October 2005 Archives

In the familiar book from 1997, A Demon Haunted World, Carl Sagan dismisses ghosts and monsters and fairies and demons. He bemoans the state of science literacy.

It's a common theme. In 1883, in an article in Science, "From Superstition to Humbug" (41: 637-639) an anonymous author wrote that the natives of India "exalt[ed]" English commanders "as more than human beings". In a tone that would resonate with many anthropologists of the day, the author comments on such "savage" inclinations:

"a benighted and superstitious populance, astonished by exhibitions of power...should, for a time, turn from its own hazy gods to new and visible wonder-workers"

Unfortunately, the article goes on to say, concepts of science are similiarly treated as some supernatural power, distorted and distended by so called civilized charlatans and naifs:

"It is curious to see how those, who a generation or two ago, would have been believers in witchcraft and all things 'supernatural' are now turning to be caught in the toils of scientific charlatanry..."

The newest topic that this 19th century author is concerned with is electricity:

"It is not with any intelligent reference to these exceedingly minute [physiological] currents...a man speaks...offers to rub a weak or disabled arm because he is 'strong and full of electricity, you know'. The fact is, we don't know, and we wish the man would explain..."

He fears the subject is corrupted by media and the public:

"It should be observed, however, that the kind of half-knowledge of this subject [physics] which is frequently obtained from newspapers and even from public lectures and popular scientific books, is the very pabulum of such errors and humbugs as we have described...It is the advance from pure superstition, in which men did not reason at all, to humbug, in which they reason from false or insufficient premises to wrong conclusions...Take, for instance, the modern master of that ancient black art of divination by rods..."

The author notes hopefully -- as we ever are -- more fuel for the notion of our flawed psychology, that physics education will improve and students will learn truth from fiction via better classroom teaching techniques:

"The tendency of the times, however, is toward the objective and experimental in teaching; and it is probable that the next few years will see considerable changes in the methods of general instruction in physics."

Over a century later, we are amazed at the constancy of human nature through distracting flashes of scientific progress -- whether the appearance of progress is a sleight of hand we don't know -- but witches, ghosts and appartitions and superstitions are alive, well, and always entertaining. CNN reports on witchcraft class deductions allowed by Dutch Law. According to the story on CNN a letter from Finance Minister Joop Wijn wrote of the decision, "Under the circustances, the cost of a course to become a witch qualifies as school fees."

The teacher of witchcraft Margarita Rongen's noted to one disbelieving lawmaker: "If he would come her and try the divination rod and see how important it is to find things..."

An editorial in the Financial Times by Ewa Bjorling, an Associate Professor of Virology and member of Swedish Parliament emphasizes that "the risk of infection from avian flu is tiny." To date, throughout the world a total of 121 humans have been infected with avian flu and 62 have died. The current strain of avian flu is not transmissable between humans, those who have been infected most likely enhaled droplets of virus contained in bird droppings, feathers, or blood while working very closely with birds. As a virus researcher Ewa Bjorling writes:

"I find the barrage of information and recommendations to "hoard" antiviral drugs now sweeping the world most regrettable"

Maria Zambon of the UK Health Protection Agency says in "H5N1 Virus Hard For Humans to Catch" (Financial Times October 26):

"Avoid being in touching distance of [birds that could be affected]. Don't kiss chickens."

But in the same issue, in "EU Bird Flu Alert on Eating Raw Eggs", the Financial Times lists some of the measures countries are taking to prevent an epidemic.

• "A European food safety authority will say consumers should avoid eating raw eggs and should cook chicken carefully."
• "Italian farmers yesterday held demonstrations aimed at reassuring the public."
• "French producers are worried that the market for foie gras...could be threatened."
• "The French agriculture ministry ordered farmers in the coastal and easter regions...to keep their poultry indoors"
• In Brazil, "Roberto Rodrigues, agriculture minister, said...metal detectors at airports would be modified to detect organic matter, and remains of meals served on aircraft arriving from infected countries would be burned."
• Also in Brazil..."the world's largest exporter of chicken said it would set up sanitary controls at airports to stop bird flu from entering the country."

When that ambling V-like line of Canadian geese snags up customs on your way to Florianopolis you'll know why.

An editorial by Abigal Zuger; "Scare Yourself Silly, but the Real Terrors Are at Your Feet", in Sunday's New York Times tells us that our greatest health fear right now is not avian flu. Nor in years past was it anthrax, Ebola, or Lyme disease. Instead our greatest risks are to the seemingly boring health issues that we refuse to deal with while riveting our attention on potential "crises":

"Scary health news gives adults the extraordinary ability to ignore the immediate in favor of the distant, to escape from the real (and the really scary) into a far easier kind of fear".

The author underlines the real concerns - the everyday thorns that we're stubbornly callous about - the antibiotic resistance in hospitals, obesity because of atrocious eating habits, cigarette smoking and myriad other health encumbering habits we refuse to give up and public health concerns (like Medicaid changes) to which we pay no attention.

Acronym Required writes frequently about public health and science in the media. H5NI mutates quickly and the concern is that it could become a virus that more easily infects humans. The World Health Organization WHO has information about avian flu.

The great risks of hyponatremia were headlined by the New York Times last week (October 20th), in a follow-up to the front page story to the New York Times article April 14, 2005, titled "Study Cautions Runners to Limit Intake of Water."

Hyponatremia is low sodium concentration in the blood (less than 135mmol/L) and the electrolyte imbalance can cause symptoms of nausea, bloating, headaches, disorientation, and rarely - coma or death. Hyponatremia is a serious health condition associated prolonged physical exertion, with some medical conditions, and as a side effect of some medications. As we wrote in a previous article, hyponatremia has been long recognized in athletes, however it has more often been associated with hospitalized patients. With the recent increase of marathons and participants, doctors have been seeing an uptick in the number of cases in athletes. Hyponatremia during prolonged exercise usually occurs when people who are often (but not always) unconditioned, drink too much during prolonged exercise bouts like a marathon or hiking the Grand Canyon. Researchers warn that hyponatremia can be can also be caused by drinking to many electrolyte drinks**.

The following article does not provide diagnosis or advice about this medical condition but looks at the media's presentation of the condition hyponatremia in prolonged exercise. We question the numbers and severe tone of the New York Times articles.

The New York Times' April, 2005 article that an original research article on exercise induced hyponatremia published in the New England Journal of Medicine which that found 13% of participants of a study had hyponatremia. The article indicated that all these marathon runners were in such serious health danger that they could have died from the condition.

This latest New York Times article is now the second to emphasize that vast numbers of runners are drinking too much water. The article quoted the marathon doctor, Dr. Maharam:

"Last year, one percent of the more than 35,000 New York City marathoners developed hyponatremia...and although that is a smaller toll than in other cities' marathons, doctors say every one of those life-threatening medical emergencies could have been avoided."

One percent, 350 marathoners had "life-threatening medical emergencies?" Despite the very real dangers of becoming hyponatremic, the incidence of the condition during marathons is far less than either of the New York Times articles would lead readers to believe. Serious hyponatremia requires hospitalization, so as Acronym Required wrote in our last article, if 13% of all marathon runners were being hospitalized because of hyponatremia, we wouldn't be reading about it in a research report, it would be a major news story after marathons. This has not happened. The news on the health conditions of the runners in the last five New York city marathons was upbeat and cheery, with no mentions of serious helath conditions. If there has been a recent spate of hyponatremic runners it's been a secret well-kept by race organizers, fans, hospitals, and participants.

• After the 2004 New York City Marathon, the one that the October 20th in which the NYT article reports that 13% of the runners had this "life-threatening" condition, the same paper -- The New York Times -- previously wrote this in "A Glimpse of Greatness Lifts an Otherwise Dour Day":

  "yesterday was unseasonably warm: it was 55 degrees at the start of the race, with a high of 65. Yet the most common injury among the 37,257 marathoners was blisters, race officials said. Although some had heat-related illnesses, there were no reports of runners in serious distress as of 6 p.m."

• The New York Times wrote about the 2003 NYC Marathon in "A Great Day for Spectators Isn't So Great for Runners" that:

  "Although the unseasonably warm weather may have led to the increase in spectator turnout, several runners complained of cramping and dehydration, and finishing times suffered as a result." But, "[e]arly reports indicated that although the heat caused several runners some distress, no serious injuries were reported....as of 5 p.m., no runners had been reported in critical condition. Event officials said that fewer than 20 runners had been taken to local hospitals."

• The New York Times article following the 2002 NYC marathon: "Easy Day For Doctors", quoted the same doctor who is now reporting high incidences of hyponatremia reporting on happy healthy runners: "Maharam...reported that only about 20 of the 31,285 entrants needed more than temporary medical assistance, and by 7:15pm...any runners treated at local hospitals had been discharged..."
• In 2001, the New York Times wrote under the headline, "No Major Emergencies", that "[t]he worst medical emergency by late afternoon was of some foreign runners mistaking Vaseline for nutritional goo..." and "by 4:30 p.m. no competitors had been admitted to a hospital."
• Finally in 2000, the New York Times noted in an article "A Healthy Performance", that according to Dr. Maharam: "20 out of 29,377 runners had been transported to hospitals...treated for minor injuries and released."

As we previously wrote in April, the numbers of hyponatremia afflicted runners reported by the research report in the New England Journal of Medicine in April and the New York Times coverage of that article seemed at least 10 times greater then the number of people who actually fall sick at races. Similiarly, while this most recent NYT article reports that 10% of the 2004 race runners had hyponatremia, the race report doesn't seem to reflect that rate of illness.

To their credit the New York Times printed a correction about the severity of the condition the next day, October 21. They said:

"A sports article yesterday about the danger of drinking water excessively during marathons misstated the toll of hyponatremia, a resulting condition that developed in about 1 percent of the 35,000 runners in the New York City Marathon last year. Dr. Lewis Maharam, medical director of the race, said that a small percentage of those runners had required hospital visits, and two had required an overnight stay; not all were hospitalized."

However the correction did not change the number of people they reported were afflicted.

The correction still leaves ambiguity about how dangerous hyponatremia is. There was never a correction printed for the first article, which was emphatic about the potential mortality of the disease. Neither of the NYT articles attempt to balance the dire statistics in their story by referring to other articles in their own paper that report on the number of people suffering from the opposite condition: dehydration. Dehydration is also detrimental to health and performance.

Research on the exact physiology of exercise induced hyponatremia is still developing. The risk of these two stories that send terrifying messages about hyponatremia to the public is that if the news article is unbalanced runners may risk not drinking the water they need - especially inexperienced athletes. This is worrisome to physiologists in the field. Reportage about a marathon in D.C. in the fall of 2004 by the Washington Post said this:

"According to Capt. Bruce Adams, the marathon medical director, approximately 45 people [of 17,000 who ran the Marine Corps Marathon] were taken to area hospitals with heat-related illnesses and dehydration, which is about four times as many as last year." (November 1, 2004)

Are people under-drinking now? Or are reports of medically dangerous hydration status simply all over the map? Some doctors vehemently state that dehydration does not occur, others report that many people are suffering from dehydration.

Doctors and researchers understand the basic reasons for hyponatremia, but research continues. One cause is the body's reaction to physiological stress via anti-diuretic hormone (ADH). ADH is released from the pituitary when sodium levels decrease in the body or when blood volume is too low. When runners drink water to the extent that sodium concentrations are significantly reduced, ADH signals the kidneys to reduce output - which is the body's protective response to dehydration. The condition, Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH), is one possible cause of hyponatremia. The most likely cause of SIADH is drinking too much water (the NYT article profiles someone who apparently drank seemingly gallons of water before, during and after the Boston Marathon). However excessive sweating - especially if sodium content is high has also been theorized to be a culprit. Some researcher report that runners can be both dehydrated and hyponatremic, others disagree. Ingestion or overuse of non-steroidal anti-inflamatory drugs (NSAID)(Ibuprofen) has also been associated with hyponatremia.

Appropriate hydration is important to performance. We have a good understanding of the general mechanism, but we don't know why elite athletes don't seem to need to drink as much, while less trained athletes sometimes drink excessively. What is the mechanism of the training effect? Is there research? It's more than an issue of self-restraint as the April NYT article indicated in the quote from one exercise physiologist:

"Elite athletes are not drinking much, and they never have." Dr. Noakes said. The lead female marathon runner in the Athens Olympics, running in 97-degree heat drank just 30 seconds of the entire race."

While the public needs to be aware of the health risks, and certainly running a front page article in the New York Times is a way to garner attention to the issue and potentially reduce liability, hydration is important too. If hyponatremia is simply a more common --but not always dangerous -- physiological effect of endurance exercise and if at levels of 125mmol/L and 135mmol/L people may not have symptoms, this should be presented. Information should not be skewed to scare people from drinking appropriate amounts of water, potentially risking dehydration.

Since there are multiple causes and physiology can vary among individuals, uniform recommendations are difficult to make, as with many health recommendations. Sports medicine doctors warn that athletes should drink no more than eight ounces of water every 20 minutes -- this includes ALL drinks, Gatorade as well as water.

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**For example see: (Weschler, L.; "Exercise-Associated Hyponatremia: A Mathematical Review". Sports Medicine, Volume 35, Number 10, 2005, pp. 899-922(24)).

Information and some references can be found at (broken link removed 07/22/12). Note: This site is a commercial site that we are not affiliated with nor endorsing. Their recommendations propose drinking sports drinks. But as the previous citation notes, and race doctors warn: sports drinks provide do not prevent hyponatremia.

CALEA Broadly Expanded

The New York Times writes that the government is requiring cities, universities, and online communications companies to "overhaul their Internet computer networks to make it easier for law enforcement authorities to monitor e-mail and other online communications."

The universities are alarmed at potentially being required to fully fund extensive, costly, upgrades in a short time period in order to comply with undefined requirements. Some, but not all of the costs have been estimated:

"Technology experts retained by the schools estimated that it could cost universities at least $7 billion just to buy the Internet switches and routers necessary for compliance."

The article, no doubt for the sake of time and brevity, sticks to the issue of cost, without addressing civil liberties, the growing federal jurisdiction to enforce undefined standards, possible effects on technology innovation, or other significant concerns. No doubt for the same reason, it skips the history of the FBI and law enforcement's extensive wire-tapping expansion over the years. Yet the article begs the question - how did these sweeping access orders sneak up on us?

Hurricane "W"ilma comes from a place in the alphabet where hurricanes rarely emerge, though meterologists correctly predicted several late season storms this year. The 21st storm of the 2005 season ties this year with with 1969, which holds the record for number of hurricanes.

The storm is ferocious enough to wow former Hurricane Hunters who note with aplomb the stomach churning difficulties of flying into the hurricane eye:

"it's really tough to hit a 2 mile wide eye when you're flying crabbed over at a 30 degree yaw angle fighting horizontal flight level winds of 185 mph and severe turbulence".

I bet. Currently the forecasters predict that the storm will *weaken* to a Category 3 or Category 4 before hitting Florida then will track the NE coast perhaps to New England. It is now smaller then Katrina but that could change; optimistically, it is not estimated to generate the storm surge that Rita or Katrina did. There is more information at NOAA and here with intimidating satellite photos.

The Committee on Science, Engineering, and Public Policy (COSEPUP), comprised of members from the National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine suggests some tactics to advance the lagging science prowess of the U.S. Their recommendations are published here in PDF or paperback form, titled "Rising Above The Gathering Storm: Energizing and Employing American for a Brighter Economic Future."

The National Academies press release for the study lists some of the actions they propose to stem what the committee views as decreased interest and competance in the U.S. for science and math. There are clear indicators of the nation's flagging abilities, they say:

• "For the cost of one chemist or one engineer in the United States, a company can hire about five chemists in China or 11 engineers in India".
• "Last year chemical companies shuttered 70 facilities in the United States and have tagged 40 more for closure. Of 120 chemical plants being built around the world with price tags of $1 billion or more, one is in the United States and 50 are in China".
• "U.S. 12th-graders recently performed below the international average for 21 countries on a test of general knowledge in mathematics and science".
• "In 1999 only 41 percent of U.S. eighth-graders had a math teacher who had majored in mathematics at the undergraduate or graduate level or studied the subject for teacher certification -- a figure that was considerably lower than the international average of 71 percent".
• "Last year more than 600,000 engineers graduated from institutions of higher education in China. In India, the figure was 350,000. In America, it was about 70,000".
• "In 2001 U.S. industry spent more on tort litigation than on research and development".

The press release summarizes the recommendations of the report:

• "[T]he creation of a merit-based scholarship program to attract 10,000 exceptional students to math and science teaching careers each year. Four-year scholarships, worth up to $20,000 annually, should be designed to help some of the nation's top students obtain bachelor's degrees in physical or life sciences, engineering, or mathematics -- with concurrent certification as K-12 math and science teachers. After graduation, they would be required to work for at least five years in public schools..."
• "Policy-makers should increase the national investment in basic research by 10 percent each year over the next seven years."
• "Each year, policy-makers should provide 25,000 new, competitive four-year undergraduate scholarships and 5,000 new graduate fellowships to U.S. citizens enrolled in physical science, life science, engineering, and mathematics programs at U.S. colleges and universities."
• "Policy-makers should provide a one-year automatic visa extension that allows international students to remain in the United States to seek employment if they have received doctorates or the equivalent in science, technology, engineering, mathematics, or other fields of national need from qualified U.S. institutions."
• "Ensure that the United States is the premier place in the world for innovation. This can be accomplished by actions such as modernizing the U.S. patent system, realigning tax policies to encourage innovation, and ensuring affordable broadband Internet access, the report says."

The report outlines clear steps for improvement. Some are controversial, for instance there are international development issues to promoting a policy of siphoning off the most promising students from foreign countries, nevertheless, for the most part these seem straight forward. However, importantly, there is no sense of buy-in from many politicians. Thomas Friedman's New York Times today (accessible to subscribers), "Keeping Us in the Race", criticizes the administration's priorities:

"This is where President Bush should have focused his second term, instead of squandering it on a silly, ideological jag called Social Security privatization."

Friedman's admonishment seems mild and understated relative to the ballooning expenses of the administration's charge into the Iraq war and bullheaded insistence on tax cuts as well as its relentless rhetorical focus on terrorism and values. No doubt others have harsher criticism. In addition, the current guised creationist chatter and distracting court proceedings for teaching "alternative" theories of man's existence on earth do nothing to bolster public confidence in science. If anything a large swath of the population may be enboldened to eschew the challenges of learning science.

While it's clear that the administrations focus is not on education it's not clear what the public sees as administrations priorities. Purusing a series of polls over the last couple of years shows that while "economy and jobs" constantly rate as a worry to pollees, education generally is one of the last priorities, while gas and energy, terrorism, healthcare, Iraq and periodic crisises such as Hurricane Katrina are always prominent concerns. Interestingly "jobs" and "education" are always broken out as two separate priorities in the polls, which skews the fact that they are dependent upon each other. "Jobs" usually rates high and "education" rates low.

The agenda not only faces challenges from the administration and public perception, it doesn't seem that science holds the allure for students that it once did. While science and math are interesting pursuits, many undergraduates opt for easier and more lucrative paths in economics or business. Though it's a cynical view on these important goals, their choices aren't lazy they're sage. Just as it's savvy for businesses to off-shore technology and manufacturing, in kind, it's smart for undergraduates to recognize the often limited job opportunities and financial incentives to majoring in science as opposed to business. In a world where any young cool performer or slob with some Karaoke practice and a song can have a shot at launching a lucrative record career from "American Idol", wealth is king. There's no nobility to being a poor researcher renting the smallest house on the block in order to fund serial post-doc positions.

While science education and technical prowess is clearly important to scientists and ultimately to our nation's ability to compete, there seem to be more pressing priorities for the public, politicians, and students. We admit to being disheartened, but without serious political will we don't seem poised for any immediate attention to these goals. All indications are that the political priorities, both practical- budgetary and ideological, at the federal and state levels are attuned to other goals that either compete with or trump attention to science education and international competitiveness.

In the latest issue of Nature (437), Morwood et al describe their continuing research on the skeletal remains of the "Hobbit" species of hominins on the island on Flores, Indonesia. In 2003 the researchers excavated the remains from caves in Liang Bua and defined a new, one meter tall species, that they dubbed Homo floresiensis. In 2004 they returned to the site and found more remains that they analyzed for the current Nature report. They use this latest research to bolster their theory about the identity of a representative specimen they call "LB1". The authors propose that LB1 was one of population of individuals that inhabited the island of Flores. This was an isolated species they say, not an unhealthy or compromised individual of a more common species, which is the theory preferred by competing scientists.

The authors measured the limbs and skeletal remains of the hominin and used this to determine the probable features of the species. They found that the species has unique morphological traits such as the ulna and humeral torsion. They estimate that Homo floresiensis inhabited the island as recently as 12,000 years ago and perhaps came out of Homo erectus which was known to populate the island over 800,000 years ago.

The authors theorize that the small stature is representative of "island dwarfism", a condition where the species is evolutionarily constrained, compared to off-island species. However its also possible that such an isolated species also benefits and protected from threats.

The findings are exciting, but the archaeologist and lead author Michael Morwood suggests that the researchers will be barred from returning to the caves to conduct more research. The Indonesian government has held back progress at the site by refusing to grant permits. As well, the authors report of the Nature study report; valuable specimens were destroyed by the Indonesian researchers.

Apparently Indonesia's senior palaeonanthropologist and "national icon" disagrees with the conclusions of the group and holds that the found bones are of a single individual affected by microcephaly. But another group, Falk et al, presented data in Science(Vol. 308. no. 5719, pp. 242 - 245) in April that also showed that LBI was healthy, not afflicted with microcephaly. Falk et al analyzed the brain of LB1 and concluded that the hominin had no evidence of higher cognitive processing centers but might be phylogenetically related to Homo erectus.

Nature (subscription) comments on the severe drought in the Amazon rainforest. In Santarem, where the Amazon and Tapajos rivers meet water, levels are 15 metres lower then normal.

Theoretically, drought could effect the forest by stunting growth so that the protective carbon absorption of the forest would be limited. This would add to the effects of deforestation, which hasn't slowed down despite years of attention to the problem. As well, fire damage from managed burning leaves the forest vulnerable to further drought. The result would be that the Amazon contributes to climate change rather then buffers it.

Note: Some people have commented that this is either a temporary effect, or drought due to local deforestation, rather than a permanent effect due to global climate change.

Last week the Food and Drug Administration (FDA) recommended changes in standards for cattle feed aimed at controlling the spread of Bovine Spongiform Encephalopathy (BSE), which can infect humans in the form of Creutzfeld-Jakob Disease (vCJD), both are prion diseases. The FDA has opened its comment period on the standards, which although new, have been discussed for years.

Commonly known as "mad-cow" disease, there have only been two reported cases in US cows. Even in the UK and Japan where prion diseases are more common, infection is relatively rare both to cows and humans. But whatever the actual risks of the disease, the public fears these diseases because they are unpredictable, fearsome and fatal.

The FDA press release says the new rules add to the series of "firewalls" against the spread of the disease by banning cattle feed made from the brains and spinal cords of cattle 30 months or older, as well as banning animals that haven't been inspected, banning certain tallow products and mechanically separated beef.

The Consumer's Union criticized the rules. They point out that there's nothing stopping cow blood from being fed to calves in lieu of milk. They stress that only the elimination of the practice of feeding any animal remains to mammals would protect the public from the current risks. Furthermore, Consumer's Union said they took similar "halfway steps" which allowed the disease to continue spreading. As well, "thirty months is not a magic safe number", they said since Japan found cases of mad cow disease in younger cows. (The risk of disease is greater for older animals so "thirty months" is commonly used in import bans aimed at curbing the spread of the disease.)

The Center for Science in the Public Interest (CSPI) also criticized the federal action. Chicken litter, restaurant plate waste and cattle blood should be eliminated from cattle feed and cattle parts should be banned from all animal feed, they said. The group is also critical of "Advanced Meat Recovery" systems that are used to extract every last bit of residue from cattle carcasses and label it "meat".

The FDA says that the plan will cost the cattle industry about $14 million a year, nevertheless the industry "applauded" the new rules.

Although the industry is understandably dedicated to preserving the profits they extract from all parts of the animal, it seems that without mitigating all the risks the agency and the industry flirt with the possibility of future disease. If you familiarize yourself with any of these agricultural practices, you'll understand why the Atlantic Journal Constitution called them "quite frankly, disgusting" (Our Opinions: Beef up U.S. mad cow protections Date: October 6, 2005). That the FDA still allows many of these processes, like feed made from chicken excrement and restaurant scraps -- seems cavalier at best. The FDA docket is submitted here for public comment.

Science and Nature are reporting about reverse genetics research of the 1918 flu virus. The structure of the flu virus last year suggested that this virus was a bird flu that jumped directly to humans.

President George Bush warned of the avian flu today and proposed that the military be mobilized to deal with public health threats. His proposal was roundly criticized by public health officials who claimed that cuts to public health funding shouldn't have been so severe. The Democrats criticized the president for not moving on the issue sooner and proposed a "director of pandemic preparedness and response", or as some agencies are reporting it, a "bird flu czar"

Acronym Required previously wrote about disaster preparedness with regard to Hurricane Katrina here and here. We also wrote about Avian Flu in these articles: "Hopes For Avian Flu Vaccine"; "Modeling Epidemics", and "Avian Flu in China- Increasing Resistance"

Progress

The total number of malaria infections worldwide are greater and more widespread than what epidemiologists predicted when they took stock of the situation few years ago. Malaria continues to decimate populations of Africa. The persistent morbidity and mortality from malaria presents a multi-faceted challenge with far reaching problems such as increased drug resistance in the parasite Plasmodium falciparum, poverty that exacerbates health problems, and inconsistent and politicized efforts to eradicate the disease. With global temperature change threatening to increase the number of mosquitoes, the urgency for malaria vector control and disease treatment only increases.

In some ways, progress has been good. Efforts to treat and prevent infection and death show multiple progress in reduced incidence of disease and death. Scientists sequenced P. falciparum in 2002 and funding for better drugs, prevention, and vaccine development is increasing. But despite the excellent array of promising technologies, scientists and public health doctors disagree about how to use existing technologies. Available methods for mosquito control are not deployed to their full potential because of politics, economics and research funding quagmires. Competing agendas of researchers, pharmaceutical companies, government agencies and public health experts complicate this. On one hand the competition between various parties is helpful for advancing multiple approaches with uncertain efficacy, but it also interferes with actual treatments for people who live in the malaria infected areas.

Politics

Various players all sincerely want to see malaria eradicated but can't stop bickering about the solutions. For example, bed nets have long offered a promising low tech method of malaria control. Permethrin impregnated bed nets are cheap and easy to distribute and studies show they decrease deaths. However, only one in 20 children use the nets. Typical to many efforts, funding is often scarce or erratic. Political stalling in distributing available funds is typical when aid is tied to policies that recipient countries don't agree with.

As if these problems weren't challenge enough, the bed net advocates seem to be directly at odds with the DDT advocates. The DDT contingent argues that spraying will eradicate mosquitoes. DDT is endorsed by the the military. But in order to promote their agenda, the defenders of DDT try to poke holes in studies about bed nets. Reason magazine disparaged bed nets in a recent article, saying "bed nets protect only at night". The truth is that mosquitoes that carry the malaria vector are actually only a threat at night. Wrong, politically motivated assertions like this interfere with the goal of decreasing deaths and illness from malaria.

Qinghao Shortage?

Another example of complications with available technologies involves the artemisinin derived drug Coartem. In 2001, the WHO approved use of this drug from Novartis. The drug combines an artemisinin derivative harvested from the qinghao plant indigenous to China, with a second drug - lumefantrine. The artemisinin combination therapies (ACT) have proven to be the most effective treatment, as older treatments are increasingly ineffective against drug resistant strains. As a result reliable artemisinin sources are high in demand.

Today, for the second year in a row, Novartis, the sole producer of the drug, reported that its supply of Coartem will not meet its production goals. This year the company will only supply 13 million doses, instead of an estimated 30 million needed. Novartis says it received too few orders in time to produce the quantity needed, and also that it can't make the drug because Tonhe, a Chinese company contracted to supply the qinghao, can't get the plants it promised because farmers are selling their harvested crops to better paying local Chinese companies.

Unfortunately Novartis ran into the same shortages last year. At the time, the World Health Organization (WHO), which chided the company for the mishap. In a letter to the editor in response to an article about the dispute a Novartis VP and General Manager of Malaria Initiatives defended their effort in the Financial Times.:

"Sir, Contrary to the headline on your recent report "Finance Dispute Halts New Malaria Treatment Project (February 19), our partnership with the [WHO]...continues to move forward rapidly...In response to recent exponential increases in demand, Novartis has rapidly scaled up production capacity and expects to be able to produce 30m Coartem treatments this year...." (March 3, 2005)

But when the time came, Novartis again failed to deliver for unknown reasons.

Sanofi-Aventis has recently announced plans to produce a artemisinin based treatment next year in a joint research and development agreement with the Drugs for Neglected Diseases Initiative (DNDi), a research group based in Geneva. Hopefully the added competition will change the dynamics of production, although if there is a shortage of the plant, arguably more competition won't solve the problem.

Vaccine

Almost everyone agrees that infection by Plasmodium falciparum will be easiest to prevent with a vaccination, yet this too remains an elusive goal. A study last year in Mozambique done by University of Barcelona and GlaxoSmithKline showed good initial results. Another study done by Oxford looked promising but fell through last year -- to their credit Oxford group has published a follow-up study about the failure.

While vaccines are the ultimate solution, we are a world of limited resources and ever burgeoning populations of people and infectious diseases. Are we attached to the idea that no disease can be controlled without a vaccine, even as malaria and other diseases could be controlled with other available technology? Vaccines attempt to circumvent politics and competing ideologies. This works as long as vaccine development doesn't get stuck in the very same political quagmires.

Acronym Required previously wrote about new schemes for vaccine funding here, and writes frequently about public health.

Note: If you've linked to this post as others have, or followed a link to this post, because you believe this H. pylori story bolsters an argument along the lines of: Scientists have been wrong therefore they're wrong about global warming; wrong about the HIV virus causing AIDS; or wrong that vaccines don't cause autism, etc., your argument is a fallacy and you've come to the wrong place.

Acronym Required has written extensively on these topics. Global warming is anthropogenic and real, and the HIV virus causes AIDS. Autism is not caused by vaccines. There's an array of people who would for myriad reasons, would love to dismiss real science. We're not them. If you'd like to see our articles on anthropogenic climate change, HIV/AIDs, or vaccines, we have some. Here are a few of our articles on global warming and climate change from our perspective:

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2005 Nobel Prize in Medicine

Australian physiologists Robin Warren and Barry Marshall were awarded the 2005 Nobel Prize in medicine for their research in the early 1980's showing that peptic ulcers were primarily caused by bacteria not stress. The story has been told many times, since Marshall has always been vociferous about his discovery and the reluctance of the medical community to change their thinking on the disease, nevertheless its an interesting tale of scientific progress.

Marshall, a medical intern at the time, and Warren, a pathologist, began their collaboration in Perth, Australia in 1981 when they decided to look more closely at a bacteria that appeared to be involved with ulcers in the stomach linings of patients. They initially isolated the gram-negative bacteria from a few patients in 1982. Marshall announced that the bacteria caused the ulcers at an international microbiology meeting in Brussels in 1983. He cultured "Pyloric Campylobacter" in 1983 and 1984 and published his findings in the British medical journal Lancet in an 1984 article titled: "Unidentified Curved Bacillus on Gastric Epithelium in the Stomach of Patients with Gastritis and Peptic Ulceration." June 16:1(8390).

Marshall apparently became distraught that scientists continued to disregard his findings in favor of their own ideas about stress causing ulcers. When he failed to infect lab rats with the bacteria to show infection, he famously swilled down some bacterial broth himself to prove his case. He reported his resulting illness in an Australian medical journal in 1985. (Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ. "Attempt to Fullfill Koch's Postulates For Pyloric Campylobacter" Med J. Aust. (142) (He fullfilled 3 of 4).

In 1989, the organism was reclassified as Helicobacter, distinct from Campylobacter, based on its functional and enzymatic properties. Despite apparent progress though, especially in Germany and Switzerland where doctors produced dozens of studies that replicated the initial results, the medical and drug communities took decades to accept the research and change treatment patterns.

The New York Times published an article in 1992 titled "New Study Backs Ulcer-Cure Theory" about research published at Baylor College. Framed more as a new theory rather than as research that had been around for a ten years, the New York Times at least acknowledged that the US research "lent more support to the belief that a common bacterium lies behind most ulcers."

Still, doctors were not convinced and according to the article, a doctor at the University of California in Los Angeles said that not only was he concerned about the side effects of antibiotics but "there were not sufficient data on the long-term effectiveness of the treatment". The NYT article also substantiated ideas that drug companies opposed the research by reporting an interview with Dr. James H. Lewis, vice president of medical development at Glaxo Pharmaceuticals, maker of Zantac, the leading ulcer drug, who said:

"[I]t is still too early to say that this is the best approach to treating ulcers"..."nobody really knows" whether bacteria cause ulcers, that were caused by numerous factors including diet, stress and genetics.

That was in 1992. In 1994 a medical panel of the National Institutes of Health (NIH) recommended that antibiotics be used for the treatment of gastic and duodenal ulcers, and gastritis. Yet four years later, physicians were still following their own instincts on the treatment of such ailments. Breuer et al reported in a study called "How Do Clinicians Practicing in the U.S. Manage Helicobacter Pylori-related Gastrointestinal Diseases? A Comparison of Primary Care and Specialist Physicians." (Am J Gastroenterol.) 1998; 93(4) that:

"Anti-H. pylori therapies judged ineffective were reported as the first choice regimen by 5% of gastroenterologists and 18% of primary care physicians. Gastroenterologists appear to implement the latest scientific developments in the field rapidly whereas PCPs [primary care physicians] manifest a delayed response, due to either insufficient knowledge or to other factors influencing their approach to treatment."

In April, 1996 the FDA approved the first antibiotic (clarithromycin) in combination with an antacid (Prilosec) to treat ulcers. According to the New York Times article Dr. Robert J. Temple, an FDA official, suggested that the reason so many doctors were refusing to treat ulcers with antibiotics could be attributed to:

"[a] reluctance of doctors to adopt new therapies, fierce conservatism of academic medicine, the sluggish nature of Government agencies and the vested financial interests of large drug companies."

The FDA also noted that the drug companies effectively convinced doctors of their treatments through advertising.

Now, decades after these scientists discovered it in stomachs, Helicobacter pylori has come up in the world. It has it's own journal and website (that is frankly most interesting for the amusing bacteria that swim beguilingly across the homepage). H. pylori are now also associated with stomach cancer, so early intervention is increasingly recognized as critical. Yet although it is widely accepted as the cause of 90% of ulcers there are still some people who remain unconvinced and prescribe incomplete or ineffective therapy. Hopefully, as the Australians get the prize they deserve, patients will get the treatment they deserve.

If one's science experiment or paper is "elegant", it arrives at the answer or explains a problem -- often one that has remained elusive for years -- with clear, insightful form that prompts smiles, admiration and sometimes chagrin from one's colleagues. Einstein's descriptions of matter and energy are perhaps quintessentially elegant, though the description no doubt underplays their significance. Physicist Brian Greene does justice to all his subjects as he eloquently walks through E=mc² and how Einstein's vision for physics described anew the relationships between mass, energy and the formation of the universe, in "That Famous Equation and You", published in yesterday's New York Times.

"But by September, confident in the result, Einstein wrote a three-page supplement to the June paper, publishing perhaps the most profound afterthought in the history of science. A hundred years ago this month, the final equation of his short article gave the world E = mc²."

The equation is well entrenched in our culture, it's faddish even, blithely plastered onto T-shirts and posters and paraphernalia for sale in campus stores. While many people wear the formula across their chests however, they often misconstrue its significance. Greene points out that Einstein actually published about M=E/c² and the paper emphasized the creation of mass from energy that Greene describes via a jousting scenario, not the creation of energy from mass associated with nuclear reactions. The equation describes not just the extraordinary energy reactions but ubiquitous, everyday ones:

"There is nothing you can do, not a move you can make, not a thought you can have, that doesn't tap directly into E = mc². Einstein's equation is constantly at work, providing an unseen hand that shapes the world into its familiar form..."

The theory reoriented how scientists thought about energy and led to Einstein's General Theory of Relativity and then to Einstein's work to derive a "single theory encompassing all of nature's laws".

"For the better part of his last 30 years, Einstein pursued the "unified theory," but it stubbornly remained beyond his grasp. As the years passed, he became increasingly isolated; mainstream physics was concerned with prying apart the atom and paid little attention to Einstein's grandiose quest. In a 1942 letter, Einstein described himself as having become a "a lonely old man who is displayed now and then as a curiosity because he doesn't wear socks."

Today this work continues and it "is no curiosity - it is the driving force for many physicists of my generation", says Greene. Succinctly describing the formation of the universe is not trivial but the task has progressed significantly. Now scientists:

...[have] established beyond any doubt that a fraction of a second after creation (however that happened), the universe was filled with tremendous energy in the form of wildly moving exotic particles and radiation. Within a few minutes, this energy employed E = mc² to transform itself into more familiar matter - the simplest atoms - which, in the course of about a billion years, clumped into planets and stars."

"During the 13 billion years that have followed, stars have used E = mc² to transform their mass back into energy in the form of heat and light; about five billion years ago, our closest star - the sun - began to shine, and the heat and light generated was essential to the formation of life on our planet."

It's good to be reminded of this "unseen hand" that is so often subordinated to some distorted permutation of the "invisible hand". While the latter is used to press us on in our daily chores, when we understand the former we are put in our place and reminded of the relative power of each.

Obviously the excerpts cannot do justice to the article, located here. The author's research is in the area of string theory and he has written a couple of books including the well-reviewed popular science book The Elegant Universe.