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“Are you allergic to any medications?” I’ve answered that query dozens of times since a childhood incident when penicillin, taken to treat a minor infection, instead gave me an itchy rash all over my body. So I respond automatically, and call out the common antibiotic. But I recently learned that this diagnosis could be wrong. Penicillin sensitivity can disappear over time, a fact researchers have known for years. So why hasn’t my doctor told me to go get an official test? It could be because she doesn’t actually know the allergy can fade.

Within an hour of taking penicillin, allergy sufferers might experience hives, swelling, wheezing, difficulty breathing, or in the worst-case scenario, the life-threatening set of symptoms called anaphylaxis. In short, it’s not an experience you’d like to repeat. So when roughly 10 percent of Americans tell their doctors that they’re allergic to penicillin, the physicians tend to listen.

But penicillin allergies are actually much less common than reported. Studies suggest that less than one percent of the population will react to this antibiotic. The patients aren’t deliberately lying—the discrepancy occurs because a penicillin allergy can fade. For 80 percent of people who react to penicillin, their sensitivity will disappear sometime in the following 10 years.

This might not seem like such a big deal. After all, whether I’m actually allergic or not, avoiding penicillin won’t kill me. When I get strep throat or another illness usually treated with penicillin, my doctor can simply prescribe an alternative medication. Frequently, that alternative is a broad-spectrum antibiotic. The good news is, drugs in this category can treat a wide range of ailments. The bad news is that they often cost more, are less effective, and have more severe side effects than penicillin. Oh, and they contribute to growing antibiotic resistance. The more an antibiotic is used, the more bacteria get exposed to it—and the more likely they are to evolve defenses against it.

The solution is pretty simple: If patients report a penicillin allergy, but have not taken penicillin or had a skin test in 10 years, their doctors should refer them to an allergist. A skin test, like those that measure sensitivity to other common allergens, should also detect a penicillin reaction. The allergist scratches the skin and dabs a little of the test substance on top, or injects a drop. If an itchy red welt forms, the patient has an allergy. If the skin results are uncertain, the allergist can administer a follow-up test called a graded challenge, in which the patient takes gradually increasing doses of penicillin while doctors carefully monitor his or her reactions.

For the study, researchers asked 276 non-allergist medical professionals—doctors, physician assistants, nurses, and pharmacists—at the New York hospital network Rochester Regional Health about penicillin allergies. Only 58 percent knew that penicillin sensitivity can go away over time. (That number drops to 55 percent when you exclude the pharmacists, 78 percent of whom got the correct answer.) And given examples of patients who reported penicillin allergies, only 20 percent of the survey subjects could identify who should get skin tests to check their sensitivity.

Of the three authors, one is an allergist and another a pharmacist. Both of these fields rely on referrals from doctors, often general practitioners. But among the survey respondents who practice general medicine, about 80 percent said that in any given year, they sent zero or only one patient for allergy testing. Given that snub, and the fact that pharmacists outperformed other pros in their knowledge of penicillin allergies, you can’t help detecting a slightly disgruntled tone in the paper.

“Overall, among all levels of general and subspecialty providers, there is an extremely poor understanding regarding penicillin tolerance rates in those who are reportedly allergic, as well as clinical scenarios necessitating allergy consultation,” the researchers write. This grim pronouncement may be warranted: Although the survey was limited to one hospital network, its results suggest that a large number of medical pros are unaware of the latest guidelines on penicillin allergies. So the next time your doctor asks what you’re allergic to, consider requesting a skin test for penicillin.

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You Might Not Need A Colonoscopy To Be Screened For Colon Cancer

In the United States, screening for colorectal cancer is usually unpleasant. A patient’s preparation begins with a liquid diet, laxatives, and the uncomfortable knowledge of where the colonoscopy camera is going to go.

But there’s another, effective way to screen for colorectal cancer: fecal immunochemical tests, or FITs, which detect blood in stool (an early sign of cancer). The tests can accurately identify cancer, according to a review and meta-analysis published in the Annals of Internal Medicine.

If the FIT comes back negative, the patient is in the clear until their next annual test. If it comes back positive, only then would they have a colonoscopy, says study author Thomas Imperiale, researcher at the Regenstrief Institute and the Indiana University Center for Health Services and Outcomes Research. “If the comparison is to do a colonoscopy on everyone, you can greatly reduce the use of colonoscopy by doing a FIT,” he says. “As long as it still enables you to detect most of those cancers.”

The latest study builds on a 2014 review of FIT performance. “At that time, there were fewer studies available,” Imperiale says. His team’s analysis looked at 31 studies which included a total of over 120,000 patients. They found that the tests had a moderate to high sensitivity for cancer, meaning they identified cancer when it was present, and had a low rate of false positives.

Different studies included in the meta-analysis had different thresholds for flagging a positive tests, which impacted the amount of cancers detected. When the test considered 20 micrograms per gram of blood in the sample as a positive, it identified three out of four cancers, with a low false positive rate, Imperiale says. But when the threshold was lowered to 10 micrograms per gram, the sensitivity goes up. “You can take the sensitivity up to identify 9 out of 10 cancers.” However, that generates more false positives.

But James Allison, emeritus professor at the University of California, San Francisco and emeritus investigator at Kaiser Permanente, isn’t worried. He says these adenomas grow very slowly, and only around 6 percent annually will actually become cancerous. Because FITs are intended to be used annually, a patient with a negative result would ideally be tested repeatedly, increasing their likelihood of detecting an adenoma. Colonoscopies, on the other hand, are only done every 10 years. “You have a long time, in a program of repeated screenings, before it hurts someone,” says Allison, who published an editorial on FIT that accompanied the new study. Not identifying them on the first test is not necessarily a problem, he says, because they’re slow growing, and if they’re discovered on a FIT a year later, they likely won’t pose a major problem.

The easy annual repeatability of FITs is one of the test’s major benefits, Imperiale says. “If you have repeated negative tests, you can start to stack meaningful results, and get away with not everyone needing a colonoscopy.” After all, only around 4 percent of people with adenomas get colorectal cancer. “95 percent of the population will never get it. Negative FITs will identify who those people are.”

Colonoscopies have been the standard screening for colorectal cancer in the United States, but the U.S. Preventative Task Force, the agency that produces medical screening guidelines,does not recommend colonoscopies over FIT, or vice versa. Instead, the organization says the goal is to get the highest number of people screened. In other countries, like Canada, FIT is always the first line screening for colorectal cancer. Patients cannot have a colonoscopy covered by insurance without first having a FIT.

The fecal immunochemical tests is much less invasive than a colonoscopy. Wikimedia

The tests are also a lot cheaper than colonoscopies, notes Imperiale—and people are much more likely to do them than they might be to do a colonoscopy, which for many is uncomfortable and stressful.

FITs aren’t for everyone. Allison would not recommend the test for people with a family history of colorectal cancer or other significant risk factors. “I do not think a FIT is appropriate there,” he says. Imperiale agrees, and says that recognizing both options means patients with different risk factors can make informed choices with their doctors. A patient with some risk factors and who rarely goes to the doctor might be better off with a colonoscopy, he says. But for a marathon runner who stays on top of preventative check-ups, there aren’t a lot of upsides to colonoscopy. “Low-risk, compliant patients may do best with FIT,” he says.

To properly use FIT as a colorectal cancer screening strategy, hospitals and clinics must have systems in place to re-test people in the years after a negative result Imperiale says. “More importantly, people who are positive need to know that they need to go in for a colonoscopy,” he says.

There are multiple FITs available from different manufacturers, with varying amounts of information available, and patients should ask their doctors about the evidence behind the particular version they’re using, Allison says. The U.S. Preventative Task Force details the FITs with the best performance.

Ultimately, this study is a reminder that checking in with your gut doesn’t necessarily require a colonoscopy. “Non-invasive tests for colon cancer are a good option for average risk patients,” Imperiale says. “There are options, and the only wrong option is to go unscreened.”

Why You Might Not See Facebook Home On Ios Or Windows

Facebook is popping out with changes all over the place to all formats. It’s made changes to the online version of the social network seen on browsers and has also made changes to the apps for iOS and Android. Only one of these changes is truly exciting, and that’s the addition of Facebook Home. Yet, it’s only available on Android and not iOS or Windows Phone.

The main reason for Facebook Home to not be offered on the other platforms is that the Android OS is just more accessible, and that’s to both users and developers. This allowed for the development of Facebook Home, a launcher app. Use of the app gives users the ability to have an alternate homescreen and lock screen that allows for access to the Facebook features without having to open up an app or browser.

Apple doesn’t allow developers as much access to the OS. While Android allows developers access to create home or launcher apps, those same developers aren’t allowed to do the same for Apple. While some alternatives are indeed offered, they can’t be designated as permanent replacements, as Apple doesn’t allow for that.

When Facebook founder Mark Zuckerberg was announcing Facebook Home, he even made references to this difference, seemingly slamming Apple, at least just a little bit. He noted that it’s not so easy to create apps like that for iOS, and that “ultimately anything that happens with Apple will be in partnership with them.” Not only would they have to have Apple’s consent to work on it, they’d have to work alongside them to have that type of access. Facebook faces similar issues in getting Facebook Home on Microsoft’s Windows Phone.

Despite this knowledge, fans of the iOS system were raised by Bloomberg as it reported that Facebook has been in talks with Apple and Microsoft to hopefully bring Home to those platforms as well. Facebook representatives admit, though, that Home might not be the same version being used on Android. It might just use pieces of Home, such as the lock screen or some of the design. Ultimately, how much of Android’s Home it uses would be up to Apple’s discretion.

Laura Tucker

Laura has spent nearly 20 years writing news, reviews, and op-eds, with more than 10 of those years as an editor as well. She has exclusively used Apple products for the past three decades. In addition to writing and editing at MTE, she also runs the site’s sponsored review program.

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That New Study Saying Masks Might Not Be Effective? It Has A Few Caveats.

About 4,860 people completed the trial, and participants in both groups caught COVID-19 at similar rates, the scientists reported on November 18 in Annals of Internal Medicine. However, the findings come with numerous limitations, experts say.

“I would not change any practice or recommendation about masking based on it,” Deepak L. Bhatt, the executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital in Boston, told Popular Science in an email. “This study provides no actionable information about masking when used properly, with a high level of adherence with actually wearing the mask, and when high proportions of the population are masking up.”

At this point, numerous studies indicate that masks prevent the wearer from spreading COVID-19 to other people. There’s also additional evidence that masks protect the person wearing them from catching the disease. The Centers for Disease Control and Prevention recently updated its guidance on masks to recognize that masks likely provide some protection to both the wearer and those around them. This means that “individual benefit increases with increasing community mask use,” wrote the agency. In other words, the more people that wear masks, the better off everyone will be.

In a statement accompanying the new paper, Christine Laine, the editor in chief of Annals of Internal Medicine, said the new findings don’t conflict with the CDC’s guidance, but suggest that whatever contribution masks have to reducing risk to the wearer is likely to be small. In an editorial published alongside the paper, Laine and her coauthors emphasized that the results don’t imply that widespread mask-wearing is ineffective at controlling the pandemic (in fact, very few members of the general public in Denmark were wearing masks during the time of the study). Rather, Laine and her colleagues wrote, the findings suggest that “mask wearing by a minority of persons—even with high-quality surgical masks like the ones provided to trial participants—does not make the wearers invulnerable to infection.”

In a second editorial published along with the paper, Thomas Frieden and Shama Cash-Goldwasser of Resolve to Save Lives, an initiative of the nonprofit Vital Strategies, wrote that the unique characteristics of the setting where the study took place limit how conclusive and generalizable the findings are (Frieden is also a former director of the CDC). In April and May, COVID-19 was spreading less ferociously in Denmark than in other locations such as the United States and United Kingdom.

“Masks have been shown to protect others and, despite the reported results of this study, probably protect the wearer,” wrote Frieden and Cash-Goldwasser. “If everyone wears a mask when near others, everyone is safer.”

Another limitation is that only about 46 percent of participants reported faithfully wearing the masks as recommended (an additional 47 percent wore the masks “predominantly as recommended,” and 7 percent “not as recommended”). It’s also possible that some people in the group that didn’t receive instructions to wear a mask did so anyway, says Raina MacIntyre, head of the Biosecurity Program at the University of New South Wales’s Kirby Institute in Kensington, Australia, who was not involved in the research. “The lack of proper measurement of compliance is the most serious problem,” MacIntyre said in an email. “Measuring compliance needs daily monitoring.” The kinds of surgical masks used in the new study aren’t designed to prevent respiratory infections and don’t not seal around the face, she added.

The extent to which a mask will shield the person wearing it from infection depends on the duration and circumstances of their exposure to the virus, the kind of mask, and how consistently they use it. “An N95 mask is better than a surgical mask,” Frieden told The New York Times. “A surgical mask is better than most cloth masks. A cloth mask is better than nothing.”

Ultimately, MacIntyre said, the study doesn’t provide data on how effective masks are—just on the effectiveness of a recommendation to mask up. The impact of mask recommendations on curbing COVID-19 transmission will depend on how widely the virus is already spreading in the community and how much people adhere to other key measures like social distancing. In a video accompanying the paper, Henning Bundgaard, the lead author and a cardiologist at the Copenhagen University Hospital, said, “It’s very important to underline that our findings suggest that people should not abandon other COVID-19 safety measures regardless of the use of masks.”

An intriguing difference between the two groups in the study, says Jerry Cangelosi, an infectious disease epidemiologist at the University of Washington in Seattle who was not involved in the research. The number of positive antibody tests was similar in both groups. However, fewer people in the masked group received a positive diagnostic test or hospital diagnosis of COVID-19. “Although I don’t think the numbers were big enough to be statistically significant it’s still striking,” he says. These findings would fit with the possibility that people who wear masks are more likely to experience asymptotic infections that cause them to produce antibodies without becoming sick.

“These results could potentially be consistent with, although it’s nothing close to proof, [the idea] that if you wear a mask you might still inhale some of the virus but it would be less than you would if you were not wearing a mask,” Cangelosi says. “Given the fact that really these masks are not really designed to protect the wearer, they’re designed to protect the community, actually these results turned out pretty good for masks.”

Bhatt would like to see further research on what kinds of masks are most useful in different situations, but emphasizes that we already have ample evidence that masks are crucial in thwarting the spread of diseases like COVID-19.

“It is not going to be 100% effective—few things in medicine or public health are—but that does not mean it does not have value,” he said. “Social distancing, wearing a mask when social distancing is not possible, and good personal hand hygiene have a large impact on COVID-19 (and other infections such as influenza, for that matter). These relatively inexpensive and easy interventions can still help reduce the number of deaths and hospitalizations that will otherwise occur worldwide.”

Pesticides Might Be Worse For Bees Than We Thought

The plight of pollinators is growing more visible than ever before. Increasingly, scientists are documenting the decline of bees and butterflies, evidence that the loud hum of buzzing insects on many landscapes is turning to a whisper.

A new analysis in the journal Nature shows that some of these threats, when put together, kill more bees than the combination of each threat alone. It turns out, cocktails of agricultural chemicals may have a synergistic effect on bee mortality. In other words, more bees die than would have if the effects of the chemicals simply added to each other.

The authors of the paper analyzed 90 studies that in total documented 356 effects from interacting bee stressors, such as combinations of chemicals, nutritional problems, and parasites. Each study included at least two factors harming bees. They categorized whether the stressors negated each other, added to each other, or compounded to cause extra damage— compounding would indicate a synergistic effect. For example, if one pesticide used alone caused 10 percent of bees to die, and another pesticide killed 15 percent, the two combined would have a synergistic effect if more than 25 percent of bees died. 

Across the studies, the researchers repeatedly found that when bees were exposed to multiple agrichemicals, the combination had a synergistic effect on mortality. Meanwhile, combos of other stressors, like parasites and nutrition, tended to have effects that just added together.

[Related: 5 ways to keep bees buzzing that don’t require a hive]

It’s still unclear why pesticides would have such an effect. In the analysis, the bee stressors didn’t have synergistic effects on non-lethal health measures, like colony growth rates. In other research, however, scientists have found that certain pesticides can weaken a bee’s immune system, potentially making them extra vulnerable to other chemicals or pathogens. There are also numerous other processes that may be responsible for the compounding effect, says Elizabeth Nicholls, an ecologist studying bees at the University of Sussex who was not involved in the analysis. “It also might be that their detoxification pathways might be impaired if they’re being bombarded with lots of chemicals at one time.”

The findings give reason to worry—these pesticide effects held up at realistic levels used in agriculture. Studies have found that bees are exposed to a range of pesticides, both from crops and nearby wildflowers. “Exposure to multiple agrichemicals is the norm, not the exception,” says the study’s lead author Harry Siviter, an ecologist at the University of Texas, Austin. “The actual commercial formulas that are used on farms often have multiple chemicals in them.”

Especially with bees tending to forage across many plants, their chances of getting exposed to multiple toxins are high, says Nicholls. “[The study] shows that you need to be thinking about exposure at a landscape level,” she says. “And it’s not okay just to test exposure from one crop and one chemical.”

We’re already seeing the effects of declining pollinators. In the United States, apples, cherries, and blueberries are among crops threatened by declining pollinators. In southwest China, farmers have to hand pollinate fruit trees to make up for the decline in insects.

Importing extra honey bees to fill the gap isn’t an option, either. Honey bee colonies have experienced greater rates of collapse in recent years. And wild bees are probably even more sensitive to threats, because they tend to be solitary and lack the robust social networks of honey bees. “Wild bees are really important, and those are the bees that are doing really badly,” says Siviter. 

An ideal regulatory process for pesticides would look at interactive effects as well as continue monitoring after their initial approval, says Siviter. Right now, the licensing process for pesticides is more limited, with little monitoring after a product is approved and in use. “If you don’t consider the interactions, you’re underestimating the impact of environmental stressors on bees.” That, ultimately, could undermine the abundance of many fruits, vegetables, and nuts at the grocery store.

Twitter Does Not Need To Be Free

When new Web companies start up, the most attractive business model is to offer the service for free so the public can gain a quick understanding of the company’s value proposition. A free Web service can grow quickly if it provides value. Along with that rapid growth, though, come the headaches of spammers and spambots–computer programs used to send annoying spam.

Two very important results would happen if Twitter went to a modest-annual-fee model. A lot of the information pollution on Twitter would be cleaned up, and Twitter would have another steady source of income. Running a company as globally important as Twitter with some 60 employees does not make sense. No way can 60 employees respond to all the genuine needs of Twitter users and the Twitter ecosystem of hardware, software, and people. The extra income from the $10 annual fee would allow Twitter to hire the employees it needs to run the company in a responsible fashion.

Here is one personal benefit to me that would happen when Twitter moves to an annual-fee model. If most of the spammers and spambots were removed from Twitter, I could more easily follow the people I want to follow on Twitter.

Who are the people I want to follow on Twitter? I’m interested in following some of the people who follow Tim O’Reilly, founder of O’Reilly Media. Tim is very thoughtful and perceptive in his tweets. In my books, the guy is simply genuine, smart, and decent–a rare combination in these times.

So I’m interested in hearing the ideas of other people who similarly admire Tim’s thinking. Right now, locating those persons is almost impossible, even though I can see a full list of his more than one million followers. That follower list, however, is so polluted with spammers, it could take me hours to track down one real human being.

If all those spammer accounts were removed, I could start listening to the people who feel that Tim O’Reilly has important things to say. And I could listen to them directly, independent of retweets from Tim. Much as I value Tim’s own ideas, I value the ideas of people in his intellectual ecosystem just as much. And Tim’s time is finite. He can only retweet so much.

Sometimes free becomes too expensive. Twitter should move to a modest-annual-fee basis. Doing so would immeasurably improve the service. In my case, I would be so relieved to be able to pay for it.

Phil Shapiro

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