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The Renaissance anatomist Andreas Vesalius’s De humani corporis fabrica (‘On the fabric of the human body’) is a foundational work of medicine in the West. Its more than 200 woodcuts revolutionized how people pictured the human body, flayed and cut to reveal musculature, nerves, organs and bones. Even now, 475 years after it was first published, the bold images of skeletons and skinless ‘muscle men’ in sinuous poses (by illustrator Jan Steven van Calcar) beguile.

More than 700 copies survive from the 1543 and 1555 editions, which Vesalius supervised. Of these, roughly two-thirds contain comments in the margins, bizarre doodles, and coloured-in and even defaced images, as we reveal in our book The Fabrica of Andreas Vesalius. Early readers, on evidence, studied Vesalius’s treatise diligently, yet had no compunction about scribbling in a hugely expensive volume.


Looking deeper, the marginalia tell two stories. One is that some found the images baffling, and attempted to clarify them in innovative ways. Another is that the pious found the figures’ necessary nudity scandalous, and felt impelled to weigh in with ink and scissors. Our study of the reactions of hundreds of readers has taught us that medical communities do not always adopt innovative solutions quickly, even when they are presented in such an elegant format as the Fabrica. It takes time to get used to novelty. And we have learnt that even the most ingenious scientific minds can fail to predict how political and religious institutions will respond to their work.

In the realm where science fiction, horror and fantasy meet lives the work of Howard Phillips Lovecraft, who endures as one of the world’s most imaginative writers. His mythos of interstellar deities and sinister forces has inspired generations of storytellers, with the word "Lovecraftian" used today to describe a specific, chilling tale. As with most people who are posthumously labeled geniuses in their fields, Lovecraft’s work never took off during his short lifetime. Only after his death in 1937 did he gain the kind of popularity that’s made him one of the most famous writers in the world.

[…] He created the fictional town of Arkham, Massachusetts, and the fictional Miskatonic University, which show up again and again in his stories about the Necronomicon, a forbidden book of dark magic, and the Old Ones — the most famous of which, Cthulhu, is practically a meme. His stories appeared in pulp magazines like Weird Tales, sometimes serialized, never particularly popular while he lived, and he died having used up the remains of an inheritance down to the last penny. He was a visionary (with, uh, documented racist views); his work was influenced by a post-World War I awareness of the horrors men can inflict on other men, which inspired his darkest, most chilling tales of murder, suspense, and otherworldly evil.

Lovecraft was a pioneer of the "speculative fiction" genre, and started the Cosmicism movement, which is marked by the belief that there are interstellar beings far outside the realm of human perception, and humans are an insignificant part of a very large, very terrifying universe. His narrators are unreliable, often addicted to substances, their minds altered and broken by the horrors they’ve witnessed. Lovecraft’s work traditionally features humans catching glimpses of a bigger universe our minds were never built to comprehend.

The United States Preventive Services Task Force (USPSTF) has released new recommendations on screening for cervical cancer. These latest recommendations continue the trend of decreasing participant burden by lengthening screening intervals, making the "annual Pap" a historical artifact. Since its introduction 75 years ago, exfoliative cytology commonly known as the Pap test has been the "gold-standard" screening test for cervical cancer.

In the current issue of the Journal of the American Medical Association ( JAMA), the USPSTF, an independent panel of experts in primary care and prevention, updates its 2012 recommendations for cervical cancer screening with one important addition. This is the first time the USPSTF has recommended a method of cervical cancer screening that does not include the Pap test.

[…] The new USPSTF guidelines recommend that women ages 21 to 29 years be screened for cervical cancer every three years with the Pap test alone. This recommendation remains unchanged from 2012. For women ages 30 to 65 years, the USPSTF recommends screening for cervical cancer with primary high-risk human papillomavirus (hrHPV) test alone every five years. As an option, they also recommend the previous guideline of hrHPV test and Pap test together (co-testing) every three years.

What was novel in the 2012 USPSTF recommendations was that women ages 30 to 65 years were given the option for the first time to be screened with hrHPV test and Pap test together every five years to lengthen their screening interval. The 2018 recommendations go one step further by including, for the first time, the option of hrHPV testing alone, without a Pap test, every five years.

The table in the new USPSTF recommendations also acknowledges an important trade-off. Co-testing is slightly better than primary hrHPV testing at detecting precancerous lesions but is associated with increased tests and diagnostic procedures that may not benefit the patient and have real costs to the health care system. Pap tests detect changes in cervical cells that could indicate the presence of pre-cancer or cancer, while HPV tests detect the genetic material or DNA of the high-risk types in cervical samples.