Category Archives: Medicine

International Genetically Engineered Machine competition

My friend Franz, who runs a delightful blog Mikrob(io)log (in Slovenian) alerted me that the team of undergraduates from the University of Ljubljana won the iGEM 2007 at MIT the other day. They did it for the second year in a row (all brand new students, of course). The Ljubljana team won in the Health & Medicine category for their work on HIV-1 virus. One member of the team is Franz’s student. Congratulations to the Slovenian team!

Announcing the new PLoS Journal: Neglected Tropical Diseases!

NTDs%20image.jpgThese last couple of days were very exciting here at PLoS. After months of preparation and hard work, PLoS presents the latest addition to its collection of top-notch scientific journals. PLoS Neglected Tropical Diseases went live yesterday at 6:42pm EDT. This journal will be

…the first open-access journal devoted to the world’s most neglected tropical diseases (NTDs), such as elephantiasis, river blindness, leprosy, hookworm, schistosomiasis, and African sleeping sickness. The journal publishes high-quality, peer-reviewed research on all scientific, medical, and public-health aspects of these forgotten diseases affecting the world’s forgotten people.

As Daniel Sarna notes, the Journal is truly international in nature – about half of the authors in the first issue are researchers living and working on the ground in developing countries, and the first papers have been authored by scientists from such countries as:

Mexico, Ghana, Cameroon, Thailand, Spain, the Netherlands, Bolivia, Nigeria, the United Kingdom, Switzerland, Mali, the United States, the Philippines, Tanzania, Egypt, Burkina Faso, the Dominican Republic, Canada, Australia, Belgium, Kenya, and China.

The potential for Open Access to make science more global and to help scientists all over the world communicate with each other on equal footing is something that is, both to me personally and to PLoS as an organization, one of the key motivators for doing our work every day. This sentiment is echoed by the inspiring Guest Commentary by WHO Director-General Margaret Chan:

Equity is a fundamental principle of health development. Access to life-saving and health-promoting interventions should not be denied for unjust reasons, including an inability to pay. The free availability of leading research articles will benefit decision-makers and diseases control managers worldwide. It will also motivate scientists, both in developing and developed countries.

PLoS Neglected Tropical Diseases will be very broad in scope, both in terms of diseases and their causes, and in terms of disciplinary approaches:

Although these diseases have been overshadowed by better-known conditions, especially the “big three”–HIV/AIDS, malaria, and tuberculosis–evidence collected in the past few years has revealed some astonishing facts about the NTDs. They are among the most common infections of the poor–an estimated 1.1 billion of the world’s 2.7 billion people living on less than US$2 per day are infected with one or more NTDs. When we combine the global disease burden of the most prevalent NTDs, the disability they cause rivals that of any of the big three. Moreover, the NTDs exert an equally important adverse impact on child development and education, worker productivity, and ultimately economic development. Chronic hookworm infection in childhood dramatically reduces future wage-earning capacity, and lymphatic filariasis erodes a significant component of India’s gross national product. The NTDs may also exacerbate and promote susceptibility to HIV/AIDS and malaria.

Bacterial, viral and fungal diseases will be highlighted, of course, but many of the most devastating and yet least understood tropical diseases are parasitic, caused by Protists or Invertebrate animals. Those organisms often have amazingly complex (and to a person with scientific curiousity absolutely fascinating) life cycles. They may have to go through several life-stages in several different hosts/vectors. The hosts and vectors themselves may have quite unusual natural histories as well. Regular readers of my blog know that I am fascinated by the way such diseases have to be addressed in a fully interdisciplinary manner: epidemiology, ecology, animal behavior, systematics, neuroscience, human and animal physiology, genetic/genomics, pharmacology and clinical trials. Only putting together all the pieces will let us understand some of these complex diseases and how to conquer them. And this new Journal will allow scientists from all these disciplines from around the world to place all of that research in one place for everyone – and I mean EVERYONE – to see for free.
Furthermore, the new journal is run on the TOPAZ software which allows the readers to use all the nifty tools of post-publication peer-review and discussion. All the articles in PLoS NTDs will allow you to post comments and annotations. You can give ratings. If you write a blog post about an article, you can send trackbacks (just like you can do on PLoS ONE and PLoS Hub for Clinical Trials).
Congratulations to all the members of the PLoS team who put in many months of hard work in putting this exciting new journal in place. So, go and take a look at the inaugural issue, subscribe to e-mail alerts and/or RSS feed and blog about the articles you find interesting in the future.

How to talk about Health Care

Rockridge Institute published a set of articles (and a video ad) that I found quite interesting about the way to frame health care. See for yourself:
Introduction to Rockridge’s Health Care Campaign:

Framing for Rockridge is about the honest expression of the progressive moral view based upon empathy and responsibility for oneself and others. It is about recognizing government’s role to protect and empower citizens. In other words, we want to communicate our moral view as directly as possible. We want to make sure the moral view is not lost in the fog of complex policy proposals.

The Logic of the Health Care Debate:

Most health care reports advocate a policy, describe it, and argue for it. We take a different approach. In this paper, we describe the logic of the overall debate over the U.S. health care system –the assumptions, the arguments, who makes them, and why. We do come out of this process with recommendations, but not of the usual sort.

Don’t Think of a Sick Child:

George W. Bush doesn’t want you to think of a sick child. Not Graeme Frost. Not Gemma Frost. Not Bethany Wilkerson. Not any of the real children affected. He wants you straining your eyes on the fine print of policies, puzzling over the nuances of coverage — whether you can afford premiums for basic, catastrophic, comprehensive or limited health insurance.

Don’t Think of a Sick Child: The Framing of the Rockridge Institute’s Health Care Security Ad:

The initial web ad in the Rockridge Institute’s campaign for health care security is intended to make a simple, emotional point: today’s profit-first, private, insurance-based health care system forces Americans to choose to exclude millions of Americans from adequate health care.

Could You Explain a Vote Against Children’s Health to the Children?:

For those in U.S. House or Senate inclined to sustain a presidential veto of a bill that will provide basic health care to more than 3 million additional American children, ask yourselves this question: Are you willing to explain your decision to a schoolroom of fragile young children who cannot afford treatment for whooping cough or measles, leukemia or juvenile diabetes? Are you willing to explain this to them, human to human?

Who’s Afraid of Sick Kids?:

When is a twelve-year-old boy with brain damage a threat? When he exemplifies the good a government program can do when it provides health security to middle-class Americans.

SCHIP and the Rigged Health Insurance Game:

The House on Thursday passed a modified version of the SCHIP bill, with a vote that was seven votes shy of a veto-proof majority. There were 142 members of Congress who voted against extending health care to more poor children. Behind their rhetoric, their intentions are clear: they want to protect the health insurance market and the huge profits that go with it.

Ask Rockridge: The Importance of Mental Health:

A Rockridge Nation member recently asked how we can reframe mental health as being necessary for health. We explore a key cognitive bias in how health is conceptualized to pave the way toward an effective alternative.

Ask Rockridge: The Meaning of Socialized Medicine:

Rockridge Nation members recently asked about the phrase “socialized medicine” and raised the deeper question of how to overcome resistance to an expanded government role in funding healthcare, prompting our response here.

You may not agree with the Lakoffian analysis, but reading these articles SHOULD make you think about the way you talk about health care.

Obligatory Reading of the Day (heck no – obligatory reading of the Week)

No Girrafes On Unicycles Beyond This Point

Triangle Malaria Symposium

The Triangle Malaria Symposium will be on Thursday, November 15, 2007, at 1-7 pm at the Duke University Searle Center. At first I thought it was this week, but now I see it is the week after, so perhaps I can make it to it. Even if I don’t, Anton is going for sure and intends to liveblog it. So far, the speakers include Peter Agre, Margaret Humphreys and Steve Meshnick so the symposium looks VERY promising.

Which Single Intervention Would Do the Most to Improve the Health of Those Living on Less Than $1 Per Day?

Since I was gone to two meetings and nobody else can walk the dog as regularly as I can, the dog spent the week at Grandma’s in Raleigh. Today I went to pick her up (the dog, that is) which placed me in the car at precisely the time of NPR’s Talk of the Nation Science Friday (OK, I intentionally timed it that way). And lo and behold, there was Gavin Yamey on the radio! Hey, I thought, I know this guy! We had lunch together and we exchange at least a dozen e-mails every week.
Gavin is editor at PLoS Medicine and, as part of the Global Theme Issue on Poverty and Human Development, he interviewed 30 experts on poverty (from economists like Jeffrey Sacks, through biomedical researchers focusing on the diseases of the poor, via medical staff working in the trenches, to the greatest experts on the topic – the poor themselves) and asked them the same question (the one in the title of this post). The answers are collected here.
You can hear the NPR interview here. Twice you can hear a faint jingle in the background. Apparently, a friend of his tried to text Gavin to tell him he was on Science Friday – as if Gavin was not acutely aware of the fact at the time! Talk of the Nation is a call-in show, thus it goes live. It is not pre-recorded. Please do not call your friends when they are On Air!
Gavin also gave a similar interview for Voice of America (find transcript through that link). I think he did marvelously.
The main points of the survey:
1) Doing something about poverty is not expensive or high-tech.
2) No single intervention is sufficient – a number of things have to happen simultaneously.
3) The rich countries reneged on their promise from the past to devote a certain percentage of their GDP to the eradication of poverty.
4) Getting the rich countries to do what they promised would go a long way.
One of the things Ira Flatow tried to do during the interview was to paint the picture as “haves versus have-nots”. I think Gavin did a nice job of deflecting this notion. The idea that the word “versus” should be between the words “haves” and “have-nots” is outdated and dangerous. The thinking that this is a zero-sum game in which the two “sides” compete, and if one side “wins” the other one “loses” is devious and wrong. The two groups are interconnected and interdependent. Either both win or both lose, and it is the haves who have the power to decide which outcome they prefer.

Global Theme Issue on Poverty and Human Development

Global Theme Issue on Poverty and Human Development (which I mentioned a few days ago here) was a great success. You can see all the articles associated with it here.
PLoS has collected all the poverty-related articles from its Journals on this nifty collections page.
A PLoS Medicine article – Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland – was one of the few that were highlighted at the event at NIH. Gavin has the details. Nick Anthis gives his angle.

Global Theme Issue on Poverty and Human Development

More than 234 journals throughout the world will simultaneously publish articles devoted to the topic of poverty and human development tomorrow, on October 22nd, 2007. You can get more information, including the links to all the participating journals at The Council of Science Editors.
Out of those hundreds of papers, seven were specially chosen (by a panel of NIH and CSE experts) and will be presented, by their authors, at an event in Masur Auditorium, NIH Clinical Center (Bldg. 10) at 10 a.m. – 1:30 p.m. today. It is free for public, so if you are in the area, you should go and see this.
There will be a live webcast of the event (later posted as a permanent video file on the site).
Please spread the word on your blogs as well.

Nothing beats the Hands-On experience!

Just watching someone give a talk is often not enough to remember it later. As they say, a picture is worth a thousand words. And certainly, seeing is believing. But, this presentation is impossible to forget, even if one would rather not remember it so vividly. Oh, and it was absolutely NSFW!
Obligatory Reading of the Day.

How much does pharmaceutical industry control what appears in medical literature?

Ghosts, drugs, and blogs:

By its hidden nature, it is obviously a challenge to determine the exact prevalence of “ghost management,” defined by Sismondo as the phenomenon in which “pharmaceutical companies and their agents control or shape multiple steps in the research, analysis, writing, and publication of articles.”

Of course they fight against Open Access Publishing – too much sunshine scares them and would make them scurry away in panic…

Could TRIPS save lives in Third World Countries by opening research articles?

That is one very interesting idea! This provision is usually used for getting medicines to 3rd world countries in times of emergency. So, why not research papers if the emergency warrants it? Gavin writes:

Imagine a scenario in which a developing country is facing a national health emergency, and there’s a research article that contains information that is highly relevant to addressing that emergency. Let’s say the emergency is an alarmingly high rate of mother-to-child transmission of HIV, and a new study shows a major breakthrough in preventing such transmission. And let’s say that unfortunately the article copyright is owned by the publisher (not the author), and the article is locked away behind a typical subscription barrier (usually around $30 per person to view it).
Could the government, asked Shahram, invoke TRIPs [The Agreement on Trade Related Aspects of Intellectual Property Rights] to simply bypass the copyright holder and disseminate the article across the nation?

Tell Gavin what you think.

World Health Organization breaks embargo and messes up.

Before two papers passed the peer-review and got published, WHO (which was given the data) made its own interpretation of the findings and included it in its press kit, including the errors they made in that interpretation. A complex story – what’s your take on it?

Tennessee bans lethal injection

Based in part on this study, lethal injection has been ruled (at least for now) unconstitutional in the state of Tennessee.
The executions by lethal injection have been on hold for several months now in North Carolina as well, until the legality of it is figured out. I hope NC follows in the footsteps of TN soon.

Advanced sales techniques of drug reps

Drug rep creates stir with details on tricks of his trade

Drug reps are carefully trained to target a physician with tactics suitable to his or her personality, according to a recently published article co-authored by a former Eli Lilly and Co. detailer, Shahram Ahari, MPH. He says detailers come armed with an array of techniques aimed at changing the physician’s prescribing behavior. Here are the tactics Ahari used with physicians, depending on their disposition.

The paper came out in April, but I have not noticed much reaction to it on medblogs. Will this new interview stir the pot now?

Qualitative vs. Quantitative Research (in Medicine and elsewhere)

In a commentary and a blog post, the editors of PLoS Medicine ask:

….is there still a reluctance to accept that anything useful can be learned from research without numbers?

An old question that tends to generate a lot of heat. Where do you stand on it, within medicine or within your own area of research?

Can a virus make you fat?

If you are a bird, yes. If you are a human, perhaps. Stay tuned.

How to deal with HIV denialists online

My Scibling Tara Smith together with Steven Novella, published an article in PLoS Medicine last week that all frequent readers of science blogs will find interesting:
HIV Denial in the Internet Era:

Because these denialist assertions are made in books and on the Internet rather than in the scientific literature, many scientists are either unaware of the existence of organized denial groups, or believe they can safely ignore them as the discredited fringe. And indeed, most of the HIV deniers’ arguments were answered long ago by scientists. However, many members of the general public do not have the scientific background to critique the assertions put forth by these groups, and not only accept them but continue to propagate them. A recent editorial in Nature Medicine [32] stresses the need to counteract AIDS misinformation spread by the deniers.

A very, very good and important article! Especially if you are struggling with various kinds of denialists on blogs all the time.
And you can also see other cool papers published today in PLoS Medicine.

The Chernobyl liquidators: incredible men with incredible stories

Sarah Wallace is interviewing some amazing people while doing her research in the Ukraine:
Part 1
Part 2
Part 3
Obligatory Readings of the Day

Who is Eva Vertes?

I have linked to and posted pictures of Eva Vertes from SciFoo before and you may ask: “Who is she? Why was she invited there?” The Wikipedia page I linked to earlier is a short stub and full of errors. So, to make it clear, see this page as well as comments on this talk she gave two years ago when she was 17:

ConvergeSouth 2007

CovergeSouth%20logo.gif
You can now register for the third ConvergeSouth conference in Greensboro, NC, October 19-20, 2007. Among many others, you will be able to meet me there. Keep and eye on the blog for new developments.

The hole in your head!

Mo is really spoiling us with exciting, well-researched posts from the history of science and medicine (remember the trepination post from a month ago?). And here he does it again: The rise & fall of the prefrontal lobotomy, the most gripping post on science blogs this week. And a Wicked Stepmother is one of the main characters!

Exclusive: Interview with Senator John Edwards on Science-Related Topics

I had a great pleasure recently to be able to interview Senator – and now Democratic Presidential candidate – John Edwards for my blog. The interview was conducted by e-mail last week.
As I am at work and unable to moderate comments, the comment section is closed on this post, but will be open on the previous post (here) where I hope you will remain civil and stay on topic. You are also welcome to comment on this interview at several other places (e.g,. DailyKos, MyDD, TPMCafe, Science And Politics, Liberal Coalition, the Edwards campaign blog as well as, hopefully, your own blogs).
I cannot answer any additional questions for Senator Edwards, of course, but there are likely to be other opportunities in the future where your questions can be answered so feel free to post them in the comments thread on the other post and I’ll make sure he gets them. The interview is under the fold:

Continue reading

Blogging About Bush

Everyone always blogs about Bush…
After all, Bush is such an easy target – there is not a day that he or some of his buddies do not do something outrageously bad. And with the Media covering it as if it was OK, where else can one voice outrage if not on blogs.
bush_sad.jpg
So, it is refreshing to see people, for once, blogging about something else, for instance about bush…
burning%20Bush.jpg
Ooops, not the Burning Bush…
THE-BURNING-BUSH.jpg
And not this kind of bush either….
bush%20topiary_elephants.jpg
But bush in the sense of “hair” you know….
big%20hair.jpg
No, not that hair…
hair%20movie.jpg
No, not that hair either, this is a science blog, after all….
hair-cycle.gif
But, this kind of hair and this kind of hair and this kind of hair and this kind of hair and this kind of hair

Congratulations, Anton!

My friend (and the driving force behind all bloggy events in the Triangle area) Anton Zuiker has a new job! And not just any job – but a perfect job:

In August, I will take a new job at Duke University Health System as manager of internal communications. This will be a chance for me to mold a communications strategy that uses traditional tools (magazines, newsletters, posters) with new media tools (blogs, videocasts, wikis). I’m looking forward to the opportunities and challenges.

They really, really need Anton. Finding information online about anything that has to do with Duke University science and medicine has been, to put it very nicely and diplomatically now, frustrating and clunky. They have really tried over the past year to vigorously change that situation, but with very little visible results. Now, with Anton on board, I am confident that Duke Health System will soon become the example of good online communication that other schools will try to emulate in the future.

HIV – population size, prostitution prevalence or circumcision?

Circumcision is always one of the topics with the most spirited discussions on science blogs. Here, a brand new paper on PLoS-ONE will likely stir up the conversation yet again (hopefully on the annotations and discussions attached to the paper itself, so please go there if you have questions/comments on the study):
Size Matters: The Number of Prostitutes and the Global HIV/AIDS Pandemic by John R. Talbott

HIV/AIDS prevalence rates across countries of the world vary more than 500-fold from .06% in Hungary to 33.4% in Swaziland. One of the most cited research papers in the field, utilizing cross country regression analysis to analyze other correlates with this HIV prevalence data, is flawed in that it weights each country’s results by the country’s population.
Based on cross-country linear and multiple regressions using newly gathered data from UNAIDS, the number of female commercial sex workers as a percentage of the female adult population is robustly positively correlated with countrywide HIV/AIDS prevalence levels. Confirming earlier studies, female illiteracy levels, gender illiteracy differences and income inequality within countries are also significantly positively correlated with HIV/AIDS levels. Muslims as a percentage of the population, itself highly correlated with country circumcision rates and previously found to be negatively correlated with HIV/AIDS prevalence, is insignificant when the percentage of commercial sex workers in a population is included in the analysis.
Conclusions/Significance
This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth.

The Adult Film Industry: Time to Regulate?

For medical reasons, if nothing else.

Everything You Always Wanted to Know About Pennicillin (and more)

Here is an example of perfect science blogging. It starts seemingly innocuously, with a quiz: Monday’s Molecule #30, where you are supposed to figure out what the compound is.
Then, after a couple of days, there is a post that you may not even realize at first is related to the first one: Bacteria Have Cell Walls
Another day or two, and A and B get connected: How Penicillin Works to Kill Bacteria
But how do we know this? Well, some people figured it out: Nobel Laureates: Sir Alexander Fleming, Ernst Boris Chain, Sir Howard Walter Florey – and now you know how we know.
Finally, putting everything in context of science, society, medicine and history, a two-parter: Penicillin Resistance in Bacteria: Before 1960 and Penecillin Resistance in Bacteria: After 1960
A tour-de-force of science blogging. I wish I could do something like that.

Malaria and DDT

I often blog about malaria because it is a fascinating disease which has to be studied in a highly integrative manner, is a great teaching topic and I could tie it in with my own field.
If you share my fascination, than your Obligatory Reading Of The Day is this post by Bug Girl (via) about the truth about DDT, Rachael Carson, malaria and the wingnut lies about it. Follow the links within it as well for more information.

My Serbian readers will die laughing when they read this….

A guy ‘jebo jeza’, ahem, literally fucked a hedgehog in Serbia and ended up in the ER. Do kids there these days don’t even know their slang? ‘Jebo jeza’ means something along the lines of ‘being in big trouble’ or ‘having everything go wrong for you’. This guy accomplished that for himself, I guess….unless this is, as is likely, an urban legend.

Fighting Malaria in Southern Mali

It is the malaria week right now, isn’t it? Check out this nifty website about the efforts to fight malaria in Kangaba, Mali. Just click and drag on each picture and you can swing it around full 360 degrees.
Hat-tip: Anton

Blogger Perceptions on Digital Preservation Survey

If you have a moment, this is a useful study to participate in:

Do you blog? If yes, then please consider participating in an online survey from the University of North Carolina at Chapel Hill’s School of Information and Library Science. The study, Blogger Perceptions on Digital Preservation, is being conducted under the guidance of the Real Paul Jones. The study team is interested in hearing from all bloggers on their perceptions on digital preservation in relation to their own blogging activities, as well as the blogosphere in general. To hear more about this survey, please visit the study’s fact sheet at http://www.ils.unc.edu/~hcarolyn/blogsurvey/. From there, you can link out to the web-based survey. The survey will be available from April 25 through May 23, 2007. We believe blogs are valuable records of the human experience. Help to contribute to continued access to these important records by participating in our study. If you have any questions, feel free to contact Carolyn Hank, the study Principle Investigator, at hcarolyn AT email DOT unc DOT edu. Thanks!

Mouse model for Bipolar Disorder

I made only a brief mention of the study when the press release first came out, but the actual paper (which is excellent) is out now. It is on PLoS so it is free for all to see: Mania-like behavior induced by disruption of CLOCK:

Circadian rhythms and the genes that make up the molecular clock have long been implicated in bipolar disorder. Genetic evidence in bipolar patients suggests that the central transcriptional activator of molecular rhythms, CLOCK, may be particularly important. However, the exact role of this gene in the development of this disorder remains unclear. Here we show that mice carrying a mutation in the Clock gene display an overall behavioral profile that is strikingly similar to human mania, including hyperactivity, decreased sleep, lowered depression-like behavior, lower anxiety, and an increase in the reward value for cocaine, sucrose, and medial forebrain bundle stimulation. Chronic administration of the mood stabilizer lithium returns many of these behavioral responses to wild-type levels. In addition, the Clock mutant mice have an increase in dopaminergic activity in the ventral tegmental area, and their behavioral abnormalities are rescued by expressing a functional CLOCK protein via viral-mediated gene transfer specifically in the ventral tegmental area. These findings establish the Clock mutant mice as a previously unrecognized model of human mania and reveal an important role for CLOCK in the dopaminergic system in regulating behavior and mood.

If that is too technical for you, check out a nice summary by Grrrlscientist and for the background (and some additional information), you may want to check out this post of mine.

Bodies

The Bodies Exhibition is coming to The Streets at Southpoint in Durham.
My wife saw it last year in NYC. My daughter will probably be too squeamish for it, but I’ll try to get my son to come with me.
Once I go….well, it is certainly a bloggable event.

More on Elizabeth Edwards

On Thursday night, I posted a large linkfest about the press-conference by John and Elizabeth Edwards and the revelation that her cancer has returned. Those were mostly first responses. There have been literally thousands of blog posts written since then, but I chose to link only to a couple of dozen that really deserve your attention due to quality, novel perspective, or information content (scroll below).
While there were certainly some very nice posts coming form the Right, wishing Elizabeth well and agreeing that the decision to continue campaigning is none of anyone’s but the Edwards’ business, most of the Right-wing blogs voiced their wish that he would quit the campaign (of course – they are afraid of him) and, in the process, revealed a very medieval view of marriage with the husband someone who is supposed to be the decision-maker in the house and the wife as someone who is to be put up on a pedestal and fawned over (especially if she’s sick). They could not fathom that the Edwards’ actually make decisions together and that his word may not always be the last one in the house (they would feel emasculated if that was the case in their own households, I guess). Another underlying emotion there is the profound fear of death (aren’t they mostly religious folks, believing in afterlife and stuff? Why fear?) and the wish not to watch someone they erroneously consider as good as dead every night on TV. Analysing their responses is quite telling about their worldview and their fobias.
Also, try to watch the Edwards’ on ’60 minutes’ tomorrow night.
So, here are the best links of the past two days on the topic:
Jeffrey Feldman: Frameshop: Cancer and Character in American Politics
The Stinging Nettle: The steel orchid
Talk About Cancer: Elizabeth Edwards: The New Face Of Cancer
Jim Buie: Elizabeth Edwards, Living Life to the Fullest
Darksyde: When Good Cells Go Bad
Pharyngula: How many times has Limbaugh hit bottom, only to sink lower still?
AJ WI: The Elizabeth Edwards Debate
Firedoglake: Sick People Make Him Uncomfortable
Nyceve: If you support John & Elizabeth, stop the media distortion now
Ana Maria Cox: Re: Re: The Edwards Question
Persiflage: I was with John and Elizabeth Edwards the night before the press conference
Eschaton: Freak
Dean Barnett (yes, him!): Thoughts on John and Elizabeth Edwards
Dr.Who: The Edwardses: Profiles In Courage
Olvlzl: Elizabeth Edwards’ Choice
Iowa for Edwards: John and Elizabeth Edwards on 60 Minutes
Ollieb: The Politics of Cancer
Movin’ Meat: That didn’t take long
The Carpetbagger Report: The conservative push-back against Edwards starts quickly
Random Thoughts from Reno: Presidential Notes
Corrente Wire: The “Liberal Media” Discusses Compassionate Conservatism
Dominant Reality: About the Edwards Family Decision
Conglomerate: Elizabeth Edwards, or What Would You Do With the Rest of Your Life?
Slate: How Bad Is Elizabeth Edwards’ Cancer
The Moderate Voice: Edwards Doesn’t Withdraw: John Doe Weighs In
Johnalive: Criticism of Edwards backfiring….
Blue Gal in a Red State: John and Elizabeth Edwards
Cold Flute: The Remarkable Elizabeth Edwards
Jo-Ann Mort (TPM Cafe): The Personal and the Political: Elizabeth Edwards as Icon
Linda Milazzo: Why I Love Elizabeth Edwards
Neil the Ethical Werewolf: My Hero
Orient Lodge: ‘There’s a trick to being strong…’
Chaoslillith: Presidential diseases aka Relax about Elizabeth
DC Idealist: Running to be worthy of Elizabeth Edwards: It’s a Whole New Game

Everyone’s favourite nurse is back!

cherry%20ames.jpgThe first four books in the Cherry Ames series are back in print, published by Springer Publishing Company.
Apparently, many people, upon reading them, decided to join the nursing profession. Mind you, that was between 1943 and 1968. when these books first came out.
I bet Kim was the first one to order the new reprints (although I bet she still keeps her old originals somewhere around the house). My wife is ordering her set today.

A potential animal model for Bipolar Disorder

It has been known for quite a while now that bipolar disorder is essentially a circadian clock disorder. However, there was a problem in that there was no known animal model for the bipolar disorder.
Apparently that has changed, if this report is to be believed:

“There’s evidence suggesting that circadian genes may be involved in bipolar disorder,” said Dr. Colleen McClung, assistant professor of psychiatry and the study’s senior author. “What we’ve done is taken earlier findings a step further by engineering a mutant mouse model displaying an overall profile that is strikingly similar to human mania, which will give us the opportunity to study why people develop mania or bipolar disorder and how they can be treated.”

Seasonality of Pre-term Births

Matt found a conference paper that shows that the risk of pre-term birth is the lowest in spring, rising through summer and fall and the greatest in winter.
The paper, IMHO erroneously, focuses on the time of conception (because it is an easy marker used to calculate the supposed birth-date). Matt correctly shifts the discussion to the time of birth. After all, pre-term births are much more likely to be caused by something happening around that time than anything at the time of conception.
On the other hand, Matt, though cautiously and almost tongue-in-cheek, makes an attempt at an adaptive explanation. To do this, he had to consider not just the time of birth but also the duration of pregnancy which brings us back to the consideration of the time of fertilization.
I don’t think there is an adaptive explanation (Matt thinks so, too, but tries to come up with one anyway). Pre-term births are not healthy shorter pregnancies. They are pathological events. I don’t think that natural selection works on preserving pathological events.
Both in the primitive state, and in today’s modern society, winter is the most stressful time of year (remember that silly formula for January 20-something being the most stressful day of the year?). Spring is the best time of year: people are coming out of their Winter Blues (or even full-fledged SAD), there is an abundance of food and it is not as hot and scorched-earth yet. The timing of birth is determined by the fetus, not the mother, but the fetus will often respond to the perceived stress of the mother.
Out of the left field: Perhaps the increase of pre-term births in industrial societies (compared to developing world and/or the past times) has something to do with Christmas and its commercialization!

Ready for another liveblogged colonoscopy?

A good reason not to de-blogroll blogs on hiatus – they may come back as much as TWO YEARS later. Like the I Love Colonoscopies blog just did. I know you want to click on that link and explore the archives. Go ahead!

New potential sleeping pill

If you discover a brain chemical which, when missing or malfunctioning (due to a mutation in its receptor) abruptly puts people and animals to sleep when they don’t want to – a condition called narcolepsy – then you can work on creating a drug that acts in the opposite way and induces sleep when you want to.
Apparently, that is what a Swiss team just did (Nature news report here and Nature blog commentary here). The drug, still without a sexy name, is known by its “code-name” ACT-078573.
The target of the drug is the orexin system. Orexins (also known as hypocretins – the discovery was simultaneous in two laboratories several years ago and both terms are in equal use in the literature – you may remember one of the studies as it received some media coverage because it tested narcoleptic Doberman pinchers) are two closely related neuropeptides (orexin 1 and orexin 2). They are produced by cleavage of a single precursor protein. They are strongly conserved through the vertebrate evolution. They are produced in a small cluster of nerve cells, but those cells make projections widely across the brain.
The major function of orexins is to integrate circadian, sleep and metabolic information to determine if the animal should be awake or asleep. The connection to metabolism is also responsible for a secondary role of orexins in the control of appetite.
In narcoleptic people (or dogs), the levels of orexin are very low, or the orexin receptor is not functioning. In other words, the funciton of orexins is to promote wakefulness. ACT-078573 is an orexin antagonist – it blocks effects of orexin, thus promoting sleepiness.
It is too early to talk to your physician about this drug yet. This was just a first preliminary study. The drug was given only once, so we do not know possible effects of prolonged use. It was given to 42 healthy males with no history of sleep disorders, thus we do not know how it would effect women, children or people WITH sleep disorders – exactly those who would potentially benefit from this drug.
Just because a single use did not provoke other symptoms of narcolepsy – loss of muscle tone, loss of coordination and hallucinations – does not mean that long-term use of the drug would not result in such side-effects (after all, even the early narcoleptic events in affected people do not usually have such side-effects – they develop over time).
Another consideration is timing. In the study, the drug was given during the day when the orexin levels are naturally high (remember – orexin promotes wakefulness). We do not know what effect, if any, the orexin antagonist would have at night when orexin levels are naturally low. After all, as with all drugs targeting the circadian system, the effect is highly dependent on timing.
Another concern is with a possible side-effects of the drug on the appetite. Though this may be turned into a positive for the drug if it can be shown to be useful in control of appetite. Nothing sells better than sleep pills except the diet pills, after all!

New Treatments

Which of the two I am interested in for entirely scientific reasons and which one for more personal reasons, you guess:
Spray Could Offer New Front-line Treatment For Men With Premature Ejaculation:

Patients with premature ejaculation who used a topical anaesthetic spray were able to delay ejaculation for five times as long, according to a study in the February issue of the urology journal BJU International. Researchers from the UK and Netherlands studied 54 men with premature ejaculation, randomly assigning them to a treatment and control group. Both groups reported that without any therapy they normally ejaculated an average of one minute after vaginal penetration.

Recently Licensed Nicotine Receptor Stimulant Trebles Odds Of Stopping Smoking:

A recently licensed nicotine receptor stimulant trebles the odds of stopping smoking. The new anti-smoking drug varenicline was first licensed for use in the UK on 5th December 2006. An early Cochrane Review of its effectiveness shows that it can give a three-fold increase in the odds of a person quitting smoking. Varenicline is the first new anti-smoking drug in the last ten years, and only the third, after NRT and bupropion, to be licensed in the USA for smoking cessation.

Community and Hope as Placebo

Praying Online Helps Cancer Patients, Study Suggests

Breast cancer patients who pray in online support groups can obtain mental health benefits, according to a new study conducted by the University of Wisconsin-Madison Center of Excellence in Cancer Communications Research that was funded by the National Cancer Institute.
“We know that many cancer patients pray in online support groups to help them cope with their illness. This is the first study we are aware of that examines the psychological effects of this behavior,” says Bret Shaw, an associate scientist in UW-Madison’s College of Engineering and lead author of the study.
The analysis was conducted on message transcripts from 97 breast cancer patients participating in an online support group that was integrated with the Comprehensive Health Enhancement Support System (CHESS) “Living with Breast Cancer” program, a computer-based health education and support system. The patients were recruited from Wisconsin and Michigan.
Surveys were administered before group access, then again four months later. Text messages within the computer-mediated support groups were analyzed using a text analysis program, which measured the percentage of words that were suggestive of religious belief and practice (e.g., pray, worship, faith, holy, God). Writing a higher percentage of these religious words within the online support groups was associated with lower levels of negative emotions and higher levels of self-efficacy and functional well-being, even after controlling for patients’ pre-test levels of religious beliefs.

I’ll try to remember this so, if I need to, I can go online and type somthing about Satan worship, faith healer, birds of pray, holy sh*t, and God damn it!

2006 Medical Weblog Awards

Polls are open. Go and vote.

Do You Want Me To Biggie-Size That Rectal Tube For You, Sir?

Do You Want Me To Biggie-Size That Rectal Tube For You, Sir?If you do not know who Roper is, read this, this and this. A total fundie wingnut in charge of a large teaching hospital! Oy vey! I did not know that fact when I originally wrote this post, but this explains it….(From July 15, 2005)

Continue reading

Holiday Double Care for Kids

Just for the holidays, you get two for the price of one – two simultaneous editions of the Pediatric Grand Rounds: the reverent version and the irreverent version. And no, not all the entries can be found on both. Beware of the pirates on that second one, though.

Tripoli 6 Update

The five Bulgarian nurses and the Palestinian doctor were found guilty earlier today, against all the scientific evidence of their innocence. I second PZ’s sentiment about this.

So, just inject the humans right away and see what happens?

Just How Useful Are Animal Studies To Human Health?:

Animal studies are of limited usefulness to human health because they are of poor quality and their results often conflict with human trials, argue researchers in a study online in the British Medical Journal.
Before clinical trials are carried out, the safety and effectiveness of new drugs are usually tested in animal models. Some believe, however, that the results from animal trials are not applicable to humans because of biological differences between the species.
So researchers compared treatment effects in animal models with human clinical trials.
They used systematic reviews (impartial summaries of evidence from many different studies) of human and animal trials to analyse the effects of six drugs for conditions such as head injury, stroke and osteoporosis.
Agreement between human and animal studies varied. For example, corticosteroids did not show any benefit for treating head injury in clinical trials but did show a benefit in animal models. Results also differed for the drug tirilazad to treat stroke – data from animal studies suggested a benefit but the clinical trials showed no benefit and possible harm.
Some results did agree. For instance, bisphosphonates increased bone mineral density in both clinical trials and animal studies, while corticosteroids reduced neonatal respiratory distress syndrome in animal studies and in clinical trials, although the data were sparse.
Animal studies are generally of poor quality and lack agreement with clinical trials, which limits their usefulness to human health, say the authors. This discordance may be due to bias, random error, or the failure of animal models to adequately represent clinical disease.
Systematic reviews could help translate research findings from animals to humans. They could also promote closer collaboration between the research communities and encourage an interative approach to improving the relevance of animal models to clinical trial design, they conclude.

First of all, it’s not just efficacy of drugs that is tested in animals but also – and more importantly – safety. If a drug kills all the mice, it will never be tested in humans in the first place.
How about animal studies in the research in basic biology: evolution, ecology, behavior, physiology, cell biology, developmental biology, genetics….? So what if those studies are never even done in humans. We are, after all, just one species out of millions, and a lousy lab animal to boot. Yet, those kinds of animal studies teach us basic biology that subsequently give us ideas for further studies of medical treatments.

Puffy ankles? You may get sleep deprived.

Fluid Displacement From Legs To Neck Can Lead To Obstructive Sleep Apnea:

When a person lies down, a small amount of fluid displaced from the legs to the base of the neck can narrow soft tissue around the throat and increase airflow resistance in the pharynx by more than 100 percent, predisposing the person to obstructive sleep apnea.
———————-
In obstructive sleep apnea, a blockage in the throat or upper airway causes victims to repeatedly stop breathing long enough to decrease the amount of oxygen in the blood and increase the carbon dioxide.
————————–
“Our data show that displacement of a small amount of fluid such as 340 ml, about 12 ounces, from the legs is sufficient to cause a 102 percent increase in airflow resistance of the pharynx in healthy, non-obese subjects,” continued Dr. Bradley

These were healthy, non-obese people without sleep apnea. Presumably, even more fluid would be shifted in obese people, and the effect would be an even greater restriction of the airways in people already predisposed to sleep apnea (snorers, for instance).
So, should you sleep with your head raised and your feet lowered? Do astronauts in zero-gravity suffer from sleep apnea?

A Brave New World of Diabetes!

Sensory Nerve Discovery In Diabetes Opens Door To New Treatment Strategies:

Researchers at The Hospital for Sick Children (SickKids), the University of Calgary and The Jackson Laboratory, Bar Harbor, Maine have found that diabetes is controlled by abnormalities in the sensory nociceptor (pain-related) nerve endings in the pancreatic islet cells that produce insulin. This discovery, a breakthrough that has long been the elusive goal of diabetes research, has led to new treatment strategies for diabetes, achieving reversal of the disease without severe, toxic immunosuppression. This research is reported in the December 15 issue of the journal Cell.

Dr. Charles explains just how revolutionary this is.

RU-486 prevents breast cancer in mice

The Abortion Pill Could Prevent Cancer:

In women with BRCA-1, the naturally occurring female hormone progesterone speeds the proliferation of mammary cells. “If we block the progesterone pathway using an antiprogesterone, it could prevent breast cancer,” says Eva Lee, lead author of the study. That’s exactly what mifepristone did for the experiment’s mice, all of which had the BRCA-1 gene. At age 1, none of those treated with mifepristone had developed tumors. But all the untreated mice had tumors by the time they were 8 months old.

From what I have heard on NPR, all 14 of the treated mice remained cancer-free, while all 27 mice who received either placebo or nothing, developed breast cancer. Of course, such clear-cut, all-or-none data are both exciting and suspicious and I am sure someone will try to replicate this very soon.
I do not know exact details of the protocol, but it appears that the mice were given RU-486 throughout life. This is, of course, impossible in humans – you cannot give this to girls/women from birth till death every day! We are looking primarily for treatment, not prevention (certainly not a pharmaceutical for prevention – behavioral methods will be welcome if discovered).
Still, knowing that breast cancer cells have progesterone receptors, that progesterone promotes breast cancer and that RU-486 prevents it will place a sharp focus of future research on this mechanism, discovering its details and potentially developing a new drug that can be used in the treatment of breast cancer.

CO2 Receptors in Insects

Identification Of Carbon Dioxide Receptors In Insects May Help Fight Infectious Disease:

Mosquitoes don’t mind morning breath. They use the carbon dioxide people exhale as a way to identify a potential food source. But when they bite, they can pass on a number of dangerous infectious diseases, such as malaria, yellow fever, and West Nile encephalitis. Now, reporting in today’s advance online publication in Nature, Leslie Vosshall’s laboratory at Rockefeller University has identified the two molecular receptors in fruit flies that help these insects detect carbon dioxide. The findings could prove to be important against the fight against global infectious disease.

This is a very important finding. For context of the importance of CO2 in transmission of malaria, check out this.