The Budding Anthropod

The New England Journal of Medicine recently published two compelling articles focusing on the fact that America spends twice as much on health care/person compared to other industrialized nations, and yet we have the most # of patients uninsured.

Here are two articles from the doctor’s perspective highlighting the need for change regardless of what party comes into office.

Three “inconvenient truths” about heathcare
Learning from our international counterparts

Our body has its own “signaler” of distress! When a cell becomes infected with a virus, it releases a molecule known as Type I Interferon (IFN). This IFN molecule can bind to receptors on uninfected cells and induce the production of enzymes that block viral replication within that cell. Its our body’s version of Paul Revere doing his “midnight ride” warning all those nearby to put their shields up — the VIRUS IS COMING!

This post is not the most thought based — but we had a story that was told in class that I was contemplating as a blog post… and then as I was walking home, I had to do a skip and a jump over a pretty slimey blob of vomit, so I figured that was a sign that I should share!

So next time you eat out at a fancy restaurant, and come down with a case of acute gastroenteritis (also known as friend that makes you run to the lieu — diarrhea and vomiting), it may not actually be caused by food contaminated by bacteria, parasites or viruses! So, of course, this is a bit rare, but today we were told a story about a norwalk virus epidemic in a hotel restaurant. So apparently a man infected with the norwalk virus threw up — which was RAPIDLY cleaned up with a mop and disinfectant. But despite the measures taken, 52/83 people in the restaurant at that time came down with the norwalk virus in 33 hours! How you may ask???

Their was an extractor fan placed at the “position of the vomiter”, and that helped spread aerosolized versions of the virus to the nearby diners. So the further you were located from the person who threw up, the safer you were! (personally, i would have booked it, but that’s just me ;))

The norwalk virus is a virus that causes GI symptoms, but unlike other bacterial and viral causes it causes more vomitting than diarrhea and can affect ALL ages. It was discovered in norwalk, CT… and is also a common cause of outbreaks on cruise ships. (haha, want to know why?!) Because you know cruise ships tend to go to those exotic climates — Mexico, the Bahamas, etc which due to its climate and depending on the area hygiene, have higher endemic rates of fecal-oral agents (such as the norwalk virus). So, one cabin mate eats an infected meal, and comes back and takes refuge in the cabin bathroom. Now all the people in the cabin are at risk because of either contaminated food or water or aerosolized virus particles handing around. They continue to spread it throughout the ship. And this virus can survive on surfaces for a long time — so not only will it infect the voyagers on that cruise, but those on the new run too.

And the moral of the story is the virus lives happily ever after because it has ensured that it can be transmitted forever and ever and ever. The end.

Many changes have taken place in India over the past few decades — and with its strengthening economy and global image, I know a lot of Indians like to send out those mass emails “why India’s #1!”. Yes, I admit, there is a lot of improvement coming out of the country — technological and cultural. But, I did have to smirk at the irony of how frequently India’s name comes up while we’re learning about our good old friendly parasites!

Its like congratulations India — you are the host of 50% of visceral Leishmania cases worldwide! I do worry about the growing social divide that will continue to exist — as Mumbai and New Delhi continue to prosper what will happen to the small rural areas where these parasites continue to share the water that all its inhabitants bathe with? Thousands of children are infested leading to mental retardation, stunted growth, left without a chance from the beginning — merely because of the path they walk in.

America’s all about efficiency and with the advent of the blackberry’s, wireless internet, and phones there is really no reason we can’t access any resource imaginable practically all the time. Right? Well, now, when you’re waiting at the airport for your next trip and notice its mid october… and remember, oh no, flu season’s about to start and I have not gotten my flu shot yet. There’s no reason to worry… in addition to picking up a starbucks and a newspaper to keep you company on that long flight, you can also receive a flu shot during your lay over. But dont forget, you can’t bring in your own water bottle into that terminal.

It is important to re-boost your flu immunization every year because just like all the high end UN officials meet up to plan our next global strategy, health officials from all over the world gather at the end of winter season to determine what flu strains will be prevalent in the US during our next flu season based off of migration from other countries such as Japan and mutations in the virus itself. So when you’re getting ready to hit up the beaches and glad “flu season is over”, the vaccine industry is just letting out a sigh because now they have to start preparing for yet another season to combat the influenza virus that has ADHD (it changes its protein coat all the time).

Just in case you were worried, I wanted to dispel an old “myth” — apparently, you cannot get warts from kissing a frog. The papillomaviruses which cause warts (from plantar warts to genital) are extremely species specific and cannot be transmitted from species to species.

So, get out there and let the inner child out– go chase mr. toad and dont be shy about giving it a little smooch. After all, maybe your inner fairy tale will come true.

While I’m on the topic of HPV, I should also bring up the discussion about Gardasil (the quardivalent recombinant vaccine — which means it works against four common strains of HPV). Gardasil is a relatively new vaccine that provides protective immunity by triggering an antibody response against capsid (viral coat) proteins of 4 common strains of HPV. Multiple studies have shown that it prevents the development of cervical lesions in women who received the vaccine. So then the question that immediately should pop up is well, why isn’t everyone getting vaccinated? It sounds like a “miracle vaccine” that could help fight the second most common cause of cancer in women in the US. (According to the CA Cancer J Clin 11,000 women were diagnosed with cervical cancer in 2008 and approximately 3,870 died in 2008 alone).

There are a lot of factors revolving around this issue, but I wanted to just scratch the surface by starting with its cost. A 3 shot regiment, Gardasil costs at least $360 for the entire regimen. The cost and the fact that it needs to be refrigerated makes it impossible to target third world nations. So that raises the question: what population is at a higher risk for HPV infection and what population will actually be able to afford Gardasil. A 2007 opinion article in the Canadian Medical Association Journal argues, “we must be certain that spending an estimated $2 billion to vaccinate a population of girls and women in Canada who are already mostly well protected by their own immune systems, safer sex practices and existing screening programs will not perpetuate the existing gaps in care and leave the actual rate of deaths from cervical cancer unchanged.”

And then another important issue is the stigma behind vaccinating young women (starting at the age of 11) against a sexually transmitted disease. Many people argue that by providing the vaccine to everyone, it is an indirect way of giving permission to be promiscuous. But currently, vaccination for Hepatitis B is required for girls entering school, so what makes HPV different? And couldn’t it be looked at in the opposite light: it could open the door for the discussion before its too late.

One last factor is the fact that the vaccine is only approved for women. Men, even though they can’t develop cervical cancer, serve as a large reservoir for HPV itself… and so regardless of how many women are immunized, men will hinder reaching herd immunity because they will serve as a constant source for reinfection.

That all being said, even with the vaccine, regular pap smears are a must to help screen for cervical cancer and should be continued routinely amongst those with or without the vaccine.

The purpose of this post was not to scare any of us! Its to raise awareness and more importantly just to think about all the factors that have to go into approving a drug, a vaccine, or any method for treatment that we use so commonly today. It should make us think how it became so common place for us to all be vaccinated against mumps, measles, rubella, and hepatitis B before we receive admission into public schools (with the exception of the opt out policy).

So, of course, I have been putting off the first post cause my head was a giant mush from all the build up of things in the past that I missed dialoging about. But, I figure with the coming of fall I should start out with an ode to our good ol’ viral friends.

The New England Journal of Medicine posted a new video in which they used a light beam to visualize a “cough”. They used 3000 frames per second to record a “half second” cough. I am sure that all of our grandmother’s watched this video in action and that’s why they constantly remind us that it is good etiquette to cover your mouth while you cough. The virus particles that exist in this “amorphous cloud” emitting from the volunteers mouth can exist for a long time without moisture or food. Those viruses just “take a little nap” until you come around, wipe the table, and then eat that delicious apple of yours, allowing them to merge with your happy cells.

Click here to see NEJM’s visualization of the cough