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There is much that we agree about in our understanding of addiction and what can be done about the harm it causes. However, unusually perhaps for collaborators, we disagree about some important implications of suggesting a rethink of the relationship between addiction and choice. First, what do we agree on? We agree that the relationship between addiction and choice needs rethinking.
Over two years ago I wrote that “new viruses are constantly being discovered... Then something comes out of the woodwork like SARS which causes widespread panic”. Zika virus infection bids fair to repeat the torment. On 28 January 2016 the BBC reported that the World Health Organization had set up a Zika “emergency team” as a result of the current explosive pandemic.
Though caused by microscopic agents, infectious diseases have played an outsized role in human history. They have shaped societies, lent us words and metaphors, and turned the tide of wars. Humans have eliminated some diseases, but others continue to plague us. In this quiz, find out if confusion is contagious or if you’re immune to the challenge.
A recent meme circulating on the internet mocked a US government programme (ObamaCare) saying that its introduction cost $360 million when there were only 317 million people in the entire country. It then posed the rhetorical question: "Why not just give everyone a million dollars instead?"
Is garlic or citronella more useful in repelling insects? Which disease is typically identified as an 'urban' disease? What is the most reliable way to purify water? To celebrate the publication of the Oxford Handbook of Expedition and Wilderness Medicine test your knowledge of the unique dangers and diseases faced in travel medicine.
Environmental Epigenetics is a new, international, peer-reviewed, fully open access journal, which publishes research in any area of science and medicine related to the field of epigenetics, with particular interest on environmental relevance. With the first issue scheduled to launch this summer, we found this to be the perfect time to speak with Dr. Michael K. […]
Green fluorescent proteins, or GFPs for short, are visibly advancing research in biology and medicine. By using GFPs to illuminate proteins otherwise undetectable under the microscope, scientists have learned a great deal about processes that take place within our cells.
Are you worried about catching the flu, or perhaps even Ebola? Just how worried should you be? Well, that depends on how fast a disease will spread over social and transportation networks, so it’s obviously important to obtain good estimates of the speed of disease transmission and to figure out good containment strategies to combat disease spread.
Diseases, rumors, memes, and other information all spread over networks. A lot of research has explored the effects of network structure on such spreading. Unfortunately, most of this research has a major issue: it considers networks that are not realistic enough, and this can lead to incorrect predictions of transmission speeds, which people are most important in a network, and so on. So how does one address this problem?
Traditionally, most studies of propagation on networks assume a very simple network structure that is static and only includes one type of connection between people. By contrast, real networks change in time — one contacts different people during weekdays and on weekends, one (hopefully) stays home when one is sick, new University students arrive from all parts of the world every autumn to settle into new cities. They also include multiple types of social ties (Facebook, Twitter, and – gasp – even face-to-face friendships), multiple modes of transportation, and so on. That is, we consume and communicate information through all sorts of channels. To consider a network with only one type of social tie ignores these facts and can potentially lead to incorrect predictions of which memes go viral and how fast information spreads. It also fails to allow differentiation between people who are important in one medium from people who are important in a different medium (or across multiple media). In fact, most real networks include a far richer “multilayer” structure. Collapsing such structures to obtain and then study a simpler network representation can yield incorrect answers for how fast diseases or ideas spread, the robustness level of infrastructures, how long it takes for interaction oscillators to synchronize, and more.
Image credit: Mobile Phone, by geralt. Public domain via Pixabay.
Recently, an increasingly large number of researchers are studying mathematical objects called “multilayer networks”. These generalize ordinary networks and allow one to incorporate time-dependence, multiple modes of connection, and other complexities. Work on multilayer networks dates back many decades in fields like sociology and engineering, and of course it is well-known that networks don’t exist in isolation but rather are coupled to other networks. The last few years have seen a rapid explosion of new theoretical tools to study multilayer networks.
And what types of things do researchers need to figure out? For one thing, it is known that multilayer structures induce correlations that are invisible if one collapses multilayer networks into simpler representations, so it is essential to figure out when and by how much such correlations increase or decrease the propagation of diseases and information, how they change the ability of oscillators to synchronize, and so on. From the standpoint of theory, it is necessary to develop better methods to measure multilayer structures, as a large majority of the tools that have been used thus far to study multilayer networks are mostly just more complicated versions of existing diagnostic and models. We need to do better. It is also necessary to systematically examine the effects of multilayer structures, such as correlations between different layers (e.g., perhaps a person who is important for the social network that is encapsulated in one layer also tends to be important in other layers?), on different types of dynamical processes. In these efforts, it is crucial to consider not only simplistic (“toy”) models — as in most of the work on multilayer networks thus far — but to move the field towards the examination of ever more realistic and diverse models and to estimate the parameters of these models from empirical data. As our review article illustrates, multilayer networks are both exciting and important to study, but the increasingly large community that is studying them still has a long way to go. We hope that our article will help steer these efforts, which promise to be very fruitful.
At first, I wasn’t sure quite why. I get what they meant. It seems like Ebola’s everywhere! It’s constantly on the news, all over the internet, and everyone’s talking about it. It makes sense to be sick of hearing about it. We’re bound to get sick of hearing about anything that much!
But still, I couldn’t shake the discomfort that rung in my head over that status. Ebola seems far away, after all, it’s only been diagnosed four times in the US. It’s easy to tuck it away in your mind as something distant that doesn’t affect you and forget why it’s a big deal.
It’s even become a hot topic for jokes on social media:
Because so many see this very real disease as a far away concept, we find safety in our distance and it’s easy to make light of it.
But guys….
4,877 deaths. 9,935 sufferers. That’s not funny. That’s not something to ask to “omg shut up.”
The idea of disease never really hit home for me until my little sister was diagnosed with cancer. Yes, Ebola and cancer are two very different things. But I know what it’s like to watch someone I love very dearly suffer. I know what it’s like to hold my sister’s hand while she cries because she can’t escape the pain or the fear that comes with her disease. I know what it’s like to cry myself to sleep begging God to take her illness away. And I can’t help but imagine a sister somewhere in Africa in a situation very similar to my own, watching her loved one suffer, hearing her cries, and begging for it to all be over- but without the blessings of medicine and technology that my sister has access to.
We are quick to throw on our pink gear for breast cancer awareness and dump ice on our head for ALS because that kind of awareness is fun and easy. I’m not trying to diminish those causes- they are great causes that deserve promotion. But I mean to make note of the fact that when another very real disease with very real consequences is brought to light and gains awareness, people groan that it’s in the news again and make jokes about it on the internet. Because Ebola doesn’t have the fun and cute promotional package, we complain and make light of it and its need for awareness and a solution.
People are suffering and dying from Ebola. Just because that suffering seems far away, doesn’t make it any less significant.
This is a guest post from my oldest daughter, Meredith. I begged her to let me post it.
Contagious disease is as much a part of our lives as the air we breathe and the earth we walk on. Throughout history, humankind’s understanding of disease has shifted dramatically as different cultures developed unique philosophic, religious, and scientific beliefs. From Galen in Ancient Rome to Walter Reed in the United States, the collective experiences of those before us have come to inform our present understanding of contagious disease. See how much you know about the history of contagious disease.
Headline image credit: Copper engraving of Doctor Schnabel [i.e Dr. Beak], a plague doctor in seventeenth-century Rome, with a satirical macaronic poem (‘Vos Creditis, als eine Fabel, / quod scribitur vom Doctor Schnabel’) in octosyllabic rhyming couplets. Public domain Wikimedia Commons
Torday, Piers. 2014. The Last Wild. Penguin Audio. Narrated by Oliver Hembrough.
Like Eva Nine, in the WondLa series, Kester Jaynes finds that he can communicate with creatures of the wild - an ability that is particularly intriguing in a dystopian world where all animals are presumed dead - killed by the incurable red-eye virus. Kester finds himself the leader of his own "wild," the ragtag remnants of the animal world. Flora and fauna are pitted against commercial efficiency and industrialism in this first book of a planned trilogy.
The plot is occasionally predictable, but slow patches are often brightened by the humorous antics of The General (a likable but militaristic cockroach) and a befuddled white pigeon who speaks nonsense that is also somehow prophetic.
The author and narrator hail from the UK, so the reader or listener should be prepared for numerous British words that are uncommon here in the US (wellies, trainers, boot, windscreen, plaits, etc.). My review of The Last Wild for Audiofile Magazine appears here.
There is no easy segue from yesterday's Captain Underpants review to today's In the Shadow of Blackbirds. I primarily review children's books. This one is definitely for young adults.
Winters, Cat. 2013. In the Shadow of Blackbirds. New York: Amulet. Advance Reader Copy supplied by NetGalley.
Through the windows, I watched the boys proceed to a line of green military trucks that waited rumbling alongside the curb. The recruits climbed one by one beneath the vehicles' canvas coverings with the precision of shiny bullets being loaded into a gun. The trucks would cart them off to their training camp, which was no doubt overrun with feverish, shivering flu victims. The boys who didn't fall ill would learn how to kill other young men who were probably arriving at a German train station in their Sunday-best clothing at that very moment. (From Chapter 2, "Aunt Eva and the Spirits")
The year is 1918, and 16-year-old Mary Shelly Black is on her way from Portland to San Diego to stay with her widowed 26-year-old aunt. Her mother is dead. Her father has recently been arrested - swept up in the anti-German immigrant frenzy that's sweeping the country.
The sign in front of the eatery claimed the place specialized in "Liberty Steaks," but that was simply paranoid speak for We don't want to call anything a name that sounds remotely German, like "hamburger." We're pro-American. We swear! (from Chapter 13, "Ugly Things")
Young men are eagerly enlisting to fight in the trenches of Europe, and amidst it all, the "Spanish flu" ravages the population - their flimsy gauze masks are no match for the deadly virus.
The businessmen in smart felt hats rode with me, probably on their lunch break. They buried their gauze-covered noses in the San Diego Union, and one of them felt the need to read the October influenza death tolls out loud. "Philadelphia: over eleven thousand dead and counting - just this month. Holy Moses! Boston: for thousand dead." The use of cold statistics to describe the loss of precious lives made me ill. (From Chapter 17, "Keep Your Nightmares to Yourself")
The bleak situation is made all the worse by her recent discovery that her dearest Stephen, the only bright spot in her sad existence in San Diego, has enlisted in the Army, not because he desires to fight and kill German soldiers, but to show love for his country and free himself from living under the same roof as his brother, a drug-addled, "spirit photographer,"
So this is war. The declaration changed Coronado and San Diego overnight. The men are all enlisting and everyone is hurrying to make sure we all look like real Americans. One of our neighbors held a bonfire in his backyard and invited everyone over to burn their foreign books. I stood at the back of the crowd and watched people destroy the fairy tales of Ludwig Tieck and the Brothers Grimm and the poetry of Goethe, Eichendorff, Rilke, and Hesse. They burned sheet music carrying the melodies of Bach, Strauss, Beethoven, and Wagner. Even Brahm's "Lullaby."
In the Shadow of Blackbirds takes a decidedly darker turn when Mary Shelly learns of Stephen's death in the trenches of Europe. She attends his funeral, but something is very wrong. She can hear him, she can feel his torment. His spirit is not at rest; and amidst the horror of war and the flu pandemic, something else is terribly, terribly wrong. Spirit photography andséances are commonplace as millions across the country yearn to connect with loved ones lost to war or disease; but Shelly is a girl of science, of rationalism - raised in a house of reason and education. But how can science and reason explain the anguished pleas of her deceased love? In The Shadow of Blackbirds is gripping historical fiction and Mary Shelly Black is a tragic yet strong protagonist. Containing some of the same themes as Avi's dark, Seer of Shadows(Harper Collins, 2008)(spirit photography, rationalism vs. spiritualism), In the Shadow of Blackbirds examines these themes as well as romantic love and post-traumatic stress syndrome. The setting (San Diego and nearby Coronado Island) and the juxtaposition of love and war, disease and science combine to offer a dark and gritty debut novel. The descriptions of trench warfare and everyday life during the massive flu pandemic are gritty and graphic, reminiscent of Mary Hooper's novel of Europe's 17th century plague, At the Sign of the Sugared Plum (Bloomsbury, 2003). The fear of death is almost palpable, made even more so by the reader's knowledge that garlic amulets and gauze masks are powerless against the killer flu. To read In the Shadow of Blackbirds is to be immersed in a grim period of American history that at times, bears resemblance to our own.
From the Author's Note,
...the influenza pandemic of 1918 (this particular strain was known as the "Spanish flu" and the "Spanish Lady") killed at least twenty million people worldwide. (Some estimates run as high as more than one hundred million people killed." Add to that the fifteen million people who were killed as a result of World War I and you can see why the average life expectancy dropped to thrifty-nine years in 1918 - and why people craved seances and spirit photography.
Note: If you've ever watched the classic Academy Award Best Picture, All Quiet on the Western Front (1930), this warning from Mary Shelly to her love will foreshadow and haunt,
"Please stay safe. It's not everyone who has the patience to photograph a butterfly."
Period photographs of life during the influenza pandemic of 1918 availabe at these sites:
If this book is half as good as your review, then it moves way up my list. This sounds fascinating--and well-researched/well-written, too. Thanks for sharing your thoughts on this one. On another note, the Phillies are looking healthier this year . . . I've hauled out my jersey, my cap, and my bobbleheads. If my make-shift red-and-white shrine is effective, then we can look fwd to a good start to the season! (I will miss Chooch for the first few weeks, though.)
Murphy, Jim and Alison Blank. 2012. The Invincible Microbe: Tuberculosis and the Never-Ending Search for a Cure. New York: Clarion.
The minute I saw this book, I knew that I would read it, not because I am a fan of nonfiction and Jim Murphy, but for personal reasons. While my mother would often tell me stories of what it was like to be a child during WWII, my stepfather was older. He lived what I considered to be a fascinating, history-book life. He was an orphan. He remembered the Great Depression. He was a runaway. He was a "runner" on Wall Street. He had tuberculosis. He recalled being forced to march outside in the cold New York winter wearing nothing but a t-shirt and underpants, a common aspect of a patient's "curing" regimen. I can only imagine that a poor orphan boy's regimen was harsher than most. To this day, I cannot look at a sepia-tinged photo of poor scantily clad children in the snow without thinking of my stepfather. The girls on the cover of The Invincible Microbe, "curing" outside on a porch, may be smiling in the photo, but I don't believe for a minute that it was by choice. To the end of his days, my stepfather loved rich foods and warm temperatures - small wonder.
So, to me growing up, TB was a thing of the past - a disease like polio, generally eradicated and of no concern to me. Then came the late 1980's and 1990's. My sister lived in Manhattan, and lo and behold, tuberculosis was suddenly a topic of discussion again. There was an outbreak in the City. She was worried. So to me, tuberculosis was then an urban thing, of no concern to me, except where my sister was concerned. My sister moved away from the City, and I thought little of it again ... until my children were born. Then to me, TB was "the bubble test," and I thought little of it, except that it seemed to be an easier test than the "tine test" I remembered from childhood, and I was thankful that my kids were protected...
or so I thought, until I read The Invincible Microbe.
The Invincible Microbe: Tuberculosis and the Never-Ending Search for a Cure, tells the story of TB from its known beginning, in prehistoric times, through the days of magical, prayerful, and deadly "cures," until today, when TB is still a scourge in five areas of the world (Democratic Republic of Congo, Ghana, The Philippines, Swaziland, Vietnam)and is only as far away from you as a plane ride.
Thoroughly researched, sourced and indexed, with numerous photographs, The Invincible Microbe is a chronological look at the Tuberculosis germ, containing first-hand accounts (including a poem written by Robert Louis Stevenson en route to a sanatorium in Saranac Lake), period advertising, and quotes from scientific journals and other sources. It incorporates both the scientific and social aspects of infectious disease, answering such questions as:
How were breakthroughs in identification and treatment of the disease achieved? How did the medical community vet new procedures and ideas? How was public health policy created? How did the germ mutate to survive? How did Tuberculosis attack the human body? How was it spread? Who decided which patients received treatment and which do not?
Sadly, these questions are still being answered, and to date, Tuberculosis has no cure.
Comprehensive and engrossing, this is a book that will appeal to ages 10 to adult.
This looks fascintating! Living in Japan as an adult I have a very different view of TB than I did when I lived in the west. It is definitely still an issue here, although not as bad as in the Philippines. Every school and employer is legally obligated to provide x-rays (in a bus!) to check for TB every year. Since every child is vaccinated, they can't do the prick test. My employers are at a loss to what to do with me as I have never been vaccinated! I definitely want to read this. I love microhistories anyway, and this is such an important subject.
1 December is World AIDS Day. Here Kenneth Mayer, MD, explains what makes the 2012 observance different from all those before – and, hopefully, those to come. Dr. Mayer is Co-Editor of Clinical Issues in HIV Medicine, Co-Chair of the HIVMA/IDSA Center for Global Health Policy’s Scientific Advisory Committee, founding Medical Research Director of Fenway Health, a visiting professor at Harvard Medical School, and an attending physician and director of HIV Prevention Research at Beth Israel Deaconess Hospital in Boston.
By Kenneth Mayer
Last year, on World AIDS Day, U.S. President Barack Obama set ambitious goals to reach more people with treatment and fundamental prevention. Echoing U.S. Secretary of State Hillary Clinton’s call for an “AIDS-free generation,” he envisioned a tipping point in a 30-year battle to subdue the world’s costliest epidemic.
This World AIDS Day, the administration’s release of a global AIDS roadmap takes the vision into practice. Outlining the U.S. government’s commitment to apply research to reality, with the efforts of affected countries and other donors, it is as much a promise as a challenge.
The plan serves as a solid indication that three decades into a struggle that began without direction, and that sometimes seemed futile, the U.S. has set a course to continue the pace it has achieved in the last year, while giving partners encouragement and reason to match those efforts. It underscores, at a time of worldwide economic challenges and competing concerns, that this investment will yield gains, this is a battle that can be won, and this is not the time to stand still.
The global health community and its researchers, policy makers, donors, field workers, and affected populations know what to do to begin to end this epidemic, and now need to do it. To realize the magnitude of this opportunity, compare where we are now to where we were 31 years ago when fear, ignorance, and prejudice stymied responses while AIDS’ death toll multiplied exponentially as it circled the world. With little clue as to how the virus was transmitted from 1981 to 1985 rumors and mistrust also spread. Through epidemiological research we overcame the terror of those years, understanding that without blood exchange or intimate sexual contact the virus was not readily transmitted. Researchers’ discovery in the mid-1990s that combinations of antiretroviral drugs could arrest the virus changed it from a death sentence into a manageable disease, for many. Shamefully, the cost of those drugs kept the benefit of that breakthrough from being shared in the poor countries where relief was most needed. Finally, in the last decade, with the importation of generic medicines, the establishment of The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief, work to confront the epidemic emerged from laboratories and wealthy countries, to what are now some of the most formidable front lines.
Yet we continue to fall short. We know that injection drugs are a major vector for HIV transmission, but many countries punish users of those drugs rather treat them with opioid substitution therapy and protect them with needle exchange programs. Homophobia and criminalization of gay sex threaten efforts to even count the toll in countries where HIV is most prevalent. Programs to prevent transmission of the virus from mothers to infants are hobbled by constraints on family planning commodities. Sex workers are marginalized by efforts that exclude their input. Treatment and prevention programs fail to reach people with physical and mental disabilities. While tuberculosis is the primary killer of people living with HIV, screening and treatment for the two diseases remain unlinked. While donors have imported some of the means to fight the epidemic, too often they have imported answers as well, failing to allow for the diversity of needs and affected populations in different countries.
With a plan that includes the needs of all affected populations, the tools we have now will be powerful. The study known as HPTN 052 showed that early initiation of antiretroviral therapy could decrease the transmission of HIV in couples in which only one partner was HIV-positive by 96 percent. The use of an antiretroviral drug as pre-exposure prophylaxis in combination with other risk-reduction measures, was shown to be effective in protecting men who have sex with men, and heterosexual men and women from acquiring the virus.
These discoveries will be useless, however, if people who need medicine to save their lives don’t get it. While eight million people are getting treatment, 34 million are living with the virus. Maintaining the momentum of treatment coverage that the U.S. has achieved in the last year in Africa is imperative to meet the original humanitarian mission of the response as well as to continued progress.
Then, with shared responsibility and political will, the next World AIDS Day can be one on which we can see the end of the road, far ahead but certain, when we can stop the further spread of HIV.
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Subscribe to only health and medicine articles on the OUPblog via email or RSS. Image credits: World AIDS Day press images via worldaidsday.org media centre.
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What do anaesthetists do? How does anaesthesia work? What are the risks? Anaesthesia is a mysterious and sometimes threatening process. We spoke to anaesthetist and author Aidan O’Donnell, who addresses some of the common myths and thoughts surrounding anaesthesia.
Aidan O’Donnell is a consultant anaesthetist and medical writer with a special interest in anaesthesia for childbirth. He graduated from Edinburgh in 1996 and trained in Scotland and New Zealand. He now lives and works in New Zealand. He was admitted as a Fellow of the Royal College of Anaesthetists in 2002 and a Fellow of the Australian and New Zealand College of Anaesthetists in 2011. Anaesthesia: A Very Short Introduction is his first book. You can also read his blog post Propofol and the Death of Michael Jackson.
The Very Short Introductions (VSI) series combines a small format with authoritative analysis and big ideas for hundreds of topic areas. Written by our expert authors, these books can change the way you think about the things that interest you and are the perfect introduction to subjects you previously knew nothing about. Grow your knowledge with OUPblog and the VSI series every Friday!
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0 Comments on The truth about anaesthesia as of 11/30/2012 6:45:00 PM
Loved the review! Though, I’m absolutely of the squeamish sort. But despite my aversion to all things icky and germ related I still think this would be an excellent teaching book.
Today on Omnivoracious, we're delighted to launch a month-long weekly advice column by Augusten Burroughs, who makes his move from memoirist to self-help strategist with This Is How (available May 8). He starts by answering a frustrated plea from a mom whose husband's foot-dragging makes the whole family cranky. Then he digs into the deeper reasons a "well known, happy, funny, kind, 25 year old" may have been dumped by their best friend.
My husband, the father of our two teenaged sons, works from home as a project manager for a large international corporation. During any given day, our lives will require that someone make a foray out of the house for band practice, food, lessons, doctors appointments, etc. Most of our outings are appointments where we are paying someone money for an actual unit of their time to be dispensed at an agreed up time.
This is the problem. My husband many, maybe even most times, in full knowledge of the rapidly looming time commitment, fires up a phone call, starts an email, sits down for a long personal moment in the bathroom. The rest of us are left seething until he presents himself ready to go. We now leave at the last possible minute, all cranky and out of sorts. If cars and traffic and every other variable aren't perfect, my husband's choices have left us NO wiggle room.
It's simply awful. I have tried to talk to him about it just because it angers me, but also because I don't think it sets the greatest example for our teens. Just the miasma of furor and unsaid words is poor parenting, I think.
What do we do? He has to be involved—so we need a way to get through to him. It's enough to drive me back to drink, which is a country I'm not welcome in any longer. Help. -- Cate
Dear Cate,
I wish I knew even more. Does your husband’s differing degree of respect for punctuality result in real-world problems? Do you end up being late frequently and missing scheduled appointments you’ve already paid for? Or do you pretty much always make it, but it was just so close you aged like a month from the stress of it?
If the answer is the former, I have more questions. Is your relationship healthy and strong and good in other areas? If you’re talking to him about this, that at least tells me the two of you do communicate to some degree, right? Because if you and your husband are a good pair and the family is working, this might be like when you buy something you truly, deeply love at the store and when you get home, you realize there are extra hidden costs: it doesn’t come with batteries, you need a subscription, you can’t wear it until you have electrolysis, whatever. And as annoying as this can be, if you’re otherwise happy, sometimes you just have to fork over the extra.
It could also be that you and your husband are equally matc
Epidemiology, a well established cornerstone of medical research, is a group level discipline that aims to decipher the distribution and causes of diseases in populations. Epigenetics, perceived by many as the most fashionable research arena in which to be involved, is a mechanism of gene regulation. What brings these perhaps unlikely partners together?
Epigenetic processes are key features in gene regulation. Epigenetic patterns are laid down in early development and are moulded through in utero and early postnatal life and continue to show some degree of plasticity across the lifecourse. Many environmental, behavioural, nutritional and lifestyle factors are believed to influence epigenetic patterns and in some case the evidence base is substantial. What is less clear is the role of this environmentally modifiable ‘epigenome’ on disease risk in populations. This is where epidemiology can help. A good starting point for an epidemiological engagement with epigenetics is clearly identified by Nessa Carey, in her recent popular science book The Epigenetics Revolution:
“The majority of non-infectious diseases that afflict most people take a long time to develop, and then remain as a problem for many years if there is no cure available. The stimuli from the environment could theoretically be acting on the genes all the time in the cells that are acting abnormally, leading to disease. But this seems unlikely, especially because most of the chronic diseases probably involve the interaction of multiple stimuli with multiple genes. It’s hard to imagine that all these stimuli would be present for decades at a time. The alternative is that there is a mechanism that keeps the disease-associated cells in an abnormal state, i.e. expressing genes inappropriately. In the absence of any substantial evidence for a role for somatic mutation, epigenetics seems like a strong candidate for this mechanism”.
Recent literature points to a role for epigenetic variation in a range of diseases including neurological disease, cardiovascular disease, osteoarthritis and obesity but in most instances these are correlations without robust evidence of causality. Indeed, epigenetics is often proffered as the answer to many unresolved causes of disease. The enthusiasm for establishing whether epigenetic mechanisms link the environment with disease development must be tempered by the knowledge that the epigenome is dynamic and has as much potential to respond to disease as respond to the environment. Therefore it is very difficult to disentangle cause from consequence when studying epigenetic variation and disease.
This is just one of the many challenges that face researchers interested in understanding the role of epigenetics in common complex disease. Other challenges include the differences in interpretation of the term ‘epigenetics’ itself – in a field that attracts cell, developmental and evolutionary biologists, epidemiologists and bioinformaticians, amongst others, it is unsurprising that epigenetics means different things to different people and discussions of its relevance to disease can sometimes suffer misinterpretation.
The methods at our disposal to accurately measure epigenetic variation and in turn assess the impact this has upon disease risk are still being developed and there is much to do in this arena with respect to when, where and how to look at the epigenome. The complexity and interplay of multiple factors in determining d
0 Comments on Epidemiology and epigenetics – a marriage made in heaven? as of 1/1/1900
We are failing to deal with one of the most important issues of our time – in every country we are getting fatter. Although being fat is not automatically linked to illness, it does increase dramatically the risk of cardiovascular disease, diabetes, and other so-called non-communicable diseases. We are starting to see very high rates of these diseases in some places, sometimes affecting 50% of the population. Even in some of the poorest parts of the developing world, where such disease itself is not yet common, we nonetheless see warning signs of its arrival. There is great concern that it may soon outweigh the burden of communicable disease such as HIV/AIDS. The humanitarian and financial cost of this non-communicable disease in such parts of the world will be unbearable, and made even worse because the risk is passed across generations, so children born today and tomorrow will have a bleak future.
It seems that we don’t know how to tackle this problem, because current attempts are obviously failing and obesity continues to increase. Governments, doctors, and even NGOs seem to have adopted the same strategy – to focus on our sins of “gluttony and sloth” and to transfer the responsibility for slimming down to each of us as individuals. Of course it’s true that we can’t get overweight unless we eat more than we need to, and the wrong types of foods, and get too little physical exercise. Our biology did not evolve to protect us from obesity and its consequences in today’s sedentary world with such easy access to food. But why is it that we find it so hard to lose weight and, if we do shed the kilos, it seems very hard not to put them back on again?
What we are missing is a focus on our early development. We’re just not adopting the right approach to the problem. And it seems that the generals who are leading us in this global war on obesity and disease have adopted the wrong strategy, and they stick resolutely to it as if they were wearing blinkers. They blame us for the failure to win the war, for our greed and laziness; they blame parents for letting their children get fat; they blame the food industry for peddling unhealthy food, and so on. As if we choose to be fat. It’s important to realise just how limited this way of attacking the problem is on a global scale. Does the little girl force-fed before marriage in Mauritania have any choice in her life? Does the 12-year-old child bride in rural India have any choice when she becomes pregnant and drops out of school? Does the little toddler in Detroit have any choice when his mother feeds him French fries? Does the little boy from Tonga whose mother had diabetes in pregnancy have any choice about developing obesity? Does the little girl in Beijing have any choice in being an only child? And yet every one of these scenarios, and many more, sets that little child up to be at greater risk of becoming obese and to have non-communicable disease.
But new research is uncovering many things that will give us new tactics and strategies for the war against obesity and non-communicable disease, and so we’re hopeful. We now know that we will have to give much greater focus to the mother and unborn child. We may well have to give emphasis to the lifestyle of the father as well. And most importantly of all, we’re starting to realise that behaviours such as propensity to exercise, or appetite and taste for certain foods, which we previously thought to be based on individual choice, have a large constitutional component – in part based on inherited genes, in part on epigenetic changes to gene function in response to the developmental environment, and
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With a title like this, you know that this book will have shelf appeal! But will the readers keep with it after it’s on the table? Did the Romans poop in public?!
In this fast and gross history, readers will learn all sorts of interesting bits about the history of our bathroom habits. The first two chapters “Poop Matters” and “Bad Plumbing, Bad News” set the scene giving readers a sense of the sociology of waste, and making them hone their minds on to the idea the how and the why of poop and fashion and poop and class. Set at a furious pace, author Sarah Albee then gets to the history starting with the Romans and ending with disposable diapers and fitting all sorts of fascinating facts in between.
For example, if someone asked you who invented the toilet, chances are you would say Thomas Crapper. Guess what? You’d be wrong. In fact, in 1596 Sir John Harington invented a flush toilet for himself and Queen Elizabeth (p.132). It’s just too bad there weren’t any sewers. Thomas Crapper doesn’t come along until 1884! But go back 5000 years further and it turns out that the Harrapan civilization (in what is now Pakistan) built sewers, and private bathhouses that drained into covered sewers.
It’s not all about toilets either. Albee explores the frightful diseases that caused havok among cities like London, New York and Paris. Cholera, dysentery, escherichia coli (E. coli), polio, schistosomiasis and typhoid are all waste related and all took out large portions of the human population (and unfortunately continue to do so in poorer and developing nations).
There are highlighted boxes throughout the book that outline topics such as waste related jobs (Fullers, Paleoscatologists, Tanners, Gongfermors, Barber Surgeons, Knight’s Squires, Delousers, Chair Men), “Hygiene Heroes” (Florence Nightengales, Ambroise Pavé, Leonardo da Vinci, Sir John Harington, Benjamin Franklin, Dr. John Snow) and “Too Much Information” (filled with some fun, gross-out facts that are somehow related to poop). There is also an interesting look at fashion and the bathroom (for example, how do you go while wearing a hoop skirt?).
Overall, this is a fun and gross book that has many points of entry. It would make a fabulous book-talk or browsing book and has enough information to help out on projects dealing with diseases, fashion, ancient civilizations, tenement life, royalty, and even colonial times.
1 Comments on Poop Happened! A History of the World From the Bottom Up, last added: 4/14/2010
Mark Jackson is Professor of the History of Medicine and Director of the Centre for Medical History at the University of Exeter. His newest work, Asthma: The Biography, is a volume in our series Biographies of Disease which we will be looking at for the next few week (read previous posts in this series here). Each volume in the series tells the story of a disease in its historical and cultural context – the varying attitudes of society to its sufferers, the growing understanding of its causes, and the changing approaches to its treatment. In the excerpt below Jackson relays the story of Carlill v. Carbolic Smoke Ball Company.
On 7 December 1889, an American inventor, Frederick Augustus Roe, obtained a patent for a device that was designed both to cure and to prevent not only the deadly strain of influenza that was sweeping across Europe from Russia, but also a wide range of other respiratory complaints, including catarrh, bronchitis, coughs and colds, croup, whooping cough, hay fever and asthma. Sold from offices in Hanover Square in London for ten shillings, the Carbolic Smoke Ball comprised a hollow ball of India rubber containing carbolic acid powder. When the ball was compressed, a cloud of particles was forced through a fine muslin or silk diaphragm to be inhaled by the consumer. Boosted by testimonials from satisfied customers and endorsements from prominent doctors, Roe was sufficiently confident that the contraption would prevent influenza that, in several advertisements placed in the Illustrated London News and the Paul Mall Gazette during the winter of 1891, he offered to pay £100 to any person who contracted influenza ‘after having used the ball 3 times daily for two weeks according to the printed descriptions supplied with each ball’. As if to demonstrate the sincerity of his offer, Roe claimed to have deposited £1,000 with the Alliance Bank in Regent Street.
In November 1891, Louisa Elizabeth Carlill, the wife of a lawyer, purchased a Carbolic Smoke Ball in London and carefully followed the instructions for use. When Mrs Carlill contracted influenza the following January, her husband wrote to Roe claiming the ‘reward’ offered in the advertisements. Suggesting that the claim was fraudulent, Roe refused to pay and provided Mr Carlill with the names of his solicitors. In the resulting legal case, initially heard in the court of Queen’s Bench and subsequently reviewed by Appeal Court, the dispute did not revolve primarily around whether the plaintiff had used the device correctly or indeed whether or not she had contacted influenza; these issues were accepted largely as fact. Rather, legal arguments focused on whether the advertisement constituted a valid offer, rather than ‘a mere puff’, as Lord Justice Bowen neatly put it, and whether Mrs Carlill’s use of the smoke ball constituted acceptance of that offer. By deciding unanimously in Mrs Carlill’s favour, the English courts set a precedent regarding unilateral contracts that continued to inform the legal doctrines of offer and acceptance, consideration, misrepresentation, and wagering throughout the twentieth century.
While Carlill v. Carbolic Smoke Ball Company became a celebrated moment in legal history, it al
0 Comments on Inhalation Treatment for Asthma: Carlill v. Carbolic Smoke Ball Company as of 11/9/2009 4:25:00 PM
Leslie Francis is Professor of Philosophy, Professor of Law, and Adjunct Professor of Internal Medicine in the Division of Medical Ethics and Humanities at the University of Utah. Together with Margaret P. Battin, Jay A. Jacobson and Charles B. Smith, she wrote The Patient as Victim and Vector: Ethics and Infectious Disease which explores how traditional and new issues in clinical medicine, research, public health, and health policy might look different if infectious disease were treated as central. The authors argue that both practice and policy must recognize that a patient with a communicable infectious disease is not only a victim of that disease, but also a potential vector- someone who may transmit an illness that will sicken or kill others. In the post below Francis looks specifically at the H1N1 outbreak.
The recent outbreak of H1N1 influenza in Mexico has been greeted with great concern to prevent spread. Trips have been cancelled, travelers have been quarantined, schools have been closed, and sporting events will go uncontested. Preventing spread is important, to be sure, especially of a novel agent with unknown infectivity and lethality. But there is a down side to all the worry about spread: it encourages us to think of each other as vectors, sources of disease to be feared.
We are all vectors or potential; that’s a biological fact. But it’s only one side of our biology. We’re “way-station” selves, breeding grounds and launching pads for literally trillions of microorganisms, all the time—but we’re also recipients of them too. In short: we’re all victims,
just as we are vectors. We live in a state of perpetual uncertainty about whether we’re victims, vectors, or both, at any given time.
As we are caught up in the fear of pandemic spread, we need to remember our victim-side, too. There’s been some discussion of this in the press reports: stories of empty hotels, the cancelled U-17 Concacaf tournament, travelers quarantined in airports, workers without
childcare, or pigs slaughtered unnecessarily in Egypt. But there have been no comprehensive reminders that people stricken with the flu or suspected as vectors are victims as well and in need of support: medical care if they are ill, economic consideration if their livelihoods are
lost, and just plain concern when events that are important to them must be cancelled to enforce the social distancing that is hoped to prevent spread.
In pandemic planning, much effort has been devoted to preventing disease spread. We are seeing the importance of these measures in the current situation. As fears wane, or refocus on later, perhaps more virulent phases of an epidemic or on future emergences of new infectious diseases, however, it is equally important for us to plan for victims and to ask what we owe them. Such planning efforts may be particularly important to encourage the sharing of epidemiological data in the future, if the economic impacts on Mexico are dire and left unattended, where data sharing and international cooperation is crucial in disease control. That’s a prudential imperative, but it’s an ethical one, too. After all, we’re all in this together,working together not only to prevent the spread of infectious disease but also to mitigate the impact of disease where it strikes.
0 Comments on Swine Flu: Victims and Vectors as of 5/6/2009 11:23:00 AM
John Playfair’s short book Living with Germs: In Health and Disease takes the reader through the essentials of infectious organisms - bacteria, viruses, protozoa and the rest - and of our defences against them, the immune system with its powerful weapons and occasionally dangerous side effects. The alternatives - antibiotics and public health measures - are also considered and there is a look ahead at some of the significant problems to come in the future. In the post below, John Playfair reminds us that infectious diseases don’t stand still for long.
The death of two sumo wrestlers last year from a new strain of herpes gladiatorum (’scrumpox’ to rugby players) is not only bad news for Japan’s number one sport but a reminder that infectious diseases do not stand still for long.
MRSA, drug-resistant tuberculosis, malaria, and the permanently shifting AIDS viruses have been for years at the very top of the list of world health problems, and now a new hybrid flu virus from pigs, containing additional genes from both avian and human strains has unexpectedly leapfrogged all these to potential pandemic status (WHO threat level 5). With global warming already introducing ‘tropical’ insect-borne diseases such as malaria, leishmaniasis, and dengue to temperate zones such as Europe and North America, and with vaccines still lacking for all fungal, protozoal, and worm infections, it is no longer thinkable to say, as the US Surgeon-General rashly did 40 years ago, that ‘it is time to close the book on infectious diseases.’
Three problems stand out. Drugs - loosely known as ‘antibiotics’ - have been very successful against some bacterial infections but much less so against viruses, where years of expensive research have been needed to identify those few weak spots where a drug can damage the virus but not its host (bacteria have far more of these). Vaccines, on the contrary, have a better record against viruses than against bacteria, and if any more infections are to follow smallpox into oblivion they will probably be viral - polio and the common childhood viruses being the most likely candidates. There remains the stumbling block of the immune system, our main protection against infection and the point at which successful vaccines operate. Almost a century ago it was discovered that with ‘toxic’ diseases like diphtheria and tetanus, all you needed for protection was a sufficient level of antibody in the blood.
But unfortunately this is not true of many infections: antibody may be ineffective, or directed at the wrong target, or actually harmful. Sometimes immune cells must go into action, killing viruses or releasing messenger molecules known as cytokines. But even cytokines can be dangerous; in fact they may account for the curious fact that swine flu appears to be more deadly in younger victims with active immune systems. So we must be prepared for more surprises.
0 Comments on Living With Germs: On Infectious Diseases as of 5/6/2009 3:37:00 AM
As I finish my preparations to return to Bangkok, I find myself thinking about this month’s Tiger’s Choice. The Happiness of Kati depicts a lifestyle that I have never seen in Thailand, and I find myself wondering if it is a realistic depiction.
Kati and her grandparents live as people in Thailand have for centuries–up until the present day. Their world is clean and quiet and filled with the blessings of nature. When Kati and her grandfather go out in their boat, they row through unpolluted waterways that Kati can dabble her toes in after she and her grandfather finish their picnic lunch. They live in a world untarnished by satellite dishes, cable TV, or mobile phones. There’s not a fast food venue or a 7/11 convenience store in sight. It is a world of the past that all Thai people yearn to return to, and it is portrayed in loving and idealized detail in Jane Vejjajiva’s novel.
And yet within this ideal world, harsh truths intrude and are handled fearlessly. Death, disease, desertion–these are examined carefully and unshrinkingly, through the eyes of a little girl and the family who loves her. It is the softened world that Kati lives in that makes it possible to look at grief and loss with a feeling of acceptance and hope. And it is the well-constructed characters who take life within a matter of sentences who take this book well beyond the realm of moral instruction into the enduring community of classic children’s literature.
0 Comments on The Tiger’s Choice: Finishing The Happiness of Kati as of 10/1/2008 4:53:00 AM
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from Russia, but also a wide range of other respiratory complaints, including catarrh, bronchitis, coughs and colds, croup, whooping cough, hay fever and asthma. Sold from offices in Hanover Square in London for ten shillings, the Carbolic Smoke Ball comprised a hollow ball of India rubber containing carbolic acid powder. When the ball was compressed, a cloud of particles was forced through a fine muslin or silk diaphragm to be inhaled by the consumer. Boosted by testimonials from satisfied customers and endorsements from prominent doctors, Roe was sufficiently confident that the contraption would prevent influenza that, in several advertisements placed in the Illustrated London News and the Paul Mall Gazette during the winter of 1891, he offered to pay £100 to any person who contracted influenza ‘after having used the ball 3 times daily for two weeks according to the printed descriptions supplied with each ball’. As if to demonstrate the sincerity of his offer, Roe claimed to have deposited £1,000 with the Alliance Bank in Regent Street.
Amen!!!! Very well said!!! *applause*
Reblogged this on Jo Robinson.
Please tell Meredith she writes right. And thank you for being such a lovely dad.
Bravo. Very well said from a girl with a big heart. As long as it doesn’t effect us it’s not very real. Thanks for posting this Mark.
Excellent points from your daughter who has inherited the very best of her mother So glad you posted this, Jo!