Sunday, July 24, 2016

Two Stories About Doing Less

From today's Science & Health section of the Star Tribune, two stories on research into ways we can do less and have a better outcome.

First, from AP, less may be more in trauma treatment. Medical researchers in Philadelphia are about to start a large, randomized (but not double-blind) experiment into whether providing less emergency treatment to people with gunshot or stab wounds results in better outcomes. The treatments that will be withheld are IV fluids and intubation. The hypothesis is that for "victims who are bleeding through an open wound, these procedures may cause an increase in blood pressure that can accelerate blood loss and death."

Starting this fall and over the next five years (or until a thousands subjects have been studied), anyone in Philadelphia who's shot or stabbed will have an even chance of receiving or not receiving these treatments from EMTs. People are allowed to opt out of the experiment by wearing a bracelet saying they want the current standard treatment.

Researchers are visiting lots of people in the lead-up to the study to explain all of this. Given the history of experimentation without consent, especially in black communities (everything from Henrietta Lacks to the Tuskegee syphilis experiments), the researchers face a fair amount of skepticism.

People wonder if the researchers aren't sacrificing people's lives to test a theory. However, it appears from the data so far that the real sacrifice may be among people who receive the current treatment:

Retrospective studies...have shown that gunshot and stabbing victims given basic life support — such as an oxygen mask, CPR or immobilization — had an 18 percentage-point survival advantage over those given advanced procedures, such as intubation, in an ambulance.
The plan is to stop the study early if, part way through, the researchers are finding disproportionately adverse outcomes for patients who don't get intubation and IV fluids.

The second story is about finding ways to use fewer solvents in chemistry, and it's from the New York Times. Solvents like acetone and chloroform are harmful and volatile, and make up the majority of chemical waste, so using less of them would be great. But the average chemist would say they are essential to chemistry.

Until now, when chemists like James Mack are investigating mechanochemistry, which uses physical action (basically milling or grinding) to achieve the same end as has been achieved with solvents. Not only does the process eliminate solvents, it can also be much faster and result in more output of the desired chemical.

So if you hear someone referring to "green chemistry," this is probably what they're talking about. The linked New York Times article includes a short video showing the process.


Odd fact: The mechanochemistry story, as reprinted in the Star Tribune, carried a completely inaccurate headline: "Proponents offer greener way to make solvents." I read the story twice looking for any mention of making solvents, but obviously the copy editor either didn't read or misunderstood the story.

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