March 2005 Archives

Methicillin Resistant Staphylococcus aureus (MRSA) has claimed a 2 day old healthy baby in an Ipswitch hospital in Great Britain. Staph aureus has been responsible for periodic lethal outbreaks in Canada, US and Britain over the past couple of decades. A number of Gram negative bacteria can infect deeper layers of tissue under the skin and cause necrotizing fasciitis -- in tabloid-speak "flesh eating bacteria"-- most commonly Group A streptococcus. Some Gram positive bacteria like Staph aureus can also cause this condition.

Antibiotic resistance is a global public health problem. Many individuals in the US are diligent about finishing their prescriptions. Hospitals and doctors are learning to prescribe antibiotics less, and working to promote hospital environments less conducive to bacterial proliferation.

In many developing countries however, the situation is much worse. Antibiotics are readily available as "over the counter" medicines, and are often overprescribed, especially in private clinics. They can be purchased without prescriptions for mere pennies, rupees, baht...TIt is not uncommon to meet people in developing countries who are mixing it up; taking steroids and antibiotics as well as traditional herbs or potions, in self-determined "power" cocktails. As well, there also individuals in the US who are also cavalier with antibiotics, perhaps because as a nation we take our health for granted.

People who play loose and fast with antibiotics, both in the US and in developing countries, are selfish and short-sighted about their decision. They believe that *not* following prescription guidelines affects only them; that the danger is to themselves. This is a popular misconception. Bacteria are natural inhabitants of our environment that evolve quickly to resist antibiotics. Bacteria are air and water borne (depending on the strain), not the individuals own private cultivation. The reason that antibiotic resistant bacterial infection is so prevalent in hospitals is because in this micro-environment, there are more bacteria, more potential hosts, and more antibiotics that bacteria have the opportunity to become resistant to. Similarly, with improved transportation, our world is a much more hospitable environment for the transfer of all existing microbial strains.

Therefore we are collectively responsible for our common health, and how we take medicine affects everyone's health, with is a common public good. Furthermore, research in antibiotic resistance is important to improving this specific public health threat.

Research for biodefense is trumping research for public health, much to the dismay of the science community. The National Institute of Health (NIH) drives medical research and funding. The vast, powerful organization is comprised of 27 Institutes and Centers, about 17,000 employees, and a $28 billion budget (fiscal 2004). Primary goals include:

• Our goal is to uncover new knowledge that will help prevent, detect, diagnose, and treat disease and disability, from the common cold to the rarest genetic disorder"
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• "Our investment in understanding such diseases as AIDS, diabetes, heart disease and cancer returns dividends in longer, healthier, and safer lives"
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• "We continue to make major inroads in fighting humanity's most enduring illnesses...."
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And...with new found importance:

• "...We are working to confront new threats to our health and safety, like bioterrorism."

In a letter to Elias A. Zerhouni, M.D., director of the NIH, published in the March 11th issue of Science, over 700 scientists(subscription) and institutions wrote to voice their concern about the repercussions of:

"[a} 2001-02 decision by the NIH National Institute for Allergy and Infectious Diseases (NIAID) to prioritize research of high biodefense, but low public-health significance."

"The number of grants awarded by NIAID that reference biodefense related microbes has increased by 1500% (from 33 in 1996-2000 to 497 in 2001 to January 2005...)." The increase in funding has largely favored research in tularemia, anthrax, plague, glanders, melioidosis, and brucellosis.

According to the authors, the new priorities compromise funding for bacteriology, mycology and virology research that is not biodefense related, and will have negative repercussions on public health.

Many people think that TV pharmaceutical ads need to serve up side effects straight up; not obscure them in "a swirling castanet show", as Bill Thomas, Republican representative from California recently put it.

The Wall Street Journal (WSJ) (subscription), reports today that a FDA study in 1992 showed that only 5% of patients understood very well, or at all, the possible risks and side effects of drugs, while 59% asked for the drugs by name. Doctors responded with the requested presciption about 57% of the time.

The article notes that Johnson and Johnson is market testing a new sort of drug ad. The ad shows a patient at a doctor's appointment, apparently gung ho about getting birth control pills. The doctor sits down with the patient and issues a cautionary "let's talk" followed by clear details of the risks of taking the pill, like blood clots and strokes.

The change in marketing tactic is no doubt brought on by strong persistent criticism of the direct to consumer industry, as well as recent Cox-2 inhibitor links to heart risks. Officials from the FDA are testifying in the Senate this week about the handling of public information regarding potential Vioxx dangers. The drug was pulled from the market last fall then released conditionally.

Apparently the highly profitable drug industry is ready to risk frankness. Direct to consumer (DTC) spending by the pharmaceutical industry increased 27% to last year to $4.44 billion. Of course it's hard to imagine how some companies will manage to fit all those side effects into those short spots.

A recent World Changing post reacts to a CRN (Center for Responsible Technology) blog entry on the potential uses of nanotechnology. The World Changing essay warns against focusing on technology as the perennial silver bullet to societal ills, and is especially critical of "technophiles" who tout future technology in lieu of taking viable action today. As an example; why focus on nanotechnology to solve malaria problems when mosquito nets that are currently available can be used to help prevent this serious disease?

The point is well taken, certainly it's nice to see people coming around to articulate this, though it seems at first glance that CRN's blog is a somewhat weak rhetorical launch pad for such an argument. So we could leave it at that, but the World Changing article and its juxtapositon to the CRN article bring up some points. The World Changing article strongly distinguishes between two types of "technophiles"; "technoprogressives", and the others;

"market libertarian technophiles who like to handwave about abstract indefinite futures in which injustice will somehow evaporate so as to help justify their own ugly indifference to injustice today".

With a flourish of typing and disdainful curl of the upper lip, the author categorically divides the sage "progressive" from the ignorant "libertarian" technophiles. It's catchy and tempting but...

Evolutionary biologist Armand Marie Leroi argues that "race" studies are worth protecting in this NYT editorial. The author of "Mutants" riffs off an Indian newspaper article that reported worriedly after the tsunami of the possible demise of several Andaman tribes. He uses the threat to these tribes to argue for more aggressive genetic research for racial identification.

One of the potential benefits of the analysis he says, is that understanding the genetic make-up of individuals is critical to appreciating the aesthetics of humanity-- as knowing the painter is to appreciating art. He also proposes that racial identification is an important screen for disease:

"various American health agencies are making race an important part of their policies to best protect the public..."

Protect the public against what? He does not say.

In what could be taken for grant justification heroics but is probably simple academic exuberance, the author glaringly fails to acknowledge the role of epigenetic variation. He also glosses over the unsavory economic and political injustices that would likely occur while scientists sought to elucidate genomic flaws and phenomic variation.

As far as the Andaman tribes goes, the tsunami spared some but not all:

"The [Andaman] Negritoes...descended from the first modern humans to have invaded Asia, some 100,000 years ago...seem to have survived December's tsunami...but the fate of...the Sentinelese, remains uncertain"

But there's hope...

"an Indian coast guard helicopter sent to check up on them came under bow and arrow attack, which is heartening."

While this may be "heartening" to him, perhaps the tribes wished they had more modern weapons- cannons or missiles.

The potential demise of the Negritoes is inevitable, according to Levoi:

"..after they have gone, the genetic variants that defined the Negritos will remain, albeit scattered, in the people who inhabit the littoral of the Bay of Bengal and the South China Sea....But the unique combination of genes that makes the Negritos so distinctive, and that took tens of thousands of years to evolve, will have disappeared. A human race will have gone extinct, and the human species will be the poorer for it."

According to the author, this is another key reason for embracing race identity:

"There is a final reason race matters. It gives us reason - if there were not reason enough already - to value and protect some of the world's most obscure and marginalized people."

How would that work? Would it be like the spotted owl---or the monarch butterfly---just keep the loggers out of their habitat? What if the islanders decided they wanted to work at the Andaman Sheraton resort in order to buy their family shoes, for instance?

Or would they end up with the same fate as the Padung (Karen) "tribes" of northern Thailand? Many tourists are fooled by these "tribal villagers". But the Karen are diminished and in many cases the "villagers" are actually immigrants brought in by businessman, promoted by Thai tourism, and "enticed" to dress up in costume and skeletal compromising neck rings in order to earn tourist dollars. The immigrants have no Thai citizenship, no rights under the law, and can't protest their employment. Lest you think it's all just quaint like colonial Williamsburg.

The fate Leroi wishes on the islanders is perhaps it's better than that of the Emu, but the tsunami wrapped sentiments are at best paternalistic.

Are we preserving a species for study? Epigenetics is important. One gene does not necessarily translate to one protein. We are not just our DNA. While genomics is valuable and interesting, isn't it ignoble to want to preserve a race? And what of all the species that die out as we preserve only the ones that look us back in the eyes and shoot at us with bows and arrows?

The NYT commissioned the Center for Science in the Public Interest (CSPI) to look at the backgrounds of the 32 scientists on the FDA's advisory panel for the safety of Celebrex, Bextra and Vioxx in light of evidence of cardiac risks to patients.

The NYT reports:

"The center found that at least 10 of the 32 panel members had consulted for or received research support from Pfizer, which makes Celebrex and Bextra; Merck, which makes Vioxx; or Novartis, which is seeking approval for a similar drug. Had the votes of those 10 scientists been excluded, the panel would have favored withdrawing Bextra from the market and blocking the return of Vioxx. Only Celebrex would have been deemed safe to use."

On one hand, many argue that it's next to impossible to find "experts" that have not been engaged in drug company consulting. On the other, people argue that these dual roles for medical researchers endanger unbiased medical science that is truly in the public interest.

In a related story, "Some Scientists Say New Ethics Rules May Damage NIH" (March 3, 2005), WSJ reports of new ethics rules announced by the NIH that forbid any of the 18,000 NIH employees from consulting for drug companies, and prohibits 6,000 NIH employees from holding stock in pharmaceutical or biotechnology companies. The new rules have produced conflict within the NIH with rumors that rules will dissuade many prestigious scientists from pursuing positions there.

Scientists have been fascinated with the question: nurture or nature? As employers making decisions about who to hire and for what skills, Larry Summers got our attention recently speaking at an academic conference about women in the workforce. Summers opened up a can of worms with his suggestion that math skills were sex based. But it's a familiar can of worms and one that everyone can have a say in.

Various commentators use these occasions to chime in with their opinions which most likely are no more predetermined sexist biases. The media busily tries to disentangle truth from fiction, but authors simplify the issues and editorials are other no more than a writer's opportunity to hold forth with personal opinions.

Scientific research in this area can look just as suspect. We recently came across work from Allison Bailey and Peter Hurd at the University of Alberta who published in Biological Psychology. They say that the ratio of finger length in men varies according to how much testosterone they are exposed to in utero. Men with smaller index fingers relative to their ring fingers, according to their research, display a statistically relevant tendency towards aggressive behavior. Their theory doesn't apply to women. The authors point out that their finding should not be grounds for any normative action. But does that sort of cautionary endnote really to convince people? Or will the media go on and on suggesting that violent tenancies can can be attributed and predicted by finger lengths?

Good parts of society have been convinced that genetics is responsible for complex behavior patterns, and this is a dangerous assumption because it can be used for nefarious purposes like reinforcing biases. Self-labeled "organizationally challenged" Lisa Belkin jokes on 2/27/05 in the NYT; "Chaos and The Cubicle", that desk tidiness is hardwired. She doesn't mention that genetic studies have connected neatness with the presence of certain certain genes. She then quotes a production specialty consultant who said: My H.R. clients have flat-out told me: 'I'd promote someone with a tidy office over someone with a messy office any day.'"

If behavior traits were genetically determined traits, should they used to promoted or demote people? To steer people towards different career paths? Should people be disallowed from certain jobs for carrying them? Could those who show traits for alcoholism be dissuaded from restaurant jobs and public transport driving jobs? Should those with compromised longevity traits be placed in jobs bound for obsolescence...computer programming perhaps?

Larry Summers tried to evade being labeled sexist, defending his suggestion that women were intellectually not as cable as men as only a "hypothesis". Doubtful. More likely he's so convinced he feels confident sharing this at a meeting of academics focused on diversity in the workplace. Perhaps he feels the political climate is ripe for such notions.