Archive for the ‘Medical’ Category
Jyoti Madhusoodanan has an interesting article at The Scientist:
The search for alternatives to antibiotics has led many scientists to a treatment practice that’s been on the fringes of modern medicine for nearly a century. Bacteriophages—viruses that infect and kill bacteria—were first used in 1919 to treat a wide range of infections.
Phage therapy fell out of favor with the advent of antibiotics; the practice has only persisted in some European countries as an experimental treatment. However, earlier this year, phage therapy was highlighted as one of seven approaches to “achieving a coordinated and nimble approach to addressing antibacterial resistance threats” in a 2014 status report from the National Institute of Allergy and Infectious Diseases (NIAID).
Classically, the treatment uses a bacteriophage, or cocktail of several phages, to specifically lyse target pathogenic bacteria. Researchers and biotech companies continue to refine this method, but in the absence of clear regulatory and manufacturing practices—and potential profits—phage therapy has yet to become mainstream for “the same reason many big companies have gotten out of making new antibiotics,” said microbiologist Jason Gill of Texas A&M University. “The development costs are the same as for any other drug, but the profits are not as high as you might make from a new kind of [cholesterol] drug.”
Still, other scientists have honed in on the bactericidal enzymes or tactics used by phages to identify potential small-molecule antibacterial drugs. And beyond human medicine, phage therapies have been successfully commercialized for use in farms and on food products. Their success—or failure—in these other applications hint at the road ahead for clinical phage therapy.
“All [phages] do is interact with and parasitize the bacteria, so we can learn from them exactly how they do this, and identify a number of different Achilles’ heels of the bacteria,” said microbiologist Raymond Schuch of Rockefeller University in New York City.
First on farms
Renewed interest in phage therapy is due in part to the growing problems posed by antibiotic overuse in the clinic, which has escalated microbial resistance. But even when antibiotics are overprescribed, most people only receive doses in response to illness.
On farms, however, small amounts of antibiotics are routinely used to promote animal growth or prevent disease outbreaks; the practice has been linked to long-term changes to animals’ commensal microbiomes, increased transfer of antibiotic-resistant bacteria from animals to farmworkers, and potential risks to human health. Recent governmental initiatives to curb antibiotic use have largely overlooked their use on farms. But a small number of phage-based alternatives are now available from Maryland-based biotech Intralytix, which manufactures sprays that target Listeria, Salmonella, and E. coli O157:H7 in foods and food-processing facilities.
“To get phages approved for food safety uses wasn’t actually very difficult,” said Gill, who is not involved with the company. “Maybe the regulatory issues [with clinical use] won’t be as big a hurdle as we think but it’s not something we know much about right now.”
Scientific clarity—understanding why and how to design phage treatments—is a higher priority, according to Gill. In a 2006 Antimicrobial Agents and Chemotherapy study, he and his colleagues attempted to use phages to treat bovine mastitis caused by Staphylococcus aureus, a growing concern in the dairy industry. However, only 16 percent of cows treated were cured. High phage concentrations in milk up to 36 hours after treatment also suggested that the virus was being inactivated or destroyed within the gland. “Not every bacterial infection is going to be equally successfully treated with phage therapy,” said Gill.
The work highlights one of its many quirks: viruses that look like efficient killers in experiments can . .
“Best medical system in the world”: ER physicians are now independent contractors and do not accept insurance
The US developed a medical system that uses the free market to resolve problems, rather than socialistic single-payer system (as in, say, France). The US approach has some serious problems if you need to go to the ER. But probably the invisible hand of the market will fix that. /sarcasm
UPDATE: Kevin Drum has a good post on this.
From the letters section of the New Yorker, responding to Ian Frazier’s piece about the opioid-overdose epidemic (“The Antidote,” September 8th)
Frazier writes that on August 28th it was announced that drug-overdose deaths have gone up forty-one per cent in New York City. Another news item, from August 25th, revealed that deaths associated with the use of opiate drugs fell in thirteen states after those states legalized medical marijuana. According to a report in JAMA Internal Medicine, “Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.” Six years after states legalized medical marijuana, opioid-related overdoses declined thirty-three per cent compared with states with no formal access to marijuana. In states where marijuana use is illegal, people looking to get high visit a local dealer, and might walk out with all sorts of extremely addictive and potentially lethal drugs. In states like California, where medical marijuana is legal, they go to a dispensary, and don’t leave with anything except marijuana. The legalization of marijuana may not be the ultimate solution to drug problems, but it represents a step in the right direction—a thirty-three-per-cent reduction versus the forty-one-per-cent increase in deaths in New York City.
Los Angeles, Calif.
In the meantime, the drawbacks to legalizing marijuana are quite obscure.
I very much like DietDoctor.com, a blog run by a Swedish physician who seems quite sensible about diet (low-carb, high fat, normal protein) and who sends out a little newsletter. Today’s discusses the lunch given to the participants at a medical conference on diabetes:
Extremely interesting article in the New Yorker by James Surowiecki. From the article:
. . . Handing mentally ill substance abusers the keys to a new place may sound like an example of wasteful government spending. But it turned out to be the opposite: over time, Housing First has saved the government money. Homeless people are not cheap to take care of. The cost of shelters, emergency-room visits, ambulances, police, and so on quickly piles up. Lloyd Pendleton, the director of Utah’s Homeless Task Force, told me of one individual whose care one year cost nearly a million dollars, and said that, with the traditional approach, the average chronically homeless person used to cost Salt Lake City more than twenty thousand dollars a year. Putting someone into permanent housing costs the state just eight thousand dollars, and that’s after you include the cost of the case managers who work with the formerly homeless to help them adjust. The same is true elsewhere. A Colorado study found that the average homeless person cost the state forty-three thousand dollars a year, while housing that person would cost just seventeen thousand dollars.
Housing First isn’t just cost-effective. It’s more effective, period. The old model assumed that before you could put people into permanent homes you had to deal with their underlying issues—get them to stop drinking, take their medication, and so on. Otherwise, it was thought, they’d end up back on the streets. But it’s ridiculously hard to get people to make such changes while they’re living in a shelter or on the street. “If you move people into permanent supportive housing first, and then give them help, it seems to work better,” Nan Roman, the president and C.E.O. of the National Alliance for Homelessness, told me. “It’s intuitive, in a way. People do better when they have stability.” Utah’s first pilot program placed seventeen people in homes scattered around Salt Lake City, and after twenty-two months not one of them was back on the streets. In the years since, the number of Utah’s chronically homeless has fallen by seventy-four per cent. . .
Obama is taking steps against excessive use of antibiotics by signing an executive order. Because of evolution, which actually does work, natural selection favors pathogens that can resist the antibiotics used, so such pathogens proliferate. In this case, however, the selection is not really “natural”: since humans are administering the antibiotics (in large numbers), we are in effect artificially selecting pathogens for antibiotic resistance—that is, we are engaged in a stupendously large program to breed pathogens that we cannot kill with our current medications.
Why one earth would we do such an insane thing? Money! You can make a lot of money by breeding superstrong pathogens that we cannot kill. Of course, eventually such pathogens will become a real problem, with people once again dying from small infections, but the beauty part is by then the money will have been made!
That is actually the “thinking” (if one can call it that) behind the great pressure to continue the super-pathogen breeding program.
Of course, Obama all to frequently seems incapable of committing himself to effective action. He may indeed have good intentions, but they are frittered away in compromises, half-measures, and backing down. Kerry Grens writes in The Scientist:
President Obama yesterday (September 18) signed an executive order and announced a National Strategy to fight antibiotic resistance. His administration also offered up a $20 million reward for developing a fast diagnostic test that could identify highly resistant bugs.
The National Strategy is a five-year plan including goals such as slowing the spread of drug-resistant bacteria; accelerating the development of new antibiotics, vaccines, and drugs; and enhancing the surveillance of antibiotic resistance. The President’s Council of Advisers on Science and Technology (PCAST) also released its report outlining similar strategies.
“What’s new here is there is a highly federal focus that’s highly coordinated,” Eric Lander, the cochair of PCAST and founding director of the Broad Institute of MIT and Harvard, told CNN. “We are endorsing a variety of specific goals in order to get our arms around this problem. If we’re producing antibiotics at a greater rate than we’re losing them, then we win in the long run.”
Those in the infectious disease community appeared pleased by the attention on antibiotic resistance.“The President’s engagement and actions in fighting antimicrobial resistance are a great step forward, but follow-up with resources and leadership in implementation will be critical,” Jesse Goodman, the director of the Center on Medical Product Access, Safety and Stewardship at Georgetown University Medical Center, said in a statement e-mailed to The Scientist.
The Natural Resources Defense Council (NRDC), however, expressed disappointment in the lack of focus on antibiotic use on farms. “Just as the administration is taking steps to deal with abuse of antibiotics in humans, it must take steps to curb the overuse of antibiotics in animals, which consume about 80 percent of the antibiotics sold in the United States. Shying away from taking these needed steps will not yield the ‘substantial changes’ that PCAST says are necessary,” Mae Wu, health attorney at the NRDC, said in a statement. The FDA has spearheaded efforts to get drugmakers to change their labeling to help curb the use of antibiotics for beefing up livestock.
Emphasis added. And Obama? He went home. He will do nothing about the core of the problem, just kind of tap around the edges.
I am so disappointed in this Administration. Plenty of fire in the belly for going after whistleblowers, protecting torturers, making more and more of government secret, letting the NSA and CIA do whatever they want, and so on—but actual constructive change? I think he used it all up in the Affordable Care Act.
It’s too late for you, unfortunately. Via Kevin Drum, this article by Melissa Dahl at New York magazine explains how to do it. From the article:
. . . To understand this apparent gender divide in recalling memories, it helps to start with early childhood — specifically, ages 2 to 6. Whether you knew it or not, during these years, you learned how to form memories, and researchers believe this happens mostly through conversations with others, primarily our parents. These conversations teach us how to tell our own stories, essentially; when a mother asks her child for more details about something that happened that day in school, for example, she is implicitly communicating that these extra details are essential parts to the story.
And these early experiments in storytelling assist in memory-making, research shows. One recent studytracked preschool-age kids whose mothers often asked them to elaborate when telling stories; later in their lives, these kids were able to recall earlier memories than their peers whose mothers hadn’t asked for those extra details.
But the way parents tend to talk to their sons is different from the way they talk to their daughters. Mothers tend to introduce more snippets of new information in conversations with their young daughters than they do with their young sons, research has shown. And moms tend to ask more questions about girls’ emotions; with boys, on the other hand, they spend more time talking about what they should dowith those feelings.
This is at least partially a product of parents acting on gender expectations they may not even realize they have, and the results are potentially long-lasting, explained Azriel Grysman, a psychologist at Hamilton College who studies gender differences and memory. “The message that girls are getting is that talking about your feelings is part of describing an event,” Grysman said. “And for boys, emotions are something to be concerned with when they are part of a larger issue, but otherwise not. And it’s quite possible, over time, that those tendencies will help women establish more connections in their brains of different pieces of an event, which will lead to better memory long-term.”
Because a memory doesn’t exist the way we tend to imagine it; it’s not a singular, fully formed thing buried in some small corner of the mind. Instead, it’s “a pattern of mental activity, and the more entry points we have to what that pattern might be, the more chances we have to retrieve it,” Grysman said. Researchers call those entry points “retrieval cues,” and they can be as seemingly mundane as what you were feeling, what you were eating, or what you were wearing.
The more entry points you’ve got about an event, the more likely you are to remember it. It’s how Grysman advises his students to study for tests. “I tell them to try to make links between the material they’re studying and other parts of their lives, and those other parts of their lives serve as entry points,” he said.
So Grysman’s theory, which he explored in an extensive review of the literature published last year, is that those early conversations with your parents implicitly told you which details are important to remember about the things that happen to you, and which are not. And because parents’ conversations with girls include references to both more information and more emotion, they’re setting their daughters up to have stronger memories over their lives. . .
UPDATE: The more I thought about this—and I did think about it, given that I have 3 grandsons 2 and under—the more it seemed that it would be easy to provide an environment for young children that will strengthen their memory. For example, in asking “What happened to you today?”, you can ask follow-up questions to provide more points of access while also helping the children know what details to notice. For example:
Who was involved? What did they say? What were their emotions/feelings? (E.g., happy, sad, laughing, crying) What did you hear? (Was there any music?) What colors? and so on.
By asking about smells, tastes, sounds, sights, and so on, children get to pay attention to their senses. By asking about emotions and feelings, they learn to pay attention not only to their own feelings (something that must be learned), but also learn to think about (analyze, to some degree) the feelings of others and what causes those feelings. And so on.
Now I want a do-over: to have my children very young once more and to listen better to their stories and ask them more about what they notice.