This also makes it infinitely more useful for healthcare. Not healthcare software specifically. Lots of use cases in logistics, irl maintenance, etc. Patient data creates hipaa challenges and tends to overflow into any system.
Nothing in HIPAA mandates air gaps. In the context of HIPAA that's really overkill.
In fact, self-hosting might even do you wrong when things go bad, because AWS is probably better managed and more secure. And they have all their certs, which is legally important.
+1. We already work with a few healthcare teams, and self-hosted is almost always their go-to. Our air-gapped edition has been in beta for a bit, and we’re seeing more use cases pop up—especially in places where HIPAA and data isolation matter a lot.
Why would a health care org care about air-gapped deployments? Most (really, almost all) health care data is stored on cloud SAAS databases already; for people who care, this vendor already had an on-prem version.
What you say makes sense, but I think there can be reasons. For our military customers we offer an air-gapped version of our app early on because it was easier for customers than getting an ATO. Also as a bootstrapped company it was a lot cheaper than FedRAMP. I'm guessing I'd lean on a similar strategy if I had a health care startup.
This is a study done on cell cultures. It should NOT be used to influence behaviors regarding human health. The article linked makes a lot of leaps not supported by the study itself.
This sounds like a smart comment, but the main reason you shouldn't take in vitro studies as indicative of real medical outcomes is largely due to unknown bio availability when consuming realistic doses. However, this study shows that the concentration of erithritol is well above the concentration where they see negative effects in vitro when consuming a realistic dose.
In addition epidemiological studies have found associations between higher plasma erythritol and clotting/cardiovascular events. So, regular disclaimers about difficulty of establishing health science aside, I would disagree this should 'not influence behaviors'.
> However, this study shows that the concentration of erithritol is well above the concentration where they see negative effects in vitro when consuming a realistic dose.
Are you saying that when you eat a normal/largish amount of erithritol (say 1-10g), the concentration of erithritol in your brain is similar to what they tested on brain cells in vitro here?
Also, how can they make a link to stroke when testing in vitro?
The study used a concentration of 6mM erythritol. This would be the mean (“bulk”) concentration found in the body after drinking 2-3 erythritol-sweetened soft drinks. I can find several with 10+ grams of it per bottle/can.
Erythritol Concentration: 6 mM (0.006 mol/L)
Molar Mass of Erythritol: 122.12 g/mol
Water in human body: 42 Liters
Calculated Total Mass: 30.77 grams (0.006 * 122.12 * 42)
A) Erythritol has ~90% bioavailability. See note at bottom.
B) Is a reasonable assumption. See same note at bottom.
C) Erythritol damages the microvascular endothelial cells, which form the BBB. So it doesn't need to cross the BBB, because that's what it damages directly. The name of TFA's study is "The non-nutritive sweetener erythritol adversely affects brain microvascular endothelial cell function"[0].
N.B. Erythritol is known to pass through the BBB via diffusion, though that's somewhat limited by its partition coefficient (logP) of -2.3. It's a small molecule, so it's not blocked based on size.
Also, this study isn't "just one study". There's a large corpus of research accumulating data both in vivo and in vitro showing both that erythritol causes these problems, and demonstrating how. This was a very thoughtful and reasonable study. The main point of the study was to measure oxidative stress, nitric oxide (NO), endothelin (ET)-1, and tissue-type plasminogen activator (t-PA). Their dysregulation is already well-known to be directly linked to the health of brain blood vessels and shown to be quite relevant in the development of stroke.
Epidemiological studies involving thousands of patients first established a strong, independent link between higher blood levels of erythritol and an increased risk for events like heart attack and stroke[1]. Subsequent mechanistic studies then showed that erythritol makes blood platelets hyper-reactive and more prone to clotting, providing a direct link to thrombosis[2]
Also in response to:
> A) is certainly wrong.
A previous study gave participants 30g of erythritol orally and their serum concentration rose from 4 µM to 6,480 µM [3]. That's why this study chose 6mM - they didn't just do some napkin math and YOLO it - previous studies pointed the way after showing that "(A) is certainly right".
>It should NOT be used to influence behaviors regarding human health.
It's not like erythritol is hard for a consumer to avoid. P(serious problems like brain cell damage) does not need to get very high for it to start to make sense to avoid it, and it seems to me that studies done on cell culture can raise P high enough.
The test setup ignores the digestive system. There are going to be a lot of substances you can pour on a culture of brain cells with negative affect that your body produces or happily consumes. That’s the point of the parent.
Add milk, an alcoholic beverage, or some lemon juice and those cells are unlikely to survive. Meanwhile the standard path of consumption handles the situation just fine before your brain is ever involved in metabolism.
To the reader, I strongly urge not listening to some rando on the internet (as opposed to the scientists) who asks you to dismiss a study, simply because the risk-reward calculus here is strongly in favor of not taking the unnecessary risk of brain damage.
How about Kombucha? Vanilla extract? Sourdough bread? Mouth wash? Oral medicines? There are more sources to alcohol than the bar, including many incidental sources we don’t think about and happily feed to children as soon as they can handle solid foods.
Like anything there’s nuance here. I’m not saying being drunk, an alcoholic, or having a single alcoholic beverage will have no negative affects. I’m discussing the difference between a culture (cells on agar) and the entirety of the human body. You are not going to reproduce the same results they had because your digestive tract, kidneys, and liver are inline.
This is really important because our food contains so many things naturally including the Erythritol in the original article.
Let’s talk about another example. Would you find Fish acceptable? How about mercury? How would you square exposure to mercury due to eating fish?
Alcohol is a carcinogen, and even small amounts are linked to increased cancer rates[1][2].
The only thing the WHO, CDC, and US Surgeon General have in common with the “YouTuber med bros click bait hype” you try to wholly discredit is that they probably all do have YouTube channels…
Jeez, learn to read and learn and stop with this BS already:
From your first article:
> The amount of alcohol a person drinks affects their risk of cancer. An important factor is the overall amount of alcohol consumed consistently over time.
That, sure as hell, means that you can drink small amounts sometimes, not 0, as there is no such thing. Again, read about hormesis. Here it is for you:
It actually is. If you're shopping low carb/keto marketed stuff, they put it in almost everything. Even other sweeteners like stevia, monkfruit, allulose often are cut with majority erythritol. You have to really scour the packaging to make sure you're buying "stevia" and not a "stevia blend" etc. Erythritol sucks too. It gives a weird cooling sensation on your tongue like menthol, I have no idea why they mix it into everything.
Because it has no calories. Xylitol is nicer but gets metabolized. Erythritol is one of the few sweeteners that are reasonable to use at home (like, you can dose it like sugar unlike aspartame), tastes reasonable on its own (you don’t need the blend you have in coke zero for example) and will not spike glucose levels so diabetics can actually use it.
Like, I can bake a cheese cake just like any other cheese cake as long as I replace the flour for the bottom with almond flour and the sugar with erythritol.
We do a lot of keto cooking here. Erythritol is the bottom of the barrel. They have monkfruit/allulose blends that are very comparable to sugar in taste and how they interact with heat - caramelization or melting in granular or powdered. I've read erythritol is more "immediately" sweet on your tongue, but for it's "potential" health detriment, as well as the overpowering "cooling" effect it's really not worth it. I guess if you're doing low cal as well you need to make additional concessions but most of those that don't get processed, really turn your GI upside down as well.
> It's not like erythritol is hard for a consumer to avoid.
How many ingredients with negative effects on the order of erythritol are in my foods, cosmetic products, homecare products, food packaging, etc that I need to be aware of? Not how hard is it to avoid erythritol -- but how hard is it to avoid every substance that is at least similarly bad for me?
In vitro studies demonstrate potential mechanisms but cannot establish causality in humans due to differences in metabolism, bioavailability, and the blood-brain barrier's protective effects.
To the reader, I strongly urge not listening to some rando on the internet (in opposition to the scientists) who asks you to dismiss a study, because the risk-reward calculus here is strongly in favor of not taking the unnecessary risk of brain damage.
Drinking distilled water will also kill oneself, just slowly. This is because it is demineralized and it can become acidic. It also risks leeching and dissolving heavy metals from foods, risking their increased absorption.
FOBT which you can do painlessly at home for a few dollars is not meaningfully less preventative than an invasive colonoscopy and carries almost no risk. https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
Very true, and this is what caught my father's bowel cancer and saved his life.
That said, for someone with increased risk, nothing compares to a colonoscopy - at it does a better job of catching things early, before you start getting blood in your poo.
But if you are at a standard risk, doing a fobt every couple-few years is hugely important. Ask your doctor now!
The superior stool based test would be the FIT-DNA test, which compares favorably to a colonoscopy in sensitivity. These are covered by insurance in the US.
I had not heard of those - I'll have to look out to see if the NHS offers these.
Currently on 5 yearly review until I hit 50, as my oldest brother had the same cancer at 56, which sadly took his life, so I am not of standard risk.
Reading summary of that paper:
"The numbers of persons who would need to be screened to detect one cancer were 154 with colonoscopy, 166 with DNA testing, and 208 with FIT."
So I'll still stick with a colonoscopy until something better comes along.
While earlier detection has been beneficial, there's such a thing as too much. Really, there's balance to be struck. For instance the detection procedures themselves (even things like non-invasive imaging) aren't risk free themselves, false positives can set off a chain of events that carry their own harm, and even it's not at all uncommon to develop cancers you "die with" instead of "die from" but once they're detected you have to assume the worst - and treatment itself causes its own form of harm.
Getting one annually is not recommended for most patients. After my bowel resection, I had annual colonoscopies for five years, then every three years, now every five (the normal recommendation for my age cohort).
Colonoscopies are no big deal from my perspective, but they do have some risk; bowel perforation being the primary one. The prep stuff is the worst aspect for most patients; I used to love lemon lime Gatorade before I used it once as a way of drinking the liquid laxative...
CAR-T and closely related immunotherapies are the definitive breakthrough. It will continue to get more and more effective against more and more types of cancers. The research issues surrounding them now are about cost and about how to manage the potentially fatal complications from using it against certain situations, especially developed solid tumors.
In "Skunk Works: A Personal Memoir of My Years at Lockheed", which is a great read, there is discussion of the incredibly difficult time they had setting up tooling for working with titanium. This remains largely true today. Making things at any scale in titanium, while controlling cost is very, very difficult. Even if the titanium itself is gotten very cheaply.
Even with tariffs batteries are very cheap. Into the 4 year mark my cost per kwh is down below $0.02 because I end up using excess power for all sorts of things because it is "free".
Technologies: Advisor, Architect, Team leader. Extensive experience in payments and healthcare including fortune 500. Created the open source HealthCloud/ClearHealth EMR. Author of "Hacking Healthcare". Experience leading AI assisted development teams.
Resume/CV: Advisor, Architect, Team leader. Extensive experience in payments and healthcare including fortune 500. Created the open source HealthCloud/ClearHealth EMR. Author of "Hacking Healthcare". Experience leading AI assisted development teams.
Not speaking to the veracity of the statement but quaise answers this in a different article: "A lot of the challenges are the same as for oil and gas. The subsurface is an uncertain environment. The deeper you go, the more extremes you have, but we've come a long way with the oil and gas industry to develop a whole suite of technologies, techniques and measurement systems to minimise that risk. The main challenge is maintaining wellbores from closing in on themselves as you go deeper. There's a lot of pressure in the rock and these holes eventually will collapse. The way we answer that is by creating a glass wall in the rock as we burn it. When our technology vaporises the rock, it creates a glass wall and that remains on the walls and prevents the hole from collapsing."
