Back to Chernobyl
I can remember reading about the Chernobyl accident in Readers’ Digest back when I was just six or seven years old. It was their condensed book in that issue, and I remember it gave me nightmares for weeks afterwards. Since then, I’ve had an obsession with the nuclear power plant, and indeed, I think it would be a cool summer job to work at a nuclear power plant. Despite my best efforts, that never panned out. By federal regulations, a person is allowed to be exposed to so much radiation per year, and those that work only a few months a year can get that amount in a relatively short amount of time, which allows them to do some things that those that work at a plant year-round theoretically cannot do. At least, this is my understanding; someone please correct me if I am wrong.
Over the years I’ve read some really cool articles and photojournals of Chernobyl and the surrounding area have come and gone. Some day, I would like to visit the area and take photos for myself. I think it would be fascinating to see a place that has been abandoned virtually overnight, leaving things today almost exactly as they were when the meltdown occurred.
This interview with Alexander Yuvchenko is always an excellent read. It’s a first hand account of the Chernobyl engineer’s efforts on that fateful day. It’s highly compelling; I highly recommend it.
Anyway, Chernobyl comes up in the news periodically for one reason or another, and today is one of those days. And it’s a potential spot of good news in an an otherwise bleak, ongoing story. It appears that the number of deaths as a result of the meltdown is higher than perhaps it should be. The confusion over the number of lives lost arises from the number of emergency and recovery workers that have died since 1986 which cannot be linked to radiation exposure.
This news, while good, does not lessen the human tragedy of the disaster by much. 4,000 cases of thyroid cancer have been diagnosed, most in people who were children or adolescents at the time of the meltdown. Drinking milk from cows who consumed irradiated grass is cited in these cases. Unexplained symptoms exhibited by those living in the affected areas are also present. Mental health experts cite high anxiety levels among the local populace as a source for concern, and it is well-known that anxiety can cause symptoms of ill health, so radiation cannot be linked to this in any significant way at the present time.
As always, the integrity of the concrete sarcophagus is in question, but radiation levels outside the 18-mile “dead zone” have apparently “returned to normal.” Despite this, I can’t say I’d want to live anywhere near there. Visit, perhaps, but not live. (Photos from inside the dead zone (”Ghost town”) can be seen at the photojournal linked above.)
Bullets: armor-piercing shells, gluten, and transferred toxins
It’s time for another bullet roundup. Lots of cool stuff, but without enough substance to really create a real post about them. Nonetheless, they’re worth posting about.
- New shells that use a chemical reaction to burn through armor plating are on the horizon. Instead of using depleted uranium shells which are toxic to the environment, the new technique uses to chemicals, that, when mashed together, create tremendous heat almost instantly, burning through armor. I wonder what this hopes to accomplish, save burning a hole in something. Will there be some sort of anti-personnel round underneath, or will the reaction simply burn everyone to death instead?
- New advances when it comes to isolating the toxins that cause wheat gluten intolerance. One person out of 200 in the West is affected by gluten intolerance, which severely limits their diet. A person who is wheat gluten intolerant cannot eat pasta, cereal, bread, or many of the other staples that most people enjoy. By isolating the two aggravating types, this raises hopes that wheat products without these two toxins can be developed.
- Household toxins can be transferred across the placenta. This isn’t especially surprising, since most foreign substances cross the placenta but it’s worth mentioning in the light of Hurricane Katrina. Jonathan has a good writeup in this week’s Science.Ars that explains why toxins in battered New Orleans are as big a health issue as disease proliferation through dirty water. In the case of a fetus, these toxins, including plasticizers, can cause significant damage to a developing baby.
Regrowing hearts, lungs, but not brains
Researchers have recently found a way to cause mice to regrow and/or regenerate vital organs: hearts, lungs, appendages, etc. In fact, the only thing that they couldn’t get to regenerate was the brain. Normally, mammals cannot regrow limbs, once they’re lost (unlike certain reptiles), because the genes that control this ability are turned off by default. Ellen Heber-Katz of the Wistar Institute found that by manipulating about a dozen genes, this ability could be turned back on. The whole thing seems rather vague to me, for the simple reason that what genes and how many there were that were altered seems to be unknown. While the results are slated to be revealed this coming week, we’re left dangling in the meantime.
The self-healing mice, from a strain known as MRL, were then subjected to a series of surgical procedures. In one case the mice had their toes amputated — but the digits grew back, complete with joints.
In another test some of the tail was cut off, and this also regenerated. Then the researchers used a cryoprobe to freeze parts of the animals’ hearts, and watched them grow back again. A similar phenomenon was observed when the optic nerve was severed and the liver partially destroyed.
While direct analogs in the human genome are unknown at this point, this could potentially lead to much longer lifespans among humans. It’s almost mind-boggling to think about: imagine an injection of fetal liver cells that would allow an elderly person to have six months of regeneration. Bad hearts are made new, arthritic joins are repaired. I doubt it’s this easy in human beings, of course, so I will retain a modest amount of skepticism for the time being, but I do think that this sort of treatment offers a great deal of hope (somewhere) on the horizon.
What I would like to know is whether stem cell research is involved. If not, this would leapfrog a huge ethical barrier, at least here in the United States. Sadly, though, I suspect that there is, simply because of the phrase “fetal liver cells.” Unfortunately, this regeneration method doesn’t offer any hope for those who choose (or chose) to indulge in reckless recreational habits of questionable legality in the past or present.
Medical residents and sleep deprivation
One of the many reasons I didn’t want to go to medical school was because I knew what it would be like during residency: 90-100 weeks with pay that broke down to somewhere around $8 an hour gross. The real deal-breaker for me was the long hours: I get irritable when I’m tired, and my performance goes downhill quickly. I know this, so I avoid it. It came as no surprise, then, when I read this press release regarding the effects of fatigue on doctors. The press release says “young doctors” which is misleading — it should say “new doctors.” Just because your doc looks young doesn’t mean he is, and just because a doc is old, doesn’t mean he didn’t get his degree just three years earlier. In any case, chances are, your “normal” doctor isn’t putting in 100 hours a week doing 24 and 32 hour shifts like he probably did once upon a time.
The effect of sleep deprivation on doctors is similar to giving them three to four drinks. Fatigue has long been blamed as a culprit in auto accidents, cited almost as much as alcohol in fatal accidents. Why then, should it be considered acceptable or even desireable for a young doctor to pull a 32 hour shift? New regulations limit the number of hours that a resident is “allowed” to work, but these are often glossed over or ignored entirely. I don’t think it’s healthy, given the responsibility that rests on their shoulders. While the rest of the country is focused on blaming medication dispensing errors as a significant source of patient mortality — and it is — perhaps the scrutiny should be turned to the residents doing much of the diagnosis and prescribing in emergency situations.
How many patients would like their doctors to have 4 drinks and then make a diagnosis and treatment decision? Probably not many, and now studies are showing that a resident being tired is analogous to being slightly drunk.
For example: The reaction time of residents who had just finished a month of heavy work schedules was 7 percent slower and they committed 40 percent more errors than when they were on a month of light schedules, On a driving simulator, they had more difficulty maintaining a consistent lane position and a constant speed during the heavy work compared to the lighter work schedule. Speed variability on the driving test was also 29 percent higher following the heavy-schedule compared to the light schedule after drinking alcohol, but there were no other performance differences between these two conditions.
In other words, after a month of 90-hour weeks with overnight shifts every fourth or fifth night, residents performed about the same as when they had a BAC of 0.04 percent after a month of 44-hour weeks of daytime shifts.
The idea behind residency is to totally and absolutely immerse the new doctors in medicine, to the point that they eat, sleep, and breath it. This is because the classroom is a poor substitute for the real world when it comes to making diagnoses and treatment decisions. So while I understand and sympathize with the motivation behind the practice of beating residents down with medicine, it clearly doesn’t work after a point. I would think that working 12 hours a day six days a week would have the same effect with fewer detrimental consequences. (And it is likely that I would be on my way to medical school instead of being a pharmacy student.) After all, who can learn or do their job effectively when they’ve been up for 24 hours?
Schizotypal creativity
Pretty much everyone is familiar with the phrase “There’s a fine line between genius and insanity.” Well apparently, this is truer than anyone previously thought. People characterized by odd behavior and language who are not fully psychotic or schizophrenic rely more heavily on the right sides of their brains than the rest of the population. This means that they are more likely to be creative than most people, leading to individuals like Mozart, Einstein, Newton, and van Gogh. (Whether van Gogh was sane is still open for discussion, though.)
It has been known for a long while that these “schizotypal” personalities are more creative, but no one has looked into the behavioral manifestations how they experimentally correlate to neurological function. Until now, that is. Brad Folley and Sohee Park of Vanderbilt University recently conducted two experiments to compare the creative thinking processes of schizotypes and schizophrenics, and used normal people as control subjects. The results were interesting: schizophrenics and normal people performed comparably to one another while performing creative tasks, while the schizotypes tended to excel at creative thinking.
In the first experiment, the researchers showed research subjects a variety of household objects and asked them to make up new functions for them. The results showed that the schizotypes were better able to creatively suggest new uses for the objects, while the schizophrenics and average subjects performed similarly to one another.
“Thought processes for individuals with schizophrenia are often very disorganized, almost to the point where they can’t really be creative because they cannot get all of their thoughts coherent enough to do that,” Folley said. “Schizotypes, on the other hand, are free from the severe, debilitating symptoms surrounding schizophrenia and also have an enhanced creative ability.”
The second experiment involved monitoring the prefrontal lobe of the brain while the same subjects were asked to identify new uses for household objects and perform a basic control task. The results showed that all groups used both brain hemispheres for creative tasks, but that the right side activity of the schizotypal personalities was far greater than the normal controls and the schizophrenics. The popular notion that people are “right-brained” if they are creative is largely bunk because creativity requires the use of both hemispheres to come up with anything coherent.
The “coherency” (for lack of a better term) stems from the left side of the brain which identifies objects with their common use, while the right brain might suggest a different use for a given object. To (over?)simplify things, it is up to the left brain to temper the right side’s suggestion to keep it within the bounds of reality.
From personal experience, this “thinking outside the box” behavior can be learned. I think that most people ignore most creative input, opting instead to do the normal thing with the normal tools at hand. Perhaps this is why children are so much more creative than adults most of the time: young children haven’t learned the social value of conformity. And it is this embraced creative input that schizotypal personalities exhibit that cause them to be labelled “abnormal.”
Parasitic brainwashing and African sleeping sickness
The other day I was watching Smallville season 2 (hooray Netflix), and the next morning I read this story about parasitic hairworms “brainwashing” their grasshopper hosts, causing them to jump into water, effectively committing suicide. Anyway, the episode I was watching involved parasitic worms causing their human hosts to do crazy things. Go figure that I dismissed the idea as fun science fiction, only to read the next morning about the same thing happening in the insect world. (I shouldn’t have been surprised though, given the stupid things people do while cracked out on PCP.)
The parasitic Nematomorph hairworm (Spinochordodes tellinii) develops inside land-dwelling grasshoppers and crickets until the time comes for the worm to transform into an aquatic adult. Somehow mature hairworms brainwash their hosts into behaving in way they never usually would – causing them to seek out and plunge into water.
Once in the water the mature hairworms – which are three to four times longer that their hosts when extended – emerge and swim away to find a mate, leaving their host dead or dying in the water. David Biron, one of the study team at IRD in Montpellier, France, notes that other parasites can also manipulate their hosts’ behaviour: “‘Enslaver’ fungi make their insect hosts die perched in a position that favours the dispersal of spores by the wind, for example.”
Now scientists have worked out the mechanism by which these worms cause this mass suicide. The worms produce proteins which directly and indirectly affect the grasshopper’s central nervous system. (Video available; be warned, watching worms larger than their hosts look as though they’re being excreted from crickets and grasshoppers creeps me out.) While the explanation seems rather vague, it can be definitively be said that the grasshoppers and crickets and spiders are not in control of themselves when they take the plunge: they are not doing it willingly.
What’s even more interesting from a human point of view, is what this means for insect behavior and how it affects human beings. In the case of the Nematomorph worm, which starts out microscopic and grows to be larger than its host when it finally takes over, it causes the insect or spider to commit suicide. In the same vein, a parasitic organism like Trypanosoma may cause the host insect to have an increased appetite. This means that the vector — the tsetse fly in this case — may be more aggressive in feeding. This, in turn, can mean greater rates of infection because the odds of an infected tsetse fly biting are greater than those of a non-infected fly, which means more African sleeping sickness being spread.
“Me-too” drugs fuel rising costs
This isn’t surprising at all, as someone who works in the field, but these so-called “me-too” drugs which are reportedly better than their forebears is driving costs.
A “me-too” drug is a drug that has its origins in another drug. Probably the most famous example of this is Prilosec (”The Purple Pill”) and Nexium (”Today’s Purple Pill”). Prilosec’s active ingredient is omeprazole. Nexium’s active ingredient is called esomeprazole.
What’s the difference? Well, Nexium is the left-handed version of omeprazole. In chemistry, S stands for sinister, which means the molecular conformation has a left-handed orientation. (D would be right handed.) So this S-omeprazole is one half of the mixture that comprises it’s predecessor. By specifically picking only the S conformation, the drug is made more potent. This sounds great, but its efficacy is only marginally better than Prilosec — which has a generic version, and costs about a third less than Nexium.
Is this slight increase in efficacy worth 1/3 more? Well, AstraZeneca’s own research suggests that they are not. Nexium was created because AZ’s patent on Prilosec was finally running out, and they wanted to continue to making money from one of their flagship drugs so they released a new version that costs more and performed only partially better. This is the classic definition of a “me-too” drug. Often the research is sort of doctored to make the new drug seem much better than the old. In the case of Nexium, the literature put out by AstraZeneca compared 20mg of Prilosec to 40mg of Nexium. Of course Nexium performed better.
I spoke with an acquaintence who happened to be a drug rep for AstraZeneca, and one of his drugs had been Nexium. He told me that AstraZeneca had compared 40mg of Nexium to Prilosec, and the difference was so negligible that they simply suppressed it, and opted to publish the lobsided 20mg-40mg comparison. He also admitted that Nexium was only released because the patent on Prilosec was expiring.
Some other “me-too” drugs come readily to mind:
- Claritin (loratidine) and Clarinex (desloratidine)
- Celexa (citalopram) and Lexapro (escitalopram)
- Nexium (esomeprazole) and Prilosec (omeprazole)
Generally, these me-too drugs are released as a means to beat patent expiry, as I explained above. In the case of Claritin, not only was the patent expiring, but it went over-the-counter. Almost no insurance companies will pay for Clarinex because it’s so similar and doesn’t demonstrably work better.
Some of these “me-too” drugs are better in most cases without doctoring research findings. Lexapro, for instance, is more potent because only the S enantiomer has any effect in the body, so Forrest opted to remove the D component entirely — citalopram vs. escitalopram. The result is a drug with a lesser side effect profile, and a greater success rate. Nonetheless, it is also a “me-too” drug, and is more expensive than Celexa (for which a generic is now available).
Given everything I’ve said above, it should come as no surprise that these more expensive “me-too” drugs cost the medical industry money. Coupled with an effective marketing campaign — drug reps and direct-to-consumer advertising — patients clamor for the newer drugs, and doctors write for them. If I were a big pharmaceutical company, I’d probably do exactly what AstraZeneca and others have done, simply because it’s good for the bottom line, despite the fact that it contributes to the rising cost of health care in the United States.