Category Archives: Health Care

Big Fat Lie

‘I got actively attacked, but I guess I had to be,’ Taubes says. ‘What are the chances of writing an article that says the entire medical establishment is wrong, and them going, ” Good point, thank you, Gary. Can we give you an award?” When people challenge the establishment, 99.9 per cent of the time they are wrong. If I was writing about me, I’d begin from the assumption that I am both wrong and a quack.’

At least he is right on this. You challenge the accepted scientific understanding and this is what will happen. But if the evidence is there scientists will be won over by the evidence over time.

‘Reading the research was a reawakening for me,’ he says. ‘I did all the things that the rest of us did. I ate a low-fat diet, went to the gym and was getting heavier anyway. But once you flip your way of thinking about it, it seems so absurd: the idea that what you put in minus what you expend equals how fat you are. Our bodies don’t work like a car. We are not thermodynamic black boxes; we are biological organisms and we have evolved complex systems of hormones and enzymes and proteins. That’s how we are regulated.’

The obesity epidemic began in America during the late 1970s, which is also when the low-fat, high-carb diet-and-exercise revolution began. ‘You have a starting point,’ says Taubes. ‘The question is what is causing it? Then I realised that we were first told to eat less fat in the late 1970s, and, if you eat less fat, you start to eat more carbohydrates – it’s a trade-off.’

The whole healthy eating debate is sure not easy to figure out. But I think some things are clear. Eating too many calories and not exercising enough are problems. And it also makes sense that it is not only the number of calories that matter but what type. We are biological beings and how we process food is not just by a count of the calories. It seems the evidence of bad effects of too much carbohydrates is growing.

It also makes perfect sense that our bodies evolved to store energy for worse times (and some of us have bodies better at doing that). Now we are in a new environment where (at least for many people alive today) finding enough calories is not going to be a problem so it would be nice if we could tell our bodies to get less efficient at storing fat for bad times ahead. But we can’t so we need to take actions to remain healthy given the how our body reacts to what we eat and do. And it seems one of those actions might mean we have to eat less than we might want to.

Robotic Prosthetic Arms for People

Dean Kamen latest invention was funded by DARPA. Once again he is doing amazing stuff. It is great what engineers can do (many worked together to get the progress so far) when given the opportunity. We need many more such efforts.

Dean Kamen Lends a Hand, or Two (August 2007):

DARPA has spent almost $25 million funding two independent teams, Mr. Kamen’s DEKA Research & Development Corp. and a group at Johns Hopkins’ University in an effort they hope will ultimately lead to commercial prosthesis that can be controlled from the human brain.

The innovation in the DEKA arm lies in its ultra light weight carbon shell, giving the user an exoskeleton with which to gain the leverage necessary to do some of the extraordinary things the system makes possible, such as lifting a 40 lb. weight.

To make the system function, the DEKA engineers coated the inside of the shell with a mosaic of thin air bladders that can be individually filled with air to offer padding and rigidity necessary to make possible normally ordinary tasks such as operating a portable power drill. When the arm is not in use the system deflates, or can even alternately fill and empty to offer a massage effect, so that it is not painful to wear for long periods.

The DEKA system is controlled by a joystick that is moved by the remaining portion of the user’s arm and by a second control mechanism in the user’s shoe. Mr. Kamen said that despite the complexity of controlling an ensemble of motors and mechanical servo devices, a user can gain basic functional control in just one day.

Learning from Leprosy Diagnosis

A Scary Diagnosis Hits Home

The diagnosis that ultimately resulted — leprosy — turned the Blanchards’ world upside down and rippled through the lives of many people they knew or had contact with. It also raised issues that are often confronted when any contagious disease is diagnosed, particularly one with scary connotations: What precautions should be taken to protect the rights of the affected individual as well as the health of the community?
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For the Blanchards, some of the answers lay almost literally in their back yard. Baton Rouge is home to the National Hansen’s Disease (Leprosy) Clinical Center, part of the U.S. Public Health Service.
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About 300,000 new cases of leprosy are diagnosed annually, according to the World Health Organization. Now known as Hansen’s disease, after the Norwegian scientist who discovered the mycobacterium that causes the illness, it affects about 2 million to 3 million people worldwide.

Where it is left untreated, Hansen’s disease is a leading cause of disability and devastating deformity. It remains endemic in Bangladesh, India, Brazil and elsewhere. In the United States, roughly 6,000 people have the disease. One hundred to two hundred new cases are reported annually, and, like BB Blanchard, about two dozen of those new patients have never been beyond U.S. borders.
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How transmission occurs is a mystery. Humans and the armadillo are the only two creatures known to get the disease. No one knows where the microbe hides in nature, although the suspicion is that the leprosy mycobacterium may be airborne like its bacterial cousin, tuberculosis.

Most people think of leprosy as a skin disease. But the rash that BB Blanchard had and the disfiguring lesions often associated with it are just a symptom. The mycobacteria burrow into nerves, where they often remain undetected for years or even decades.

Marketing Drugs

Melody Petersen, author of Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines on Bill Moyer’s Journal:

I actually thought that they were a lot about science. That’s what they tell the public. They are all about science and discovering new drugs. But as I started to follow their daily activities and talk to executives, I learned that really it was marketing that drove them.

According to Petersen, the rewards have been large. America has become the top consumer of prescription drugs in the world, with nearly 65% of the population on physician-prescribed medication. In 2005, Americans spent $250 billion dollars on such drugs. This consumption made pharmaceuticals the most profitable business sector in America from 1995-2002.
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We’ve come to a time when decisions on how to treat a disease have as great a chance of being hatched in a corporate marketing department as by a group of independent doctors working to improve the public’s health.

Unfortunately patients are driven more by marketing than medicine. Much worse though, doctors seem to bend to these patients marketing driven desires. Plus the corrupting influence of money on research and marketing to doctors seems likely a significant reason for the poor performance and high cost of USA health care.

Fat Cell Count Set in Childhood

Fat cell number is set in childhood and stays constant in adulthood

As fat people have an abundance of fat tissue, the natural assumption is that fat people have more fat cells, or ‘adipocytes’. That’s only part of the story – it turns out that overweight and obese people not only have a surplus of fat cells, they have larger ones too.
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During adulthood, about 8% of fat cells die every year only to be replaced by new ones. As a result, adults have a constant number of fat cells, even those who lose masses of weight. Instead, it’s changes in the volume of fat cells that causes body weight to rise and fall.
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we couldn’t have a clearer indication of the importance of childhood as a window for preventing obesity and the chronic diseases affected by it – cancer, heart disease, diabetes and more.

The message is especially stark following the recent Foresight report, which estimated that if current trends are left unchecked, by 2050 a quarter of all UK children under the age of 16 will be obese. The knowledge that their fat cell count will then be set for life makes the cost of inaction even higher. Fortunately, it seems that the UK Government is taking appropriate steps and recently pledged over a third of a billion pounds on a concerted strategy to tackle childhood obesity.

Gecko-inspired Bandage

MIT creates gecko-inspired bandage

Drawing on some of the principles that make gecko feet unique, the surface of the bandage has the same kind of nanoscale hills and valleys that allow the lizards to cling to walls and ceilings. Layered over this landscape is a thin coating of glue that helps the bandage stick in wet environments, such as to heart, bladder or lung tissue. And because the bandage is biodegradable, it dissolves over time and does not have to be removed.
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Gecko-like dry adhesives have been around since about 2001 but there have been significant challenges to adapt this technology for medical applications given the strict design criteria required. For use in the body, they must be adapted to stick in a wet environment and be constructed from materials customized for medical applications. Such materials must be biocompatible, meaning they do not cause inflammation; biodegradable, meaning they dissolve over time without producing toxins; and elastic, so that they can conform to and stretch with the body’s tissues.
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When tested against the intestinal tissue samples from pigs, the nanopatterned adhesive bonds were twice as strong as unpatterned adhesives. In tests of the new adhesive in living rats, the glue-coated nanopatterned adhesive showed over a 100 percent increase in adhesive strength compared to the same material without the glue. Moreover, the rats showed only a mild inflammatory response to the adhesive, a minor reaction that does not need to be overcome for clinical use.

Among other advantages, the adhesive could be infused with drugs designed to release as the biorubber degrades. Further, the elasticity and degradation rate of the biorubber are tunable, as is the pillared landscape. This means that the new adhesives can be customized to have the right elasticity, resilience and grip for different medical applications.

Walking Without Shoes

You Walk Wrong

Last year, researchers at the University of the Witwatersrand in Johannesburg, South Africa, published a study titled “Shod Versus Unshod: The Emergence of Forefoot Pathology in Modern Humans?” in the podiatry journal The Foot. The study examined 180 modern humans from three different population groups (Sotho, Zulu, and European), comparing their feet to one another’s, as well as to the feet of 2,000-year-old skeletons. The researchers concluded that, prior to the invention of shoes, people had healthier feet. Among the modern subjects, the Zulu population, which often goes barefoot, had the healthiest feet while the Europeans – i.e., the habitual shoe-wearers – had the unhealthiest
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My new Vivo Barefoots aren’t perfect – they’re more or less useless in rain or snow, and they make me look like I’m off to dance in The Nutcracker. But when I don’t wear them now, I kind of miss them. Not because they’re supposedly making my feet healthier, but because they truly make walking more fun. It’s like driving a stick shift after years at the wheel of an automatic – you suddenly feel in control of an intricate machine, rather than coasting on cruise control. Now I better understand what Walt Whitman meant when he wrote (and I hate to quote another Transcendentalist, but they were serious walking enthusiasts): “The press of my foot to the earth springs a hundred affections.”

Potential Viral Therapy for Difficult Cancers

Potential viral therapy weapon for difficult cancers is safe and effective in study

Combining a herpes virus genetically altered to express a drug-enhancing enzyme with a chemotherapy drug effectively and safely reduced the size of highly malignant human sarcoma grafted into mice. This new finding may add to the growing arsenal of so called oncolytic viruses under development as novel cancer treatments, especially for difficult, inoperable tumors
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“Based on these findings and other preclinical studies, we expect oncolytic viral therapy will be one additional treatment modality available in the future for oncologists,” Dr. Cripe said. “The challenge over the next decade will be determining which viruses work best for which cancers, at what doses, schedules, routes of administration, and in what combinations with other treatments.”

Medical Study Integrity (or Lack Thereof)

Merck wrote drug studies for doctors

The drug maker Merck drafted dozens of research studies for a best-selling drug, then lined up prestigious doctors to put their names on the reports before publication, according to an article to be published Wednesday in a leading medical journal.

The article, based on documents unearthed in lawsuits over the pain drug Vioxx, provides a rare, detailed look in the industry practice of ghostwriting medical research studies that are then published in academic journals.
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“It almost calls into question all legitimate research that’s been conducted by the pharmaceutical industry with the academic physician,” said Ross, whose article, written with colleagues, was published Wednesday in JAMA, The Journal of the American Medical Association, and posted Tuesday on the journal’s Web site.

Merck acknowledged Tuesday that it sometimes hired outside medical writers to draft research reports before handing them over to the doctors whose names eventually appear on the publication. But the company disputed the article’s conclusion that the authors do little of the actual research or analysis.

It is sad that the integrity of journals and scientists is so weak that they leave them open to such charges. The significant presence of the corrupting influence of too much money leaves doubt in my mind that the best science is the goal. Which is very sad. In, Funding Medical Research, I discussed my concern that universities are acting more like profit motivated organizations than science motivated organizations. I am in favor of profit motivated organization (those getting the micro-financing in this link, for example) but those organization should not be trusted to provide honest and balanced opinions they should be expected to provide biased opinions.

If universities (and scientists branding themselves as … at X university) want to be seen as honest brokers of science they can’t behave as though raising money, getting patents… are their main objectives. Many want to be able to get the money and retain the sense of an organization focused on the pursuit of science above all else. Sorry, you can’t have it both ways. You can, and probably should, try stake out some ground in the middle. And for me right now, partially because they fail to acknowledge the extent to which money seems to drive decisions I don’t believe they are trying to be open and honest, instead I get the impression they are leaning more toward trying to market and sell.
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Study challenges notion of ‘pandemic’ flu

Peter Doshi, a graduate student in the History, Anthropology, and Science, Technology and Society Program at MIT, based his study on an analysis of more than a century of influenza mortality data. He found that the peak monthly death rates in the 1957-1958 and 1968-1969 pandemic seasons were no higher than–and were sometimes exceeded by–those for severe nonpandemic seasons.

Doshi says the pandemic-equals-extreme-mortality concept appears to be a generalization of a single data point: the 1918 season, a period in which “doctors lacked intensive care units, respirators, antiviral agents and antibiotics.” He argues that “had no other aspect of modern medicine but antibiotics been available in 1918, there seems good reason to believe that the severity of this pandemic would have been far reduced.”

As may be expected given improvements in living conditions, nutrition and other public health measures, influenza death rates substantially declined across the 20th century. Doshi calculates an 18-fold decrease in influenza deaths between the 1940s and 1990s, a trend that began far before the introduction of widespread vaccination.