How Safe Is Traditional Chinese Medicine?

The following is written by Kai Kupferschmidt of sciencemag.org:

Dangers of Chinese Medicine Brought to Light by DNA Studies

Traditional Chinese medicine (TCM) is enjoying increasing popularity all over the world. But two molecular genetics studies published this week show that the trendy treatments can be harmful, as well. The papers focus attention on the fact that not all of their ingredients are listed, or even legal, and that some can cause cancer.

“These two studies show very clearly how dangerous the products of TCM can be,” says Fritz Sörgel, the head of the Institute for Biomedical and Pharmaceutical Research in Nuremberg, Germany, who was not involved in the work. “The public needs to be better informed about these dangers.”

Hundreds of millions of dollars are spent on TCM products each year—a growing portion of it on the Internet—and some scientists are looking at these preparations hoping to discover new pharmacological substances. Many would like to emulate the success of Tu Youyou, the Chinese scientist who isolated artemisinin, now the world’s most important malaria drug, from an ancient Chinese medicine. Tu won a Lasker award last year and is rumored to be a Nobel candidate.

But critics have long warned that some mixtures can also contain naturally occurring toxins, contaminants like heavy metals, added substances such as steroids that make them appear more effective, and traces of animals that are endangered and trade-restricted.

Now, researchers at Murdoch University in Australia have investigated the problem using modern sequencing technology. The team, based at the university’s Australian Wildlife Forensic Services and Ancient DNA Laboratory in Perth, analyzed 15 samples of traditional Chinese medicine seized by Australian border officials.

“We took these traditional preparations, smashed them to pieces, and extracted the DNA from the powder,” explains molecular geneticist Michael Bunce. The scientists then fished out copies of two specific genes, trnL, a chloroplast gene common to all plants, and 16srRNA, conserved among plants and animals, and multiplied and sequenced them. By comparing the sequences to those in genetic databases, they could pinpoint the animals and plants used to make the medicine. “Sometimes we really struggled to assign a particular DNA to a particular species,” Bunce says. But as genetic databases expand, this should become easier.

Some products contained material from animals classified as vulnerable or critically endangered, such as the Asiatic black bear and the Saiga antelope—just as the producers claimed. But often, the medicine also harbored ingredients not mentioned on the packaging, the team reports online today in PLoS Genetics. “For example, a product labeled 100 percent Saiga antelope contained considerable quantities of goat and sheep DNA,” Bunce writes.

“Using DNA to identify the animal species and thus prove illegal trading is very elegant,” says Dietmar Lieckfeldt, who works in molecular forensics at the Leibniz Institute for Zoo and Wildlife Research in Berlin, Germany. Identifying animals by their DNA has been possible for a while, he says, but the next-generation sequencing technology makes it possible to nail different species in a mixture very quickly.

In the herbal preparations, Bunce and his colleagues found members of 68 different plant families, among them plants of the genera Ephedra and Asarum. Both can contain toxic chemicals such as aristolochic acid, a compound banned in many countries because it causes kidney disease and cancer of the upper urinary tract (UUC). While detecting DNA from a certain species does not mean that a toxin produced by that plant is present, chemical analysis of one of the four samples containing Asarum DNA did turn up aristolochic acid.

The threat posed by aristolochic acid is also highlighted in a paper published in the Proceedings of the National Academy of Sciences on Monday. The researchers, led by pharmacologist Arthur Grollman of Stony Brook University, focused on Taiwan, the country with the highest rate of UUC in the world. A previous analysis had shown that roughly one-third of the Taiwanese population consumed herbs likely to contain aristolochic acid.

The scientists sequenced the tumors of 151 patients with UUC. Among patients with characteristic mutations in the important tumor-suppressor gene TP53—which make people more vulnerable to cancer—84% also showed a known molecular signature of exposure to aristolochic acid, they found. The study provides compelling evidence that aristolochic acid is a primary cause of UUC in Taiwan, the authors argue.

Bunce and his colleagues also found DNA from plant families known to contain medicinally important species that could pose risks when used in combination with other drugs, as well as DNA from soybean and plants of the cashew family, which can contain allergens. “This just shows that the ingredients in these preparations aren’t accurately declared,” Bunce argues. Indeed, says Sörgel, the studies show that partaking in traditional Chinese herbal medicine is a gamble: “We just don’t know enough about it.”

Boob Quickies

This post was originally about boobs.
And then somehow it grew into some sort of verbose blog monster.

I had set out to write about how my breasts have impacted my life, but that post will have to wait for another day. There has been a lot of controversy in our culture lately regarding women. The concept of being a woman in our culture has been the center of a nasty political war, to the point that even a simple blog post about how awesome boobs are turns into a statement of what it means to be a woman. Honestly, it shouldn’t be a big deal, but it is. And as a result, I’ve noticed a surge of woman-related content on my usual Internet browsing sites.
This isn’t going to be the deep and reflective post I intended to write. Mostly, it’s because of the research. There is just so much information out there, so many opinion articles, that I really can’t say what hasn’t already been said before. The primary purpose of this blog is to store and share articles that interest me, since I know I will eventually want to refer back to them. So this post is going to be quickie-style.

Don’t worry, there will be plenty of boobs.

(Without boobs, where would be store our kittens?)

First off, the cost of being owning a vagina. Jezebel threw together this nice little article outlining the basic cost of owning a vagina, based on the staffer’s personal experience and drug-store prices. Not incredibly scientific, but enough to give you a ball-park estimate and an average idea of all the items needed for proper maintenance. The list doesn’t include pregnancy costs (though it does include pregnancy test, for those trying and those who have the occasional scare). I suppose it makes sense, if the list is the basics. It inspires me to go through my finances and calculate what its costs for me to maintain my own fabulous lady parts. I already know that bras, at about $75 a piece (+/- $10), typically run me $150 to $225 a year. And eventually I’ll have to start getting breast exams, which are another hefty expense.

SMBC, which always makes me giggle, recently released this delightful gem.

Back to the boobs!
The over-diagnosis of breast cancer is one of those things that a lot of women and feminists are still quiet about, because 1) many of them have had a sister/mother/friend/relative whose life was saved by early detection, and they don’t want to admit that such a case may have been due to over-diagnosis and 2) the medical, social, and political implications are too horrifying to think about.

The road of breast cancer is a very difficult one to endure. Chemo saves many lives, but also takes an incredible physical and emotional toll. Chemo is not “just another drug” that can be handed out like aspirin. Its a detrimental drug which should only be given because the other alternative is death. Additionally, mastectomies are essentially an amputation, and emotionally devastating because of how much importance our culture places on breasts. According to social standards, a huge portion of what it means to be a woman is wrapped up in our breasts, and when one is raised in such an environment, losing a breast can result in a huge psychological toll. Many are still in denial, or trying to come to terms with the concept of breast cancer over-diagnosis. But the reports are still out there, and for the sake of our health and our boobs (which are pretty super awesome), this issue deserves to be  investigated further. Diagnostic techniques are improving, and detecting breast cancer with a single drop of blood may soon be possible. However, on a brighter note, a recent discovery gives us hope in detecting the infamous “triple negative” breast cancer, which is considered the deadliest form of breast cancer.

A few more quickies on breast cancer: The first large-scale U.S.-based study to evaluate the link between an injectable form of progestin-only birth control and breast cancer risk in young women. Stick to the pill, ladies.  There is also a link between long-term estrogen hormone use and breast cancer, and a new breast cancer susceptibility gene, named XRCC2, has been discovered.

I few weeks ago I shared the idea that we should all knit out congressmen a vagina, so they will stay out of ours. The idea was conceived by The Snatchel Project. The Internet loved it! I started seeing crochet and knitted uteruses, vulvas, and cervixes everywhere (Even a uterus lamp). But it’s not the first time woman have used yarn to emulate female anatomy. Knitted tits have been used to raise awareness about breast cancer for years. You can even buy knitted bikini tops.

Today Cracked released a delightful article written by Luke McKinney, “The 7 Most Sexist Things Ever Invented For Boobs.” It’s both horrific and hilarious. I would love to see prototypes of some of these inventions, just so I can giggle in horror.

Political slut quickies: John Stewart explains why the transvaginal ultrasound bill of Virginia has enraged women across the country. Ever since Rush called Sandra Fluke a slut on air, woman have rushing to re-appropriate the word slut. Why? Probably because shame has long been used as a powerful tool to silence women. And there was this controversial Doonesbury comic, which was pulled from several newspapers. (Because it’s okay to call a woman a slut and introduce bills infringing on her rights, but not okay to satirically bring attention to it.)

Also, Elizabeth Banks threatens to bleed all over furniture if women are denied access to the pill, and Rick Perry’s facebook page is now buried with woman asking him about menstruation, and updating him of their flow status.

German Health Care

Most Patients Happy With German Health Care

By Richard Knox
July 3, 2008

Mention European health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care.

It’s not that way in Germany. Very little tax money goes into the system. The lion’s share comes, as in America, from premiums paid by workers and employers to insurance companies.

German health benefits are very generous. And there’s usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It’s one of the world’s best health care systems, visible in little ways that most Germans take for granted.

Checking In With An Old Friend
Juergen in der Schmitten was a medical student when I first met him 17 years ago. Now, he’s a 42-year-old general practitioner in a suburb of Dusseldorf.

On one particular night, Juergen was the doctor on call for the region. Any German who needs after-hours care can call a central number and get connected to a doctor.

Around 11 p.m., a woman with a fever called Juergen. She wanted him to make a house call. They talked for maybe five minutes, in the end agreeing that she would come into his office in the morning.

A situation like this would be unlikely in the United States. Americans might not get through to a doctor at all, let alone have a discussion about whether the physician should make a house call in the middle of the night to treat a case of flu.

The Patients’ Perspective
Sabina and Jan Casagrandes say they’ve had really good care from the German health system. And they’ve used it a lot.

Sabina is American, Jan is German. They live in a fourth-floor walkup with their two little girls in Cologne, an ancient city on the Rhine in western Germany.

“I’ve probably been very expensive for the health insurance system here,” Sabina says. “When I was 33 years old, I had a giant lump on my neck all of a sudden, where your thyroid is. And it was a big tumor.”

It took two operations to remove her cancer. Luckily it was curable with surgery and radiation. Sabina says she had the best care she could imagine.

“Then I came home to my little daughter, who I couldn’t really lift up because of my neck having been cut open,” Sabina says. “So I asked my doctor, ‘What can I do?’ And she said, ‘Well, your health insurance will pay for someone to come help you in the house.'”

Sabina’s health insurer paid a friend to shop, cook and even help care for the baby until Sabina was back on her feet. That’s not unusual in Germany. In fact, under the country’s system for long-term care, family members can choose to be paid for taking care of a frail elder at home if they want to avoid nursing home care.

Coverage For All
The health care system that took such good care of Sabina is not funded by government taxes. But it is compulsory. All German workers pay about 8 percent of their gross income to a nonprofit insurance company called a sickness fund. Their employers pay about the same amount. Workers can choose among 240 sickness funds.

Basing premiums on a percentage-of-salary means that the less people make, the less they have to pay. The more money they make, the more they pay. This principle is at the heart of the system. Germans call it “solidarity.” The idea is that everybody’s in it together, and nobody should be without health insurance.

“If I don’t make a lot of money, I don’t have to pay a lot of money for health insurance,” Sabina says. “But I have the same access to health care that someone who makes more money has.”

But she acknowledges that nearly 8 percent of her salary is a sizable bite.

“Yes, it’s expensive. You know, it’s a big chunk of your monthly income,” Sabina says. “But considering what you can get for it, it’s worth it.”

Actually, it’s about the same proportion of income that American workers pay, on average, if they get their health insurance through their job. The big difference is that U.S. employers pay far more, on average, than German employers do — 18 percent of each employee’s gross income versus around 8 percent in Germany.
More Added Benefits In Germany
Moreover, German health insurance has more generous benefits than U.S. policies cover. There are never any deductibles, for instance, before coverage kicks in. And all Germans get the same coverage.

For instance, the Casagrandes’ insurance covers an expensive medicine Jan needs for a chronic intestinal problem. He says if they moved to America, they might not be able to buy insurance at all because of their pre-existing conditions — a nonproblem in Germany.

“He says for himself — or for us — the health care system in the United States is the major reason why we have never moved there, and never will move there. Because both of us have chronic illnesses that have to have a lot of medical attention, and we would go broke,” Sabina says, translating for Jan.

Jan adds something else. “It’s also the No. 1 reason in the United States that people personally go bankrupt,” Sabina translates, “which would never happen here … never!”

Coverage For The Family
On the other side of Germany, in Berlin, we meet another couple who know both the American and German health systems.

Nicole and Chris Ertl own Tip Toe Shoes, a children’s shoe shop in a well-off area of the German capital. The Ertls sell high-quality European shoes — tiny Italian sandals, French and Danish boots and clogs in wonderful colors.

Chris is from San Diego, Nicole is German. She also works part time as a physician therapist and gets her health care through her job like the great majority of Germans. Like the Casagrandes, she’s happy with her coverage.

“It’s a good deal!” she says. “It’s really good because it’s a package.”

It’s a package many Americans might envy. Nicole pays a premium of $270 a month for insurance that covers her children, too. Nicole pays a single $15 copayment once every three months to see her primary-care doctor — and another $15 a quarter to see each specialist, as often as she wants. She pays no copayments for her children’s care —-and her insurance even covers her daughter’s orthodontia bill.

“They always have good care,” Nicole says, “because for kids, everything is free. The drugs, it’s always free” until they turn 18.

 

Different Rules For The Self-Employed
But even though her insurance covers the kids, it doesn’t cover her husband. Because Chris Ertl is self-employed, he has to buy insurance on his own, from a for-profit insurance company.

About one in 10 Germans buy this so-called “private” coverage. It’s not just for people who are self-employed. Civil servants and anyone who makes more than $72,000 a year can opt out of the main system. It’s a kind of safety valve for people who want more and can pay for it.

But most people don’t opt out. Chris says that’s because there’s a fundamental difference in the way Germans view health care and the government’s role — which, in Germany, means refereeing the system and making sure it’s fair and affordable.

“The general opinion in Germany is always that the government will do it for us, everything will be OK,” Chris says. “In the States, I think you grow up knowing that no one’s going to help you do anything. If you want health care, go get it.”

It’s important to remember that the German government doesn’t provide health care or finance it directly. It does regulate insurance companies closely — the nonprofits in the main system and the for-profits where Chris gets his coverage. So Chris’ insurer can’t raise his rates if he gets sick or jack up his premiums too much as he gets older. The government also requires insurers to keep costs down so things don’t get too expensive.

“Where am I better off medically?” Chris says. “I would probably say Germany.”

In some ways, Chis Ertl’s coverage is better than his wife’s. He gets his choice of top doctors — the chief of medicine, if he wants. If he goes into the hospital, he gets a private room. When he goes to the doctor, he gets a free cup of coffee and goes to the head of the line. All this embarrasses him — and annoys Nicole.

“When he goes to the doctor, he has a lot more service,” she complains.

Germans really hate any hint of unfairness in health care. The fundamental idea is that everybody must be covered and, preferably, everybody should get equal treatment. So the fact that 10 percent or so can buy some perks is an irritant — something Germans complain about but manage to put up with.

But it’s unthinkable that 48 million people wouldn’t have health insurance at all — the situation in America. As an American, Chris thinks that’s shameful. “It’s terrible,” he says. “It’s unbelievable. It shouldn’t happen.”

Germans, he says, would never tolerate that. And their system has been working pretty well for 125 years.

Radio piece produced by Jane Greenhalgh.

The Best Contraception Method I’ve Ever Seen

The Best Birth Control In The World Is For Men

by Jon Clinkenbeard.
March 26, 2012, 11:25 AM CDT

If I were going to describe the perfect contraceptive, it would go something like this: no babies, no latex, no daily pill to remember, no hormones to interfere with mood or sex drive, no negative health effects whatsoever, and 100 percent effectiveness. The funny thing is, something like that currently exists.

The procedure called RISUG in India (reversible inhibition of sperm under guidance) takes about 15 minutes with a doctor, is effective after about three days, and lasts for 10 or more years. A doctor applies some local anesthetic, makes a small pinhole in the base of the scrotum, reaches in with a pair of very thin forceps, and pulls out the small white vas deferens tube. Then, the doctor injects the polymer gel (called Vasalgel here in the US), pushes the vas deferens back inside, repeats the process for the other vas deferens, puts a Band-Aid over the small hole, and the man is on his way. If this all sounds incredibly simple and inexpensive, that’s because it is. The chemicals themselves cost less than the syringe used to administer them. But the science of what happens next is the really fascinating part.

The two common chemicals — styrene maleic anhydride and dimethyl sulfoxide — form a polymer that thickens over the next 72 hours, much like a pliable epoxy, but the purpose of these chemicals isn’t to harden and block the vas deferens. Instead, the polymer lines the wall of the vas deferens and allows sperm to flow freely down the middle (this prevents any pressure buildup),  and because of the polymer’s pattern of negative/positive polarization, the sperm are torn apart through the polyelectrolytic effect. On a molecular level, it’s what supervillains envision will happen when they stick the good guy between two huge magnets and flip the switch.

Easier than aiming magnets at your junk.

With one little injection, this non-toxic jelly will sit there for 10+ years without you having to do anything else to not have babies. Set it and forget it. Oh, and when you do decide you want those babies, it only takes one other injection of water and baking soda to flush out the gel, and within two to three months, you’ve got all your healthy sperm again.

The trouble is, most people don’t even know this exists. And if men only need one super-cheap shot every 10 years 0r more, that’s not something that gets big pharmaceutical companies all fired up, because they’ll make zero money on it (even if it might have the side benefit of, you know, destroying HIV).

If this sounds awesome for you or your loved one, get the word out. Share this article. Or this link. Or this one. Or this one. Sign this petition. Do something! A revolutionary contraceptive like this needs all the support it can get.

UPDATE: A lot of people are asking to be kept in the loop. So here’s the clinical trial/mailing list sign-upfrom the Parsemus Foundation to get further information about this procedure’s development. And again, please fill out the short non-spam petition to get the procedure funded and keep buzz going.

Delightfully Vintage STD Posters

I love these! If I ever have an office, I am going to print and frame some of these and hang them up. Or maybe I’ll just hang them up in my home.
Of course, that might freak out any potential boyfriends.
But it would be totally worth it.

Click here for more information on these posters, including artist and era.

Patient Experience Infographic

World Tuberculosis Day

Today is World Tuberculosis Day, a day dedicated to raising awareness to one of the world’s deadliest diseases, because no holiday is complete if it doesn’t involve celebrating the misery of millions of people.
That’s why Christmas is so popular.

Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis, which is one of those bacteria that is really awesome to talk about and really annoying to work with.
Really, really, really annoying.
Seriously, you have no idea.
It sucks.

The Disease

Despite how charming Doc Holiday made tuberculosis look, the disease is just as annoying as the bacterium. If you catch tuberculosis, treatment can take anywhere from 6 months to 2 or 3 years, depending on it’s drug resistance. Oh yeah, it’s highly drug resistant. And we only really have 8 types of drugs to treat it with (2 first line and 6 second line drugs) . Mutli-drug resistant TB (MDR-TB) is resistant to rifampicin and isoniazid, the first line of drug defense doctors use. Extensively drug-resistant TB (XDR-TB) is also resistant to three or more of the six classes of second-line drugs. Totally resistant TB was first reported in 2003, and was pretty rare. At first. Now it’s a bit more widespread.
Because it’s an annoying bastard.

Also, if the drug resistance and multi-year treatment isn’t bad enough, in the United States, you have no choice on whether or not you get treated. You HAVE to get treated, because the disease is such a danger to public health. Part of the drug resistance is due to people no continuing their treatment, which can be rigorous. And while there is a vaccine, it’s has varying degrees of effectiveness against pulmonary tuberculosis.

On top of everything else, many cultures have a huge social stigma against those who have it, even after they’ve been cured. During the treatment, they may be completely ostracized from their village and even their families who fear the disease. You can’t blame the people for wanting to protect themselves, but it also leaves the patient , leaving them with no emotional support structure and facing the shame of disease. They will often find themselves alone, and become very depressed and stop taking their treatment. It’s a problem Doctor’s Without Borders has to face every day, and has done their best to bring public attention to the multiple issues surrounding the disease with their adorably named project “TB And Me”.

Most people think that TB is a “third world problem.” But in reality, it’s everywhere. There are parts of London which have rates nearly as high as Chinese provinces. Alaska is facing a tuberculosis epidemic among their homeless and do random sweeps every few weeks. Even my father caught tuberculosis as a boy living in Colorado. It is highly contagious: a person with active TB can infect 10 to 15 people a year. It killed 1.7 million people in 2009. Over 2 billion people are infected, though not all of these cased are active. Of these 2 billion, 10% will develop an active infection during their lifetime.

The Bitchy Diva

It’s a Class III organism, which means you have to use a bunch of annoying precautions when working with it. Not only do you have to process the specimens under a biohood, you have to do it in a special room completely dedicated to working with tuberculosis, and only tuberculosis. This room separated from the rest of the lab by a series of doors and negative air pressure. You also have to wear a special mask so you don’t accidentally inhale it, since the infective dose of M. tuberculosis is fewer than 10 bacterium. And before you work with it, you have to spread bleach-soaked paper towels everywhere, so that if by chance even one bacterium falls onto the counter, it will immediately die a horrible, bleachy death.

We don’t mess around with tuberculosis. It’s not a fun and cute bacteria like E.coli. It’s a high maintenance bitchy little diva that will slowly and violently murder your lungs if it gets a chance.

Science Stuffs

Mycobacterium are a genus of Actinobacteria. There are over 70 species of Mycobacteria, but most people are familiar with M. tuberculosis and M. leprae, the causative agent of leprosy. While most clinically significant bacteria grow within 18-48 hours, Mycobacteria takes it’s time. Some species will form colonies within 7 days (termed “rapid growers,” because microbiologists have a skewed perception of time), while other may take 6 weeks or longer to grow. Maybe they like to take their time growing because they don’t want to come across as desperate. Or maybe they’re just stubborn and will grow when they’re damn well good and ready.
Either way, it’s really annoying.

One of the most significant characteristics of Mycobacterium is their cell wall, which is thicker than most other bacteria and completely stuffed with mycolic acids that give it a waxy appearance. The cell wall consists of the hydrophobic mycolate layer and a peptidoglycan layer held together by the polysaccharide arabinogalactan, which is one of those words I love watching drunk people try to pronounce.

M. tuberculosis is a bacillus and may be considered Gram-positive, but this is actually a huge misnomer. Due to the high lipid content of their unique cell wall and general stubbornness, they do not retain any portion of the Gram stain, and thus are neither truly Gram positive  or Gram negative. While they don’t truly retain crystal violet, upon staining they can appear to be weakly Gram positive, because it likes to laugh in the face of logic. Or they won’t stain at all and be referred to as “ghosts.” Again, either way, it’s really really annoying.

If only they were this cute.

A much more useful stain for this species is the Ziehl–Neelsen stain, commonly referred to as the acid-fast stain.
M. tuberculosis is acid-fast, meaning they are resistant to decolorization by acids during staining.  This is due the the lack of an outer cell membrane. It decided somewhere along the way that outer cell membranes were too mainstream, and never bothered getting one.

 M. tuberculosis is nonphotochromogenic, meaning it won’t produce a pigment in the presence or absence of light. Their colonies are buff-colored, dry, rough, and honestly rather ugly. They look like demented warts.

If growth conditions are optimal in broth cultures, M. tuberculosis will actually grow in long, rope-like strands, which we called “cording,” which is actually pretty cool. M. tuberculosis is strictly aerobic, requiring high amounts of oxygen, which is why it loves to invade your lungs.. They are nonmotile, and lack spores and capsules. In terms of biochemical identification, they are negative for catalase, including the 68 degrees Celsius catalase test which is commonly performed on Mycobacteria species. They are positive for niacin and nitrate.

M. tuberculosis was first described on 24 March 1882 by Robert Koch, a guy every biologist should recognize, if not for all his grand achievements in the field of microbiology, then at least for his dapper style.

 Note the fine beard and bow tie, which can both be used to clean microscopes. He received a Nobel Prize in 1905 for his discovery. In 1998 we sequenced it’s annoying little genome.

Doctors Without Borders have made several awesome infographic posters to help educate about TB rates:
TB-infographic-treatment
TB-effects-infographic2-final

Click here to learn more about World TB Day!
Click here to learn more about Tuberculosis and it’s growing drug resistance.

This Is How The Zombie Apocalypse Begins…

Baffling Illness Strikes Africa, Turns Children Into Violent “Zombies”

by Jason Mick

World Health Organization is on high alert about new Ugandan outbreak, cause is not fully known

It’s called the “nodding disease” and it’s a baffling illness that has struck thousands of children in northern Uganda.  The illness brings on seizures, violent behavior, personality changes, and a host of other unusual symptoms.

I. Violent and Mindless: Child Victims Have no Cure, no Future

Grace Lagat, a northern Uganda native, is mother of two children — Pauline Oto and Thomas — both of whom are victims of the disease.  For their safety, when she leaves the house, she now ties them up, using fabric like handcuffs.  She recalls, “When I am going to the garden, I tie them with cloth. If I don’t tie them I come back and find that they have disappeared.”

Reportedly the children gnaw at their fabric restraints, like a rabid animals — or “zombies”of popular fiction — in an attempt  to escape.

The effort to restrain the children is not unwarranted.  In one of the most bizarre symptoms of this tragic illness, children with the disease are reportedly setting fire to buildings in their communities.  Coupled with the aimless wandering this disease provokes in victims, this is a deadly combination.  More than 200 people have been killed in fires believed to be set by the zombified children.

_{The disease leaves child victims in an often-violent “zombiefied” state. [Image Source: CNN]}
The disease is not new.  It popped up in the 1960s in Sudan.  From there it slowly spread to Libya and Tanzania.

The Uganda infections, though, are a new outbreak — a troubling sign.  The jump into a new region could be pure coincidence, or it could indicate the disease has become more virulent or found a new transmissions vector.

_{Uganda is located in central Africa [Image Source: U of Tex., Modifications: Jason Mick]}

Infected children typically have regular seizures, which are proceeded by a repetitive nodding of the head.  This characteristic symptom has given rise to the unofficial title for the malady.

II. World Medical Organizations Racing for a Cure

The Center for Disease Control (CDC) and World Health Organization (WHO) have been tracking the spread of this frightening ailment.  Dr. Joaquin Saweka says the scene in Uganda is horrific, stating, “It was quite desperate, I can tell you.  Imagine being surrounded by 26 children and 12 of them showing signs of this. The attitude was to quickly find a solution to the problem.”

Yet the WHO and CDC are not fully sure what is causing the illness, which cripples children and turns them into mindless, violence-prone zombies.  The best clue they have is that most of the cases occur in regions inhabited by “Black flies”, which carry the parasitic worm Onchocerca Volvulus.  That worm is responsible for another dangerous disease dubbed “river blindness”, the world’s second leading cause of infectious blindness.

_{The illness may have something to do with Black flies (left, center) and their parasitic worm (right). [Image Source: WHO (left), Wikimedia Commons (center), Human Healths (right)]}

However 7 percent of infected children live in regions not inhabited by the Black fly, so a link is speculative at best.

Children with the disease also frequently exhibit vitamin B6 deficiency, leading medical experts to believe that the disease may be nutrition related.  However, infections by microbes, parasites, fungi, or even fungi/microbes carried by a parasitic host, can all lead to nutritional deficiencies.

Dr. Scott Dowell, director of global disease detection and emergency response at CDC, says the race is on to determine the cause and a cure.  He states, “At first we cast the net wide. We ruled out three dozen potential causes and we are working on a handful of probabilities.  We know from past experience an unknown disease could end up having more global implications.”

In the current cases children as old as 19 have been found to be stricken, with the majority of the worst symptoms being spread over the 3-11 age range.

One mystery surrounding the disease is the seizures themselves.  While typically seizures are either randomly occurring or follow some singular cue/pattern, the nodding disease seems to have multiple triggers, including eating new foods, changing weather, and other changes.

Seizure often leave the children soiled with urine and drooling.  Local nurses are afraid to touch the infected.  States local nurse Elupe Petua, “I feel, because I don’t know what causes it, I don’t even know how it transmits, when I touch them I feel that I can also get the infection because I don’t know what causes it.”

III. Medication is Ineffective

Anti-epileptic medication slows the onset of symptoms, but is unable to stop the progression of the disease.  The seizures eventually leave many children unable to walk, only able to drag their bodies along the ground as flies tried to attack them.

_{The current treatment approach of anti-epileptics has done little to halt the illness.
[Image Souce: CNN]}

The government of Uganda has come under criticism for not being vocal enough in addressing the tragedy and demanding foreign aid/research expertise.  Local politicians have taken to transporting victims from affected villages by bus to city hospitals in order to force the issue into the eyes of the more affluent city-dwellers.

The issue is yet another woe for a nation in which the impoverished majority was terrorized for years by warlord Jospeph Kony’s militia, dubbed the “Lord’s Resistance Army.”

Mr. Kony is currently wanted by the International Criminal Court on multiple counts of violent war crimes, including rape and murder.  These offenses are punishable by death, if he is ever brought to trial.

IV. What if the “Nodding Disease” Found a Way to Reach the U.S.?

Dr. Saweka says that for all the hand-waving by the government about using better anti-epileptics and offering more funding, he appreciates and shares in the villagers frustration.  He states, “People complain that it looks like the lives in developing countries have less value than the lives in the western countries. When you know the root cause, you address the cure. Now you are just relieving the symptoms. We don’t expect to cure anybody.”

_{Ugandans, grief stricken, feel somewhat abandoned by the government and the wealthy developed “First World”. [Image Source: CNN]}

While the “First World” may not be focused on — or even aware of — the zombification that is leaving children in these African nations violent, crippled shells of their former selves — tied like dogs — it is an issue that must be addressed.  After all, viruses, bacteria, parasites thanks to the wonders of evolution can mutate and adapt to new environments and new transmission vectors.

Thus this zombie virus may seem like a foreign issue to regions like the U.S. and EU who are struggling with their own financial crisises.  But if the illness finds a way to broaden its spread, this “zombie” outbreak could cripple the globe.

Tuberculosis Infographic

Open Source Drugs

The following was written by Jacqueline of Skepchick.org. I absolutely love this concept, as well as her clear and succinct writing style.

OPEN SOURCE DRUG DISCOVERY

Drug discovery is challenging, lengthy, and extraordinarily expensive. All companies focus on making money and drug companies are no different. They spend their research and development budgets focusing on diseases that affect the affluent world population. As a consequence diseases such as malaria and tuberculosis that are abundant in sub-Saharan Africa and India are left unstudied by industry. Despite the omission by drug companies, other efforts are underway to aid in drug discovery for these diseases.

Just to hash out a few details of where the problem arises– the Center for Disease Control (CDC) states that 35 countries (30 African and 5 Asian) account for 98% of the malarial related deaths. Similarly, in 2010, 8.8 million people became sick with tuberculosis (TB) of which 82% of the cases lived in 22 TB ridden countries. These diseases do exist in other parts of the world, but result in significantly less deaths.

Despite the lack of interest from drug companies for treating these infectious diseases, other organizations have picked up the slack. The Bill & Melinda Gates Foundation has contributed significant funds to these poverty ridden populations in the form of care, research, and vaccines. Much of their focus is on HIV/AIDS treatment in addition to other conditions including malaria and TB. However, while reading Science I recently came across an open source drug design initiative based out of India.

A few years ago, Samir Brahmachari launched the Open Source Drug Discovery (OSDD) network. The initiative began in 2008 and set out to combat India’s leading cause of death, TB. The initial $12 million of seed money was provided by the Indian government and that has led to 5500 participants in 130 countries. So has this global network of researchers provided any results? Their first goal was to sequence the TB genome and the task was accomplished in a mere four months by 500 volunteers. Since then they utilized this information and have determined two viable drug candidates that are currently being tested. Following the principles of OSDD, the data from their clinical trials are open for all to see. It is too soon to tell if the drugs will be successful, but if so they will be on the market as generic drugs.

This approach could produce affordable health care and treatments for many without.

Science Quickies: Space Trains and Shiny Dinosaurs, Birth Control Myths and HIV vaccines.

Sweet zombie Jesus, we could be building space trains!!! Why, oh why, do we not have space trains yet? They’re trains that send things into goddamn space!!!

Ancient dinosaurs were not only feathered, but shiny! Pigment-containing organelles show that the Microraptor had black iridescent feathers, much like a crow. It also had four wings, and was about the size of a pigeon. I am in favor of bringing these guys back, as it would make feeding birds in the park a lot more entertaining.

A new study shows that in America’s HIV “hot spots,” African-American women testedt five times higher then the national average. The US hot spots were Atlanta, GA, Raleigh-Durham, NC, Washington D.C., Baltimore, MD, Newark, NJ, and New York City, and the tested age range was from 18 to 44.

In light of the recent contraception funding, Heina of Skepchick wrote a great article outlining 7 common birth control and abortion myths.

Scientists, with their admirable persistence, made a huge step forward in HIV vaccine development. Keep it up, darlings!

Checking into a hospital soon? Make sure you go to one whose infection prevention programs are led by a director who is board certified in infection prevention and control, as such hospitals have lower incidences of MRSA infections. This is one of those studies that seems like a no-brainer and waste of time and resources, but it’s often the very obvious studies that are the most cited; A good reminder that we can’t simply assume things. We must have the evidence to back us, even on the obvious things.

Diseased Fashion

via io9:

How a disease from ancient Rome made its way into your sandblasted jeans

BY KEITH VERONESE

 MAR 9, 2012 3:12 PM

Sandblasting jeans is a common way to give blue jeans a “distressed” look, with worn spots and artfully frayed holes. But the process of sandblasting is coming under fire due to its connection with silicosis, an incurable lung disease. Several manufactures and retail outlets are banning sandblasted jeans, but why? Let’s take a look at a silicosis, occupational practices leading to the disease, and its symptoms.

Silicosis, a work related disease
Silicosis in an occupational lung disease, one attained from prolonged exposure to small particles of silica found in sand or quartz.Exposure comes through regular use of pneumatic drills, stone cutting, glass manufacturing, and, in a recent application, giving jeans an intentionally distressed look though hours sandblasting.

The symptoms of silicosis include shortness of breath, persistent cough, weight loss, cracked nail beds, and, in some cases, a slight blue discoloration of the skin. A Turkish physician noted the correlation between sandblasting jeans and silicosis in a 2004 publication, beginning a movement to change modern sandblasting practices.

When small particles of silica are inhaled, they sediment in the base of the lungs and often calcify. Lack of ventilation and personal protection (workers often wear only a disposable paper mask like the one above) combined with long exposure periods lead to silicosis.

Most jeans-related sandblasting operations take place in poor areas, confinement to a small three by two foot area and long work weeks (65-70 hours), with most workers using only a disposable mouth and nose mask as protection. The silica leaves a fine layers on the body and hair as well, posing an exposure problem even after the individual leaves work.

The ancient Rome connection
Silicosis is not a new disease, as the Romans recognized that respiratory problems accompanied mining work. Silicosis came to the forefront in the 1930s due to the Hawks Nest incident in the United States.Between 400 and 1,000 of the 3,000 total workers died from complication of silicosis after using pneumatic drills and explosives to bore a tunnel for hydroelectric use in West Virginia.

Thanks to increased vigilance and employee protection equipment, modern mining-related silicosis cases are practically non-existent in the United States. Strangely, silicosis is on the rise for dental technicians, with four silicosis related deaths occurring in Turkey during 2011.

Silicosis is Incurable
There is no cure for silicosis, but only a few means of symptom alleviation, as there is no way to remove the silica deposits from the lungs. Administration of antibiotics can alleviate bacterial infections accompanying silicosis and bronchoalveolar lavage can loosen deposits in the lung. After contracting silicosis, one out of three individuals dies within five years.

50 Recent deaths in Turkey
Although Turkey banned the practice of sandblasting jeans in 2009, over 4,000 people within the country are afflicted with silicosis and a 50th citizen died from the lung disease in February of 2012.

The practice is still common in Bangladesh, India, and China. As many as 25,000 people die from silicosis and its complications in China each year.

Several designers and retail outlets (Target, Gap, Wal-Mart, Levi, Versace, H& M) are joining together to ban the practice in lieu of safer practices like physically scraping the jeans to give a distressed look. Dolce & Gabbana is one of the few major designers still using sandblasting to manufacture jeans.

Top image by Allison Joyce at Mother Jones. Images courtesy of Ecouterre, DKNY, and the AP. Sources linked within the article

End Of Life Decisions

The following was written by Kristian Foden-Vencil and presented by NPR’s health blog Shots. Click the headline if you wish to read the original article, as well as listen to an audio version of the story. I consider this to be one of the most important issues in American health care today, especially with our aging population.

Oregon Emphasizes Choices At The End Of Life

It turns out Americans facing death want something they also want in life: choice.

A two-page form created in Oregon is providing insight into how people want to be cared for at the end of their lives. And the so-called POLST form — short for Physician Orders for Life-Sustaining Treatment — offers far more detailed options than a simple “do not resuscitate” directive does.

Terri Schmidt, an emergency room doctor at Oregon Health and Science University, remembers the day an elderly man with congestive heart failure came into the hospital from a nursing home. The man didn’t have a form, so, by law, Schmidt had to provide all the medical care possible.

“I intubated the man. I did very aggressive things. It didn’t feel right at the time,” says Schmidt. “There was just this sense in my mind that this is a 92-year-old very elderly person with bad heart failure. And about 15 minutes later, when I was able to get a hold of the family, they said, ‘You did what? We talked about this! He didn’t want it. We had a big conversation in his room about a week ago.’ ”

That’s a situation Helen Hobbs, 93, is looking to prevent. She has filled out a form, and her doctor signed it, so it’s legally enforceable.

She likes having different options. “I did want antibiotics in case of infection,” says Hobbs, who lives in an assisted living facility in Lake Oswego. “I don’t want CPR if I’m in cardiac arrest. I don’t want to be tied down with tubes. You know, there’s no point in prolonging it.”

Administrators at her senior residence advised Hobbs to keep her POLST form in a plastic tube in her freezer, so EMTs will know where to find it. Other nursing homes tell residents to keep their forms under the sink or on the fridge. It’s not exactly a perfect system.

Oregon started using the POLST form widely in the mid-1990s. All told, 14 states have adopted it, and 20 more are considering it.

Since 2009, the forms in Oregon have been entered into a statewide database. Doctors there can go online to see whether a patient has one.

And the database is beginning to reveal some interesting information about people’s choices, according to Dr. Susan Tolle of the Oregon Center for Ethics in Health Care. “We have really learned that this is not a black and white process,” Tolle says. “Less than 10 percent of people wanted to refuse all treatment. A majority want some things and not other things.”

Tolle avoids the topic of whether these detailed end-of-life instructions save money. She’s wary of starting another debate about death panels. But the database has allowed the state to quantify the policy by some measures.

“What we found was that if people marked ‘comfort measures only’ and ‘do not resuscitate’ and did not want to go back to the hospital, there was a 67 percent reduction in life-sustaining treatments, primarily hospitalization and emergency room visits,” says Tolle.

Christian Brugger is a professor of moral theology at the Saint John Vianney Seminary in Denver. He wants to make sure the elderly do not feel like they have to have one of these forms.

“I’ve heard often that elderly patients can feel pressured by the medical community or by their family not to be a burden,” says Brugger. “I think those kinds of pressures are very hard to calculate. And we want to be very careful that we don’t put those kinds of pressures on the elderly.”

Brugger says giving someone a durable power of attorney is a better solution to this delicate issue.

This story by Kristian Foden-Vencil is part of a reporting partnership that includes Oregon Public Broadcasting, NPR and Kaiser Health News.

How Birth Control Saves Taxpayers Money

Julie Rovner, of NPR’s health blog Shots, wrote the amazing following article outlining how contraceptives, an important aspect of American public health, actually does save the taxpayers money.

by JULIE ROVNER

While the controversy continues to swirl around radio talkmeister Rush Limbaugh and his admittedly inappropriate comments about Georgetown Law Student Sandra Fluke, an analysis from the left-leaning Brookings Institution adds an economic twist to the debate over coverage of contraception.

Love them or hate them, contraceptives do save taxpayers money, Brookings concludes.

The study, from the Brookings Center on Children and Families, looked at three different ways to prevent unintended pregnancies, which account for about half of all pregnancies in the U.S.

All three approaches more than pay for themselves. But one -– increasing funding for family planning services through the Medicaid program -– clearly outshines the other two in terms of cost-effectiveness.

Yes, you may have heard there are lots of ways to lower the rate of unintended pregnancy. There are mass media campaigns to urge young people to avoid unprotected sex. Other programs urge teens to delay having sex, or, as a fallback, teach them how to use contraception effectively. And then there’s Medicaid’s help low-income women afford the most effective contraceptive methods.

But this study, using a simulation model devised by Brookings, is the first to estimate exactly how much could be saved using each method.

It found that a national mass media campaign that would cost $100 million would result in about $431 million in savings to taxpayers, largely by reducing unintended pregnancy, particularly among people who don’t make much money.

Programs the Brookings researchers called “evidence-based teen pregnancy prevention,” which combine an emphasis on abstinence “while also educating participants about how to use various methods of contraception” have both reduced the rate of sexual activity and increased the use of contraception.

Spending $145 million on such programs would return $356 million to taxpayers, according to the model.

But by far the biggest return on investment would come from expanding access to family planning through Medicaid, something made possibly through the 2010 Affordable Care Act. A $235 million investment there would lower taxpayer costs of $1.32 billion by preventing unintended pregnancies.

“Evidence-based pregnancy prevention interventions are public policy trifectas: They generate taxpayer savings, they improve the lives of children and families, and they reduce the incidence of abortion,” writes Adam Thomas, the study’s author.

Big deal, say some people, unimpressed with the idea of birth control as a money saver.

“So you’re saying by not having babies born, we’re going to save money in healthcare?” asked an incredulous Rep. Tim Murphy (R-Pa.), of Health and Human Services Secretary Kathleen Sebelius at a House Energy and Commerce Health Subcommittee hearing last week.

Exactly, Sebelius replied, explaining what studies like the one from Brookings have shown for years. “Providing contraception as a critical preventive health benefit for women and for their children reduces health care funds,” she said.

“Not having babies born is a critical benefit. This is absolutely amazing to me. I yield back,” said Murphy.

In Limbaugh’s apology to Fluke, there’s no suggestion that he had changed his mind about who should pay for contraception: Women, not the government, should pick up the tab.

Urgent Aid Needed for Myanmar

Medicins San Frontieres/Doctor’s Without Borders recently released a report called “Lives In The Balance,” calling for urgent funding and assistance in helping Myanmar close the devastating gap between people’s need and access to treatment for HIV and TB.

From the their website:
“Tens of thousands of people living with HIV and tuberculosis (TB) in Myanmar are unable to access lifesaving antiretroviral therapy, a dire situation exacerbated by the recent cancellation of a new round of funding from the Global Fund to Fight AIDS, TB, and Malaria.”