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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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