The first clue was a yellowish, irregular bit of skin on the patient’s left upper eyelid. There was also a “soft bumpy” swelling, three inches long, on her right hand below the index finger. Neither symptom was definitive on its own. But the “leather-like spot” on the eyelid was suggestive of xanthelasma, a deposit of cholesterol beneath the skin. The swelling on the hand, meanwhile, looked like it might be a subcutaneous lipoma, a fatty lump between the skin and muscle tissue. The two together, thought Dr. Jan Dequeker and colleagues at University Hospitals in Leuven, Belgium, were commonly found in middle-aged or older people with hyperlipidemia—a major risk factor for heart disease. This patient, however, was just 24 years old.
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A simple blood test would have confirmed the diagnosis. But that was impossible at this point. You see, Dequeker and his colleagues weren’t examining the young woman in person, they were looking at a 500-year-old picture of her.
That said, the image was extraordinarily precise. It was rendered by none other than Leonardo da Vinci.
The time-travel detection of illness in Lisa Gherardini of Florence, Italy—the woman now known the world over as the Mona Lisa—is part of a fascinating offshoot of medical archeology that combines the art of diagnosis with the diagnosis of art.
Professors at top medical schools have long used the approach to teach the essential craft of patient observation to medical students, as the Wall Street Journal’s Amy Dockser Marcus reported several years ago.
Professor Hermann Haller, a Yale-trained physician who directs the department of nephrology and hypertension at Germany’s Hannover Medical School, is among them, as he wrote in an illuminating blog post last summer. Haller, for instance, points out a figure who may well be suffering from neurosyphilis—an infection of the nervous system (the brain and spinal cord) common to people with chronic or untreated syphilis—in the Renaissance painting, “The Allegory of Love” (a.k.a. “An Allegory with Venus and Cupid”), by Agnolo Bronzino. Here, amid the celebration of amorous engagement, Haller shows us, is a reminder of the ravages of a venereal disease that was widespread in the 16th century.
By “diagnosing the canvas,” modern-day sleuths have concluded that Rembrandt van Rijn may have suffered from an endocrine disorder—or perhaps from stereoblindness (an inability to see in three dimensions), as a pair of Harvard neuroscientists suggested in 2004.
Why would they surmise such a thing of one of the greatest painters in history? Well, in 23 of Rembrandt’s 24 painted self-portraits, the scientists explain, “the eye on the right side of the painting tends to look straight ahead and the other eye deviates outward.” Such a misalignment would suggest the artist had a unilateral strabismus, a deviating eye.
Or consider Andrew Wyeth’s famous 1948 painting, “Christina’s World,” in the collection of New York City’s Museum of Modern Art. The subject—a young woman in a pink dress lying in a grassy Maine field, her right arm bent awkwardly behind her—was Wyeth’s neighbor and frequent inspiration, Anna Christina Olson, who was thought by many at the time to have polio. But, says Christopher Wanjek at Live Science, when Marc Patterson, a pediatric neurologist at the Mayo Clinic, looked at the same painted figure, a different and rarer diagnosis popped to mind: Charcot-Marie-Tooth disease.
Writer Jason Daley at Smithsonian.com captured the aim of this new science well: “In a world of x-rays, MRIs and other tools, diagnosing the canvas” encourages both doctors and medical students “to pay attention to what’s right in front of them.” And as physicians spend more and more time filling out electronic medical records and less and less time with patients, the lesson seems all the more urgent.
Now, it seems there’s a new twist on this forensic art: the second opinion. In the September issue of the Mayo Clinic Proceedings, Mandeep Mehra, medical director of the Brigham and Women’s Hospital’s Heart and Vascular Center and a noted expert on heart transplant, and University of California, Santa Barbara, researcher Hilary Campbell challenged the notion that the Mona Lisa suffered primarily from hyperlipidemia (though that could be a secondary ailment).
Check out the yellowish skin, they write in a letter to the medical journal: potential “impaired hepatic conversion of carotene to vitamin A, resulting in excess deposition of serum carotene in the stratum corneum.” Witness the receding hairline and coarse, thinning hair. Note the puffy neck that might indicate a goiter. And that iconic enigmatic smile? Hmm. It “may at one level be representative of some psychomotor retardation and muscle weakness,” they deduce.
Their diagnosis? Postpartum hypothyroidism, naturally!
Then again, it could just be the painting’s varnish…“which may yellow over time.”
DIGITAL HEALTH
Blood pressure reduction with telehealth. A new study suggests that remotely monitoring blood pressure with digital tools may lead to—at least temporarily—a reduction in blood pressure. But here's the fly in the ointment, according to the research published in the journal JAMA Cardiology: The effects aren't long-lasting. “This intensive intervention had sustained effects for up to 24 months (12 months after the intervention ended),” wrote the study authors. “Long-term maintenance of BP control is likely to require continued monitoring and resumption of the intervention if BP increases.” (MobiHealthNews)
INDICATIONS
Acorda dealt a blow over MS drug. A U.S. appellate court has struck down patents on Acorda Therapeutics' multiple sclerosis treatment Ampyra, paving the way for generic versions of the treatment. The decision sent Acorda's stock tumbling nearly 25% and underscores the high-stakes business of biopharmaceutical IP, wherein barriers to entry are an essential part of doing business. (Reuters)
THE BIG PICTURE
Living organ donations. There's a gigantic shortage of available organs in America, with tens of thousands of people waiting on a vital organ at any given time. In an effort to mollify the situation, doctors have been exploring ways to open up "live organ" donations—transplants which may have the benefit of lasting longer. But there are myriad issues that make live donations difficult, including paid leave for the donors and various insurance hurdles, as Fox News reports. (Fox News)
REQUIRED READING
The Most Ambitious Climate Plan In History, by Janet Yellen & Ted Halstead
'Cleantech' Was a Dud, But There's Still Money to Be Made in Green Investments, by Adam Lashinsky
Commentary: Jack Ma Is Not Retiring—Yet, by Clay Chandler
Can the Ford Focus Really Be 'Built in the USA'? by David Meyer
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