Monday, September 29, 2014

Ebola Update

The U.S. Centers for Disease Control and Prevention (CDC) reports that as of last week, over 6,000 people have been infected with the Ebola virus and more than 2,900 have died. Although Ebola infections have been identified in five countries, to date the epidemic is confined primarily to just three; Guinea, Sierra Leone, and Liberia. Senegal has had just one case (a man who traveled from Guinea) and Nigeria, with 8 deaths, hasn't had a new case in almost three weeks.

The death rate among infected persons remains close to 50%. This is a virus that kills its victims rather quickly and is difficult to treat. Fortunately, person-to-person transmission requires close contact in the form of exchange of fluids. But that means that the people at highest risk of becoming infected are health care workers. The World Health Organization reports that more than 120 health care workers have died since the outbreak began. The lack of proper facilities and equipment to effectively isolate patients and protect health care workers is a factor.

Most airlines have cancelled commercial flights to the three countries at the center of the outbreak. Travel between and within the three countries has been restricted as well. A side effect of travel bans is that the flow of health care workers and medical equipment/supplies to affected areas is made more difficult.

This epidemic is not over yet. It may not even have peaked.

Tuesday, September 23, 2014

A National Strategy to Combat Antibiotic Resistance

In a 37-page document released this month, the Obama administration proposed a national strategy for combatting the growing problem of antibiotic-resistant bacteria.   It's about time.   From an evolutionary point of view, the misuse and overuse of antibiotics in health care and food production will inevitably lead to the emergence of antibiotic-resistant strains of bacteria, because bacteria can adapt and evolve so quickly.   We've been talking about this problem for a while now on this blog.

An interagency task force led by the secretaries of health and human services, agriculture, and defense has been tasked with developing a specific action plan within six months.  The task force will then coordinate with government agencies to see that the required actions are taken.  Finally, the task force will report regularly to the President on progress made toward specific goals outlined in the document.

The goals, objectives, and achievement targets listed in the document are clear, appropriate, and likely to be effective if they could actually be accomplished.   It will be interesting to see, say five years from now, if any real progress has been made, or whether this is just a good plan without adequate follow-through.  For example, one of the stated objectives; to "eliminate the use of medically important antibiotics for growth promotion in animals..." is likely to meet with stiff resistance from farmers.

I, for one, applaud the effort and hope for real progress.

Thursday, September 18, 2014

E-cigarettes Help Smokers Quit

Say what you want about e-cigarettes, but the fact is that they work better than other methods at helping smokers quit on their own. According to a study just published in Addiction, smokers who choose e-cigarettes are more likely report that they have quit smoking than smokers who try to quit based on willpower alone and smokers who use nicotine replacement therapy products such as the nicotine patch.

And there’s the conundrum for regulators. On the one hand, they need to support regulations that keep e-cigarettes widely available, because if current smokers choose to use them and thereby ultimately quit smoking cigarettes, lives will be saved. On the other hand, they don’t want e-cigarettes to become too popular, especially among the young or people who have never smoked. The end result could be a lot of people who become nicotine addicts without ever having smoked cigarettes. And while e-cigarettes are thought to be much safer than cigarettes and probably don’t increase the risk of cancer, who wants a whole new generation of nicotine addicts? And how safe are e-cigarettes, anyway? It may be years before we know.

I expect regulators (the FDA) to focus on how e-cigarettes are marketed, and to develop regulations that try to prevent e-cigarettes from becoming too popular with young non-smokers. But of course, that’s precisely the market that manufacturers would like to reach, because it's a much larger market than just current smokers who seriously wish to quit. Regulators versus manufacturers - it’s the battle over the marketing of cigarettes all over again.

Monday, September 15, 2014

Alcoholic Beverages Made From Non-GMO Grains

A leading manufacturer of distilled alcohol products has announced that it will begin manufacturing a line of neutral grain spirits from non-GMO grain, in addition to its traditional products made from genetically modified grains. The company says that it’s a market-driven decision, based on consumer perceptions that GMO foods may pose “unknown safety risks”.

If you oppose the development and planting of GMO plants because you think they might be bad for the environment, then you can rightfully cheer this decision. But if you think that drinking a distilled alcohol product made from GMO grains might be more harmful to drink than alcohol made from non-GMO grain, you’re misguided. Although the grain from GMO plants would contain a foreign protein or two, proteins are destroyed by the heat of the distillation process. And even if proteins weren’t destroyed by heat, they don’t vaporize and then condense again, so they wouldn’t end up in the final distillation product anyway. The final distillation product is essentially just alcohol and water.

The bottom line is that there aren’t any GMO proteins in distilled alcohol, even when it’s made from GMO grain. By making distilled alcohol products from non-GMO grain, the manufacturer is responding to the perception of a health risk by its potential customers, not the actual reality.

Friday, September 5, 2014

The Connection Between HIV and Multiple Sclerosis

It began as an observation in 2011; an Australian doctor who treats patients with HIV noticed that he had never had an HIV patient who went on to develop multiple sclerosis (MS). A literature search essentially confirmed his observations - there was just one known HIV patient who developed MS, and that patient's symptoms went away after undergoing the usual treatment regimen for HIV. So, he thought; is HIV infection (or its treatment regimen) somehow protective against MS?

To find out, the doctor and his coworkers needed access to the records of a large number of patients, because the number of people in a population who are HIV-positive is not all that large, and the number who develop MS is smaller still. They found what they needed in the records of the National Health Service of England. Among over 21,000 HIV-positive patients, they found only seven MS patients, when (according to a non-HIV-infected control group) there should have been 18. In other words, HIV-positive patients being treated for their disease were 60% less likely to develop MS. The results are published in the Journal of Neurology, Neurosurgery, and Psychiatry.

MS develops when the patient's immune system attacks the sheaths protecting nerve cells in the central nervous system. Some researchers think that the trigger causing the immune system to attack is an unknown virus. If so, there's a good possibility that the antiviral cocktail used to treat HIV is also attacking this unknown virus, thereby reducing the risk of developing MS.

Much more research needs to be done before we can be sure. But here's a case where the curiosity of an observant doctor may ultimately lead to an effective treatment for MS.

Sunday, August 31, 2014

Organic Foods Contain More Antioxidants

Back in 2012, a comprehensive meta-analysis of many previous studies concluded that in terms of nutrition, organic foods are generally no better for you than non-organic foods (this blog Sept. 6, 2012). Of course, that didn’t sit too well with supporters of the organic food movement. Well finally, proponents of organic foods have something to talk about, too. Another comprehensive meta-analysis, this one by primarily European researchers, concludes that organic foods have fewer pesticides and more antioxidants than non-organic foods.

The finding of fewer pesticides is to be expected, of course, since the pesticides they’re talking about aren’t supposed to be used on organically grown crops in the first place. The same was found in the previous nutritional study. The finding that organic foods contain more antioxidants will be welcomed by supporters of organic foods. As you may know, antioxidants are thought to be protective against cell damage, and hence could (in theory) assist in delaying cellular aging and possibly reducing the risk of cancer.

Unfortunately, “in theory” does not always coincide with “in reality”. Neither group of authors is claiming that eating organic foods actually leads to better health, because at the moment there is no evidence to support such a claim. If its better health we want, we should concentrate on eating more fruits and vegetables of either kind (organic or non-organic) according to our preference, and less refined sugar and fat.

Saturday, August 23, 2014

Illegal Human Organ Trafficking

It is illegal to sell or buy human organs in most countries. It is also against the principles of the Transplant Society and the International Society of Nephrology, whose joint Declaration of Istanbul states that organ trafficking and transplant tourism “ violate the principle of equity, justice, and respect for human dignity and should be prohibited.”

But where there’s money to be made, someone will try to make it. As the gap between the demand for kidneys and their supply (from cadavers or live donors) continues to widen, unscrupulous underground “businessmen” manage to bring desperate patients and willing sellers together, for money. If you can find one of these kidney brokers, the going price seems to be nearly $200,000 to buy a kidney, but less than $20,000 to sell one.

Kidney brokers are rarely caught and convicted, in part because they may not live on the same continent as the buyer and seller. So where exactly is the crime committed? Furthermore, brokers claim to enlist only altruistic donors who are not paid. They tell the potential buyer that the high price is to “cover expenses”. Donors are paid under the table and then coached to say that they are not doing it for money. No one really believes that, however, when the donor is from Costa Rica and the patient (a total stranger) is from Israel or the U.S. Desperate buyers are willing to turn a blind eye to the truth when their life is at stake. For a peek into this shadowy world, see the New York Times article on the subject or visit the Declaration of Istanbul website highlighted above.

Reasonable people have argued that the only way to eliminate the black market in human organs is to permit the buying and selling of organs, subject to controls to protect potential donors. They argue that thousands of lives could be saved every year. Whether buying/selling organs could be done without undue coercion of the poor is still an open question. At least one study in this country suggests that perhaps it could (this blog, April 26, 2010.) I’m not convinced, however, that the same results would hold in places where people are truly desperate, and not just below the average U.S. income. I’m reserving judgment on this idea for now.