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No nitric oxide, or not enough?

In 1987 Louis Ignarro published a paper in the Proceedings of the National Academy of Science that was the culmination of years of work trying to identify a molecule known before then only by its function – Endothelium-derived relaxing factor, or EDRF. As the name implies this was a substance […]

All sepsis patients do not have scurvy

“Doctor – Your Sepsis Patients Have Scurvy,” asserted Paul Marik MD in a Critical Care Editorial. Marik, who at the time was a respected critical care physician at Eastern Virginia Medical School in Norfolk, Virginia, supported his scurvy claim by noting that patients with sepsis suffer a “severe total body […]

Drug design using evolutionary first principles

Updated! The promise and power of science is that it produces results better than superstition, anecdote, and intuition. Vaccines, antibiotics, and insulin are powerful examples of those results. However, success can sometimes lead to the phenomenon of overshoot. Overshoot is when treatments miss the mark, and cause more harm than […]

Less is more monitoring?

In my specialty of emergency medicine, it seems we have an insatiable need for information about our patients. Many of our patients are speedily attached to the EKG machine, placed on continuous cardiac monitoring, pulse oximetry, and then phlebotomy – the routine bloodletting we do in the service of laboratory […]

We evolved to be flexible

Medicine is conservative,  favoring stability over change. We breathe a sigh of relief when a patient’s vital signs are stable. We worry about labile (changing) emotions, mood, or blood pressure. We have an inordinate fondness for homeostasis; we grow concerned when we detect outliers or departures from “normal” homeostasis. However, […]

Constrained energy model

Herman Pontzer and colleagues published a landmark study of energy expenditure in people from a very physically active hunter-gatherer group, the Hadza of Tanzania. These important findings have been central to how I think about diet and obesity. Here is what they found: Hadza hunter gatherers spend about the same […]

Fighting over interferon

Interferon is an innate immune molecule with an important antiviral function that provides a first line of defense against infection. Interferons are found across the tree of life, existing in all tetrapods and most fishes. It is thought that interferon evolved first in jawed fishes, about 400 million years ago. […]