Smoking tobacco is still bad

Going through the WHO health statistic report I mentioned a few posts ago, I pulled out and summarized the information about tobacco-related deaths. Tobacco is still a top killer. I was aghast at the sheer number of deaths the WHO attributes to tobacco, and the fact that most lung cancers are associated with its use. Even with my background in health I didn't realize how severe the effect still is. Especially since I live with a smoker, I have to admit that it scares me to imagine he is losing years from his life. There have been many smokers in my family, some negatively affected by it and others not. But the odds are not good and the statistics are worth keeping in mind when deciding to buy the next pack. I agree with people deciding what is best for themselves and in making personal choices about their health, including smoking. As someone who suffers respiratory problems from second-hand smoke I have a bias towards nonsmoker rights, but also have to admit that I have yet to see clear scientific evidence about the effects of secondhand smoke (by the way, if you have links to studies, please pass them my way). And I believe smokers have rights, too. It's a touchy subject, I know, but making informed choices is important, no matter what they may be. So I pass this information along to you.

At-home monitoring recommended for Hypertension

The American Heart Association has recommended that all hypertensive patients monitor themselves at home. There is some scrutiny of this new policy due to a device manufacturer being financially tied to the Association's blood pressure website, but experts agree that patients monitoring their pressure fluctuations over the course of the day, and for a number of days, could be beneficial to determining how well medications are working. CNN had the story. Most devices cost between 50 and 100 dollars and can be purchased at pharmacies or online. Insurance most often does not cover the cost. 72 millions Americans are thought to have hypertension.

Big tobacco funds academic research

A New York Times report has outed the fact that Virginia Commonwealth University receives research grants from Philip Morris, a major tobacco company. Last year, they received at least a million dollars. The catch is that no researcher can publish, or even discuss, the results of their tobacco research without permission from the company. The sad part, the researchers at VCU didn't know what the administration had agreed to. No wonder the addictive and lung-blackening nature of cigarettes was unknown until recent decades.

New defense against antibiotic-resistant bacteria

Researchers at Merck have found a new compound in South African soil samples that may result in a new drug for fighting antibiotic-resistant bacterial infections. Platensimycin represents a new class of antibiotics and has been found to be effective against MRSA. Though research is ongoing and no drug plans yet on the table, the pharmaceutical company researchers have given the medical community hope in the fight against bacteria.

Evolutionary rate of mutation

The European Journal of Human Genetics had an interesting news editorial about a recent study ab0ut the loss of chromosomal regions in the human genome. It seems that the rate of mutation, from the development of single nucleotide polymorphisms to visible chromosomal loss, is more constant than previously thought. The research supports the rate of mutation needed for adaptive change in a species.

Monkey model of Huntington's

Researchers at the Yerkes National Primate Research Institute have developed a monkey model of Huntington's disease using genetic engineering (lentivirus targeting with GFP to be exact). Two monkeys from a successful breeding of monkeys with the characteristic CAG repeats exhibit symptoms of the disease. The group hopes next to develop monkeys with late-onset disease to better mimic the human condition, though it is yet unknown how closely the monkeys will approximate the human disease.

Human bird flu cases

Colorized H5N1 influenza virus, also known as avian flu. Source

Bird flu, also called avian flu, is caused by an influenza virus that normally only infects birds, though it is becoming more common in pigs. Avian flu is a strain of type A influenza known as H5N1, different from the swine flu of the recent outbreak (which is H1N1).

Though the outbreak of influenza among birds in recent years has been extensive and resulted in the culling or death of many thousands of birds, the number of human cases has been minimal and human to human transmission rare. According to the World Health Organization, as of April 2009, approximately 421 humans have been infected with the virus and there have been roughly 257 deaths (these are cumulative numbers since the outbreak began). Most infections have occurred in areas reliant on poultry and those where the poor or the farmers live in close contact with wild and domestic fowl, including Indonesia and Vietnam. Mortality has been highest in those aged 10-19 years, according to the U.S. Centers for Disease Control and Prevention (CDC).

The first human cases were documented in the open farm markets of Vietnam, China, and Indonesia in 2005, though the animal outbreak has been ongoing since 2003. In 2006, the first case was reported in the Middle East. Since that time, Egypt has had the fourth highest number of deaths (23) and the third highest number of infections (67). There are a few widely sensationalized cases of spread among family members, such as in Thailand in 2004 and Indonesia in 2006 (killed 7 of 8 infected family members), but the spread was not beyond one person in each case (contact with dead fowl is the most common factor of family infections). The H5N1 strain of bird flu, as of now, has shown a lack of ability to bind to the cells of the human respiratory tract, which is necessary for the virus to infect humans and limits its spread. Mutations in the virus's ability to adhere to cells in the human respiratory system would make it a formidable opponent for modern medicine.

A Chinese father who contracted bird flu from his son was found to have been in contact with 91 people, none of which contracted the disease. Genetic analysis (published by Lancet in 2008) found that the bird flu strain had not undergone any major mutation that would allow it to spread more readily among humans. The World Health Organization (WHO) has been quoted as saying that the origin of human infection with bird flu is via bird droppings. Ingestion may be introducing a new route of transmission for this strain as opposed to the familiar aerosol, or airborne, transmission that influenza most commonly uses. Fecal transfer of disease is common for many pathogens.

So far, the evidence seems to indicate a genetic susceptibility to H5N1 infection and alternate transmission routes before human infection can occur. This is good news since the virus is extremely lethal to those who contract it. However, if the rate of mutation seen in the common flu virus is any indication, bird flu will find a way to more directly harm humans in the near future. Some governments are stockpiling antiviral medications, such as Tamiflu, for the possibility that a human pandemic is coming (and has been helpful for other outbreaks, such as H1N1). Research has found that suppressing viral replication is key to treating any human infections that may occur because the high mortality rate (60%) is due to highly efficient replication and corresponding increased host immune response. Also, the flu vaccine is being tested and adjusted to possibly cover the H5N1 strain, which it currently does not do.

New male osteoporosis screening guidelines

The American College of Physicians has issued new guidelines for the screening of osteoporosis in men. Osteoporosis is a loss of bone mass, which is normal as we age. However, severe decreases can lead to fractures and other complications - basically a fragile skeletal frame. There is some debate as to how important screening is and to what extent this qualifies as a disease. Regardless...

The new guidelines recommend that clinicians assess risk factors for osteoporosis in older men and that clinicians obtain a dual-energy x-ray absorptiometry (DXA) scan for men at increased risk for osteoporosis who are candidates for drug therapy.

...

Based on this meta-analysis, risk factors for low BMD–related fracture in men and women were age (> 70 years), body mass index (BMI) less than 20 to 25 kg/m², weight loss of more than 10%, physical inactivity or sedentary lifestyle, previous osteoporotic fractures not resulting from significant trauma, prolonged or ongoing use of certain drugs (eg, prednisone or other corticosteroids), and low-calcium diet.

In men, androgen deprivation therapy and spinal cord injury were also associated with the risk for osteoporosis.

The report was described at Medscape, but originally found in the May 6 issue of Annals of Internal Medicine.

Meningitis vaccine not for everyone

The ACIP has released new recommendations about the vaccination of children aged 2 to 10 for meningitis.

"At its February 2008 meeting, the Advisory Committee on Immunization Practices (ACIP) decided not to recommend routine vaccination of children aged 2 – 10 years against meningococcal disease unless the child is at increased risk for the disease," the report states. "This report summarizes the deliberations of ACIP and the rationale for its decision and restates existing recommendations for meningococcal vaccination among children aged 2 – 10 years at increased risk for meningococcal disease. ACIP continues to recommend routine vaccination against meningococcal disease for all persons aged 11 – 18 years and those persons aged 2 – 55 years who are at increased risk for meningococcal disease."

The ACIP decision not to recommend routine vaccination against meningococcal disease for all children aged 2 to 10 years was based on reviews of safety and immunogenicity data, the epidemiology of meningococcal disease, cost-effectiveness analysis, and programmatic considerations.

The report was published in the May 2 issue of Morbidity and Mortality Weekly Report. The quote is from Medscape.

Commensal bacteria

In an age when antibiotics are available in soap, sprays, and cleaning supplies, bacteria have gotten a bad reputation. Though it is true that many diseases, some extremely horrible, are caused by these microbes, there are also many beneficial, and sometimes necessary, bacterial species for human life. A normal healthy person is actually colonized by bacteria both on their skin and in their body. When depleted, there are supplements available to aid in their recolonization.

Roles of bacteria

Bacterial species living inside a human being are found in the gastrointestinal (GI), or digestive, tract. There are actually more bacteria in the large intestine alone, than there are cells in the human body. From the mouth to the anus, these tiny life forms aid in breaking down and digesting food, converting nutrients and dietary fiber for absorption, synthesizing vitamins, and degrading toxins. They also aid the immune system to develop vigorous responses. More than half of the body’s immune tissue is located in the lining of the small intestines, called Peyer’s patches. All of the bacteria in the GI tract are expelled and renewed daily.

Both within and without, friendly bacteria compete with infectious agents for space. We inhale and ingest virulent bacteria on a daily basis. Without the normal oral and intestinal flora, disease would be much more common and severe. In fact, when taking antibiotics, a person is much more susceptible to infection because the beneficial bacteria are depleted and leave space for other cultures to grow. This also occurs when antibiotic lotions or creams are used in excess upon the skin.

Useful bacteria - Acidophilus

The most well-known bacterial inhabitant of the digestive tract is Lactobacillus acidophilus, which aids in the digestion of lactose. The byproducts of this breakdown discourage colonization by other bacteria. This bacterium is sometimes found in yogurts to aid in dairy consumption. There are also now other bacteria being added to foods such as yogurt, which is itself a probiotic (live bacteria) culture. These are expected to aid in immune responses and digestion, as well as alleviate lactose intolerance.

Acidophilus also aids in niacin, folic acid, and vitamin K formation, and it assists in the recycling of amino acids from bile. This bacterium is also found in the vagina, as the lactic acid it produces discourages fungal growth. This is one reason why women are susceptible to yeast infections when on antibiotics. There are acidophilus powder or pill supplements available in most health stores.

Other types of commensal bacteria

Staphylococcus epidermidis and Proprionibacterium acnes are two bacterial species that are naturally present on the skin and are less virulent alternatives to flesh-eating bacteria (Staphylococcus aureus for example) that could take their places if given the opportunity. P. acnes is often the cause of skin acne, but is usually commensal, meaning that it exists on the skin without doing harm. The bacterium lives off of fatty acids and sebaceous fluid secreted by the pores of the skin. The microbe is sensitive to ultraviolet light. S. epidermidis is actually resistant to the antibiotics penicillin and methicillin, but is generally non-virulent, except in the case of patients with suppressed immune systems or catheters.

Streptococcus mutans is present in the mouth and converts sucrose, sugar, to lactic acid. If not kept in check, this species can cause dental plaque and tooth decay. Like acidophilus, this bacterium creates an acidic environment, which competes out much more virulent microbes, including fungal infections and virulent Strep and Staph.

 

For an interactive graphic see CAN-BIND

 

Autism is more complicated than this

This is a waste of taxpayers money and the judicial system's time. Families argue autism-vaccine link in special U.S. court. Billions of dollars have been collected in excise taxes on vaccine doses, which should be removed to make the cost of vaccination less. No research has indicated that mercury is deposited in the brain by vaccines and no neurophysiological mechanisms have associated vaccines with autism. The link just isn't there. There is, however, a hereditary link with autism. I'm sorry, but these families need to admit that there's something more complex going on than a vaccine conspiracy. Like most things I urge moderation. Not everything should be vaccinated against. But now we're seeing a resurgence of deadly diseases we once had beat because of the lack of vaccination being promoted by those who keep arguing with the evidence. And currently, vaccines don't even contain the mercury-based preservative thimerasol that's under fire. And removing it did not decrease the rate of autism diagnosis, neither has a decreased vaccine compliance rate. Autism is a complex neurological disorder, that might not even be abnormal. It is deviant from what we define as normal. In recent years the definition and diagnosis has been expanded to include a spectrum of disorders that some doctors argue are not a disorder at all. However, there are many children and adults who live with a debilitating neurological condition. Court battles like this won't help. Money being diverted to real research on the matter and concentrating on giving their children a normal life will.

What is still being learned from Darwin

A fellow pathologist wrote a great article on Evolution that I wanted to share. Darwin and deduction discusses the human evolution that still occurs and what observations from Darwin's work are still being fleshed out and elaborated upon.

Mesenchymal stem cells to treat disease

Gene Therapy had an interesting series of review articles recently on the potential of mesenchymal (adult) stem cells.

Therapeutic potential of genetically modified mesenchymal stem cells

Stem and progenitor cell-mediated tumor selective gene therapy (abstract)

Endothelial progenitor cells for cancer gene therapy (abstract)

Gene-modified bone marrow cell therapy for prostate cancer (abstract)

And for those who want a little more depth -

Inflammation and tumor microenvironments: defining the migratory itinerary of mesenchymal stem cells (abstract)

Cancer treatments would benefit greatly from targeted therapy, and developing controllable stem cell populations would such a boon for many diseases. Just think - no immune response because they are your own cells, no radiation sickness or adverse drug reactions, and no systemic damage only destruction of the targeted cell population.

Bad news for fat kids

I was reading through the recent posts at The Scientist newsblog and am a little dismayed at some recent findings:

The number of fat cells in a person's body is determined during childhood and stays constant throughout life, with about 10 percent of fat cells dying and being replaced annually, according to study published in Nature yesterday (May 4).

This is bad news for me. I was an overweight kid...and am an overweight adult. I constantly struggle with trying to maintain a lower weight let alone lose more. Well, at least my sister got to be skinny.

The target age for final adipocyte numbers was 16.5 years. And they saw discrepencies in the rate at which the body produces the cells. Hopefully this information will lead to treatments for those who have more than just a nutrition problem.

A sad situation for NIH-funded labs

During the current administration, federal funding has decreased severely. I saw it first hand as a graduate student in an NIH-funded lab. Many of my papers are still sitting there waiting for final experiments before being peer-reviewed for publication. My lab could no longer afford me or the reagents in my final year there. We even had to give up two lab and three office spaces due to a lack of funds, moving into a much smaller area than we thought we could manage. There was some hope, as I made my exit, that the post-docs could cross the t's and dot the i's once money came back, but my last contact with them (last month - 16 months after my departure) was that nothing has been done with the write-ups of my 4+ years of blood, sweat, and tears.

The Scientist has a story of another researcher who fared much worse. Losing your lab describes something very sad that is occurring far too often nowadays.

I, like many other scientists, ended up with an alternative career in the sciences instead of a research position because the career ladder was cut off at the third rung.

Adult boosters recommended

A list of seven vaccines you need right now was published by CNN's health channel. It's a good reminder that as adults age we may lose immunity to childhood diseases. I myself need to look into an MMR booster. I'll be moving up towards Canada, which has had Mumps outbreaks, and Measles is making a comeback as I noted earlier. Also, due to whooping cough (pertussis) making its way back into the mainstream, I'm going to opt for the Tdap version of the Tetanus booster when I get my update, which I'm due for this year I think.

It's particularly important to be up-to-date as an adult as childhood vaccine compliance decreases. I'm not sure anyone under the age of 60 who has no chronic disease or immune suppression requires the shingles vaccine, but that article is a decent reminder that infectious disease knows no age.

Roadblocks to eliminating AIDS

When I was finishing up my degree I taught graduate school courses on pathology. One topic that I was extremely interested in was HIV/AIDS. I had become interested in the topic in my undergraduate virology course when I had to help develop a class presentation on the virus.

Since then I've written several articles (see summarized update below) and commentaries on the subject. Recently I wrote a news update [broken link] on the clinical trials of the newest prevention technique - vaginal gel. Unfortunately, many of the latest trials have had to be halted due to the lack of usage among participants. Organizations are testing the female-based methods in Africa, the epicenter of the AIDS epidemic. Only 10% of women used the gel as directed! Several dropped out of the trial due to pregnancy. 1/4 of the women who initially signed up for the trial couldn't participate because they were already infected with HIV and didn't know it.

It's a shocking realization that after 25 years, there is still a place on the planet where condom use and HIV infection is not taken seriously. Thousands of children die or are made orphans by their parents deaths each day. Women and children are half of the victims. And the traditional high risk groups are no longer the ones to watch. Heterosexual partners of a high risk person is the largest growing group of HIV patients! Even in the United States, the prevalence of HIV infection is equivalent to the late 1980s [broken link] according to the latest information released by the CDC.

I'm just stunned, that as the number of infections and deaths has gone up, the level of prevention has not changed. You can bet that I'll still be writing on this in ten years, just as I was almost ten years ago. I hope it's to say that infection rates are down, but I doubt it will be about a cure. The virus is too able to adapt. It has to be stopped before it starts. Prevention!

------

AIDS Epidemic Update January 2008

Acquired Immunodeficiency Syndrome (AIDS) was first recognized as a disease by scientists in 1981. To date, a reported 25 million deaths have been attributed to AIDS and its associated opportunistic diseases. AIDS is caused by the Human Immunodeficiency Virus (HIV), a retrovirus with counterparts in other species such as monkeys, cats, and horses.

The AIDS epidemic is believed to have peaked in the late 1990s though world health officials still contend there is much to do. The past year (2007) still saw 2.5 million new infections. In sub-saharan Africa AIDS affects men, women, and children. Elsewhere in the world outbreaks are mostly concentrated to high risk groups, but has been on a rise in heterosexual female partners of high risk group members since 1990 (NY Times 12/90, Journal Watch 1999). High risk groups include intravenous drug users, homosexual men, and sex workers.

New AIDS Infection Rate Estimates

The World Health Organization (WHO) and United Nations AIDS agency reported in November 2007 that the number of global AIDS cases fell from over 39 million to 33.2 million in 2007. This was due to new methodology that deflated previous estimates, mainly revised numbers from India and new data from sub-saharan Africa, the epicenter of the epidemic where AIDS is still the leading cause of death. Previous AIDS numbers were devised by projecting the AIDS rates of certain high-risk groups to the entire population at risk as well as the number of infected pregnant women at clinics. The new numbers include data such as national household surveys. Critics contend that even with revisions the numbers may still be too high and more revisions may be in store in the near future.

The Origin of HIV in America

New information about the origins of AIDS also came to light in 2007. A group involving evolutionary biologist Michael Worobey at the University of Arizona conducted genetic analysis on stored blood samples from early AIDS patients. Haitian immigrants in Miami as early as 1979 suffered from a mystery illness that turned out to be AIDS. The governments had stored the samples and the study was able to use five samples taken from Haitian immigrants in 1982 and 1983 along with 117 other early AIDS patients worldwide.

Other studies had previously suggested that the virus first entered the human population around 1930 in central Africa, most likely from slaughtered chimpanzees infected with the simian AIDS virus, SIV. Worobey’s group ruled out the possibility that HIV came directly to the United States from Africa. They found a 99.8% probability that Haiti was a link between the virus’s trek from Africa to the United States, a path long under debate by researchers. The study found that HIV was brought from central Africa to Haiti by an infected person around 1966, matching earlier estimates, but that HIV was brought into the United States in about 1969, earlier than previously thought. The virus was probably brought in by a single infected immigrant.

Reference

Gilbert, M.T.P. et al., 2007. The emergence of HIV/AIDS in the Americas and beyond. Proceedings of the National Academy of Sciences of the United States of America, 104(47), p.18566-70.

 

Recommended Reading - Selling Sickness

I read this book, chapter by chapter, as a starting point for a few articles I've done. Combined with the background given me by Laurie Garret's tome on the public health infrastructure, Betrayal of Trust, I have been able to search for more information including legislative decisions, FDA approvals and recalls, and even clinical data files.

It absolutely amazes me the extent to which the regulatory agencies and pharmaceutical companies fail the consuming public. Consumerism has changed medicine into an industry focused on business and profits, rather than a profession based on helping sick people get well or preventing healthy people from getting sick. I received my graduate degree from a medical school and I have taken courses with future doctors...I even taught future doctors! And I am appalled at the undermining that will occur when they have lives in their hands. Companies pay for conferences and "educate" about their medications and the diseases they treat. Companies hire PR and marketing firms to create new names for disorders and diseases so they will sell better. The FDA approves new treatments based on promises instead of results. Then later recalls some because they end up killing patients they were supposed to help.

I believe that the researchers working on the treatments truly want to create cures and real medicine. I believe that most doctors get into medicine to help people. I believe that the firms doing the selling are not trying to injure people. But when someone who knows nothing about medicine is told to take an idea and run with it...that is exactly what happens. People get hurt. And those people are downplayed in memos, made fearful by ambiguous commercials, and humored by paid representatives.

I recommend reading Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us All Into Patients by Ray Moynihan and Alan Cassels. It will give you control of your own health.

Pharmaceuticals in the drinking water

In March 2008, the Associated Press released the results of their 5-month investigation into the presence of pharmaceuticals in the water supply (such as birth control pills, antibiotics, antidepressants, and acetaminophen or ibuprofen) in the water supply of 24 major metropolitan areas.

They found a lot to be worried about. Not only are human medications being flushed down the toilet, literally, but drugs used on animals are making their way into the drinking water. The concentrations were well below the normal medical dosage, in tiny quantities of parts per billion or trillion, but the fact that antibiotics, antidepressants, and hormones were found in the drinking water of an estimated 41 million Americans has raised concerns among health officials.

Most drug byproducts, expelled from the body after a person has taken the pills or medication, are removed from the water supply during waste treatment. However, not all compounds are filtered out by current treatment methods. As the usage of pharmaceuticals increases, the amount of residue in the water may increase for both prescription and over-the-counter medications and there is currently no federal requirement for screening.

The investigation included testing results by U.S. metropolitan areas from California to New Jersey and Detroit to Kentucky and included watershed evaluations. The most notable finds from the U.S. Geological survey and local water authorities outlined by the report included 56 different pharmaceuticals in Philadelphia, anti-anxiety and anti-epileptic medications in the treated water of more than 18 million Southern California residents, sex hormones in San Francisco’s water, mood stabilizers in the Passaic Valley treatment plant that serves New Jersey, six drugs in Washington D.C.’s supply, and antibiotics in the drinking water in Tucson, Arizona.

However, not all areas test for all pharmaceuticals, greatly limiting what could be found. Also, more than half of the cities contacted for information by the AP did not respond, including Houston, New York City, Boston, Baltimore, and Miami, though watershed testing revealed hormones and pharmaceuticals in the New York water supply. The water authorities insist that the water is safe. The AP found that sometimes when the local water providers said the results of screening were negative, independent screeners had different results.

The contamination is not just an urban problem. Caffeine was found in the water supply of less populated areas and those who draw from a well are at risk of contamination from failed septic systems. Other countries are also at risk, studies have found Asia, Australia, Canada, and Europe to also have pharmaceuticals in their lakes, rivers, reservoirs, and streams.

Local environmental groups, such as Environment Colorado, are calling for the pharmaceutical industry to take responsibility. In a press release, the group called for drug makers to either re-engineer their medications to not make their way into the water supply or to pay for the cleanup and new treatment methods that are necessary. They voiced concerns about the development of resistant infections and the adverse health effects of hormone exposure.

Additional treatment methods and research are necessary because some compounds become more toxic when presented with chlorine, a common treatment chemical. Also, technologies such as reverse osmosis, which would solve the problem, are too expensive to initiate on the large-scale according to reports from environmental research and watchdog groups.