to account for reverse causality in a separate analysis, and found that it could explain some but not all of the connection seen here.

In other words, while there might be a real cause-and-effect link between poor oral health and dementia, it will take more well-done research to better understand the specifics of this relationship, including the exact mechanisms behind it. Some scientists theorize, for instance, that the bacteria found in people with gum disease can help trigger or accelerate the complex chain of events that leads to dementia. The team behind this paper also notes that losing teeth could harm the aging brain by depriving people of familiar sensations. And there are likely other factors that can negatively affect both the mouth and brain at the same time, such as nutritional deficiencies.

Of course, keeping your mouth in good shape already has plenty of benefits, including for heart health. So even if there’s still a lot left to be studied here, it’s yet another reason to brush your teeth every day and to see a dentist regularly. The authors also point out that more has to be done to ensure that people can get access to good dental care throughout their lives.

“Given the impact of cognitive deterioration on periodontal health, oral health professionals are well-placed to track and intervene in early changes in periodontal health and oral self-care, but only if dental healthcare services are sustained over time and adequate oral health support is provided in the home setting when deterioration in self-care is identified,” they wrote.

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Health

Everything You Need to Know About the 2022-2023 Flu Shot

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Photo: Joe Raedle (Getty Images)

It’s flu shot season and, once again, the influenza vaccine is an important one to get. With mask-wearing on the decline, there’s likely to be more of every common respiratory virus around. So you might as well protect yourself against the ones that have safe, effective vaccines readily available.

In years where the flu shot is well matched to the strains that end up circulating, the vaccine is 40% to 60% effective at preventing the flu, according to CDC data. The vaccine also reduces your chance of getting seriously ill from the flu even if you do get sick—much like the COVID vaccines. Neither shot provides perfect protection, but you’re much better off vaccinated than not.

The CDC recommends that everyone receive a flu shot every year, starting with babies ages 6 months and up.

What are my options?

All the flu shots this year are quadrivalent, meaning they prime your immune system to recognize four different flu viruses. (In the past, some have had three.) Standard flu shots are usually given with a needle in the arm and are developed by a process that involves growing the virus in chicken eggs.

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There are two vaccines produced with entirely egg-free processes: Flublok Quadrivalent and Flucelvax Quadrivalent. People who are allergic to eggs are usually fine with any vaccine, but the egg-free kind is there for you if you want it.

There are two vaccines formulated for people ages 65 and older. One is high-dose (Fluzone High-Dose Quadrivalent), and the other is adjuvanted (Fluad Quadrivalent). Both are intended to provoke a stronger response than the standard flu vaccines. We have more information on these types of shots here.

And finally, the nasal spray (FluMist Quadrivalent) is back. This is a “live, attenuated” flu vaccine, meaning that the viruses in it are able to reproduce in the nose. (They cannot reproduce at the higher temperatures in your lungs.) It’s available for people between 2 and 49 years old who are not pregnant and not immunocompromised. There are other contraindications; see the CDC’s page on live attenuated flu vaccines for more on who can take this vaccine and who should not. The American Academy of Pediatrics has recommended the injectable over the nasal spray in the past, but this year both versions are included in their recommendations.

When should I get it?

The timing of flu season varies each year, but Halloween is considered the unofficial deadline for getting your flu shot to be fully prepared for the coming season. That means September and October are the best times to get a flu shot.

If you got your shot in July or August, that’s OK, but protection tends to wane over the season. Going forward, getting your shot closer to the start of flu season is recommended if that’s convenient for you.

Children ages 6 months to 8 years should get two doses of the flu vaccine if it’s their first time getting the shot or if they only had one dose prior to July of 2022. These two doses should be given four weeks apart. For these kids, you’ll want to get the first dose soon so they can get the second dose in time for flu season. For example, if you get one dose in mid-September and the second in mid-October, you’ll be all set. Next year, one dose will be enough.

If you don’t manage to get your flu shot by the end of October, you can still get it afterward. It’s never “too late” as long as flu season is going on. The season often peaks in February, and some years the peak can be as late as March. A late flu shot will still protect you from viruses you have yet to encounter, although if you wait until spring, pharmacies may no longer have the shot in stock.

Can’t the flu shot give me the flu?

No.

What if I’m also getting a COVID booster?

You can get your flu shot and your shiny new bivalent COVID booster at the same time. If you are getting a high-dose or adjuvanted flu shot, the CDC recommends using a different arm for each shot. (Both shots can cause soreness and redness at the vaccine site.)

   

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Health

Inhaling Whippits Left a Man Unable to Walk

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Photo: Shutterstock

In a new paper this month, doctors describe how a 32-year-old man’s habit of inhaling nitrous oxide via “whippits” left him partially paralyzed. Following treatment and the end of his nitrous oxide use, the man did eventually regain the function of his legs. But the medical tale is perhaps a timely reminder of why states like New York have recently decided to ban the sale of industrial-strength whipped cream chargers that contain the gas to teens.

The case study was published last week in the New England Journal of Medicine by doctors at Mount Sinai Hospital in New York and the Brigham and Women’s Hospital in Massachusetts.

According to the report, the man had visited a local emergency department six weeks after he began feeling a tingling sensation along his arms and two weeks after he lost the use of his legs. Two months before the symptoms started, he began inhaling nitrous oxide. Scans revealed nerve damage along the spinal cord and the telltale signs of a condition known as subacute combined degeneration (SCD).

SCD is caused by a deficiency of vitamin B12. Though it’s not entirely clear how the lack of B12 leads to SCD, B12 is known to be essential for the maintenance of myelin, the protective outer sleeve around our nerve cells in the brain and spinal cord. And it’s also known that long-term use of nitrous oxide can inactivate the body’s supply of B12. After ruling out other possible causes for the man’s illness, such as autoimmune disorders, the doctors determined that the nitrous oxide was to blame.

Nitrous oxide has many uses, including as a mild inhaled sedative in medicine. But it can also be used for the short-lasting euphoric effects that have led people to dub it laughing gas. Recreationally, people can inhale nitrous oxide through whippits, a reference to the whipped cream canisters from which it’s often sourced.

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In November 2021, New York banned the sale of industrial strength canisters to people under 21. But this summer, confusion surrounding the law and some poorly phrased news reports led people to believe that New York would be banning the sale of whipped cream cans in general to teens and children.

Misinterpreted as the law was, it is true that young people are the most likely to use nitrous oxide and other inhalants. Negative health effects vary depending on the substance being inhaled and how much of it is being used at once, but they include headaches, drowsiness, slurred speech, vomiting, and life-threatening complications like organ failure or a heart attack. Aside from SCD, long-term use of nitrous oxide can also cause memory loss and even psychosis.

The man in this case was given vitamin B12 shots, which restored his levels of the vitamin, and he reportedly stopped using nitrous oxide. And though SCD can lead to severe permanent neurological damage if untreated, doctors reported that the man was able to walk under his own power again four weeks later at a follow-up visit.

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Health

How to Recognize a Male Yeast Infection

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Photo: sheff (Shutterstock)

You might not have known that people with penises can get yeast infections, given that advertising for over-the-counter relief is widely geared toward those who do not. Prevention advice is usually aimed at vaginas, and yeast infection treatment is typically categorized as women’s health. In fairness, vaginas get the bulk of yeast infections, but it’s worth knowing that anyone can get one—and how to identify it.

What is a yeast infection?

No matter who you are and what equipment you’re packing, you likely have some common fungus known as candida albicans hanging out in your body. According to WebMD, there’s probably a little in your mouth and digestive tract right now, not to mention in other moist parts of your skin. This fungus is typically present in vaginas, too. While it doesn’t cause issues most of the time, if too much of it grows in any one place, it leads to a yeast infection.  

Sure, that could happen anywhere the fungus is present, like your mouth—when that happens, it’s called oral thrush. When it happens on the tip of a penis, it’s called balanitis.

What are the symptoms of penile yeast infection?

According to the Mayo Clinic and WebMD, look out for these symptoms if you believe you might have a yeast infection:

  • Moist skin on the penis, potentially with a thick, white substance accumulating in folds of skin
  • Shiny, white areas on the skin of the penis
  • Redness, itching, or burning on the tip of the penis
  • Discharge that resembles cottage cheese or may even smell unpleasant and “bread-like”
  • Swelling at the tip of the penis
  • Trouble pulling back the foreskin
  • Trouble urinating
  • A hard time getting or keeping an erection

Of course, most of these symptoms could also easily be symptoms of something else, so pay close attention to if you’re experiencing a number of them and keep the following risk factors in mind.

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How do you get a yeast infection on your penis?

Balanitis is more common on uncircumcised penises. According to WebMD, these are some other risk factors:

  • Taking antibiotics for a long time
  • Having diabetes
  • Being overweight
  • Having a weak immune system
  • Having issues cleaning yourself
  • Having a sensitivity to soaps, perfumes, or chemicals

Finally, the answer to the most burning question: Can you get a yeast infection through sex with someone who has one? Yes, you can. So, if you have sex with a partner who’s got a vaginal yeast infection, that overgrowth of fungus may spread to your junk, too.

Diagnosis and treatment for balanitis

Diagnosing a penile yeast infection is pretty easy, per WebMD: Your doctor will ask you about your symptoms, take a look, and potentially swab the tip for a lab test. It’s important that you avoid trying to diagnose yourself because so many symptoms of a yeast infection are similar to those of other sexually transmitted infections.

There are over-the-counter antifungal creams your doctor may recommend, but they may also prescribe one, or a steroid cream or oral medication. In the event of recurring infections, they may recommend circumcision, better hygiene habits, managing diabetes better, losing weight, or avoiding certain soaps or chemicals.

The infection should clear up within three to five days of starting treatment. To help prevent this from happening again, be sure to clean and dry your penis every time you shower or have sex, use unscented hygiene products, and wear loose, cotton underwear. Communicate with your partner about their health and if they have a yeast infection, make sure to use a condom during sex until theirs is cleared up.

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Business

FTC wants more information on Amazon’s One Medical purchase

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The first Amazon deal made under new CEO Andy Jassy is getting Federal Trade Commission scrutiny.

In question is Amazon’s $3.9 billion acquisition of the primary health organization One Medical.

The investigation could delay the completion of the deal.

A request for additional information was received by both One Medical and Amazon on Friday in connection with an FTC review of the merger, according to a filing made with securities regulators by One Medical’s parent, San Francisco-based 1Life Healthcare Inc.

AMAZON TO ACQUIRE ONE MEDICAL FOR ABOUT $3.9B

SAN RAFAEL, CALIFORNIA – JULY 21: A sign is posted in front of a One Medical office on July 21, 2022 in San Rafael, California. Amazon announced plans to acquire health provider One Medical for an estimated $3.9 billion. ((Photo by Justin Sullivan/Getty Images) / Reuters Photos)

In recent years, Amazon has been making a push into health care.

It purchased acquisition of the online pharmacy PillPack for $750 million in 2018.

Preparations shown at Amazon’s first COVID-19 test lab. (Hardy Wilson/Amazon)

Amazon announced plans in late July to buy One Medical, a concierge-type medical service with roughly 190 medical offices in 25 markets. 

AMAZON SHUTTING DOWN ITS HYBRID VIRTUAL, IN-HOME CARE SERVICE

Last week, the e-commerce giant said it would shut down its own hybrid virtual in-home care service called Amazon Care, a One Medical competitor, because it wasn’t meeting customers’ needs.

Ticker Security Last Change Change %
AMZN AMAZON.COM INC. 127.51 -0.31 -0.24%

Groups calling for stricter antitrust regulations quickly urged the FTC to block the One Medical merger, arguing it would further expand the company’s massive market power.

Amazon.com Fulfillment Center. Amazon is the Largest Internet-Based Retailer in the United States. (iStock / iStock)

An Amazon spokesperson declined to comment.

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The FTC has already been investigating the sign-up and cancellation practices of Amazon Prime and has issued civil subpoenas in that case.

The Associated Press contributed to this report.

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Business

FTC Investigating Amazon Deal to Buy One Medical Network of Health Clinics

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WASHINGTON—The Federal Trade Commission is investigating

Amazon.com Inc.’s

AMZN -0.24%

$3.9 billion deal to buy

1Life Healthcare Inc.,

ONEM 0.35%

which operates One Medical primary care clinics in 25 U.S. markets.

1Life, which went public in 2020, disclosed the investigation in a securities filing. The disclosure says One Medical and

Amazon

AMZN -0.24%

each received a request on Friday for additional information about the deal from the FTC.

Amazon’s

AMZN -0.24%

bid for One Medical added momentum to the push by technology and retail giants to make inroads into the nation’s $4 trillion healthcare economy. The deal was the first major acquisition announced during the tenure of Chief Executive

Andy Jassy,

for whom expansion into healthcare is a priority.

The FTC’s move to investigate the deal could delay its completion as federal competition investigations often take months to finish. Significant U.S. antitrust probes on average take about 11 months, according to data compiled by law firm Dechert LLP.

FTC Chairwoman Lina Khan is a critic of Amazon, having written a 2017 law review article that argued Amazon’s conglomerate-like structure shouldn’t have escaped antitrust scrutiny. Ms. Khan said Amazon’s entry into businesses beyond its e-commerce platform allowed it to gather data it could use to undercut other companies.

The FTC is investigating Amazon’s Prime membership program, according to a legal petition Amazon filed last month. The company argued that FTC staff had made excessive demands on founder

Jeff Bezos

and other company executives and asked officials to quash the subpoenas.

An Amazon spokeswoman declined to comment.

Mr. Jassy is focused on healthcare as an industry in which Amazon could find significant growth opportunities. The company recently revealed that it plans to shut down a healthcare unit it launched in 2019 called Amazon Care after it announced the One Medical deal.

The transaction would give Amazon more than 180 clinics with employed physicians across roughly two dozen U.S. markets. One Medical Chief Executive

Amir Dan Rubin

is expected to remain as CEO once the deal closes.

The line between Amazon and Walmart is becoming increasingly blurred, as the two companies seek to maintain their slice of the estimated $5 trillion retail market while chipping away at the other’s share, often by borrowing the other’s ideas. Photos: Amazon/Walmart

As Amazon seeks to grow in healthcare, the company faces added challenges from competitors such as

UnitedHealth Group Inc.’s

Optum health-services arm and

CVS Health Corp.

, in addition to hospital systems.

In a memo to employees,

Neil Lindsay,

senior vice president of Amazon Health Services, said the healthcare industry continues to be an important arena for innovation.

“As we take our learnings from Amazon Care, we will continue to invent, learn from our customers and industry partners, and hold ourselves to the highest standards as we further help reimagine the future of health care,” Mr. Lindsay wrote.

Write to Dave Michaels at dave.michaels@wsj.com

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Appeared in the September 3, 2022, print edition as ‘FTC Probes Amazon Deal for One Medical.’

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