Children should avoid anti-depressants
Now there’s a headline I never thought I’d see… The British National Institute for Health and Clinical Excellence (NICE) has formally determined what practitioners have known for quite a while: that children and anti-depressants should only be mixed in moderate to severe cases of depression. The risk of SSRIs leading to suicide and suicidal thoughts is relatively well-known given the civil suits against Pfizer (the makers of Zoloft) stemming from teenaged suicide allegedly triggered by the drug.
The determination by NICE went a step further and stated what I’ve known for quite a long time: that many of the folks on anti-depressant need therapy more than they need medication. In the UK, NICE has said that this doesn’t happen as often as it should due to a shortage of therapists. I suspect that this is one of the problems, but the other is that people simply don’t want to take the time out of their lives for cognitive behavioral therapy (CBT) when they could have a magic bullet that does almost as well. In the United States, this is certainly the case.
There are certainly legitimate cases where people need these medications, but nowhere near the numbers that actually take them. I believe that we have direct-to-consumer advertising and doctors and patients who simply don’t want to bother with therapy. I hope that this will change soon. Frankly, I expect that it will as insurance companies realize that while paying for therapy now is more expensive, they can save a fortune later in long-term drug costs when those people that only needed a little help are back on their feet, SSRI-free.
Nobel prize for medicine awarded to discoverers of H. pylori
Helicobacter pylori, the stomach bacteria best known for causing stomach and duodenal ulcers was discovered in 1982 by Doctors Robin Warren and Barry Marshall. The organism is one of the only bacteria able to survive in the low pH in the stomach which can dip as low as 1 to 2 after a person eats a meal. A stomach ulcer (image), of course is a hole in a mucosal lining of the stomach which causes inflammation and bleeding. Before the bacterial cause was found, however, many people died because the root cause of the ulcer was never fixed.
In the days before the discovery of H. pylori, people thought that ulcers were caused by stress and a poor diet. While these things can help trigger an ulcer, they generally aren’t the root cause. By identifying the underlying culprit, not only did Doctors Warren and Marshall help many people suffering from ulcers get better, but they also changed the way society looked at those who had ulcers. Instead of being looked at almost as a moral problem, they made it a “real” physical ailment by isolating its cause.
So determined was Dr. Marshall to prove that H. pylori was the cause that he infected himself with it to prove once and for all that it was, indeed, the culprit. Because H. pylori prefers an acidic environment, it can stimulate the parietal cells to secrete more acid which can further damage the mucosal lining, which can lead to bleeding and eventually death. H2 blockers and proton-pump inhibitors (PPIs) can decrease the amount of acid in the stomach, but they don’t completely get rid of the problem, they just stifle one of the symptoms. Combining a PPI and antibiotics (generally two at a time), you can get rid of the ulcer for good — or at least until the next infection. Generally, amoxicillin with Flagyl or Biaxin is used to treat an ulcer.
While deadly stomach ulcers are generally a thing of the past in first-world societies, they’re still a huge problem in developing countries, where almost everyone has an H. pylori infection, even over 20 years after the discovery of our little friend.
HIV becoming less virulent?
Research comparing samples of HIV-1 from 1986-89 to samples from 2002-03 have found the virus weakening. The new samples do not multiply as well and they appear more susceptible to drugs. This, of course, flies in the face of other research showing that HIV is actually becoming more drug-resistant and virulent. What is actually the case is still up for grabs, but the new findings suggest that in several (human) generations, HIV may not be lethal.
Traditionally, it has been thought that the more hosts HIV passes through, the more lethal it would become. The new study contradicts this, suggesting evolutionary forces at work: if a virus becomes more efficient, it’s going to wipe out hosts quicker and more effectively. In the short-run, this may be beneficial, but in the long run, it will wipe out what is effectively its environment, leading to extinction of the species itself.
“There is a natural trend to reach an ‘equilibrium’ between the agent and the host interests, in order to guarantee concomitant survival for a longer time,” he said.
It makes sense, then, that the virus would adapt to decrease in virulence which ensures its survival for a long time to come. While it’s too early to say one way or the other, this latest study affords new hope in the search for a cure for HIV and AIDS. In the meantime, caution is urged in being lulled into a false sense of security, despite the fact that other infectious diseases have shown the same tendencies in weakening. Among these are smallpox, TB, and syphilis.
Obviously it goes without saying that this doesn’t mean that crazy people like Christine Maggiore are correct and/or have the moral high ground, however.
Less help during disease outbreaks
The BBC is running a story about how there’s less volunteer help during disease outbreaks. Sometimes I wonder who funds these stories, and why the results are considered newsworthy. I realize the irony here, since I’m writing about it myself, but I’m writing about it because it is a non-story.
Eighty-four per cent of the 6,000 surveyed were willing to report for duty after an environmental disaster.
But just 48% said they would do the same during an outbreak of Sars.
Just over half - 57% - said they would work during a radiological event, and 61% in the event of a smallpox epidemic.
But any disaster involving mass causalities, such as a transport accident, would see 86% willing to work.
I wonder, sometimes, if common sense has any place in science. Common sense, while not always common, nor always sense, does play some role when it comes to things such as this. While common sense would say that the odds of having a coin land tails after flipping nine heads in a row would be more than 50%, this is not the case. Similarly, the idea that a heavy object falls faster seems as though it would be obvious, but objects fall with the same rate of acceleration regardless of weight.
So back to this study.
Kristine Qureshi, who led the research, said: “Although we might assume that healthcare employees have an obligation to respond to these high impact events, our findings indicate that personal obligations, as well as concerns for their own safety play a pivotal role in workers’ willingness to report to work.”
Robyn Gershon, associate professor of sociomedical sciences, at the Mailman School’s National Center for Disaster Preparedness, who also worked on the study, added: “Employers must recognise that their healthcare workers are likely to be as concerned or even more concerned about their safety than the average citizen, because they have a greater understanding of the risks involved.”
My response to that is “You don’t say?!” Honestly, health care workers are not automatons. They are living, breathing people with their own hopes and dreams and families to think of. While the idea of an utterly selfless doctor going off to fight SARS outbreak somewhere is attractive, the cost-benefit analysis of the situation must be evaluated. Does that warm, fuzzy feeling from doing the right thing, and a tax write off offset the risks to himself or his family enough to cause him to help out during an infectious outbreak?
One should not be obligated to put oneself in harm’s way for the benefit of another human being. No job or calling is so high that it can be required. This is true of police officers (who contrary to popular belief are not required to protect you) and doctors and firefighters. While codes of ethics and “typical” public servant behavior might make such behavior seem as though it were somehow mandatory, potentially sacrificing one’s life always comes down to individual choice.
Giving mice Down’s syndrome
A “technical” step forward has been made in understanding Down’s syndrome: researchers have successfully introduced 90% of the 250 genes on human chromosome 21 into the embryonic stem cells of mice. A normal person has two copies of chromosome 21, but a person with Down’s syndrome has three, making it part of the aneuploidy class of disorders (of which I have touched on in the past). Using the compromised stem cells, researchers were able to create a strain of mice that carried the extra chromosome.
This strain of mice has problems with memory, brain function, and heart formation. It remains to be seen whether they show a disposition towards other diseases like leukemia, which people with Down’s often have to deal with. By creating the modified stem cells, researchers hope to learn which genes control which aspects of the Down’s symptom. For instance, by learning which genes affect heart formation, they hope to one day create stem cell therapies that will turn off the genes of developing children with Down’s.
While far from a cure, this ability to create strains of mice that can be experimented with shows huge promise in the field of Down’s research. If scientists can discover which genes control brain and heart formation, and which genes alter thyroid function, they can potentially suppress their expression in developing fetuses at some point down the road.
This, of course, is assuming that such therapies will be legal in places like the United States, whose laws are quite restrictive when it comes to stem cell research. I suppose that one could go to a place like the UK for treatment, but I suspect that if real-word promise is offered for relatively mainstream conditions, conservative public opinion in the US will change. Slowly.
Fetal crying
Fetuses, it seems, can cry too. New research shows a fetus going through the same motions an infant or young child does when they cry: sharp, irregular intake of breaths, an open mouth, and chin quivering. There’s even a video of a moving ultrasound showing a girl crying at 28 weeks. I found the video absolutely amazing, not ever having seen a still ultrasound or anything of the sort, being an only child and one of the youngest in my extended family. It aroused protective feelings in me, and I’m sure I’m not the only one who’s going to feel that way when they see the video clip.
I expect that anti-abortion advocacy groups will use this as fodder for their campaign, especially since they already use hurting an unborn child as a tool against abortion. This video comes at a time when the subject of fetal pain is being hotly debated, and other studies are indicating that they cannot.
Their report, being published today in the Journal of the American Medical Association, is based on a review of several hundred scientific papers, and it says nerve connections in the brain are unlikely to have developed enough for the fetus to feel pain before 29 weeks.
Well, I just saw a video that begs to differ. Arguing whether what I saw was pain or not seems to be a semantical argument at best, because that fetus was clearly in discomfort. Assuming (and this is a big assumption to make right now) that the fetus can feel pain, fetuses being aborted in the 28-29 week stage will likely have to anesthetized before they can be aborted for ethical reasons.
“This is an unknowable question,” said Dr. David Grimes, a former head of abortion surveillance at the Centers for Disease Control and Prevention who now delivers babies and also performs abortions in Chapel Hill, N.C.
“All we can do in medicine is to infer.” Nonetheless, he said, the new article makes a compelling case for lack of pain perception in fetuses before 29 weeks.
Indeed it is “unknowable,” but I think this video makes a strong case for fetal pain, and certainly crying. While I have mixed feelings on the abortion issue, and I don’t feel that this is the place to air them, I certainly sympathize with that fetus. Hearing tones at the 100Hz level at 95dB would probably make me cranky, too.
Drug-resistant bacteria strains becoming more virulent
I have written about drug-resistant bacteria in the past, and not a day goes by that there isn’t some press release on Eurekalert about antibiotic resistant bacteria. Most of these press releases are negative, and today was no exception. Every time I read about drug-resistant strains in the news, it freaks me out a little bit, and makes me uneasy deep down. Perhaps because I am more familiar with the subject than most, and I know that there isn’t much being done about the problem in the medical community because it’s not a profitable problem to tackle for the big pharmaceutical companies. Traditional antibiotics like macrolides, penicillin derivatives, fluoroquinolones, and others have been “enough” for most people… until recently.
My unease comes from several different factors. One of them is that here in the United States, it takes roughly ten years for a new chemical entity (NCE) to go from concept to approval to market. This ensures (in theory) that a drug is relatively safe and effective. With fast-tracking, this time can be roughly halved. That means if a drug company were to come across a new compound that killed several strains of drug-resistant bacteria, it would take almost ten years before prescribers would have it available to them. At the very least, it would take five years. In the meantime, untold numbers of people could die from related infections.
Drug-resistant strains like MRSA are responsible for such lovely conditions as necrotizing fasciitis, or flesh-eating bacteria, as it is popularly known. Most people that end up with NF are otherwise-healthy individuals who somehow contracted it. This can happen as a result of soft tissue trauma (car accident, a cut or scrape, etc.) and it can be idiopathic, which means that its cause is unknown. The only cure for NF is to remove all of the compromised tissue. This can lead to amputated limbs or removing sections of the body. It’s not pleasant, and is just one of the common manifestations of drug resistant bacteria, and it happens to normal people: people like you and I just going about their daily lives. Of course there are risk factors that can increase your chances of infection, like diabetes mellitus and HIV, but they are hardly a requirement for infection.
In any case, a particularly disturbing press release today warns of drug-resistant bacteria gaining virulence. This means that aside from being able to resistant the antibiotics that we have today, they are also becoming more aggressive, spreading and killing faster than before. Once again, these are normal children that were infected.
[...]researchers at the University of Chicago describe three cases of rapidly progressive and ultimately fatal Staphylococcus aureus infections in small children.
Although all three children were previously healthy, the infection caused severe sepsis, rapid clinical deterioration and bleeding into the adrenal glands, a complication, known as Waterhouse-Friderichsen syndrome, that is usually associated with fulminant bacterial meningitis.
Two of the three bacterial strains were resistant to standard antibiotics. In all three cases, the disease progressed so rapidly that neither standard nor alternative antibiotics had an effect.
“What we saw in these patients is not in the textbooks,” said Robert Daum, M.D., professor of pediatrics at the University of Chicago and senior author of the study. “This is the first time this unusual syndrome has been described in patients with a Staph infection.”
This latest news only adds to the problem of drug-resistant strains. Right now, there is no way of beating this particular strain because it moves too fast. And indeed, with current knowledge, the only solution seems to lie in creating a vaccine that can prevent humans from becoming infected, since it “is the only way we have ever truly beaten an infectious disease.”
It is never my intention to fear-monger, because I believe that crying “wolf!” is a bad idea unless there is really, truly a problem. And the problem of antibiotic resistant bacteria is a very real one, and it is something that the public needs to be more aware of. Many of the topics and things that I write about here on polyscience are largely fluff stories in that they’re simply interesting or cool, and don’t have much of an impact on people. But I believe this is not one of those fluff pieces.