Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts

Wednesday, February 6, 2019

Netflix and Cringe: Scientists and Physicians Respond to Goop on Netflix

This week is was announced that Gwyneth Paltrow’s Goop would serve as the basis for a new show on Netflix. Paltrow would co-host the series, which promises to also "utilize experts, doctors, and researchers to examine issues relating to physical and spiritual wellness." Goop is the home of dubious unproven (not to mention expensive) products and advice columns claiming to enhance health and wellness. Paltrow and her company have previously been taken to task for promoting unfounded "treatments" such as crystal therapy, magic stickers, and "Jade Eggs."

Scientists and medical professionals did not take kindly to the announcement. Netflix recently raised its subscription price, and many people are miffed that this revenue is going to support pseudoscience.

Here is a small sampling of recent tweets written in response to the news:







There may be some help on the horizon for those concerned about the reckless dissemination of unfounded claims and outright falsehoods. OB/GYN and pain medicine physician, Dr. Jen Gunter, just wrapped production on a new show that promises to provide an antidote against Goop:



Like it or not, Netflix is enabling the spread of Goop. As Goop oozes more into the mainstream, many argue that Netflix should be held accountable for spreading pseudoscientific nonsense that will, at best, have people wasting money, and at worst could be discouraging people from seeking medical care that actually works.


Contributed by: Bill Sullivan
Follow Bill on Twitter.


BILL SULLIVAN is the author of Pleased to Meet Me: How Genes, Germs, and the Environment Make Us Who We Are (coming August 6, 2019 from National Geographic Books). Sullivan is a professor at the Indiana University School of Medicine in Indianapolis, where he studies genetics and infectious disease.

Wednesday, November 14, 2018

90 Years Ago, A Contaminated Petri Dish Changed The World

Scientists throw away contaminated petri dishes every day. There is probably a frustrated researcher chucking her petri dishes into the bin right now as you read these words, cursing at the contaminant that ruined her experiment. 

In those petri dishes are soft beds of agar that bacteria feast upon. Hundreds of bacterial colonies grow on the agar, each one containing millions of bacterial cells. But fungal spores lurk in the air, and if one of them happens to land on the agar, it may grow better than the bacteria. When a mold appears in a researcher’s bacterial dish, it is not a good thing.

Alexander Fleming stares menacingly at a plate of bacteria.
Unless you were keeping your eyes peeled for a substance that can kill bacteria. In the 1920’s, a scientist named Alexander Fleming at St. Mary’s Hospital in London was doing just that. Fleming was growing colonies of Staphylococcus aureus bacteria on his petri dish plates. Staphylococcus aureus is commonly found on the skin, where it normally lives in peace. But it can turn into a deadly troublemaker if it finds its way into the bloodstream. One of Fleming’s first discoveries was that snot could kill the bacteria. He soon isolated the murderous enzyme (lysozyme), but it proved to be a rather weak assassin with no viable therapeutic potential. Besides, it would have been a marketing nightmare...what would you call it? Snoticide? Boogie bombs?

One fateful autumn day in 1928, Fleming arrived at his laboratory to a pile of petri dishes that needed cleaning. While sorting through them, he noticed a mold growing on one of his culture dishes of Staphylococcus aureus. Fleming had undoubtedly seen a contaminated dish of bacteria before, but something more caught his eye that day. It turned out to be the discovery of a lifetime – one that has saved an incalculable number of lives.

As Louis Pasteur said, “Chance favors only the prepared mind.” Fleming’s mind was prepared, and he was always on the lookout for things that could kill bacteria. On that contaminated plate of Staphylococcus aureus, he astutely noted that bacterial colonies grew better if they were farther away from the mold. In fact, no colonies could grow next to the mold. He figured that the mold was producing a substance that was actively killing bacteria that dared to come near it. The miserly mold would want to do this so it could have all the nutrients to itself. Fleming named this mystery bacteria-slaying substance penicillin, since the species of contaminating mold was called Penicillium.

The famous plate showing bacterial colonies being
killed by the mold, Penicillium.
Fleming published this extraordinary finding in the British Journal of Experimental Pathology in 1929 and the world…paid absolutely no attention to it at all. Pathogenic bacteria continued to lead tens of millions of people to early graves through the 1930’s. Fleming was no chemist, so he was not in position to isolate the active ingredient in the mold that was killing the bacteria. He needed help. But try as he might, Fleming couldn’t get other scientists interested in the promise of mold as a remedy for bacterial infections.

In hindsight, that seems crazy. But there were practical issues that dampened enthusiasm for his idea. At the time, fungi were very difficult to grow in bulk, and the strain of Penicillium Fleming promoted produced very little penicillin. Fleming’s follow-up studies also suggested that penicillin would not work well in the clinic. Because it was so rare, he was forced to use low doses in his attempts to treat ill patients. He also applied the “mold juice” topically on the skin instead of injecting it into the bloodstream, which would have been far more effective. These poorly designed experiments led many to the false conclusion that penicillin was an impotent bacterial assassin. You can imagine the skeptics dismissing his work: “First snot, now mold juice? C’mon, Fleming.” Consequently, Fleming’s discovery laid dormant for over a decade.

In 1939, while leafing through back issues of the British Journal of Experimental Pathology, a chemist at Oxford named Howard Florey decided to revisit Fleming’s ignored penicillin paper. Together with Ernst Boris Chain, this dynamic duo produced a highly purified mold extract and injected it into mice with sepsis. They soon published the striking result that their Penicillium extracts cured the mice of this deadly bacterial infection.

Imagine Fleming’s response when he woke up one day to read this report! Fleming was thrilled that someone was making use of his old work and immediately called Florey to arrange a visit to their laboratory. Chain was surprised to hear that he would get to meet Fleming, as he was under the impression that Fleming had passed away. The trio won the 1945 Nobel Prize in Physiology or Medicine and inspired many microbiologists to search for more bacteria-killing microbes out in the wild. Before long, our medicine cabinet was filled with additional antibiotics like erythromycin, tetracycline, streptomycin, and many more. These wonder drugs were being produced naturally by microbes found in the dirt, on rotting foods, and even in the throat of a chicken. Scientists left no stone unturned in their hunt for weapons of microbial destruction.

It took ten years before a pair of scientists took Fleming's paper on penicillin seriously. It makes one wonder: How many other medical treasures are buried in obscure scientific journals?
The story would have a happy ending were it not for two things. In an interview after his Nobel acceptance speech, Fleming gave a very prescient warning about the reckless overuse of antibiotics: "The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism." Unfortunately, we failed to heed Fleming’s premonition and now face an imminent threat of “superbugs,” bacterial strains that have evolved resistance to these precious medicines. Poor Fleming...ignored twice, but later proven correct on both accounts. Second, virtually no one is in the business of antibiotic discovery anymore because it does not generate high profits like medicines for chronic conditions, which patients must take every day for the rest of their lives. Considered together, Fleming’s near-century old discovery may soon be ineffective and we will return to the “pre-antibiotic” era when a simple scratch from a rosebush could mean death. We need more “prepared minds” in research and in business to keep the antibiotic pipeline strong.

Contributed by: Bill Sullivan

Bill is writing a book! PLEASED TO MEET ME: The Hidden Forces Shaping Who We Are arrives in August 2019 from National Geographic Books.

Friday, February 16, 2018

Can Your Cat Cause Demonic Possession?






Cats are routinely associated with malevolent entities in horror stories. They are the favorite pet of witches and villains, a frequent denizen of haunted houses, and the object of several superstitions. Now doctors have linked felines to demonic possession!

Wait, what?

In a new case study published yesterday in the journal Medicine, scientists in China reported that acute infection with the common parasite Toxoplasma gondii triggered the onset of an unusual autoimmune disease called anti-N-methyl-D-aspartate (NMDA) receptor encephalitis. Anti-NMDA receptor encephalitis occurs when the body attacks one of its own brain proteins, leading to bizarre personality changes that mimic the stereotypical behaviors that come to mind when we think about demonic possession.

In this case report, a nine-year-old girl arrived at the hospital with seizures, headache, and vomiting. Then she developed unexplained personality and behavior changes. She tested positive for both anti-NMDA receptor antibodies and recent infection with the Toxoplasma parasite.

Anti-NMDA receptor encephalitis was the subject of the bestselling book, Brain on Fire: My Month of Madness, by Susannah Cahalan. In this memoir, which reads like an episode of Mystery Diagnosis, Cahalan describes her terrifying transformation from a vibrant young journalist to an unrecognizable and violent monster. As her condition progressed, she grew paranoid of others, thought family members were imposters, and lashed out at people. She lost control of her bodily movements, suffered seizures, and spoke in tongues. If you didn’t know better, you’d claim she needed an exorcist. Luckily, a neurologist properly diagnosed her disease and gave her immune suppressant drugs that drove it into remission.


Did Regan have a cat?
It is not clear why some people (mostly women) start making antibodies that attack the NMDA receptors in their brain. Some cases are linked to the development of tumors, especially teratomas in the ovaries. Certain viruses that infect the brain, including herpes simplex virus, have also been linked to anti-NMDA receptor encephalitis. Now it seems Toxoplasma, which also infects the brain, may be a trigger of this haunting disease, too.

Toxoplasma is a devious parasite with a complex life cycle. It is capable of infecting any warm-blooded animal, but can only complete its sexual cycle in the intestines of cats. After infecting a cat, the cat spews billions of infectious parasite oocysts into the litter box (or the environment) for up to two weeks. These oocysts are very sturdy and can last up to two years in the environment, giving them plenty of time to be inhaled or ingested by another animal (including humans). In addition to picking up oocysts from the litter box, garden, or sandbox, we can also acquire the infection by eating undercooked meat or unwashed fruits and vegetables.

Once a person becomes infected, the parasite disseminates throughout bodily tissues, including the brain and heart, and transitions into a latent stage called the tissue cyst. While current treatments can stop the parasite from replicating, no drug exists that can get rid of the tissue cysts. In other words, infection with Toxoplasma is permanent. The thought of having a brain filled with these parasites is disquieting, but most scientists believe the cysts are inert unless the individual becomes immune compromised, in which case the parasites can cause massive tissue damage from unchecked growth.

A growing number of scientists argue, however, that in certain individuals the Toxoplasma tissue cysts are not benign and may cause neurological disorders. One of the better-established correlations is the link between Toxoplasma infection and schizophrenia. Interestingly, up to 10% of schizophrenia patients test positive for anti-NMDA receptor antibodies.

The mechanism explaining how Toxoplasma infection may cause anti-NMDA receptor encephalitis remains to be elucidated. Toxoplasma infection is remarkably common (up to one-third of the global population is believed to carry this parasite), but anti-NMDA receptor encephalitis is rare. For now, the authors of the study advise that clinicians assess the possibility of Toxoplasma infection when evaluating a patient with anti-NMDA receptor encephalitis.

To prevent Toxoplasma infection and minimize your chances of becoming possessed by this parasite, be sure to thoroughly cook meat and wash produce and veggies. Wear gloves and a mask when gardening and keep sandboxes covered when not in use. You cannot catch Toxoplasma by petting your cat, but it is important to clean the litter box promptly and wash your hands with soap and water. Pregnant women, in particular, should heed these warnings as infection during pregnancy can lead to miscarriage or serious congenital birth defects. See the infographic below for more.

UPDATE (7/26/18): A new study was published today by Li et al. that used a mouse model of infection to show that anti-NMDA receptor autoantibodies are induced by the presence of latent Toxoplasma tissue cysts.

Brain on Fire has also been made into a movie that can be seen now on Netflix.
Contributed by: Bill Sullivan

Thursday, April 20, 2017

Unsung Heroes In Our Battle Against Infectious Disease


Humanity has always been at war with infectious agents, but it wasn’t until 1860 when Louis Pasteur famously theorized that microbes (first observed by Antony van Leeuwenhoek in the 1600s) cause disease. It took another 70 years before Alexander Fleming noticed that Penicillium mold produced a substance that killed bacteria. While most people are familiar with these luminaries in the field, have you heard of Francesco Redi, Ignaz Semmelweis, Theobald Smith, Mary Hunt, and a cow named Blossom? In this presentation, we celebrate some of the “unsung heroes” whose victories are often neglected from the infectious disease saga.


In the talk below, Dr. Bill Sullivan, a professor at the Indiana University School of Medicine, takes us on a fascinating tour through medical history, answering these questions and more:

How did we figure out that microscopic creatures can make us sick?
Why were milkmaids considered to be so beautiful and what does that have to do with vaccination?
How were starfish important to the discovery of the immune system?
What do you mean penicillin wasn't the first antibiotic?


Tuesday, June 7, 2016

Coronary Artery Disease: A Role For Calcium?


In the heart, there still lie a myriad of mysteries. For everything we know about this integral organ, there are still several things we have yet to figure out. One of the most pressing questions is what factors are “at the heart” of the current coronary artery disease (CAD) epidemic and how can we stop it? It turns out that the answer, while still not fully understood, may have to do with a familiar element. Calcium, the mineral we all know from the milk commercials that is touted for healthy bones and teeth, may play a prominent role in keeping your heart healthy as well.
Anyone who has watched a medical show, from Grey’s Anatomy to Scrubs, will recognize this predictable scene in the hospital:  “Clear!” A flat line appears on a black screen, accompanied by a caustic continuous siren, blaring uproariously. The paddles that conduct electricity failed to restart the heart. “Clear!” The handsome doctor shouts once more after a dramatic pause. This time, the flat line turns into a rhythm and the continuous alarm morphs into a dulcet beeping, indicating the patient will live. Television often portrays the cure all for fixing the heart is simply a little electrical jolt from a defibrillator, easy as that.

http://shedka.com/wp-content/uploads/2014/11/house.jpg
The doctor will see you now!

             


https://steverempe.files.wordpress.com/2012/08/butter-knife.jpg?w=529
Do not try this at home!



The heart is profoundly affected by electricity. Electrocution is an effective method for execution because sending large currents through the heart can render it useless. At the very least, a small shock can definitely cause your heart to skip a beat (just ask the little brother who stuck a butter knife into a power socket!). Electricity is so essential to the heart, the organ has evolved its own conducting system, which means it can regulate its own beat without input from the brain.

 

 

Many ailments can cause a heart to stop, but one disease is wreaking havoc on the human population and killing people in unprecedented numbers. As recently as 2013, coronary artery disease (CAD) has reigned supreme as the most common cause of death worldwide. As many as eight million people a year die from complications caused by CAD. Like cancer, it would be hard to find a person who doesn’t know someone that has been afflicted with CAD. Despite the steep number of people affected by the disease, there is little consensus on what causes this deadly condition or how to stop it.
The theories are numerous and some are understandably more credible than others. Coronary artery disease is thought to have a direct correlation with diet and exercise - most people diagnosed with CAD are obese and sedentary. And indeed, changing your diet, cutting cholesterol, quitting smoking, and beginning a healthy exercise regime does lower the incidence of CAD-related adverse events such as heart attack or sudden coronary death (which is exactly what it sounds like). But that isn’t the whole story, not by a long shot.


http://www.cdc.gov/heartdisease/images/hd-behavior.jpg
It is a difficult decision, but as they say,
"an apple a day keeps the doctor away". www.cdc.gov 
For a clearer view of what is really happening to the heart when it suffers from CAD we need to take a closer look - we need to look at the individual cells in the heart. There are several important players at this level, but the cells that reside in the large middle layer have been shown to play a significant role. This layer is made-up of cardiovascular smooth muscle (CSM) cells and these cells are thought to be the main players in the propagation of CAD.
In a healthy heart, the CSM cells are quiescent, that is to say they are stable, just hanging out and not doing too much. In a heart affected by CAD, however, the CSM cells come to life - they begin to divide and travel. When the CSM cells begin to divide and conquer, things start to go south because the simple act of proliferating and moving causes inflammation below the skin layer of the blood vessel. Like a cut on your finger, the injury causes inflammation and alerts the immune system, which will come to the rescue, close the cut, stave off infection, and save the day! The immune system’s army of white blood cells wants to save the day in the heart vessels as well and, while its intentions are good, the results can ultimately be disastrous. Why? After the work is done by the white blood cells, they leave what can be likened to a “scab” on your blood vessel. This thickening on the wall of the vessel can elicit additional responses from the immune system, thereby compounding the problem and causing the scab-like mound to grow and grow, possibly blocking off the entire blood vessel. When this occurs, it is referred to as a myocardial infarction (heart attack). The blood that supplies your heart is cut off, and the oxygen the heart needs to pump never arrives. When the heart can’t feed itself with oxygen, it certainly can’t send any to the rest of the body!

http://www.cdc.gov/heartdisease/images/hd-coronary-ad.jpg
A clog, even in a small artery, can cause big problem
for your heart and your health. www.cdc.gov

But why do the normally passive CSM cells start to act out and move around? That is the million-dollar question. As mentioned above, the electrical signals in the heart are critical for the coordinated, rhythmic beating of the heart. The constant and familiar lub-dub of the heart is the result of a myriad of events occurring in perfect harmony. Perhaps just as important as the electrical current, however, are the affects it elicits, namely the release of the well-known mineral, calcium.
In addition to being pivotal for healthy bones, calcium is also a crucial player in achieving those perfectly rhythmic heartbeats. Calcium might even explain how the smooth muscle in your heart switches from innocent bystander to mischievous villain. The calcium in the heart acts a second messenger for CSM excitation-contraction (beating) and sends the signals that modulate CSM proliferation, migration, and calcification.


The blue dots represent calcium. When the heart behaves normally, the calcium remains constant and the cells of the heart do not divide. If excess calcium is allowed to build up in the sarcoplasmic reticulum (SR), however, the cells of the heart begin to divide and move. Eventually, the vessel wall becomes so large it is difficult for blood to pass. (modified from McKenney-Drake, Rodenbeck, at el., Atherosclerosis, 20

In order for the heart to beat properly, calcium levels must be precisely balanced with the help of channels or transporters, which regulate the flow of calcium ions in or out of cells. It seems likely that when calcium transporters break down, the mismanagement of calcium will cause problems in the heart. In mild CAD, certain avenues available to calcium transport malfunction, which causes the calcium to aggregate in the sarcoplasmic reticulum (SR, the compartment in the heart cells that stores calcium). When this happens, it essentially “activates” the proliferation of CSM cells. Dr. Dineen-Rodenbeck recently verified this hypothesis by blocking a common transporter that is responsible for bringing calcium back into the SR. When calcium is unable to aggregate in the SR, the cells are not switched “on” and all remained quiet. Once CAD becomes severe, the SR stores are basically depleted and the risk of death caused by complications associated with CAD rise. This is an important discovery because knowing the role of calcium in the heart and understanding what occurs when it is lowered or elevated may lead to treatments. In the end, the regulation of calcium may be the key to managing the CAD epidemic.
These studies should not be taken as proof that you need to regulate your dietary calcium differently – after all, calcium is essential for strong bones and teeth. Rather, these findings will help guide future research and treatment efforts that may be able to manage calcium levels specifically in the heart to alleviate CAD.

Contributed by:  April Barnard
 
References

Rodenbeck SD, Barnard AL, and Sturek M. SERCA inhibition attenuates medial thickening in an organ culture model of coronary artery disease. FASEB J (In Press).

Dineen SL, McKenney ML, Bell LN , et al. Metabolic syndrome abolishes glucagon-like peptide 1 receptor agonist stimulation of SERCA in coronary smooth muscle. Diabetes 2015; 64:3321–3327
 
Sturek M. Ca2+ regulatory mechanisms of exercise protection against coronary artery disease in metabolic syndrome and diabetes. J Appl Physiol. 2011;111:573-586.