Category Archive 'Medicine'
29 Feb 2012

Two New Blood Types Added

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Science Daily reports that the count of blood group proteins has been increased for the first time in more than a decade by two more, raising the count from 30 to 32.

You probably know your blood type: A, B, AB or O. You may even know if you’re Rhesus positive or negative. But how about the Langereis blood type? Or the Junior blood type? Positive or negative? Most people have never even heard of these.

Yet this knowledge could be “a matter of life and death,” says University of Vermont biologist Bryan Ballif.

While blood transfusion problems due to Langereis and Junior blood types are rare worldwide, several ethnic populations are at risk, Ballif notes. “More than 50,000 Japanese are thought to be Junior negative and may encounter blood transfusion problems or mother-fetus incompatibility,” he writes.

But the molecular basis of these two blood types has remained a mystery — until now.

In the February issue of Nature Genetics, Ballif and his colleagues report on their discovery of two proteins on red blood cells responsible for these lesser-known blood types.

Ballif identified the two molecules as specialized transport proteins named ABCB6 and ABCG2.

“Only 30 proteins have previously been identified as responsible for a basic blood type,” Ballif notes, “but the count now reaches 32.”

The last new blood group proteins to be discovered were nearly a decade ago, Ballif says, “so it’s pretty remarkable to have two identified this year.”

22 Aug 2011

Militants Go After British Doctors

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If anyone had any doubts that Chronic Fatigue Syndrome is essentially just a medical term for a confirmed habit of whining and malingering, this news item from Britain’s Guardian describing activists’ attacks on doctors questioning or investigating CFS demonstrates the existence of the sort of political constituency which genuine illnesses just do not have.

The full extent of the campaign of intimidation, attacks and death threats made against scientists by activists who claim researchers are suppressing the real cause of chronic fatigue syndrome is revealed today by the Observer. According to the police, the militants are now considered to be as dangerous and uncompromising as animal rights extremists.

One researcher told the Observer that a woman protester who had turned up at one of his lectures was found to be carrying a knife. Another scientist had to abandon a collaboration with American doctors after being told she risked being shot, while another was punched in the street. All said they had received death threats and vitriolic abuse.

In addition, activists – who attack scientists who suggest the syndrome has any kind of psychological association – have bombarded researchers with freedom of information requests, made rounds of complaints to university ethical committees about scientists’ behaviour, and sent letters falsely alleging that individual scientists are in the pay of drug and insurance companies.

“I published a study which these extremists did not like and was subjected to a staggering volley of horrible abuse,” said Professor Myra McClure, head of infectious diseases at Imperial College London. “One man wrote he was having pleasure imagining that he was watching me drown. He sent that every day for months.”

Chronic fatigue syndrome – also known as myalgic encephalomyelitis (ME) – is common and debilitating. A recent BMJ (formerly the British Medical Journal) feature suggested that as many as one in 250 people in the UK suffers from it. Patients are sometimes unable to move and become bedridden, occasionally having to be fed through a tube. For more than 20 years, scientists have struggled to find the cause, with some pointing to physiological reasons, in particular viral infections, while others have argued that psychological problems are involved.

It is the latter group that has become the subject of extremists’ attacks. The antagonists hate any suggestion of a psychological component and insist it is due to external causes, in particular viruses. In the case of McClure, her “crime” was to publish a paper indicating that early studies linking the syndrome to the virus XMRV were wrong and the result of laboratory contamination. So furious was the reaction that she had to withdraw from a US collaboration because she was warned she might be shot.

A similar hate campaign was triggered by a study published in the Lancet earlier this year. It suggested that a psychological technique known as cognitive behavioural therapy could help some sufferers. This produced furious attacks on the scientists involved, including Michael Sharpe, professor of psychological medicine at Oxford University. He had already been stalked by one woman who was subsequently found to be carrying a knife at one of his lectures.

“The tragedy is that this tiny group of activists are driving young scientists from working in the field,” said Sharpe. “In the end, these campaigns are only going to harm patients.”

22 Apr 2011

What’s In Your Intestine?

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Wired describes a newly published scientific paper offering a new form of human taxonomic classification. This development offers promise of assistance in treating gastrointestinal diseases and obesity and in more specifically personalizing medical treatment in general.

In much the same way that every person has one of eight common blood types, each of us may contain one of several possible bacterial communities, suggests new research. …

In the latest study [Published Apr. 21 in Nature], [Mani] Arumugam, fellow EMBL bionformaticist Peer Bork and dozens of other researchers sequenced every gene they could find in fecal samples from 22 people from Denmark, France, Italy and Spain. Then they searched the data for patterns, looking to see if certain arrangements of bacteria tended to be found in certain people.

The search returned three distinctive “enterotypes,” or bacterial communities dominated by a distinct genus — Bacteroides, Prevotella or Ruminococcus — each of which is found with a particular community of bacteria (see picture above).

“One analogy that people draw — I don’t know how accurate it is yet — is blood type,” said Arumugam. “It’s not exactly the same. Blood types don’t change, but we don’t know if enterotypes do.”

Further analysis of microbiomes from 13 Japanese and four Americans returned the same three clusters, suggesting the patterns are widespread and unconnected to ethnicity, age or gender. With such a limited sample size, however, containing no microbiomes from South Asia, Africa, South America and Australia, it remains to be seen whether other enterotypes exist.

Beyond identifying the enterotypes, “anything we say now will be a hypothesis,” said Arumugam. In terms of function, each of the enterotype-defining genera has been linked to nutrient-processing preferences — Bacteroides to carbohydrates, Prevotella to proteins called mucins, or Ruminococcus to mucins and sugars — but far more may be going on.

“Exactly what they are doing in there is still to be explored,” said Arumugam.

20 Feb 2008

Muslim Medical Students in Britain Refusing to Sterilize

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The Telegraph, 2/4, reported that in Britain Islamic rules are having an impact on medical procedures. One wonders: Do National Health Service patients get to refuse the services of Muslim doctors and surgeons?

Muslim medical students are refusing to obey hygiene rules brought in to stop the spread of deadly superbugs, because they say it is against their religion.

Women training in several hospitals in England have raised objections to removing their arm coverings in theatre and to rolling up their sleeves when washing their hands, because it is regarded as immodest in Islam. …

Universities and NHS trusts fear many more will refuse to co-operate with new Department of Health guidance, introduced this month, which stipulates that all doctors must be “bare below the elbow”.

The measure is deemed necessary to stop the spread of infections such as MRSA and Clostridium difficile, which have killed hundreds.

Minutes of a clinical academics’ meeting at Liverpool University revealed that female Muslim students at Alder Hey children’s hospital had objected to rolling up their sleeves to wear gowns.

Similar concerns have been raised at Leicester University. Minutes from a medical school committee said that “a number of Muslim females had difficulty in complying with the procedures to roll up sleeves to the elbow for appropriate handwashing”.

Sheffield University also reported a case of a Muslim medic who refused to “scrub” as this left her forearms exposed.

Documents from Birmingham University reveal that some students would prefer to quit the course rather than expose their arms, and warn that it could leave trusts open to legal action. …

But the Islamic Medical Association insisted that covering all the body in public, except the face and hands, was a basic tenet of Islam.

“No practising Muslim woman – doctor, medical student, nurse or patient – should be forced to bare her arms below the elbow,” it said.

17 Sep 2007

Doubting Observational Studies

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A stopped clock is right twice a day, and even the New York Times occasionally publishes an intelligent article.

In this week’s Sunday Magazine, Gary Taubes offers some much-needed skepticism about the omniscience of the kind of research whose results we continually hear trumpeted in the media.

Mr. Taubes’s reflections could readily be extended to other areas, particularly to climate studies.

Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem.

… hypotheses begin their transformation into public-health recommendations only after they’ve received the requisite support from a field of research known as epidemiology. This science evolved over the last 250 years to make sense of epidemics — hence the name — and infectious diseases. Since the 1950s, it has been used to identify, or at least to try to identify, the causes of the common chronic diseases that befall us, particularly heart disease and cancer. In the process, the perception of what epidemiologic research can legitimately accomplish — by the public, the press and perhaps by many epidemiologists themselves — may have run far ahead of the reality. …

The goal of the endeavor is to tell those of us who are otherwise in fine health how to remain healthy longer. But this advice comes with the expectation that any prescription given — whether diet or drug or a change in lifestyle — will indeed prevent disease rather than be the agent of our disability or untimely death. With that presumption, how unambiguous does the evidence have to be before any advice is offered?

The catch with observational studies…, no matter how well designed and how many tens of thousands of subjects they might include, is that they have a fundamental limitation. They can distinguish associations between two events — that women who take H.R.T. have less heart disease, for instance, than women who don’t. But they cannot inherently determine causation — the conclusion that one event causes the other; that H.R.T. protects against heart disease. As a result, observational studies can only provide what researchers call hypothesis-generating evidence — what a defense attorney would call circumstantial evidence.

07 Jun 2007

Bush Nominates a Methodist

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President Bush has nominated Dr. James W. Holsinger Jr., a professor of preventive medicine at the University of Kentucky College of Public Health, as Surgeon General.

The Holsinger nomination will ignite a firestorm of controversy because Dr. Holsinger wrote a politically incorrect paper for the United Methodist Church in 1991 at a time when that denomination was considering changing its position on homosexuality.

Holsinger’s paper on the Pathophysiology of Male Homosexuality identifies anatomical inconsistencies and epidemiological hazards attendant upon common male homosexual activities, concluding that the inevitably greater likelihood of injury and disease provides a “speaks for itself” argument against the proposed change.

This nominee’s decade-and-a-half old heresy will not go unavenged by the forces of political correctness.

Representatives of the life style which Dr. Holsinger criticized in 1991 are well entrenched in prominent positions in government and the punditocracy, and will certainly not be inclined to forgive his observations.

Today’s initial ABC News story, just for instance, manifests such a tone of high-pitched indignation, and undertakes so detailed a point by point effort at refutation that its author’s personal interests and affiliations seem only too clear.

Aspects of the fight on this one will have amusing elements of comedy, but I don’t see how Bush can possibly believe this nominee is going to be confirmed. It seems remarkable that the president is willing to take the heat over a foredoomed gesture like this one, but isn’t willing to stick his neck out (at least, perhaps until the last possible moment) to right an injustice as eggregious as the conviction of Lewis Libby.

19 May 2007

FDA’s Abuse of Power

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David R. Henderson and Charles L. Hopper recount a real horror story in the Wall Street Journal.

On April 27, the FDA rejected Arcoxia (etoricoxib), a new COX-2 inhibitor from Merck. The FDA explained that it didn’t see the need for another drug like this. Robert Meyer, director of the FDA’s Office of Drug Evaluation II, told reporters that, “simply having another drug on the market” wasn’t “sufficient reason to approve the product unless there was a unique role defined.”

The FDA is supposed to judge whether a drug is safe and efficacious and that’s all. In its literature, the FDA even agrees with this role, saying that, “Once a new drug application is filed, an FDA review team — medical doctors, chemists, statisticians, microbiologists, pharmacologists, and other experts — evaluates whether the studies the sponsor submitted show that the drug is safe and effective for its proposed use.” But the FDA slyly added a third requirement: Is Arcoxia better than what’s currently on the market?

According to the law, this isn’t part of the FDA’s approval process and for three good reasons. First, it would be difficult and expensive to show, before it’s marketed, that a new drug is better than all competing drugs. It already costs on average just shy of a billion dollars to get a new drug approved. A study by Joseph DiMasi, an economist at the Tufts Center for the Study of Drug Development in Boston, found that the cost of getting one new drug approved was $802 million in 2000 dollars ($956 million in 2007 dollars). Most new drugs cost much less, but his figure adds in each successful drug’s prorated share of failures. And this $1 billion figure was before the FDA dreamed up this new requirement.

The fact that we’re talking about drugs often causes us to forget what we know about other products whose safety and efficacy are important. We shouldn’t. Imagine that Saturn had to prove that its new car, Aura, is safe, works well, and is better than Accord and Camry before a single Aura hits the showroom floor. If the evidence is too costly for Saturn to collect, Aura will be rejected regardless of the facts. To prove superiority, what manner of tests would Saturn run? How much would this cost and how long would it take? What if five years later Saturn presented its evidence and, on some attributes Aura was better, on some it was equal, and on some it was worse than Accord and Camry? Is it a better car?

There’s no right answer. It would be better for some drivers and not as good for others. But there doesn’t need to be a right answer. This is the second reason drug companies don’t have to prove their drug is better than existing drugs. People are capable of choosing the cars that best meet their specific needs. Faced with this situation, however, the hypothetical federal agency regulating cars would probably say, as the FDA did with Arcoxia, “Why do we need Saturn’s Aura when we’ve already got Honda’s Accord and Toyota’s Camry? The Camry and Accord are fine cars.” Hasta la vista, Aura.

Complete article

I found the statement “It already costs on average just shy of a billion dollars to get a new drug approved” really horrifying. Can you imagine how many drugs must be abandoned because there is not a sufficient market for the individual item to justify development costs on that scale? Be sure not to get a rare disease, Americans.

04 Jun 2006

Watch Out For Morgellons!

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The Center for Disease Control is about to begin investigating a possibly imaginary disease called Morgellons, the first modern case of which was identified by a mother in a small town in Southwestern, Pennsylvania on the basis of a disease description in a 1690 monograph by Sir Thomas Browne.

Not altogether surprisingly, the San Francisco Bay Area is a hotbed of Morgellons affliction.

Morgellons Research Foundation

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