Category Archives: Health Care

Tracking the Ecosystem Within Us

Gut Check: Tracking the Ecosystem Within Us

For more than 100 years, scientists have known that humans carry a rich ecosystem within their intestines. An astonishing number and variety of microbes, including as many as 400 species of bacteria, help humans digest food, mitigate disease, regulate fat storage, and even promote the formation of blood vessels. By applying sophisticated genetic analysis to samples of a year’s worth baby poop, Howard Hughes Medical Institute researchers have now developed a detailed picture of how these bacteria come and go in the intestinal tract during a child’s first year of life.
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Before birth, the human intestinal tract is sterile, but babies immediately begin to acquire the microbial denizens of the gut from their environment — the birth canal, mothers’ breast, and even the touch of a sibling or parent. Within days, a thriving microbial community is established and by adulthood, the human body typically has as many as ten times more microbial cells than human cells.
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The results, said Palmer, were striking: the group found that the intestinal microbial communities varied widely from baby to baby – both in terms of which microbes were present and in how that composition changed over time. That finding, she said, is important because it helps broaden the definition of healthy microbial colonization in a baby.

Another intriguing observation, Palmer noted, was a tendency for sudden shifts in the composition of the infants’ intestinal microbial communities over time as different species of bacteria ebbed and flowed.

I find this area and this study fascinating. I’m not exactly sure why this study and the incredibly significant positive bacteria for human life news doesn’t get more notice. Oh well I guess there are not cool pictures of robots or scary stories of potential threats to those reading which makes the news less interesting to some. Still I find this stuff amazing: Energy Efficiency of Digestion – Beneficial Bacteria – Skin Bacteria – Hacking Your Body’s Bacteria for Better Health – Where Bacteria Get Their Genes

Using Bacteria to Carry Nanoparticles Into Cells

Bacteria ferry nanoparticles into cells for early diagnosis, treatment

Researchers at Purdue University have shown that common bacteria can deliver a valuable cargo of “smart nanoparticles” into a cell to precisely position sensors, drugs or DNA for the early diagnosis and treatment of various diseases. The approach represents a potential way to overcome hurdles in delivering cargo to the interiors of cells, where they could be used as an alterative technology for gene therapy, said Rashid Bashir, a researcher at Purdue’s Birck Nanotechnology Center.

The researchers attached nanoparticles to the outside of bacteria and linked DNA to the nanoparticles. Then the nanoparticle-laden bacteria transported the DNA to the nuclei of cells, causing the cells to produce a fluorescent protein that glowed green. The same method could be used to deliver drugs, genes or other cargo into cells.

“The released cargo is designed to be transported to different locations in the cells to carry out disease detection and treatment simultaneously,” said Bashir, a professor in the Weldon School of Biomedical Engineering and the School of Electrical and Computer Engineering. “Because the bacteria and nanoparticle material can be selected from many choices, this is a delivery system that can be tailored to the characteristics of the receiving cells. It can deliver diagnostic or therapeutic cargo effectively for a wide range of needs.”

Harmless strains of bacteria could be used as vehicles, harnessing bacteria’s natural ability to penetrate cells and their nuclei, Bashir said. “For gene therapy, a big obstacle has been finding ways to transport the therapeutic DNA molecule through the nuclear membrane and into the nucleus,” he said. “Only when it is in the nucleus can the DNA produce proteins that perform specific functions and correct genetic disease conditions.”
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River Blindness Worm Develops Resistance to Drugs

River blindness resistance fears

Resistance could lead to breakouts of the infection in communities where it has been brought under control, a Canadian study in the Lancet reports. Ivermectin, used since the late 1980s, is the only drug available for the mass treatment of river blindness. Experts warned the findings highlighted the urgent need for new treatments. River blindness (onchocerciasis) is caused by a nematode worm which is transmitted by a black fly.
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He added that isolated resistance could be controlled by using insecticides or an antibiotic called doxycycline, which is effective but needs to be given every day for a long time.
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Professor Taylor’s team have recently received a large grant from the Bill and Melinda Gates Foundation to search for new drugs or combinations that can have the same effect as a course of doxycycline but delivered in shorter time frame.

The Bill and Melinda Gates Foundation is funding a tremendous amount of important work.

Antibacterial Products May Do More Harm Than Good

photo of a dandelion

Strange but True: Antibacterial Products May Do More Harm Than Good by Coco Ballantyne:

Unlike these traditional cleaners, antibacterial products leave surface residues, creating conditions that may foster the development of resistant bacteria, Levy notes. For example, after spraying and wiping an antibacterial cleaner over a kitchen counter, active chemicals linger behind and continue to kill bacteria, but not necessarily all of them.

When a bacterial population is placed under a stressor—such as an antibacterial chemical—a small subpopulation armed with special defense mechanisms can develop. These lineages survive and reproduce as their weaker relatives perish. “What doesn’t kill you makes you stronger” is the governing maxim here, as antibacterial chemicals select for bacteria that endure their presence.

Pretty basic understanding of evolution makes the breeding of very resilient bacteria a fairly obvious result. One thing that might not be as obvious until it is mentioned is that by killing off the “weaker” bacteria you also provide a niche for the more resilient bacteria to multiply and fill the gap left by the bacteria that were not a problem that were killed off. Imagine if, instead of digging out the 3 dandelions you wanted to remove from your yard, you removed all plants from your yard (including those 3 dandelions). I would bet most often that would result in more dandelions not fewer as the dandelions were able to fill in the void of plants in the yard.

In general, however, good, long-term hygiene means using regular soaps rather than new, antibacterial ones, experts say. “The main way to keep from getting sick,” Gustafson says, “is to wash your hands three times a day and don’t touch mucous membranes.”

Reducing the Impact of a Flu Pandemic

Model for tracking flu progression could reduce flu pandemic’s peril – Engineer who survived pandemic of 1968 focuses on reducing influenza’s death toll:

Nearly 40 years ago, MIT Professor Richard Larson spent a week sick in bed with the worst illness he’d ever had–the particularly virulent strain of flu that swept the globe in 1968. “That was the sickest I’d ever been,” Larson recalled. “I really thought that was the end.” It took him two or three months to recover fully from the illness.

Known as the Hong Kong flu, the virus killed 750,000 people worldwide, the second worst influenza pandemic the world has seen since the infamous 1918-1919 epidemic of so-called Spanish flu.
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The findings strongly suggest that influenza emergency plans should include measures to reduce social contact, such as encouraging people to work from home and avoid large gatherings, Larson said. This is especially important because it generally takes at least six months from the time of an outbreak to develop an effective vaccine.

Tuberculosis Risk

We have posted about the Tuberculosis risks previously: Extensively Drug-resistant Tuberculosis (XDR TB), May 2007 – Deadly TB Strain is Spreading, WHO Warns, Mar 2007 – Tuberculosis Pandemic Threat, Jan 2007 – ‘Virtually untreatable’ TB found, Sep 2006. One USA citizen, while infected with XDR TB, flying to Europe and then to Canada and driving back into the USA has created a huge amount of publicity on this topic in the last week.

The risks are well known, given the extreme mobility in the world today, for TB, and other communicable diseases, becoming more troublesome, costly and deadly – often due to improper antibiotic use. But we continue to avoid giving this risk near the level of attention it seems to deserve. Deaths due to these diseases is likely to be very high in the next 20 years.

In fact there were 1.6 million TB deaths in 2005 (see WHO fact sheet below). Even if you only care about deaths in the USA (I am not advocating such a position, but even for those that hold such a position…) failing to address these issues will greatly increase the odds of large numbers of deaths in the USA (for TB and other diseases that become difficult or impossible to treat with antibiotics).

The current news will do little in my opinion (though it will help raise awareness). It will take a significant number of deaths in the USA, for significant policy changes to be implemented. Luckily scientists and policy makers have been giving these risks thought and so possible actions are already fairly well know. Unfortunately we seem very inclined to ignore problems for those out of sight (either continents away, or in the future) so until the consequences of the current action forces people to confront this issue little has been done (well actually good action is being taken, but much more is left to do).

One huge issue is quarantine. Personally, I try to use as a guide that people have the right to do what doesn’t infringe upon others rights. This allows plenty of room for debate about what level of trade-off is acceptable but I find it a useful guide to shape my thoughts. People don’t have the right to drive drunk and endanger others. People don’t have the right to pollute the air of others by smoking (or polluting the air with dangerous chemicals, CO2…). People don’t have the right to expose others to dangerous communicable diseases. Doctor’s don’t have the right to proscribe antibiotics when not medically justified (creating risks to those in the future)… But how society decides to define the social contract that everyone must agree to (rather that a way I find useful to help me analyze what is reasonable) is in need of some increased clarity in the light of health care issues today.

World Health Organization fact sheet on Tuberculosis:
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Radical Life Extension

The near-term inevitability of radical life extension and expansion by Ray Kurzweil:

It took 15 years to sequence HIV and from that perspective the genome project seemed impossible in 1990. But the amount of genetic data we were able to sequence doubled every year while the cost came down by half each year.
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If we think linearly, then the idea of turning off all disease and aging processes appears far off into the future just as the genome project did in 1990. On the other hand, if we factor in the doubling of the power of these technologies each year, the prospect of radical life extension is only a couple of decades away.

KurzweilAI.net includes many articles on Kurzweil’s ideas, by him, and others. Major topic areas include: Nanotechnology, Will Machines Become Conscious? and Singularity. The ideas can seem crazy but as Kurzweil discusses the ability to predict with the tremendous increase in the power of technology. I still think many things like radical life extension is unlikely so soon but the ideas presented are interesting and worth thinking about.

Extensively Drug-resistant Tuberculosis (XDR TB)

Superbug poses dire threat to Africa

The journey to Dr. Moll’s terrifying discovery began in early 2005, when he noticed something peculiar. The staff at his hospital had become accustomed to the marvellous “Lazarus effect” of anti-retroviral treatment for AIDS: seeing desperately sick people quickly start gaining weight and return home or go back to work. But now, in his ward, he had two men in their 30s on ARVs whose HIV infections were suppressed to undetectable levels. Yet their TB, which would normally have cleared up in a matter of weeks, kept getting worse.

He suspected multidrug-resistant TB, or MDR, believed at the time to be as bad as the disease could get. So he collected sputum from 45 patients and sent it off to a lab in Durban for cell culturing. (The only way to tell if a TB strain is drug-resistant is to grow cultures from a patient sample, zap it with the different drugs and see which, if any, fail to kill it.) The process takes six to eight weeks. “In that time, we more or less forgot about it,” Dr. Moll said. One of his two young men died.

But the phone call from the lab, when it eventually came, slammed the issue to the top of their agenda: Of the 45 samples, 10 were indeed drug-resistant. But they weren’t resistant to just one or two of the drugs used against TB. They were resistant to all six medications available for use in Tugela Ferry. In other words, there was nothing to cure that TB at all.

As we have discussed previously, antibiotic resistance is a huge problem today and especially looming in the future. Perhaps we will find new fantanstic cures but the failure to take sensible action puts us at great risk.

Treadmill Desks

Treadmill desks cut obesity

The participants were able to use the computer while walking without falling or injuring themselves. In fact, they enjoyed it so much, they wanted to keep the walking desks even after the study ended.
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Findlay got the idea from Mayo Clinic researcher James Levin, a co-author of the BJSM study who has been touting the benefits of his walking desk for years.

I must admit I like to think this idea would be work, but am a bit skeptical. I did switch to a job a few years back where I really just sat at my desk all day and would get tired. Previously I had walked around a fair amount going to see people… Someone suggested that getting some activity at lunch would help me feel more energized. It worked. If nothing else walk around at lunch.

Well, most of us in the corporate world feel like rats on a treadmill, so we might as well make the figurative literal…

Great comment on the post. Many of the other comments state categorically this cannot work. I wonder why they think they know what will work for everyone? I am skeptical but that is not the same thing as being sure this can’t work – I think being open to testing out ideas (especially ones that already have studies that claim they work) is a good thing. I would love to try it out myself (though given my skepticism I wouldn’t want to pay up to buy the equipment 🙂 ).

Genetic Information Nondiscrimination Act

I agree with restricting the use of genetic information for things like insurance – US to outlaw corporate prejudice based on genes:

Soon it will be illegal to deny US citizens jobs or insurance simply because they have an inherited illness, or a genetic predisposition to a particular disease.

On 25 April, the House of Representatives voted 420 to 3 to pass the Genetic Information Nondiscrimination Act (GINA). The Senate is expected to endorse the act within a few weeks, which is also supported by President Bush. “I am so stunned by the majority,” says Sharon Terry, president of the Genetic Alliance, a charity lobbying for the rights of people with inherited illnesses.

Genetic information can provide valuable information about risks. It is not often that I am for saying people should be prohibited from using information that would aid them in making better decisions. However it can be the best public policy to require insurance companies to be prohibited from using information that would allow them to better access risks and price insurance accordingly. So those that know they have such genetic risks will be paying less than they would if the insurance companies were allowed to use that information and everyone else will pay more (to cover for those with the increased risk). I think that is the best policy for the society. However it is not really about outlawing corporate prejudice it is about saying that we will have everyone is society share the cost of risks rather than those that can be identified as greater health risks.

Thinking this is about preventing bad corporate behavior seems to me an attempt to change the focus of the real issue. And that is not a good idea because this is a complex area that we are going to have to make a wide number of decisions about as a society. Pretending the issue is simple does society a disservice. This is an large economic issue and what choices various societies decided to make will be debated extensively for quite some time I believe..

Related: Improving the heath care system posts (from our management blog) – post about health care (from this blog)