Tuesday, December 30, 2008

ProMED-mail Internet-a-thon

Like 2008 itself, the ProMED-mail 2008 Internet-a-thon is drawing to a close:

Your financial support enables ProMED to continue providing you and 48,000 others in 187 countries worldwide with reliable, independent reporting of emerging infectious diseases and outbreaks as they happen.


Plagueblog recommends that you support this noble cause.

Wednesday, December 24, 2008

Holiday Cookie Dough Warning

Via ProMED-mail: the New Zealand Food Safety Authority reports on a salmonella outbreak apparently caused by (raw) contaminated flour.

“It is possible for low levels of bacteria to be on wheat or other points of the flour milling process, and studies indicate that about one percent of flour on average contains Salmonella.”
“Flour is a raw ingredient and intended to be consumed cooked. Although flour is not expected to be a sterile product, we support the company’s precautionary decision to withdraw the product. The affected batches of these brands can be safely used to cook if proper care is taken. If people have used these brands in their baking - for biscuits, cakes, breads or other Christmas treats - they can be reassured that the cooking will have killed the bacteria and that these home baked foods are safe to eat.”


In other words, bake those cookies before you eat any.

Saturday, December 13, 2008

Hog Ebola

Via ProMED-mail: Bloomberg reports on the discovery of Ebola Reston in Philippine hogs.

International scientists will converge on farms in the Philippines to help local authorities discover how pigs contracted Ebola-Reston, a monkey-killing strain not known to harm people. The findings may help identify which species carries the virus in the wild without getting sick, enabling the pathogen to persist undetected in the environment, said Juan Lubroth, head of infectious diseases in the animal health unit of the Food and Agriculture Organization in Rome.


Note that bats, those flying rodents of death, are still the main suspects for filovirus reservoirs. Ebola Reston first came to Reston, Virginia in Philippine monkeys, but this is the first known occurrence of Ebola in pigs. Ebola Reston is not believed to be harmful to humans.

Wednesday, December 10, 2008

Goo-Goo Melamine, Part VII

Via What to Eat: the New York Times reports that China now estimates the infant melamine scandal at about 300,000 cases with 6 dead. The previous estimate was 50,000 cases with 4 dead.

The Ministry of Health issued a statement saying that 860 babies who drank tainted milk were still hospitalized with kidney or urinary-tract problems; 154 of those were described as being in serious condition. “Most of the sickened children received outpatient treatment only for small amounts of sand-like kidney stones found in their urinary systems, while a part of the patients had to be hospitalized for the illness,” the ministry said.

Sunday, November 16, 2008

Goo-Goo Melamine, Part VI

Via ProMED-mail: the AFP reports that the FDA has issued a wider-ranging import alert for melamine-tainted Chinese "protein-containing products." This AP report provides more details:

Under the directive, FDA inspectors at U.S. ports of entry will detain foods from China made with milk and certain ingredients derived from milk. Importers must pay to have their products tested by an independent laboratory that meets FDA standards. Only products found to be melamine-free will be allowed into the country.
The order also applies to pet foods and some bulk protein products, the focus of a melamine recall in 2007.
Essentially, the FDA action shifts the burden of proof to Chinese companies, which must now supply evidence that their products are safe. Most consumers should not be affected, since major U.S. food manufacturers get their milk ingredients here.

Wednesday, November 12, 2008

Google Flu

Via Google Web Clips: Elizabeth Landau at CNN.com/health reports on a new Google tool, Google Flu Trends.

Google's new public health initiative, Google Flu Trends, looks at the relative popularity of a slew of flu-related search terms to determine where in the U.S. flu outbreaks may be occurring.
"What's exciting about Flu Trends is that it lets anybody -- epidemiologists, health officials, moms with sick children -- learn about the current flu activity level in their own state based on data that's coming in this week," said Jeremy Ginsberg, the lead engineer who developed the site.


See also the Official Google Blog for details.

Sunday, October 12, 2008

NIH Blue Ribbon Panel Biolab Hearing

Via Universal Hub: there will be a hearing this Tuesday in Roxbury about the biosafety level 4 facility BU still hopes to build right next to a million Greater Bostonians. From the Federal Register:

There will be a meeting of the NIH Blue Ribbon Panel to advise on the Risk Assessment of the National Emerging Infectious Diseases Laboratories (NEIDL). The meeting will be held on Tuesday, October 14, 2008, at the Roxbury Center for the Arts, Hibernian Hall, 184 Dudley Street, Roxbury, MA 02119 from approximately 6:30 p.m. to 9:30 p.m.
Discussions will focus on principles and strategies for effective community engagement. There will also be time allotted on the agenda for public comment.
Sign up for public comment will begin at approximately 5:30 p.m. on October 14, 2008. In the event that time does not allow for all those interested to present oral comments, anyone may file written comments using the address below.
For further information concerning this meeting contact Ms. Laurie Lewallen, Advisory Committee Coordinator, Office of Biotechnology Activities, Office of the Director, National Institutes of Health, Mail Stop Code 7985, Bethesda, MD 208927985, telephone 3014969838, email lewallla@od.nih.gov. Background information may be obtained by contacting NIH OBA by email oba@od.nih.gov.
Dated: September 16, 2008.
Kelly R. Fennington,
Special Assistant to the Director, Office of Biotechnology Activities, National Institutes of Health.
[FR Doc. E822313 Filed 92208; 8:45 am]


ACE also promises a webcast at http://videocast.nih.gov.

Wednesday, October 08, 2008

A Plague of Bedbugs

Via Tech San: the UK Telegraph reports on a plague of bedbugs in Spain this September.

Convents and hostels along the route to the north-western Spanish city of Santiago de Compostela have become infested by bedbugs, spread by the more than 100,000 pilgrims who travel to the shrine of St James every
The insects, which bury themselves deep inside mattresses and pillows in the pilgrims' quarters, are causing untold numbers of travellers to have sleepless nights and are responsible for many falling ill on the way.
The Federation of Friends of the Camino de Santiago has proposed a simultaneous clean up at all overnight stops along the route from the town of Roncesvalles on the French border in the Pyrenees.
"It's a plague and it's incredibly dangerous," said Angel Luis Barreda from the organisation that oversees the pilgrimage path.


It's actually not the case that bedbugs nest in "deep inside mattresses and pillows." They prefer nooks and crannies in wood, from which they emerge at night when they detect the carbon dioxide emissions of sleeping humans.

Sunday, October 05, 2008

Goo-goo Melamine, Part V

Although China claims its milk is no longer contaminated with melamine, the scandal continues to spread. Melamine-contaminated products have been found in Siberia, Germany, the Netherlands, Canada, and even Utah. The FDA has produced a safety/risk assessment for melamine. While unable to set a level for infants, they did provide one for adults:

In food products other than infant formula, the FDA concludes that levels of melamine and melamine-related compounds below 2.5 parts per million (ppm) do not raise concerns.


The BBC reports that several animals in a Chinese zoo near Shanghai were fed the contaminated milk powder for over a year:

Concerned keepers sent the animals for a check up after hearing about the milk contamination and have now stopped feeding with Sanlu milk.
The orang-utans and the lion are the only animals to have developed kidney stones and are being treated for the condition.
Officials at the Beijing Zoo and zoos in the other major cities of Shanghai, Guangzhou and Xian said they had no cases of animals sickened from milk powder, the Associated Press reported.

Tuesday, September 23, 2008

Goo-goo Melamine, Part IV

Via ProMED-mail: Radio New Zealand reports that the melamine crisis in China has spread to 53,000 infants, 13,000 of whom are hospitalized. Rumors reach back to December 2007, and the UN wants an explanation:

The World Health Organisation has asked the Chinese authorities to explain why it took months for the tainted milk scandal to be made public.
The UN children's agency UNICEF has asked Chinese authorities to launch a full investigation into the matter.

Sunday, September 21, 2008

Goo-Goo Melamine, Part III

Via ProMED-mail: The melamine death toll has risen to 4 Chinese infants (or possibly five, according to The Daily Yomiuri). Melamine has now been found by several countries in imported milk, yoghurt, coffee, and candy. Several African countries have banned Chinese milk.

A Japanese company has recalled some snacks manufactured in China, and the FDA has stepped up inspections:

Leon said the FDA is sampling bulk shipments of milk-derived products from Asia for possible contamination with melamine or other banned ingredients. The products being tested include whole milk powder, whey powder, milk concentrate, lactose, casein protein, and other milk derivatives.

Wednesday, September 17, 2008

Goo-goo Melamine, Part II

Via ProMED-mail: The New York Times reports that China's latest melamine scandal has spread to 6,244 infants and 22 dairy companies. Xinhua News Agency reports:

The State Administration of Quality Supervision, Inspection and Quarantine said it had tested 491 batches of baby milk powder produced by all the 109 companies in the country in a special inspection move.
69 batches from 22 companies nationwide were found containing melamine, a chemical which had tainted Sanlu's baby formula and led to kidney stone illness of more than 1,200 infants across the country.
The number of companies with melamine-tainted milk accounted for 20.18 percent of the total of milk powder companies in China. And the number of tainted batches accounted for 14.05 percent of the total batches tested.
The melamine content in the Sanlu brand reached 2,563 mg per kg, the highest among all the samples. In other samples, the range was from 0.09 mg to 619 mg per kilogram.


Xinhua also reports that 10,000 tons of contaminated formula will be destroyed.

Sunday, September 14, 2008

Goo-goo Melamine

Via ProMED-mail: the FDA has issued an advisory against infant formula from China. At least 14 Chinese infants became ill, and powdered formula produced by the dairy concern Sanlu was subsequently found to contain melamine.

In response to reports of contaminated milk-based infant formula manufactured in China, the U.S. Food and Drug Administration (FDA) today is issuing a Health Information Advisory. This is to assure the American public that there is no known threat of contamination in infant formula manufactured by companies that have met the requirements to sell infant formula in the United States. Although no Chinese manufacturers of infant formula have fulfilled the requirements to sell infant formula in the United States, FDA officials are investigating whether or not infant formula manufactured in China is being sold in specialty markets which serve the Asian community.
The FDA is advising caregivers not to feed infant formula manufactured in China to infants. This should be replaced with an appropriate infant formula manufactured in the United States as mentioned below.


The Xinhua News Agency reports that the smoking formula has been removed from the shelves in China:

Hundreds of Carrefour and Wal-Mart stores in China are pulling Sanlu milk powder off shelves.
The withdrawal came after both the health authority and Sanlu confirmed the milk to be contaminated with a toxic chemical.
Dong Yuguo, spokesman for Wal-Mart China, said on Friday the company received notices to stop selling the formula.
Xinhua's reporter did not find Sanlu milk powder on shelves in one of the Wal-Mart stores in the Xuanwu District, Beijing, Friday afternoon. The store staff said the brand was ordered to be withdrawn.
Wal-Mart now has 109 stores in China.


This is hardly the first melamine incident. I have added a melamine label for reader convenience, and am updating the China advisory to: PlagueBlog recommends avoiding any pharmaceuticals, infant formula, food, animal feed, or edible components thereof originating in China. And the inedible components, too.

Thursday, September 04, 2008

A Potential Cure for Ebola

Via io9.com: PLoS reports on a potential cure for Ebola.

Here, we use a novel technology to measure penetration of Ebola virus into the cell in real time and show that Ebola virus stimulates phosphoinositide-3 kinase, a signaling molecule known to induce endocytosis. Importantly, drugs that interfere with this signaling inhibit infection by Ebola virus and block virus spread. This work provides a mechanistic insight into how Ebola virus manipulates the cell to start an infection, may explain part of virus induced pathogenesis, and provides a potential way to treat this deadly disease.

Sunday, August 17, 2008

Pandemic Fiction

Via Futurismic: "Pandemic" by J. F. Bone is an old (1962) story from Analog about a pathologist working on a species-threatening pandemic with a new, grim (but still plucky) nurse. Copyright has apparently lapsed.

Generally, human beings don't do totally useless things consistently and widely. So--maybe there is something to it--
"We call it Thurston's Disease for two perfectly good reasons," Dr. Walter Kramer said. "He discovered it--and he was the first to die of it."

Tuesday, August 12, 2008

The Perils of Being a Disease Maven

Via ProMED-mail: The New York Times reports on the perils of being a bioterrorism expert--or even an amateur--when the FBI is on the prowl.

Another casualty was Kenneth M. Berry, an emergency room physician with a strong interest in bioterrorism threats. In August 2004, agents raided his colonial-style home and his former apartment in Wellsville, a village in western New York, as well as his parents’ beach house on the Jersey Shore.
In scenes replayed for days on local television stations, the authorities cordoned off streets as agents in protective suits emerged from the dwellings with computers and bags of papers, mail and books.
“He was devastated,” Dr. Berry’s lawyer at the time, Clifford E. Lazzaro, said in an interview. “They destroyed his marriage and destroyed him professionally for a time.”

Friday, August 08, 2008

Whole Foods and E. coli

Via Universal Hub: the Massachusetts Department of Health and Human Services reports that seven cases of E. coli in the state have been traced to ground beef from Whole Foods.

Officials from the supermarket chain have cooperated with staff from DPH during the agency’s investigation to determine the source of the contamination. Preliminary findings suggest that ground beef products that were previously identified as part of a nationwide recall may have entered the retail supply at Whole Foods during June and July.
Last month, the United States Department of Agriculture (USDA) announced the extension of a national recall for ground beef produced by Nebraska Beef, Ltd. due to possible E. coli contamination. Nebraska Beef produces products under the Coleman brand name, and a review of records from Whole Foods indicates that some of the stores received product from the recall list. At this time, it is not known why the food listed under the USDA recall was sold to the public after the recall date.


The state recommends throwing away any ground beef purchased at Whole Foods between June 2nd and August 6th.

Thursday, August 07, 2008

The Mother of All Parasites

Via The Anti-Toxo: Future Microbiology reports the discovery of a missing-link apicomplexan and its implications.

Symbiosis and parasitism are thus wide-spread in both the dinoflagellates and apicomplexans, suggesting that modern parasites like Plasmodium spp. and Toxoplasma likely started out as mutualistic symbionts that initially nourished their animal hosts before turning to parasitism. These symbiotic/parasitic relationships thus extend back in evolutionary time to the earliest origins of the animals, which means that either as parasites or symbionts, these protists have been interacting with the animal immune system since its inception. As a consequence of this protracted dance, malaria parasites are exquisitely well-equipped to evade our immune system: a sobering harbinger for malaria vaccine prospects.

Wednesday, August 06, 2008

Prions are Forever

Via ProMED-mail: in June ScienceDaily reported on prions surviving waste water treatment.

Until now, scientists did not know whether prions entering sewers and septic tanks from slaughterhouses, meatpacking facilities, or private game dressing, could survive and pass through conventional sewage treatment plants.
Joel Pedersen and colleagues used laboratory experiments with simulated wastewater treatment to show that prions can be recovered from wastewater sludge after 20 days, remaining in the "biosolids," a byproduct of sewage treatment sometimes used to fertilize farm fields.


I suppose if you can get prions from squirrels, you can get them anywhere.

Tuesday, August 05, 2008

Adjustable Glasses

Via plime: The World Bank reports on the bright prospects of cheap, adjustable corrective eyeglasses with oil-filled lenses.

For too many of the world’s poorest people, life is just a blur. WHO estimates that roughly a billion people—mostly in developing countries—need eyeglasses to read, write, work, and go about their daily lives. But they cannot find them, let alone afford the high price tag. It can take as much as three months’ wages or more to afford glasses in many African countries.
At least 10 % of this group is made up of youngsters of school age.
These vision problems could eventually be corrected on a large scale through use of cheap, self-correcting spectacles, invented by Oxford University physicist Josh Silver, and being made by a British NGO for between $5–$10, with the ultimate target price being about $1 a pair.

Monday, August 04, 2008

The Achilles' Heel of HIV

Via plime: The Daily Texan reports on progress towards an HIV vaccine.

Along with fellow researchers, Paul has identified one region on the surface of the virus that is mostly unchanging. He explained that this small region is critical for the virus to bind to cells; without this section, the virus would not be able to infect the cells.
The UT researchers call this small region the "Achilles heel" of HIV, which causes AIDS.
"We identified this region as a suitable target for antibodies," Paul said.


On the dissent front (not that they intended it that way) Discover reports on a connection between schistosomiasis and HIV:

Schistosomiasis, seen primarily in developing countries, is caused by tiny flatworms that live in snail-infested freshwater like rivers and lakes. When people wade, swim or bathe in contaminated water, worms bore through the skin and travel in the blood, causing anemia, diarrhea, internal bleeding, organ damage and death.


HIV sounds like the least of their problems.

Wednesday, July 30, 2008

Beware of Green Food

Via Universal Hub: the FDA advises against the consumption of tomalley from Maine lobsters due to the risk of Paralytic Shellfish Poisoning (PSP).

The FDA advisory applies only to tomalley, the soft, green substance found in the body cavity of the lobster that functions as the liver and pancreas. Cooking does not eliminate the PSP toxins. However, studies have shown that, even when high levels of PSP toxins are present in lobster tomalley, lobster meat itself is typically unaffected.


Also on the green food watch, the CDC reports a couple of smoking jalapeños:

An FDA laboratory detected Salmonella Saintpaul with the outbreak strain fingerprint pattern in a sample of jalapeño pepper obtained from a distribution center in McAllen, Texas. The distributor is working with FDA to recall the contaminated product in the United States. The peppers were grown in Mexico; investigators are working to determine where they were contaminated.
The Laboratory Services Division of the Colorado Department of Public Health and Environment detected Salmonella Saintpaul with the outbreak strain fingerprint pattern in a jalapeño pepper provided by an ill individual. The state health department is working with the FDA to determine the origin of the jalapeño pepper.


Plagueblog recommends eating locally-grown produce (unless you are local to Mexico) and ruminants. In no case should you be eating any part of an animal whose internal organs can be described as a "soft, green substance [...] that functions as both liver and pancreas."

Wednesday, July 16, 2008

Rapamycin

Via Technovelgy:

Rapamycin, a drug approved by the FDA to stop tissue rejection after organ transplants, has been found to reverse the brain dysfunction caused by a genetic disease - tuberous sclerosis complex (TSC).
"This is the first study to demonstrate that the drug rapamycin can repair learning deficits related to a genetic mutation that causes autism in humans. The same mutation in animals produces learning disorders, which we were able to eliminate in adult mice," explained principal investigator Dr. Alcino Silva, professor of neurobiology and psychiatry at the David Geffen School of Medicine at UCLA. "Our work and other recent studies suggest that some forms of mental retardation can be reversed, even in the adult brain."


See Science Daily for more details.

Monday, July 14, 2008

Marburg Death in the Netherlands

Via ProMED-mail: the European Center for Disease Prevention and Control reports a Marburg death in Leiden, the Netherlands, of a woman who had recently visited the Maramagambo forest in Queen Elizabeth National Park, Uganda.

The patient died on July, 11.
ECDC’s initial assessment is that the threat to public health is limited and mainly focussed on the people who have been in close contact with the patient after the onset of her symptoms. People intending to travel to Uganda should be aware there may be a risk related to visiting caves in the Maramagambo forest.


PlagueBlog recommends New England as a safer travel destination than Uganda--as long as you keep out of the Muddy River.

Sunday, July 13, 2008

A New Non-variant CJD

Via an unnamed source: the BBC reports the discovery of a new type of sporatic CJD (Creutzfeldt-Jakob disease).

Dr Pierluigi Gambetti, director of the US National Prion Disease Pathology Surveillance Center, in Ohio, said that he believed the newly discovered type had probably "been around for years, unnoticed".
He suggested one interesting common factor was that the patients came from families with a history of dementia, suggesting a genetic cause, but did not carry the gene traditionally associated with a small number of sporadic CJD cases.

Tuesday, July 01, 2008

Tomato Doubts

Via ProMED-mail: USA Today reports that the ongoing salmonella outbreak has led to doubts about the tomato theory:

At a news conference Friday, representatives of the FDA and the CDC were more forceful in saying that they aren't sure tainted tomatoes caused the outbreak of salmonella saintpaul, a fairly rare strain. Previous statements had been more vague.
Over the weekend, the tide of opinion among epidemiologists, produce companies and food safety officials also began to turn in that direction.
Tomatoes couldn't have caused an outbreak that has stretched from early April to late June, says Jim Prevor, editor of Produce Business magazine. "There's not a field in the world" that produces that long, he says.


No new smoking vegetable has been implicated.

Tuesday, June 24, 2008

Salmonella hits Massachusetts

Via ProMED-mail: The CDC reports that the Saintpaul [sic] salmonella strain has now been reported in Massachusetts, with twelve people affected.

Among the 316 persons with information available, illnesses began between April 10 and June 13, 2008. Patients range in age from <1 to 99 years; 50% are female. At least 69 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.
Only 3 persons infected with this strain of Salmonella Saintpaul were identified in the country during the same period in 2007. The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated tomatoes are distributed throughout much of the country. Because of inherent delays in reporting and because many persons with Salmonella illness do not have a stool specimen tested, it is likely many more illnesses have occurred than those reported. Some of these unreported illnesses may be in states that are not on today’s map.


The FDA has specific information on what tomatoes are safe to eat.

Tuesday, May 27, 2008

Parasites Unleashed

Via Boardgame News: Zygote Games has finally released Parasites Unleashed, a card game.

Become one of life's ultimate insiders! In PARASITES UNLEASHED! you control a wily parasite, racing to complete your life cycle, mate, and lay eggs before your opponents. Do all the entertainingly gross things real parasites do -- bore into vital organs, hide inside a blood cell, hitch a ride inside a mosquito, even take over your host's brain! But beware, because your enemies can add stages to your life cycle, and zap you with medicine!

Friday, May 16, 2008

Lactose Intolerance in Europe

Tthere's an article about lactose intolerance at Food Reactions, with a map showing the percentage of people with primary lactase deficiency (the genetic inability to produce the lactose-eating enzyme lactase) across Europe.

In a review by Gudmand-Hoyer E in published on The American Journal of Clinical Nutrition (1994), [primary lactose deficiency] is lowest in Scandinavia and Northwest Europe (3-8%) and close to 100% in most of Southeast Asia. In Europe the frequency increases in the southern and eastern directions, reaching 70% in southern Italy and Turkey. There is also a high prevalence of lactose maldigestion in the people of Africa with the exception of cattle-raising nomads. Moreover, studies conducted by Scrimshaw and Murray and Sahi review the prevalence of lactose maldigestion globally. The prevalence is above 50% in South America, Africa, and Asia, reaching almost 100% in some Asian countries.


If you look very carefully at the map, though, you will see that the rate of lactose intolerance reaches not just 70% in Sicily but a pan-European high of 81% just north of Napoli (around the lower calf of Italy, above the spur). This region is called Campobasso, and it's where I get my gene for hypolactasia.

Tuesday, May 13, 2008

Via ProMED-mail: the South Carolina Department of Health and Environment Control reports on a rabid raccoon that exposed sixteen people to rabies, because they wouldn't let Darwin be Darwin.

Sixteen people who were exposed to rabies by a raccoon are under the care of a physician after the raccoon tested positive for the disease, the S.C. Department of Health and Environmental Control said today.
"The baby raccoon was found in the woods and was being cared for by several people over the past several weeks," said Sue Ferguson of DHEC's Bureau of Environmental Health.
According to Ferguson, many of the exposures occurred when feeding the raccoon, as caretakers came into contact with the animal's saliva. Seven more people are being evaluated for possible exposure risk.

Monday, May 05, 2008

Biolab Follies

Via Universal Hub: the Boston Phoenix reports on BU's ongoing "Biolab Follies."

Throughout the past few years, and particularly during the past 12 months, the biolab’s backers have suffered a string of setbacks: legal, diplomatic, political. Boston University Medical Center (BUMC) may still end up hosting a BSL-4 facility, but this is hardly the sure thing it once was. In fact, given the current momentum of the debate, the smart money might actually be on the biolab not coming to fruition, at least as it was originally conceived.
So what went wrong, exactly? Or, for those who see things differently: what went right?


The story chronicles the political side of the biolab debate, with, perhaps, too much attention to race and too little to zombie protesters.

Sunday, May 04, 2008

Heparin Tainting Deliberate

I found this report accidentally in a Parkinson's search, because the CEO of Baxter happens to be one Robert Parkinson. The Chicago Tribune reports that Parkinson called the contamination of its heparin supplies a "deliberate adulteration scheme" by suppliers in China. (PlagueBlog is shocked that such a thing could happen.)

The scale of the scandal over tainted heparin continued to expand. David Strunce, chief executive of Wisconsin-based Scientific Protein, acknowledged that the company has no way of knowing which of 12 different suppliers might have introduced foreign matter into the heparin supply chain. Strunce also claimed Chinese regulators have interfered with his company's efforts to investigate the matter.
The FDA has tallied more than 80 reports of deaths and more than 1,000 adverse events associated with patients in the U.S. who had one or more allergic reactions to heparin products, including those sold by Baxter, since Jan. 1, 2007.


As a result, the Chicago Tribune also reports, Baxter is considering getting out of the heparin business altogether:

The product generates $30 million of Baxter's more than $11 billion in annual sales, and Wall Street analysts asked Parkinson last week whether it was worth the legal risks and liability to remain in the business given that sales are so small.
"We haven't made a decision whether or not we are going to re-enter [the market] with heparin," Parkinson told analysts.


PlagueBlog recommends producing drugs, including their ingredients, domestically.

Saturday, May 03, 2008

Rabies on the Cape

Via an unnamed source: the Cape Cod Times reports two cases of rabies in pet cats in the past two weeks.

The discovery of rabies in the cats has dire public health implications, local veterinary and natural resources officials said yesterday. They urged residents to make sure their cats, as well as dogs and ferrets, are vaccinated.
Cats are the "perfect bridge to human health," said Dr. Thomas Burns, president of the Cape Cod Veterinary Medical Association, who treated the Yarmouth cat.
Officials fear an unvaccinated house cat could contract rabies, pass it on to a person before exhibiting symptoms, then wander off and die in the wild. The person might not be aware of the infection, the officials said.


PlagueBlog fondly recalls the days when ferrets were illegal in Massachusetts and continues to recommend fish--the perfect pet and the perfect food.

Thursday, May 01, 2008

Heavy Drugs

Via Universal Hub: Xconomy reports on a Lexington (Mass.) company that plans to build better drugs with deuterium.

Concert Pharmaceuticals may have found a way to help established drug substances pack a better punch. By substituting a few normal hydrogen atoms with the heavier form, deuterium, the company believes it is possible to create new chemical entities with greater efficacy and fewer side effects. And since these entities are based on proven drugs, the reasoning goes, it will probably take less time and money to take them to the market.

Wednesday, April 30, 2008

Magic Finger Powder

Via plime: the BBC reports on an Ohio man who allegedly regrew a severed fingertip using his brother's experimental extra-cellular matrix.

"There are all sorts of signals in the body," explains Dr Badylak.
"We have got signals that are good for forming scar, and others that are good for regenerating tissues.
"One way to think about these matrices is that we have taken out many of the stimuli for scar tissue formation and left those signals that were always there anyway for constructive remodelling."
In other words when the extra cellular matrix is put on a wound, scientists believe it stimulates cells in the tissue to grow rather than scar.

Friday, April 25, 2008

Heparin Update

Via ProMED-mail: The New York Times reported the latest news on the counterfeit heparin scandal this week.

The F.D.A. sent a warning letter on Monday to Changzhou SPL, the Chinese plant identified as the source of contaminated heparin made by Baxter International in the United States. It warned that the plant used unclean tanks to make heparin, that it accepted raw materials from an unacceptable vendor and that it had no adequate way to remove impurities.
Heparin is made from the mucous membranes of the intestines of slaughtered pigs that, in China, are often cooked in unregulated family workshops. The contaminant, identified as oversulfated chondroitin sulfate, a cheaper substance, slipped through the usual testing and was recognized only after more sophisticated tests were used.
The F.D.A. has identified 12 Chinese companies that have supplied contaminated heparin to 11 countries — Australia, Canada, China, Denmark, France, Germany, Italy, Japan, the Netherlands, New Zealand and the United States. Deborah Autor, director of compliance at the F.D.A.’s drug center, said the agency did not know the original source of all the contamination or the points in the supply chain at which it was added.
Officials have discovered heparin lots that included the cheap fake additive manufactured as early as early as [sic] 2006, although a spike in illnesses associated with contaminated heparin began in November and persisted through February, officials said.


China apparently admits to the contamination but denies that it caused any adverse reactions. All PlagueBlog recommendations concerning China still stand.

Thursday, April 10, 2008

The Smoking Hamster

Via an unnamed source: WBZ reports that a local woman is suing PetSmart for selling a diseased (Lymphocytic choriomeningitis) hamster to a Rhode Island woman who later passed away and donated her organs. The plantiff's husband received a liver, and also died.

Magee claims her husband died because the liver he received was infected with the rodent-borne disease. Five days after the transplant, which was performed at Mass. General Hospital, Magee's husband developed a high fever and began to bleed internally. According to Magee, one of his lungs collapsed.
He died about one month after the transplant.
The suit filed against PetSmart also alleges two other people also died after receiving organs from the same donor who bought the hamster.


If you must have pets, PlagueBlog recommends fish.

Tuesday, April 01, 2008

MS, Gout, and Lactose

Via Mathilda37, a paper from 1998 on the inverse relationship between multiple sclerosis and gout:

A possible association between multiple sclerosis (MS), the disease on which EAE is modeled, and uric acid is supported by the finding that patients with MS have significantly lower levels of serum uric acid than controls. In addition, statistical evaluation of more than 20 million patient records for the incidence of MS and gout (hyperuricemic) revealed that the two diseases are almost mutually exclusive, raising the possibility that hyperuricemia may protect against MS.


Here's her analysis:

No-one with MS has gout, no-one with gout has MS[.]
So what? Well, this is really, really important. It means that something about gout effectively puts the brakes on MS, and the causal factor of gout is high uric acid levels in the blood. It turns out that MS sufferers tend to have very low uric acid levels in their blood, and so can’t get gout.
This explains why some of the MS treating diets have worked in the past. They all seem to require ‘no dairy’ . This works because… consumption of dairy products lowers the risk of gout attacks, so you are looking at a factor that lowers blood uric acid levels. The lactose seems to be the real culprit, as cheese and butter didn’t seem to have any effect on the gout sufferers[.]

Wednesday, March 26, 2008

The Picky Pox

Via Universal Hub: corrections and reflections on the smallpox inoculation scene in the John Adams miniseries from J. L. Bell.

The actual inoculation process shown on screen—scraping pus from an infected person’s sores and inserting it into a cut on the inoculatee—was one of the cruder medical protocols of the time. Physicians also used ground-up scabs and threads dipped in pus to transmit the disease. They looked for infected people who seemed to have mild cases. According to an anonymous commenter on this posting, the series showed pus too thick to be from the early stage of the disease, and thus not contagious. I must confess that I don’t know my pus that well. But I commend the miniseries for including this unattractive but common aspect of eighteenth-century life, even within the confines of its budget.

Tuesday, March 25, 2008

Intestinal Dysbiosis

Via Henry Bauer: an alternative theory to explain classic AIDS (as opposed to the more widely-defined HIV/AIDS of today), intestinal dysbiosis.

One thing that those who reject the HIV/AIDS hypothesis agree on is that HIV is not the cause of AIDS. But when it comes to alternative theories of causation, disagreement abounds. And some of the most vexing questions surround the earliest cases of AIDS, those that were initially dubbed Gay-Related Immune Deficiency (GRID). Why did it originate in some gay communities? Why did this happen in the late 1970s and early 1980s? Why in the particular form of PCP (Pneumocystis carinii pneumonia), candidiasis, KS (Kaposi’s sarcoma)? And why still do gay men so often test “HIV+”? Why do some “HIV+” people thrive without medication while others get ill?
Here’s a suggestion that answers all those questions in a coherent way. [...]
Inadvertent alteration of these intestinal microflora may eliminate beneficial bacteria while simultaneously promoting the proliferation of harmful microbes. This state, intestinal dysbiosis, can lead to a series of problems, problems which taken together may explain much of what is called AIDS, at least with respect to some groups of gay men.
First, the lining of the gut may become more porous than normal, a condition known as increased intestinal permeability or leaky gut (2). This then allows microbial translocation—a flood of antigens into the blood stream—to occur, which in turn sets off a systemic immune response and the production of large numbers of antibodies to lots of different things. This condition, hypergammaglobulinemia—too many antibodies to too many things—is a known cause of false-positive reactions on the “HIV tests”.


PlagueBlog recommends not delving too deep (i.e., more than three pages) into the PDF if you're squeamish. This is not a pretty theory, and that may be its main disadvantage in the marketplace of ideas.

Monday, March 24, 2008

HIV Dissent

Via a mailing list and three degrees of separation, I came across this recent article: Questioning HIV/AIDS by Henry H. Bauer, in the Journal of American Physicians and Surgeons (Winter 2007). It gives an overview of the history of HIV theory and its discontents:

For more than two decades, dissenters from the assertion that HIV = AIDS have published books and articles and maintained a presence on the Internet, but major media have paid little if any attention; thus most people seem unaware that there are any serious doubts about the matter. The media silence was breached briefly in 2000 when President Thabo Mbeki of South Africa convened a group comprising both HIV/AIDS believers and HIV/AIDS skeptics to advise him on the scientific status of the issue. However, the media coverage gave short shrift to the doubters’ views by comparison to the believers’ Durban Declaration with its 5,000 signatures, which asserted: “The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous, meeting the highest standards of science.... It is unfortunate that a few vocal people deny the evidence. This position will cost countless lives.”


The author goes on to point out, as so many HIV dissenters have, that science is backed up with citations, not signatures, and that no such "clear-cut, exhaustive, and unambiguous" connection between HIV and AIDS has been established. You can read much more about it in his blog.

Sunday, March 23, 2008

Autism as Diagnostic Substitution

Half Sigma cites a two-year-old paper from Pediatrics to explain the autism "epidemic" as a change in diagnostic categories, rather than any known increase in the incidence of autism. The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education reported the following results:

The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern.

Monday, March 10, 2008

Counterfeiting Heparin

Via ProMED-mail: the ever-widening counterfeit Chinese heparin scandal doesn't seem to have hit the news very hard compared to the ongoing downers-for-dinner scandal, even though the downer recall is merely punitive in comparison with the recall of half the nation's heparin supply, and especially when you consider that the recall itself was delayed by the FDA because the basic need for heparin outweighed the serious safety concerns.

Heparin is a blood thinner administered to most inpatients, as well as to dialysis patients. It is derived from pig intestines; the raw ingredient is imported from China, before or after processing. Last week the New York Times reported on the discovery of the subtle counterfeit substance intended to pass for real heparin--and no such adulteration in heparin batches known not to cause adverse reactions. This counterfeit ingredient has evidently caused 19 deaths and almost 800 non-fatal adverse reactions so far.

German patients have also suffered adverse reactions leading to a recall, and as a precaution Japan recalled all heparin associated with a suspect Chinese producer late today.

Considering the malice aforethought involved in this sort of counterfeiting and the fact that it's hardly the first time, PlagueBlog recommends cutting off trade relations with China.

Friday, February 29, 2008

Nosocomial Hepatitis C

Via ProMED-mail: everybody is reporting on the multi-incident iatrogenic transmission of hepatitis C at a clinic in Nevada. (Here, for example, is the report from Fox5 News, Las Vegas.) The Southern Nevada Health District site has a FAQ with graphics of the smoking syringe:

Following a joint investigation with the Nevada State Bureau of Licensure and Certification (BLC) and with consultation from the Centers for Disease Control and Prevention, the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients.

Tuesday, February 26, 2008

Cure Your Own Cancer

Via plime: the AP reports on a Duke University student working to find a cure for his own rare form of cancer:

Chordoma — the cancer Josh learns he has — is a one-in-a million disease. Just 300 people get the terrible news each year, not even one per day. It strikes all ages, at different spots along the spinal column. The tumors can be removed, but the cancer is relentless. Chemotherapy doesn’t work. Life expectancy is around seven years.
The MRI shows Josh’s tumor is in a tough spot, in a bone inside his skull. It extends onto his brain stem and wraps around several arteries. There are two surgeries, then weeks of recovery in the hospital. He and Simone pass the time reading whatever they can about the disease.
There isn’t much. The massive apparatus of medical research — pharmaceutical companies, foundations, universities, government agencies — is utilitarian. High-prevalence diseases are at the front of the line, rare ones like chordoma usually at the back.
But then, a stroke of good fortune. It turns out that the only researcher in the country with a grant to study chordoma happens to be at Duke, working in a VA lab across the street from campus.


Josh later cuts back on his research activities in favor of the Chordoma Foundation which he and his mother founded to better organize research into chordoma. The article also mentions a few other patient-researchers.

Thursday, February 14, 2008

Acromegaly in the News

Via pilme: the Daily Mail reports on a chance meeting at a restaurant that led to a diagnosis of acromegaly, a rare condition that affects 3 people in a million.

The life-saving handshake happened on December 6, when lifelong friend Rob Thompson brought Dr Britt to an Italian restaurant Mr Gurrieri runs in Canary Wharf.
"I came out to meet them at the door. My friend, Rob, brought Chris along for the first time," he said.
"We shook hands and I sat them down at the table. He didn't say anything to me at the time but he turned to Rob as soon as he sat down and said 'I'm sure he has acromegaly, I can tell you. I'll stake my career on it.'
"Rob didn't tell me straight away. He came in two days later and was really nervous about telling me.
"I got straight on the internet. I read down the lines and saw the word 'tumour'. That word is frightening, especially when it has to do with the head.
"I went to my GP with everything I could print off from the internet and waved it under his nose.
"He looked it up and said he wasn't sure but would send me off for a blood test and MRI scan. They came back positive for acromegaly."
The condition, in which a tumour grows on the pituitary gland, causes an increase in growth hormones that can cause giantism in children.
In adults, it causes soft tissues to be deposited in the hands and growth of the skull bones.

Tuesday, February 05, 2008

Pesticide Dumplings

Via plime: the AP reports on the discovery of pesticide in Chinese dumplings imported into Japan:

Officials said Japanese authorities were recalling millions of bags of dumplings and other foods made by Tianyang Food Processing Ltd., the Chinese company that Japanese officials implicated in the earlier incidents.
A day earlier, China's product safety agency announced that tests on the ingredients of Tianyang dumplings — from the same batch sent to Japan — found none of the insecticide cited by Japanese authorities, said the country's General Administration of Quality Supervision, Inspection and Quarantine.
Investigators detected the insecticide methamidophos on the six bags of Tianyang dumplings over the weekend, a Hyogo prefecture (state) police official said on condition of anonymity, citing policy.
The official said that one of the bags had two tiny holes in it, and that investigators were checking whether the dumplings inside were contaminated.
The dumplings were the same type blamed for sickening 10 people, some of them seriously, in central and western Japan in December and January.

Friday, February 01, 2008

Progressive Inflammatory Neuropathy

Via ProMED-mail: the AP reports that the CDC has given a name to the pork-inhalation autoimmune disease contracted by workers at a couple of slaughterhouses:

Minnesota officials said they were broadening their investigation to thousands of former employees at the Quality Pork Processors Inc. plant in Austin, going back a decade to when a powerful compressed air system was installed to remove brain tissue from pig heads.
Investigators have been trying to determine whether pig brain tissue, sprayed into the air as droplets during removal by the compressed air system, was inhaled by workers and made them sick.
If further investigation proves their theories true, they will have identified a rare, new condition that could shed light on a whole family of poorly understood disorders in which the body's immune system attacks the nerves or the sheath that surrounds them, the Star Tribune reported.


You'd think after mad cow, they'd be a little more careful about aerosolizing livestock brains, but no. PlagueBlog recommends avoiding all pork, short or long.

Monday, January 28, 2008

Indonesia Hits 100 Again

Via ProMED-mail: Reuters reports that Indonesia has hit its hundredth bird flu death.

A 23-year-old Indonesian woman from East Jakarta has died from bird flu, taking the country's death toll to 100, according to a report from Indonesia's bird flu information centre on Monday.
The woman died on Sunday and two separate laboratory tests confirmed she contracted H5N1, the report said.
Earlier on Monday, a 9-year-old Indonesian boy who had tested positive for bird flu died, the health ministry said in a statement.

Sunday, January 27, 2008

World's First Blood-Type Conversion

Via plime: AFP reports on a girl who changed blood type after a liver transplant.

Demi-Lee Brennan was aged nine and seriously ill with liver failure when she received the transplant, doctors at a top Sydney children's hospital told AFP.
Nine months later it was discovered that she had changed blood types and her immune system had switched over to that of the donor after stem cells from the new liver migrated to her bone marrow.
She is now a healthy 15-year-old, Michael Stormon, a hepatologist treating her, told AFP. Stormon said he had given several presentations on the case around the world and had heard of none like it.
"It is extremely unusual -- in fact we don't know of any other instance in which this happened," Stormon told AFP from the Children's Hospital.

Saturday, January 26, 2008

Cholesterol Still Good For You

Via Half Sigma again: a New York Times editorial on cholesterol never having hurt a fly. Gary Taubes explains how cholesterol got its undeserved bad reputation:

In the 1950s, two hypotheses competed for attention among heart disease researchers. It had been known for decades that cholesterol was a component of atherosclerotic plaques, and people who have a genetic disorder that causes extremely high cholesterol levels typically have clogged arteries and heart attacks. As new technology enabled them to look more closely at lipoproteins, however, researchers began to suspect that these carrier molecules might play a greater role in cardiovascular disease than the cholesterol inside them. The cholesterol hypothesis dominated, however, because analyzing lipoproteins was still expensive and difficult, while cholesterol tests were easily ordered up by any doctor.
In the late 1960s, biochemists created a simple technique for measuring, more specifically, the cholesterol inside the different kinds of lipoproteins — high-density, low-density and very low-density. The National Institutes of Health financed a handful of studies to determine whether these “cholesterol fractions” could predict the risk of cardiovascular disease. In 1977, the researchers reported their results: total cholesterol turned out to be surprisingly useless as a predictor. Researchers involved with the Framingham Heart Study found that in men and women 50 and older, “total cholesterol per se is not a risk factor for coronary heart disease at all.”
The cholesterol in low-density lipoproteins was deemed a “marginal risk factor” for heart disease. Cholesterol in high-density lipoproteins was easily the best determinant of risk, but with the correlation reversed: the higher the amount, the lower the risk of heart disease.
These findings led directly to the notion that low-density lipoproteins carry “bad” cholesterol and high-density lipoproteins carry “good” cholesterol. And then the precise terminology was jettisoned in favor of the common shorthand. The lipoproteins LDL and HDL became “good cholesterol” and “bad cholesterol,” and the lipoprotein transport vehicle was now conflated with its cholesterol cargo. Lost in translation was the evidence that the causal agent in heart disease might be abnormalities in the lipoproteins themselves.
The truth is, we’ve always had reason to question the idea that cholesterol is an agent of disease. Indeed, what the Framingham researchers meant in 1977 when they described LDL cholesterol as a “marginal risk factor” is that a large proportion of people who suffer heart attacks have relatively low LDL cholesterol.

Friday, January 18, 2008

Morgellons Gets a Little More Respect

Via plime: the AP reports that the CDC has commissioned a study of Morgellons, a mysterious, possibly parasitic, possibly psychosomatic ailment that has been known possibly for centuries but dismissed as delusional parasitosis.

The study will be done in northern California, the source of many of the reports of Morgellons (pronounced mor-GELL-uns). Researchers will begin screening for patients immediately, CDC officials said Wednesday. A Kaiser official expects about 150 to 500 study participants.
Morgellons sufferers describe symptoms that include erupting sores, fatigue, the sensation of bugs crawling over them and — perhaps worst of all — mysterious red, blue or black fibers that sprout from their skin. They've documented their suffering on Web sites.


The Morgellons Research Foundation has more information, including pictures of the alleged neon threads that grow out of victims.

Thursday, January 17, 2008

Cholesterol Declared Good For You

Via Half Sigma: the New York Times reports that the link between "bad" cholesterol and bad outcomes has been torpedoed by two recent studies of non-statin cholesterol-reducing drugs:

In the last 13 months, however, the failures of two important clinical trials have thrown that hypothesis into question.
First, Pfizer stopped development of its experimental cholesterol drug torcetrapib in December 2006, when a trial involving 15,000 patients showed that the medicine caused heart attacks and strokes. That trial — somewhat unusual in that it was conducted before Pfizer sought F.D.A. approval — also showed that torcetrapib lowered LDL cholesterol while raising HDL, or good cholesterol.
Torcetrapib’s failure, Dr. Taylor said, shows that lowering cholesterol alone does not prove a drug will benefit patients.
Then, on Monday, Merck and Schering-Plough announced that Vytorin, which combines Zetia with Zocor, had failed to reduce the growth of fatty arterial plaque in a trial of 720 patients. In fact, patients taking Vytorin actually had more plaque growth than those who took Zocor alone.
Despite those drawbacks, that trial, called Enhance, also showed that patients on Vytorin had lower LDL levels than those on Zocor alone. For the second time in just over a year, a clinical trial found that LDL reduction did not translate into measurable medical benefits.


Statins do help people, but the mechanism may be something other than their cholesterol-lowering effects.

Wednesday, January 16, 2008

Popcorn Lung

Via plime: The Brisbane Times reports on a Denver man who's the only known consumer to fall prey to the dread disease of popcorn lung.

Popcorn lung, officially called bronchiolitis obliterans, generally has been associated with people who worked in microwave popcorn plants mixing large vats of flavours. Hundreds of workers have said they have severe lung disease or other respiratory illnesses from inhaling diacetyl vapours.
The chemical has been the subject of hundreds of lawsuits against the companies that produce or use the butter flavouring.
Watson is suing the store where he bought his popcorn instead.

Tuesday, January 15, 2008

The Gay Germ

The genetics of male homosexuality came up on a mailing list recently, so I had the opportunity to push the plague perspective, or as it is more commonly known, the gay gene theory or pathogenic hypothesis. Nor is the gay germ alone among infectious causes of personality:

Cochran claims that theories of the cause of narcolepsy - that it is an auto-immune disease triggered by a virus - make the mechanism of selective brain modification plausible. He also claims that only humans and sheep exhibit homosexual behavior at population levels near 1% or greater. He says that given their physical proximity, it would be plausible to expect a pathogen that affected both species.
Proponents cite increasing evidence that some cases of Schizophrenia may be linked to exposure with Toxoplasma gondii. Other studies suggest that a variety of mood disorders may be linked to Borna Virus.

Monday, January 14, 2008

Beware the Stealthy Headache

Via Universal Hub: TS the EMT reports that we almost lost a building full of people in Boston to carbon monoxide poisoning:

Shortly after nine o'clock, a little girl crawled out of bed, tiptoed into the living room, and told her mother she wasn't feeling well.
A few minutes later, the girl's sister complained of a headache, too. Then the mother began to feel ill herself. Assuming they were all coming down with a bug of some kind, she picked up the phone and called 911.
[...]
Fortunately, nobody was found unconscious in an apartment. Workers from the gas company came to investigate, and apparently they located the source of the problem. The windows were opened, the building aired out, and the residents were able to return to their homes.
This could have been a real catastrophe. A few hours later, everyone would have been alseep. The rising carbon monoxide levels would have gone unnoticed. Dozens of people would have lapsed into unconsciousness, and by the time anyone noticed a problem, everyone in the building might have been dead.
In fact, this might have been a criminal negligence case in the making. Leaving the scene we heard talk that work was being done on the building, and that workers had temporarily disconnected the smoke- and carbon-dioxide detectors.

Monday, January 07, 2008

Follica, the Kindest Cut

Via Universal Hub: Xconomy reports on Follica, a biotech startup dedicated to curing baldness.

Cotsarelis, an expert in epithelial stem cells such as those found in the skin, was studying how skin heals and noticed that new hair follicles seemed to be forming in the middle of some of some wounds. He learned that when the skin’s top layers were removed, some cells within the wound revert to a more primitive state (what he calls an “embryonic window”) from which they can develop into either hair or skin. With more research, says Zohar, Cotsarelis found that he “could actually push them to one direction or another.” In a widely read Nature paper published last May, Cotsarelis showed for the first time that it’s possible to create new hair follicles in adult mammals—and to shut down hair growth. He could even grow thicker, darker hair.
Zohar says Follica has further developed this work and filed additional patents to protect the technology. What’s so beautiful about the approach, she says, is that translating it into a treatment for humans involves only devices and drugs that are already on the market. A doctor would first use a microdermabrasion tool, say, or a laser to remove the top layers of the skin—as is already commonly done in a number of dermatologic and cosmetic procedures—knocking some cells back into a primitive state. The doctor can then use this newly created therapeutic window to inject drugs that push the cells to develop along one pathway or another and grow hair or skin. Zohar won’t reveal what drugs Follica is using, except to say that they are small molecule drugs normally taken orally for purposes with no relation to hair growth.