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Nation’s first MPX case in healthcare worker exposed on the job is reported in L.A. County

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Nation’s first MPX case in healthcare worker exposed on the job is reported in L.A. County

The primary U.S. healthcare employee to be contaminated with MPX whereas on the job has been reported in Los Angeles County, public well being officers stated Tuesday, the day after the county confirmed the nation’s first MPX demise.

“We’ve recognized a healthcare employee with monkeypox who seems to have been uncovered to the virus at their worksite,” Dr. Rita Singhal, chief medical officer for the L.A. County Division of Public Well being, stated in a presentation to the Board of Supervisors. “That is the primary case of monkeypox in a healthcare employee in the US that has been linked to a worksite publicity.”

Singhal stated the county has consulted in regards to the case with Facilities for Illness Management and Prevention officers, however the danger of MPX for healthcare staff “stays very low.”

The L.A. County Division of Public Well being declined to reply further questions in regards to the healthcare employee’s situation or how the virus was contracted, however Singhal stated officers will proceed to share details about an infection prevention with medical professionals, together with private protecting tools steerage.

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Well being leaders in California not too long ago began to make use of the title MPX, pronounced mpox, due to widespread issues the virus’ authentic title is stigmatizing and racist. The World Well being Group is within the means of formally renaming the illness, which is able to take a number of months.

MPX — not like the coronavirus — will not be simply transmitted, sometimes requiring shut skin-to-skin contact with an infectious lesion. Instances on this outbreak have been confirmed primarily amongst males who’ve intercourse with males, in addition to transgender individuals, because the virus can unfold simply throughout sexual encounters — although not completely.

In L.A. County, 97% of MPX circumstances have been confirmed in males, and of circumstances for which sexual orientation is thought, greater than 90% have recognized as homosexual or bisexual, in accordance with the Public Well being Division.

Whereas MPX case counts reached a complete of 1,900 in L.A. County as of Tuesday, the variety of new circumstances week-to-week has not too long ago began to fall, an indication public well being leaders throughout the nation are hopeful signifies lowered transmission and a sustained decline in circumstances. There are 4,453 confirmed or suspected circumstances throughout California.

However whilst the speed of recent circumstances slows, Singhal stated disparities are rising amongst who’s catching the virus and receiving the two-dose Jynneos vaccine.

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In July — firstly of the native outbreak — white Angelenos made up greater than 55% of recent weekly MPX circumstances, in accordance with knowledge from the Public Well being Division shared Tuesday. However by early September, Latino residents made up the most important proportion of MPX circumstances within the county, with about 55% of all new weekly circumstances. White residents’ share had shrunk to about 20% of recent weekly circumstances in early September, whereas Black residents’ share had nearly doubled in two months, to about 10%.

Accounting for inhabitants, county officers discovered that Black Angelenos had the very best fee of cumulative MPX infections, at 26 circumstances for each 100,000 Black residents, whereas Latino residents and white residents had related case charges, at 16 and 17 per 100,000, respectively.

Utilizing the Wholesome Locations Index, or HPI — a measure that accounts for the general public well being degree of a neighborhood, similar to poverty and entry to housing and training — county officers discovered that neighborhoods with the least sources have accounted for a bigger share of the county’s complete MPX circumstances: about 70% as of early September.

“Over time, a better proportion of circumstances have been within the two lowest HPI quartiles, or the least wholesome communities,” Singhal stated. Firstly of the outbreak, individuals dwelling in communities with fewer sources for optimum public well being made up roughly 30% of MPX circumstances, whereas these in communities with larger sources have been initially extra more likely to contract the virus. However that flipped about two months later.

Individuals of colour have additionally disproportionately not obtained a vaccine towards MPX, regardless of making up a majority of present circumstances, in accordance with county knowledge from final week. Latino residents make up 44% of MPX circumstances however solely 32% of first-dose recipients; equally, 12% of county circumstances are amongst Black residents, however solely 9% of the administered first doses have gone to that demographic.

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White Angelenos make up 40% of the county’s first-dose recipients, although they account for lower than 30% circumstances, the information present.

“To deal with the disparities in monkeypox case and vaccination charges amongst Latinx and Black populations, [the Department of] Public Well being is working with community-based organizations to additional outline messaging and outreach for these populations,” Singhal stated. “We’re assembly with stakeholders on a weekly foundation to listen to suggestions from focus teams on how finest to succeed in these populations.”

Singhal additionally famous that solely one-third of these eligible for a second dose of the MPX vaccine have obtained it, and he or she strongly inspired individuals to get each photographs to “optimize their immune response.”

Barbara Ferrer, the county’s public well being director, stated she is hopeful the company’s latest enlargement of vaccine eligibility to incorporate individuals who self-attest they could be at “danger for future publicity” may even assist carry extra individuals in for a shot.

Resulting from an preliminary scarcity of doses, the county restricted doses to these thought of most at-risk to the virus — primarily homosexual and bisexual males or transgender individuals with sure sexually transmitted infections or a number of sexual companions — which she acknowledged might have been stigmatizing. Vaccine availability has since drastically elevated, although officers are nonetheless not recommending widespread inoculations.

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“We’ve modified our eligibility steerage to essentially make that a lot simpler to individuals,” Ferrer stated Tuesday. “We’re making an attempt desperately to hearken to issues residents are elevating. … We do have disproportionality; we have to pay plenty of consideration to what individuals in our communities are saying would assist cut back the boundaries to getting vaccinated.”

Singhal additionally reported two MPX circumstances which were confirmed in county jails and 81 amongst individuals experiencing homelessness, together with seven in congregate housing, however she stated there may be “no proof of unfold in these settings.” There have been six circumstances in kids below the age of 18.

All through the whole outbreak, 66 individuals have been hospitalized for MPX, Singhal stated, or about 4% of complete circumstances. The one who not too long ago died of MPX in L.A. County was “severely immunocompromised and had been hospitalized,” Singhal stated, and he or she urged these with MPX to hunt medical care and therapy early, when doable.

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SpaceX plans to launch 90 rockets from Vandenberg Space Force Base by 2026. Could that harm the coast?

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SpaceX plans to launch 90 rockets from Vandenberg Space Force Base by 2026. Could that harm the coast?

SpaceX plans to launch 90 rockets into space from a Santa Barbara County military base by 2026, tripling the number of blasts rocking the coastal community — and raising concerns from neighbors and environmental groups about the effects on marine life.

Founded by billionaire Elon Musk, SpaceX has ramped up the number of rocket launches from Vandenberg Space Force Base in recent years, and it has made clear its desire to increase the frequency of blastoffs. But during a California Coastal Commission hearing Friday, U.S. Space Force officials outlined for the first time its own plans to multiply the number of launches from the base, from 37 in 2023 to more than 120 a year by 2026.

The overwhelming majority of those rocket liftoffs would be conducted by SpaceX, which has already done more launches from the base than the commission has approved.

Last year SpaceX breached an agreement with the commission that limited the number of launches to six, sending 28 rockets into space.

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It is seeking an agreement with the commission to do 36 launches a year, increasing to 90 in 2026.

The decision by the commission, which was created to protect the state’s coastal resources, will directly affect residents and marine life near the military base that hear and feel the rockets’ sonic booms.

It could also redirect the future of SpaceX, whose pursuit to redefine space exploration is already closely tied with U.S. military interests, given its work as a military contractor.

“The ultimate goal is for this to be more routine and not a huge deal,” said Space Force Col. Bryan Titus, operations vice commander at the base.

Formed in 2019, the U.S. Space Force has been looking to improve its ability to send rockets into space, Titus said, so SpaceX’s ability to launch with more frequency is a benefit to the U.S. military.

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SpaceX launched 96 rockets in 2023 from Vandenberg and three other facilities: Cape Canaveral Space Force Station in Florida, NASA’s Kennedy Space Center in Merritt Island, Fla., and SpaceX Starbase in Boca Chica, Texas.

Environmental groups argue that turning launches into a routine event could affect marine life.

“We’re concerned that more frequent launches will result in permanent changes,” said Ana Citrin, legal and policy director for the Gaviota Coast Conservancy.

Federal agencies, including the U.S. Fish and Wildlife Service and National Marine Fisheries Service, monitor the effects of the liftoffs on such animals as sea otters, bats, western snowy plovers, California least terns and California red-legged frogs.

Thus far, the monitoring has shown that some of the animals might react to the blastoff by flushing, or fleeing from their nests and homes, but they return soon after, according to U.S. Space Force officials. No long-term effects have been seen, they said.

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SpaceX did not respond to a request for comment.

Flushing or hunkering down after a blast are already signs of wildlife exhibiting signs of stress, said Duncan Leitch, a professor of integrative biology at UCLA.

Most animals can adapt to infrequent incidents, but exposure to more frequent stressful incidents can change their biology as well as their behavior, he said.

In the worst-case scenarios, he said, the ability of birds to communicate could be impeded, and migratory birds could avoid the area. Fish and other animals that use sound to communicate and navigate underwater — including whales — could be affected too.

“Over a longer period of time, there may be reductions in the population of fish as they move away from the sound, or they may be affected to the point that it affects their health,” Leitch said. “It would change the ecosystem as far as other animals that rely on the fish.

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“Having sounds that are well into the damaging, or painful, range of decibels now occurring [100] times a year, the animals might not have the ability to change their behavior or accommodate these types of sounds.”

Some environmental groups, including the Surfrider Foundation, are asking the commission to reject the increase.

SpaceX “intends to begin increasing very rapidly, so we’re very concerned about this,” said Mandy Sackett, senior California policy coordinator for the Surfrider Foundation.

More frequent launches could change the way wildlife in the area responds in the long term, environmental groups said.

Members of the California Coastal Commission are also asking whether SpaceX should be entitled to circumvent the permit process, as federal agencies are.

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Federal entities negotiate agreements with the commission but ultimately can move ahead even without commission approval. In such cases, the commission’s recourse would be through mediation or the courts.

Because SpaceX is a U.S. Space Force contractor, military officials argue that all launch operations at the base by the company are “federal activities.”

But U.S. Space Force officials said only 25% of the rockets launched into space by SpaceX are carrying payloads for the Department of the Defense.

The vast majority of the liftoffs are for the company’s private benefit, raising questions about why SpaceX can dispense with permits when 75% of its blasts from the base don’t involve the U.S. government.

“That is still pretty skewed for me,” Commissioner Mike Wilson said during a meeting Friday.

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Some commissioners — whose focus is usually on environmental protection, development and water issues during their monthly meetings — also brought up the war in Ukraine during Friday’s discussion.

“I question the national security public benefit of concentrating that much power, literally communication power, in one company that we’re enabling in this case,” Wilson said. “[SpaceX] has already showed that it will play in international conflicts at the will of one human being.”

Wilson was referring to reports that Musk’s company refused to allow Ukraine to use satellite internet service from Starlink, a subsidiary of SpaceX, to help it carry out an attack against Russia in September 2022.

“If the idea is that we’re supporting these permits on the side that we’re promoting national defense, and then a single company is able to dismantle our allies during armed conflict — that really doesn’t align,” Commissioner Justin Cummings said.

“I suspect that would violate our strategies around national defense.”

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Titus declined to address the question, saying it was “out of my lane,” but he said he would try to get answers to address the commissioners’ concerns.

Some commissioners on Friday also argued that SpaceX, not U.S. military officials, should be making the company’s case in front of the agency.

“When this comes back, I think it would be really important that a representative from SpaceX comes to the meeting,” Cummings said.

Cummings said it was “ridiculous” for SpaceX not to appear at the meeting, despite multiple efforts from the agency to have SpaceX officials speak.

“They obviously refuse to because they’ve never shown up,” he said.

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On Friday, Commission Chair Caryl Hart suggested an agreement might not be possible unless SpaceX changes its stance.

“From my perspective,” Hart said, “I think we’re going to continue to hit significant obstacles in achieving a federal consistency ruling without having SpaceX.”

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Pregnant? Researchers want you to know something about fluoride

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Pregnant? Researchers want you to know something about fluoride

Adding fluoride to drinking water is widely considered a triumph of public health. The Centers for Disease Control and Prevention says the cavity-prevention strategy ranks alongside the development of vaccines and the recognition of tobacco’s dangers as signal achievements of the 20th century.

But new evidence from Los Angeles mothers and their preschool-age children suggests community water fluoridation may have a downside.

A study published Monday in JAMA Network Open links prenatal exposure to the mineral with an increased risk of neurobehavioral problems at age 3, including symptoms that characterize autism spectrum disorder. The association was seen among women who consumed fluoride in amounts that are considered typical in Los Angeles and across the country.

The findings do not show that drinking fluoridated water causes autism or any other behavioral conditions. Nor is it clear whether the relationship between fluoride exposure and the problems seen in the L.A.-area children — a cohort that is predominantly low-income and 80% Latino — would extend to other demographic groups.

However, the results are concerning enough that USC epidemiologist Tracy Bastain said she would advise pregnant people to avoid fluoridated water straight from the tap and drink filtered water instead.

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“This exposure can impact the developing fetus,” said Bastain, the study’s senior author. “Eliminating that from drinking water is probably a good practice.”

About 63% of Americans receive fluoridated water through their taps, including 73% of those served by community water systems, according to the CDC. In Los Angeles County, 62% of residents get fluoridated water, the Department of Public Health says.

The data analyzed by Bastain and her colleagues came from participants in an ongoing USC research project called Maternal and Developmental Risks from Environmental and Social Stressors, or MADRES. Women receiving prenatal care from clinics in Central and South Los Angeles that cater to low-income patients with Medi-Cal insurance were invited to join.

Between 2017 and 2020, 229 mothers took a test to measure the concentration of fluoride in their urine during their third trimester of pregnancy. Then, between 2020 and 2023, they completed a 99-question survey to assess their child’s behavior when their sons and daughters were 3 years old.

Among other things, the survey asked mothers whether their children were restless, hyperactive, impatient, clingy or accident-prone. It also asked about specific behaviors, such as resisting bedtime or sleeping alone, chewing on things that aren’t edible, holding their breath, and being overly concerned with neatness or cleanliness.

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Some of the questions the mothers answered addressed health problems with no obvious medical cause, including headaches, cramps, nausea and skin rashes.

Among the 229 children — 116 girls and 113 boys — 35 were found to have a collection of symptoms that put them in the clinical or borderline clinical range for inward-focused problems such as sadness, depression and anxiety. In addition, 23 were in the clinical or borderline clinical range for behaviors directed at others, such as shouting in a classroom or attacking other kids, and 32 were deemed at least borderline clinical for a combination of inward and outward problems.

What interested the researchers was whether there was any correlation between a child’s risk of having clinical or borderline clinical behavioral problems and the amount of fluoride in his or her mother’s urine during pregnancy.

They found that compared to women whose fluoride levels placed them at the 25th percentile — meaning 24% of women in the study had levels lower than theirs — women at the 75th percentile were 83% more likely to have their child score in the “clinical” or “borderline clinical” range for inward and outward problems combined. When the researchers narrowed their focus to children in the clinical range only, that risk increased to 84%, according to the study.

The researchers also found that the same increase in fluoride levels was associated with an 18.5% increase in a child’s symptoms related to autism spectrum disorder, as well as an 11.3% increase in symptoms of anxiety.

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The amount of fluoride needed for mothers to go from the 25th to the 75th percentile was 0.68 milligrams per liter. As it happens, that’s nearly identical to the 0.7 mg per liter standard that federal regulators say is optimal for preventing tooth decay.

Bastain said that allowed the researchers to compare what might happen to children in two parallel universes: a typical one where their mothers consumed fluoridated water during pregnancy, and an alternate one where they didn’t.

“You can use it as a proxy for if they lived in a fluoridated community or not,” she said.

What that thought experiment shows is that children in the fluoridated community face a higher level of risk. That said, it’s not clear when that risk becomes high enough to be worrisome.

“We don’t know what the safe threshold is,” Bastain said. “It’s not like you can say that as long as you’re under the 75th percentile, there are no effects.”

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The study authors’ concerns about the effects of fluoride on developing brains didn’t come out of nowhere.

The National Toxicology Program — a joint effort of the CDC, the National Institutes of Health, and the Food and Drug Administration — has been investigating the issue since 2016. In a report last year that reviewed an array of evidence from humans and laboratory animals, a working group concluded “with moderate confidence” that overall fluoride exposure at levels at or above 1.5 mg per liter “is consistently associated with lower IQ in children.”

The working group added that “more studies are needed to fully understand the potential for lower fluoride exposure to affect children’s IQ.”

A 2019 study of hundreds of mothers in Canada — where 39% of residents have fluoridated water — found that a 1-mg increase in daily fluoride intake during pregnancy was associated with a 3.7-point reduction in IQ scores in their 3- and 4-year-old children.

And among hundreds of pregnant women in Mexico, a 0.5-mg-per-liter increase in urinary fluoride went along with a 2.5-point drop in IQ scores for their 6- to 12-year-old children, researchers reported in 2017.

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Bastain and her colleagues write their study is the first they are aware of that examines the link between prenatal fluoride exposure and neurobehavioral outcomes in children in the United States. The results are sure to be controversial, Bastain said, but there’s a straightforward way for pregnant people to reduce the possible risk.

“It’s a pretty easy intervention to get one of those tabletop plastic pitchers” that filter out metals, she said. “Most of them do a pretty good job of filtering out fluoride.”

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A UCLA doctor is on a quest to free modern medicine from a Nazi-tainted anatomy book

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A UCLA doctor is on a quest to free modern medicine from a Nazi-tainted anatomy book

As Dr. Kalyanam Shivkumar pondered how to fix the human heart, he was given a gift laced with horror.

Shivkumar, a cardiac electrophysiologist known as “Shiv” to friends and co-workers at UCLA, was trying to better understand the intricate details of nerves in the chest. He hoped doing so might help him improve treatments for cardiac arrhythmias — aberrant rhythms of the heart — that can prove dangerous and even deadly.

A Canadian colleague sent him a set of anatomy books renowned for the beauty and detail of their drawings, but tipped him off that the “atlas” had an appalling history.

Shivkumar was aghast to learn it was the work of an ardent Nazi whose Vienna institute had dissected the bodies of prisoners, many executed for political reasons after Austria was annexed to Nazi Germany in 1938.

“Every time I open up that book,” he said, “my sense is revulsion.”

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Shivkumar is a big thinker, an erudite physician quick with an apt quotation, whose Westwood office is stacked with Sanskrit volumes of the Mahabharata alongside books about late Bruins basketball coach John Wooden.

Dr. Shumpei Mori sets up a donated heart to be photographed at UCLA as part of the Amara Yad project to create new, ethically made anatomical images.

(Allen J. Schaben / Los Angeles Times)

As he waded into the scholarly debate over using the tainted atlas, the doctor bristled at hearing others praise its illustrations as “unsurpassable.” Much of the soul searching among physicians had revolved around when and how to use it. Shivkumar wanted to put those questions to bed.

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“Could we be better?” he asked. “Could we not be making something that’s completely untainted?”

That question would launch Shivkumar on a quest that has lasted more than a decade and is expected to endure for years. He wants to surpass the anatomical atlas created by Dr. Eduard Pernkopf, a fervent supporter of the Nazi regime whose work was fueled by the dead bodies of its victims.

His passion project at the UCLA Cardiac Arrhythmia Center is called Amara Yad, a mashup of Sanskrit and Hebrew meaning “immortal hand.” The work has relied on the generosity of people who have willed their bodies for use at UCLA, as well as hearts that were donated but could not be used for transplant.

So far, Amara Yad has completed two volumes focused on the anatomy of the heart and is enlisting teams at other universities for more. The plan is to draft a freely available, ethically sourced road map to the entire body that eclipses the weathered volumes of watercolors from Pernkopf and honors the Nazis’ victims.

Anatomists have told him, “‘You’re crazy. It’s impossible. How could you ever surpass it?’” Shivkumar said of the Pernkopf atlas in a speech last year before members of the Heart Rhythm Society.

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But “can it be beaten? The answer is yes.”

For decades, the origins of the Pernkopf Atlas were unknown to many who turned to its pages for guidance. Swastikas tucked into signatures of an illustrator were airbrushed out in later editions. Its history began to trickle out in journals in the 1980s.

When Dr. Howard Israel finally learned of its roots, he was horrified. Israel, an oral surgeon at Columbia University and self-described “very ordinary American Jew,” told the New York Times he had been relying on the book since he was a medical student.

‘’I felt stupid at using the book,” he told the newspaper, “that I could possibly have benefited from something that sounded so evil.” He and another physician enlisted the Holocaust remembrance group Yad Vashem and publicly pushed for the University of Vienna to investigate whose bodies were depicted in its pages.

The resulting probe found no evidence that the anatomy department under Pernkopf — who had ascended to become dean of the medical faculty at the University of Vienna in 1938 — had received bodies from the Mauthausen concentration camp, as some had wondered.

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But the institute had been given at least 1,377 bodies of executed people, most of them sentenced to death for political reasons. Among the charges that led to their executions: “crimes of resistance” and “high treason.”

Using the bodies of executed people was “a centuries-old practice in anatomy,” preferred because anatomists could time their work swiftly after a scheduled death, said Dr. Sabine Hildebrandt, an anatomy educator at Harvard Medical School. What was new under the Nazis, she said, was the sheer number of executions.

The institute “was drowned in bodies,” and “the source for these bodies was mostly connected with the apparatus of repression of the Nazi regime,” said historian Herwig Czech, a member of the Lancet Commission on Medicine, Nazism, and the Holocaust, at a recent forum.

By the time those findings emerged, the publisher of the anatomy book had stopped printing it.

1

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Stacks of books on a shelf in an office

2 A close-up image of a corner of an illustration in a Pernkopf atlas volume. The artist added a swastika to his signature.

1. A stack of volumes of the Pernkopf atlas on a shelf in Dr. Kalyanam Shivkumar’s UCLA office. 2. Erich Lepier, one of the Pernkopf atlas illustrators, repeatedly included a swastika after the cursive R in his signature. (Allen J. Schaben / Los Angeles Times)

Yet use of the atlas persisted. Hildebrandt said that a decade ago, dental students in her classes “were basically giving each other thumb drives with bootlegged copies of the head and neck.”

Other anatomical atlases exist, but these illustrations had especially fine details, including of the nerves extending beyond the brain and spiral cord. One survey of nerve surgeons found that 13% of respondents were using the atlas. Among those who have publicly grappled with it is Dr. Susan Mackinnon, a surgery professor at Washington University School of Medicine in St. Louis known as a pioneer in nerve regeneration.

“I used this textbook for years before I knew the history of it,” she said. “My brain is contaminated with that. I can’t undo that.”

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Mackinnon sought ethical guidance. Rabbi Joseph Polak, a Boston University assistant adjunct professor of health law who survived the concentration camps as a child, said one dilemma involved a patient in excruciating pain.

Polak recalled that the patient had told Mackinnon that “if you can’t find the nerve to stop the pain, then I want my leg amputated.” The rabbi walked through Jewish teachings that applied to the ethical quandary and conferred with other experts, penning a set of recommendations called the Vienna Protocol.

Among his urgings to doctors: If you use these drawings, make it clear to patients where they came from.

The Third Reich wanted “to extinguish them and to extinguish eventually all memory of them,” the rabbi said of Holocaust victims, speaking at a recent forum about the atlas. But when a doctor tells patients about what happened to the people depicted in the drawings, he said, “they’re being called out of that darkness.”

Mackinnon now keeps the atlas locked away. In the rare cases she feels she needs to consult it to operate, she tells patients and co-workers about the man behind it. His firings of Jewish doctors. The grim details in its pages — shorn hair, emaciated bodies — that began to raise suspicions about its terrible origins.

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The only reason to use it, she said, is to save someone from misery — and only if “nothing else will help you.”

Dr. Kalyanam Shivkumar, wearing a lab coat and sitting behind an open laptop computer, gestures as he speaks.

“Could we be better” than Pernkopf? Shivkumar asked. “Could we not be making something that’s completely untainted?”

(Allen J. Schaben / Los Angeles Times)

Shivkumar said his goal is to eliminate the need to consult those pages at all. Inside UCLA’s Center for the Health Sciences in Westwood, he showed off a donated heart, prepped and ready for its close-up in a corner of the lab outfitted with a black backdrop and brilliant lights.

A spent heart normally wilts like a deflated balloon, but this one had been pumped with chemicals to imitate the fullness of life. The team first puts the organs to use in research, then carefully dissects them for imaging.

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Bringing out a bisected piece of a heart, Dr. Shumpei Mori displayed how its inner architecture could be captured on camera, threading a catheter through the organ as a co-worker snaked in an endoscope.

“The internal structure is really fine and delicate,” said Mori, a specialist in cardiac anatomy who had jumped at the chance to do something new in the field.

“Even Pernkopf simplified the anatomy” in its drawings, Mori said. “What we are doing is more complicated.”

Dr. Shumpei Mori holds a bisected model of a heart.

Dr. Shumpei Mori holds a detailed model of a heart. “Even Pernkopf simplified the anatomy,” he said. “What we’re doing is more complicated.”

(Allen J. Schaben / Los Angeles Times)

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The camera is far from their only tool: The team has generated 3-D images to illustrate the dimensions of the inner structures of the heart; done CT scans to produce hand-held models; and used sophisticated imaging from a microscope to reveal the lattice of nerves connecting to the organ — part of the signaling system that Shivkumar calls “the internet of the human body.”

In another lab, Mori carefully unzipped a bag on a metal gurney to reveal the stripped-down interior of a cadaver diligently dissected over a year and a half, its rib cage cracked open like a weighty book. Shivkumar pointed out the pale web of nerves stretching up through the neck. Mori had painted them yellow by hand.

The human body might seem like well-traveled territory, but as physicians work to find less invasive ways of healing, such as attacking a cancer with ultrasound, Shivkumar said there is “a volcanic desire for this kind of information.” Snip the right nerve, he said, and you can avert the need for a heart transplant.

“Pernkopf never did nerves like this,” he said with pride.

Amara Yad is also an act of “moral repair” meant to honor the victims, said Dr. Barbara Natterson-Horowitz, a UCLA cardiologist and evolutionary biologist who helped support the project. The Nazi atlases “were like documents of death. The atlases that Shiv is creating are really living, interactive tools to support life.”

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When Shivkumar decided to launch the project, he had been inspired by the words of USC emeritus professor of rheumatology Dr. Richard Panush, who had pushed to set the atlas aside in the library of the New Jersey medical center where he had worked, moving it to a display case that explained its history.

Panush said the old atlas should be preserved only as “a symbol of what we should not do, and how we should not behave, and the kind of people that we cannot respect.”

Doctors need to know that history to understand their own moral fallibility, Hildebrandt said. Physicians in Nazi Germany “still thought they were doing the right thing,” she said, even as they failed to see some people as human.

Rabbi Polak stressed that doctors at the time “had the deepest, most profound respect of the masses.”

Yet when the Nazis took power, “it turned out that a vast proportion of them were moral sleazeballs,” Polak said. “They were the first to join when they saw that it could promote their careers.”

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Model hearts in different forms and views line a bookshelf at UCLA.

Model hearts line a bookshelf at UCLA. The Amara Yad project is working with other universities to tackle other parts of human anatomy.

(Allen J. Schaben / Los Angeles Times)

Shivkumar said that beyond making new tools for physicians, the Amara Yad project is working with Oxford University to develop an accompanying curriculum that will explore ethical failures in medicine. Pernkopf’s anatomy book is only one example.

The history of the atlas “invites the contemplation of how doctors and medical scientists and anatomists are related to a regime,” said Sari J. Siegel, who heads the Center for Medicine, Holocaust and Genocide Studies at Cedars-Sinai. Thinking about it underscores that “medicine is political.”

“It can’t be divorced from the larger contexts in which it exists.”

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Shivkumar, born to a Hindu family in the southernmost state of India, is used to people wondering why he became “possessed” with this project. He recalls first learning about the Holocaust from a photographer friend of his grandfather, a former newspaper editor once imprisoned for sedition against the British Empire.

He was 11 when the photographer showed him images dating to World War II, and it chilled him “to see that human beings could be so brutal to other humans.” As a child, his parents had told him they owed the world because their part of India was lucky to be long spared from such conflict.

In Amara Yad, we “get a rare opportunity in history to correct an unbelievably depressing stain that was placed in our field,” he told the Heart Rhythm Society.

It irritates him to think of the abundant resources that a Nazi had at hand to do this sort of work. “Imagine having five Shumpeis!” he exclaimed at one point, gesturing at his colleague who hand painted the nerves. At UCLA, the project has piggybacked on ongoing research and relied on donations. He is hoping to garner $500,000 annually to continue and expand the work.

But Shivkumar likes to quote the Emperor Ashoka on that point: “To do good is difficult. One who does good first does something hard to do. … Truly, it is easy to do evil.”

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