Contagion--Ripped From the Headlines

The new movie "Contagion" hits the movie theaters this coming Friday, but Keith Darce of the San Diego Union has seen it already and obviously likes it--partly because it aims to be "true," and partly because it has a local connection to biotech firms in the region.

The film likely benefited from a trip to the CDC’s headquarters in Atlanta taken late last year by one of its stars, Kate Winslet, and producers Michael Shamberg and Stacey Sher, who previously worked together on “Erin Brockovich” and “Pulp Fiction.”

Winslet, who plays a member of the CDC’s Epidemic Intelligence Service, met with Dr. Anne Schuchat, the assistant surgeon general and director the National Center for Immunization and Respiratory Diseases. 

Although the genre has an ignoble track record for reflecting reality, the makers of “Contagion” appear to have gone to great lengths to ensure that their film rings true with public health experts as much as it might with moviegoers when it opens Friday.
One scene highlights genetic sequencing, a powerful biological tool that promises to revolutionize the way disease outbreaks are fought.
A pair of San Diego County companies have led the way in creating a new generation of machines capable of mapping the DNA of viruses and bacteria in a matter of hours instead of days and weeks.

The Plague is Still the Plague

The Black Death arrived in Europe in the 14th century and devastated the population. It finally left Europe in the 17th century, after which the population and economy rebounded. As the New York Times reminds us:

The agent of the Black Death is assumed to be Yersinia pestis, the microbe that causes bubonic plague today. But the epidemiology was strikingly different from that of modern outbreaks. Modern plague is carried by fleas and spreads no faster than the rats that carry them can travel. The Black Death seems to have spread directly from one person to another.Victims sometimes emitted a deathly stench, which is not true of plague victims today. And the Black Death felled at least 30 percent of those it inflicted, whereas a modern plague in India that struck Bombay in 1904, before the advent of antibiotics, killed only 3 percent of its victims.

A New Way of Understanding What Might Kill Us

It has been more than half a century since the discovery of penicillin revolutionized our ability to control communicable disease. Since that time a lot of progress has been made on all kinds of diseases, although the emphasis has been more on degenerative diseases--treatments for cardiovascular conditions, cancer, and other issues that are associated especially with an aging population. But, a story in today's New York Times puts the control of bacteria and viruses back in the spotlight. The story focuses on the work of Dr. James M. Musser, chairman of pathology and genomic medicine at the Methodist Hospital System in Houston.

It is the start of a new age in microbiology, Dr. Musser and others say. And the sort of molecular epidemiology he and his colleagues wanted to do is only a small part of it. New methods of quickly sequencing entire microbial genomes are revolutionizing the field.

The first bacterial genome was sequenced in 1995 — a triumph at the time, requiring 13 months of work. Today researchers can sequence the DNA that constitutes a micro-organism’s genome in a few days or even, with the latest equipment, a day. (Analyzing it takes a bit longer, though.) They can simultaneously get sequences of all the microbes on a tooth or in saliva or in a sample of sewage. And the cost has dropped to about $1,000 per genome, from more than $1 million.

Why Are We Still Even Talking About Vitamin A?

The BBC News today highlights a paper just published in the British Medical Journal that extols the virtue of Vitamin A supplements for children.

UK and Pakistani experts assessed 43 studies involving 200,000 children, and found deaths were cut by 24% if children were given the vitamin. And they say taking it would also cut rates of measles and diarrhoea. The body needs vitamin A for the visual and immune systems to work properly. It is found in foods including cheese, eggs, liver and oily fish.

The incredibly sad part of this is that we have to keep talking about it in order to get the world to remember how important Vitamin A is for children. A very nice history of the discovery of how important Vitamin A can be is told in the PBS special of "Rx for Survival--Back to the Basics." Dr. Alfred Sommer at The Johns Hopkins Bloomberg School of Public Health is interviewed in this program, which I highly recommend to you:

A Malaria Treatment So Wacky It Just Might Work--Someday

The New York Times has a very interesting story today about a project that is being funded by the Gates Foundation to try to bring malaria under control. The idea is to treat patients (mice, to begin with) by placing them (or parts of them) in a very low wattage microwave. It will be some time before we know if this treatment will work to rid a body of malaria, but the article's main value is that in interviewing one of the method's co-inventors, Dr. Jose Stoute at Penn State, it provides a very nice summary of the complex biology of the malaria parasite, which helps us understand why this parasite has been a nemesis for thousands of years.

The idea, he said, is based on the fact that malaria parasites invade red blood cells and eat the hemoglobin inside them. Hemoglobin contains iron — and, as any bozo who’s ever tried to heat up a sandwich wrapped in tinfoil knows, it’s a bad idea to microwave metal.

Of course, the red cells containing parasites are floating along in arteries right next to healthy red cells, so whatever damage the microwave does to the parasites cannot be visited on the healthy cells, too.

Do You Think You Have Lung Cancer? Ask Your Dog

My wife and I have had German Shepherds for more than twenty years and we have always been impressed not just by how smart they are, but by the fact that they (like a lot of other animals) "see" things in the world that we can't. BBC News reports this week on an experiment at a hospital in Germany showing that dogs have a remarkable ability to diagnose lung cancer in a person by smelling their breath.

It is thought that tumours produce "volatile chemicals" which a dog can detect.

Researchers trained four dogs - two German shepherds, an Australian shepherd and a Labrador - to detect lung cancer.

Three groups of patients were tested: 110 healthy people, 60 with lung cancer and 50 with chronic obstructive pulmonary disease, a narrowing of the airways of the lungs.They all breathed into a fleece filled tube, which absorbed any smells. The dogs sniffed the tubes and sat down in front of those in which they detected lung cancer smells. They were successful 71% of the time. The researchers showed the dogs were not getting confused by chemicals associated with chronic obstructive pulmonary disease or smoking. Dr Thorsten Walles, the report's author from Schillerhoehe Hospital, said: "In the breath of patients with lung cancer, there are likely to be different chemicals to normal breath samples and the dogs' keen sense of smell can detect this difference at an early stage of the disease. "Our results confirm the presence of a stable marker for lung cancer. This is a big step forward."

HIV/AIDS in the News in the Middle East and West Africa

The incidence of HIV/AIDS is low by world standards in the Middle East and in many Western African countries, as well. But that does not mean that problems don't exist. Reuters reports on a new study by a group in Qatar published in PLoS Medicine suggesting that there is a generally unrecognized epidemic in a few middle eastern countries. This appears to be largely a result of men having sex with men (MSM):

Epidemics of HIV are emerging among gay and bisexual men in the Middle East and North Africa and high levels of risky sexual behavior threaten to spread the AIDS virus further in the region, researchers said Tuesday.

In the first study of its kind in a region where homosexuality and bisexuality are taboo, researchers from Weill Cornell Medical College in Qatar found evidence for concentrated HIV epidemics -- where infection rates are above 5 percent in a certain population group -- in several countries such as Egypt, Sudan, Pakistan and Tunisia.

Safer Deliveries in Sierra Leone

Data from the World Health Organization show that Sierra Leone has the highest rate of maternal mortality of any country in the world, with 2,100 maternal deaths per 100,000 live births (compared, for example, with 11 in the US and 7 in Canada). The New York Times reports on a new internationally-funded program in Sierra Leone to waive fees for pregnancy and delivery in order to improve birth outcomes.

Sierra Leone is at the vanguard of a revolution — heavily subsidized for now by international donors — that appears to be substantially lessening health dangers here in one of the riskiest countries in the world for pregnant women and small children.

Country after country in sub-Saharan Africa has waived medical fees in recent years, particularly for women and children, and while experts acknowledge that many more people are getting care, they caution that it is still too early to declare that the efforts have measurably improved health on the continent.

In Sierra Leone, though, it seems clear that lives are being saved, providing an early and concrete lesson about the impact of making health care free for the very poor and vulnerable.

By waiving the requirement for payments — which sometimes amount to hundreds of dollars and clearly represent the main barrier to using health facilities — the government here appears to have sharply cut into mortality rates for pregnant women and deaths from malaria for small children.

Smoking Slowly Being Snuffed Out in US

Janet Lavelle of the San Diego Union-Tribune followed up today on a report just issued by the California Department of Public Health showing that the smoking rate has fallen to a record low in California. This is a very encouraging sign since smoking is one of the major "real" causes of death throughout the world.

The rate of adult smokers statewide dropped to a record low of 11.9 percent in 2010, making California and Utah the only states to reach a federal target to cut smoking rates to 12 percent by 2020.

Officials attributed at least some of the drop to California’s aggressive public anti-smoking campaign launched in the late 1980s. While the latest statistics are encouraging, health officials said smoking remains the leading preventable cause of disease and death, killing more than 400,000 Americans annually.

It is important to note that this overall drop is not just a result of the overall aging of the population. It is very importantly dropping in the teen years--the ages at which people are  most likely to get addicted to cigarettes.

A New Twist on the "Real" Causes of Death

As I note in Chapter 5 of the text, there have been widely circulated studies of the "real" causes of death, by which the researchers mean things like smoking, alcohol and drug use, and diet. Now researchers at Columbia University's Mailman School of Public Health have produced a new twist on this theme--the social categories that increase your chance of early death. None of this will be news to readers of my book, but the numbers are very interesting, nonetheless:

The investigators found that approximately 245,000 deaths in the United States in the year 2000 were attributable to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to area-level poverty.

Overall, 4.5% of U.S. deaths were found to be attributable to poverty -- midway between previous estimates of 6% and 2.3%. However the risks associated with both poverty and low education were higher for individuals aged 25 to 64 than for those 65 or older.

US Has Significant Spatial Inequalities in Life Expectancy

Christopher Murray and his colleagues at the Institute of Health Metrics and Evaluation at the University of Washington have just published a study of life expectancy by county in the United States, covering the period from 1987 to 2007.  They found that, even as the general trend in life expectancy is up, there are wide swaths of the country in which life expectancy has not changed or has even dropped over time.

The region where life expectancy is lowest, and in some places declining, begins in West Virginia, runs through the southern Appalachian Mountains and west through the Deep South into North Texas. Places of high life expectancy are more scattered. In addition to Northern Virginia they include counties in Colorado, Minnesota, Utah, California, Washington state and Florida.

The study did not examine the causes of these disparities, but the Washington Post offered up a couple of possible explanations:

Fluoride Really Is Good For Your Health

Poor dental hygiene and oral health can be bad for your overall levels of health, and the single best thing that has ever happened to oral health is fluoride. Yet, an article in the latest issue of The Nation's Health reminds us that too many people are wary of fluoride treatments.

Dental advances over the past six decades mean that many Americans do not remember a time when tooth decay and disease was a major national public health problem.

Much of the credit for the nation’s better oral health can be attributed to the decision in the 1940s to begin adding fluoride to public drinking water systems. According to the American Dental Association, fluoridation reduces tooth decay in all age groups by 20 percent to 40 percent “even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.”

More Misery in Missouri

The horrendous tornadoes in Joplin, Missouri, have as of today caused the death of 151 people. And the misery continues in myriad ways, including the eruption of a dangerous fungus which may have contributed to the death of at least three of those people.

Jacqueline Lapine, a spokeswoman for the Missouri Department of Health and Senior Services, said the department has received reports of eight suspected deep-skin fungal infections among survivors of the May 22 twister. She said all of the victims had suffered multiple injuries and developed secondary wound infections.

Zygomycosis, also known as mucormycosis, is a sometimes-fatal infection that spreads rapidly and can be caused by soil or vegetative material becoming getting under the skin. It's more prevalent in people with weakened immune systems or untreated diabetes but can affect healthy people who get badly hurt.

Education Can Save Your Life

There is a long and steady positive relationship between education and longevity--the more education you have, the longer you are likely to live. And I say that not just because I am a college professor and have a vested interest in that relationship. It's a fact. But it is also becoming more complicated, according to another college professor, Robert Hummer, of the University of Texas. He will discuss his research online at the Population Reference Bureau (PRB) in Washington, DC, on June 9th. If you don't catch it live, it will be available later on the PRB website. Here's the teaser:

Many people know that individuals with higher levels of education tend to live longer and healthier lives than individuals with low levels of education. In a recent study, Robert Hummer and colleagues built on this knowledge by demonstrating new important characteristics of the relationship between education and adult mortality in the United States.

The End of AIDS?

This week is the 30th anniversary of the first AIDS cases being recognized as a cluster of diseases in the United States by the Centers for Disease Control, although the disease probably entered the country in the 1970s. Thirty years ago no one was sure exactly what this disease was. I have a copy of the Wall Street Journal from December 10, 1981 with the headline "Mysterious Ailment Plagues Drug Users, Homosexual Males." Only six years later it was a global emergency, and merited a separate essay in the Fourth Edition of my Population text, which came out in 1988. I ended that essay with the comment that "it also seems possible, however, that the massive resources that are being poured into research may yield a cure for AIDS." I thought about that comment as I pondered the Economist's cover story this week--23 years later--on "The End of Aids?" That question mark at the end is the most important part of the headline. The Associated Press offered this thought about it:

New E. Coli Outbreak Threatens Europeans

In 1935 Hans Zinsser reminded us that bugs are always waiting in the shadows "ready to pounce when neglect, poverty, famine, or war lets down the defenses." It seems this week that someone in Europe let down the defenses:

Scientists on Thursday blamed Europe's worst recorded food-poisoning outbreak on a "super-toxic" strain of E. coli bacteria that may be brand new.

But while suspicion has fallen on raw tomatoes, cucumbers and lettuce as the source of the germ, researchers have been unable to pinpoint the food responsible for the frightening illness, which has killed at least 18 people, sickened more than 1,600 and spread to least 10 European countries.

An alarmingly large number of victims — about 500 — have developed kidney complications that can be deadly.

The Power of Placebos

This week's Economist reports on a recent volume of the Royal Society's Philosophical Transactions devoted to the placebo effect in medicine. The very fact that people think they are being treated has been shown in a variety of cases to improve health. This is, indeed, why clinical trials in medicine compare treatments against placebos instead of against no treatment at all. But the Economist connects additional dots in its story, because it seems that the placebo effect is almost certainly the main reason why treatments based on "complementary" or "alternative" medicine (things that are outside of modern western science) may seem to work, even when there is no scientific basis for their ability to work. The story focuses on Dr. Edzard Ernst at Peninsula Medical College in the UK.

Over the years Dr Ernst and his group have run clinical trials and published over 160 meta-analyses of other studies. (Meta-analysis is a statistical technique for extracting information from lots of small trials that are not, by themselves, statistically reliable.) His findings are stark. According to his “Guide to Complementary and Alternative Medicine”, around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine, homeopathy and reflexology—are statistically indistinguishable from placebo treatments. In only 5% of cases was there either a clear benefit above and beyond a placebo (there is, for instance, evidence suggesting that St John’s Wort, a herbal remedy, can help with mild depression), or even just a hint that something interesting was happening to suggest that further research might be warranted.

Despite this lack of evidence, and despite the possibility that some alternative practitioners may be harming their patients (either directly, or by convincing them to forgo more conventional treatments for their ailments), Dr Ernst also believes there is something that conventional doctors can usefully learn from the chiropractors, homeopaths and Ascended Masters. This is the therapeutic value of the placebo effect, one of the strangest and slipperiest phenomena in medicine.

Sin City Turns Out Also to Be Suicide City

I had just returned from a trip to Las Vegas (business, not pleasure!) when I received a note from Adam Lippert at Penn State alerting me to a very interesting podcast featuring Matt Wray, a sociologist at Temple University, discussing the fact that Las Vegas has the highest urban suicide rate in the United States. I thought to myself--what are the odds? 

The point of the story is that suicide is the 10th leading cause of death in the US and accounts for twice as many deaths each year as homicides (see Table 5.2 in my 11th edition), and yet it is rarely a topic of public discussion. 

The podcast focuses on Las Vegas. When most people think of Vegas, they think of slot machines, bright lights, maybe a certain Elvis song. Most people wouldn’t immediately think of suicide — except for Matt Wray, a Temple sociologist who has been studying the topic extensively.

Death Secrets From Egyptian Mummies

Health historians have famously diagnosed the causes of death of famous people like Napoleon Bonaparte and, most recently, Charles Darwin, by searching through symptoms and relating those symptoms to likely pathologies leading to death. It is rare, of course, to be able actually to examine the body and do something resembling a post-mortem. Yet, that is what researchers have been able to do with Egyptian mummies.

An Egyptian princess who lived more than 3,500 years ago is the oldest known person to have had clogged arteries, dispelling the myth that heart disease is a product of modern society, a new study says.

To determine how common heart disease was in ancient Egypt, scientists performed computer scans on 52 mummies in Cairo and the United States. Among those that still had heart tissue, 44 had chunks of calcium stuck to their arteries — indicating clogging.

"Atherosclerosis clearly existed more than 3,000 years ago," said Adel Allam, a cardiology professor at Al Azhar University in Cairo, who led the study with Gregory Thomas, director of nuclear cardiology education at the University of California in Irvine. "We cannot blame this disease on modern civilization."

On the other hand, maybe heart disease among the ancients could be blamed on diet and exercise?

Joep Perk, a professor of health sciences at Linnaeus University in Sweden and a spokesman for the European Society of Cardiology, said the heart disease discovered in the mummies was probably due to the rich diet and lack of exercise among the Egyptian elite. He was not linked to the mummy research.

"The pharaohs and other royalty probably had more fat in their diet than the average Egyptian," he said. "The sculptures and hieroglyphs may show people who were very thin and beautiful, but the reality may have been different."

New One-Dog Policy Takes Effect in Shanghai, China

In the land of the one-child policy, there is now a one-dog policy in effect in Shanghai, China's largest city, mirroring similar laws already in place in Beijing and Guangzhou. The policy was adopted this past February, but was implemented as of today. Pet-owners with more than one dog are allowed to keep them, but new licenses are to be issued only to homes currently without a dog. The reason for the policy is apparently to prevent unlicensed dogs from roaming the cities and biting people, causing alarms about the spread of rabies.

Shanghai's new pet ownership rules also slash steep fees for dog registration — in hopes of bringing more undocumented dogs onto the books — and require those walking dogs to keep them on leashes.