Fighting Disease with Disease

We are all familiar with recent articles lamenting the speed with which bacterial species responsible for infections have developed resistance to antibiotics. We asked, "What happens when we run out of ways to tweak existing antibiotics?" The prospect of living in a world where bacterial infections triumph over pharmaceutical therapies is a terrifying one.
However, the day that bacterial infections will thrive unhindered by therapy is likely much farther away than those fearing catastrophe propose. While innovations in synthetic antibiotic development have slowed, there are alternatives. Viruses are highly effective at debilitating animals and human beings, why not use viruses to attack and kill bacteria? This article explores a how bacteriophages, or viruses that selectively attack bacteria, can render E. coli defenseless against antibiotic therapy.

Want to swallow this guy?

There is also research using bacteriophages that kill bacteria directly, by lysing bacterial cells they infect, rather than combining forces with antibiotics. (see link) Polish studies demonstrate that this approach has been effective in treating cerebrospinal meningitis in a newborn, dermal infections from E. coli, Staphylococcus, and other bacteria, abscesses under the liver and diaphragm, and various chronic bacterial diseases.

Even more interesting, are attempts to use bacteria to attack and kill. . . other bacteria. This article summarizes attempts to engineer E. coli to produce agents that will selectively kill Pseudomonas aeruginosa, a bacterial species that causes urinary tract infections, pneumonia, skin infections in burn victims and other common infections.

Are we moving from synthetic chemical antibiotics to using living organisms to pathogens?

The Value of Meditation

This article focuses on the effectiveness of meditation in treating issues such as pain, anxiety, and stress.

“According to a new study, even a brief crash course in meditative techniques can sharply reduce a person's sensitivity to pain” (Health Magazine 2010).The study’s results were astonishing; researchers mildly burned 15 men and women on two separate occasions. On the second occasion, the subjects participated in simple meditation techniques and exercises, after which they reported their pain levels. The subjects reported the pain as being 57% less unpleasant and 40% less intense after the meditation, numbers that mirror powerful painkillers such as morphine!

Meditation has also proven effective in treating conditions such as arthritis, anxiety, and mental health problems.  So what about meditation is so effective? Scientists believe that during meditation, the brain’s areas that are responsible for maintaining focus and processing emotions are at a heightened sense; this gives the meditator more control over their physical feelings. “The conventional wisdom has been that meditation relieves pain not by diminishing sensation but by helping people consciously control their perception of pain” (MacLean, Katharine, Ph.D.). Studies also show that in terms of pain relief, meditation changes the nature of pain or stress before it’s perceived by the brain, thus allowing people to better handle the stress.

I chose this article in light of our recently-completed behavior change assignment. Meditation has many health advantages, and it demonstrates the importance of the mind’s control over the health of the body. I believe that this mind-body balance is crucial to maintaining and improving one’s health, and the practice of meditation as a medical prescription may soon become common.

Link: http://www.cnn.com/2011/HEALTH/04/05/meditation.reduce.pain/index.html

Globalization of Disease

The recent outbreak of cholera in Haiti highlights the global connections of disease, as discussed in this article by the bbc.

The links of this disease to South Asian strains of cholera displays how inter-connected the world is. With increasing technological advances, the world is not as isolated from disease as it once was; it's becoming increasingly easier for diseases to spread across continents and borders. I think this example presents how important it is for developed countries to pay attention to the burden of disease in developing countries. While it's a success for those of us in the developed sphere to eradicate certain diseases, if we ignore the plights of the "3rd world" then these diseases can easily be re-introduced into our populations. What we're seeing in Haiti is that this re-introduced disease is actually more virulent than before due to reduced immunization and resistance in the population of Haiti (given that the country had eradicated cholera before).

The recent outbreak of cholera in Haiti also shows that the international community needs to be much more careful in watching the flow of people and disease. Clearly lax approaches regarding oversight of disease allowed cholera to spread form Asia to Haiti. While I think it would be wrong to quarantine areas of the world, I do think certain restrictions should be placed on the movement of people in and out of certain areas - at least ensuring that people who do leave the area do not have the disease, and that people entering the area have proper resistance. In the case of extremely contagious disease this should be vital. Incidents like this should remind us that with an increasingly-connected global community, we should learn to be mindful of our neighbors who suffer from communicable disease not just as a matter of social justice, but also for the benefit within our environs.

Cholera Surge in Haiti

In Haiti, a new concern regarding cholera outbreaks, is placing fear in many people about getting infect. "Health experts in Haiti warned in January when the cholera outbreak began to slow that there could be a surge of new cases in the spring, when rain would help spread contaminated water," says authors of the article affiliated with the Associated Press.

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a large amount of painless, watery diarrhea and vomiting that can quickly lead to severe dehydration and death if treatment is not promptly given (WHO).

Last year, Haiti experienced a total of 160,929 cases of cholera, with 3,573 of those leading to death. WHO and partners, including the GOARN (Global Outbreak Alert and Response Network), have continued to support Haiti in their response to the outbreak. Civil unrest in Haiti has caused a delay in the delivery of supplies for prevention and treatment of patients, particularly in Northern Haiti. Trainings on cholera treatment and initiatives to chlorinate water for 300,000 people had to be postponed because of this, which demonstrates the large effect that an unstable government and civil structure of a nation can have on the ability to promote health. In many other countries, the unrest of the people have caused halts in the prevention methods and treatment dispersal for a various number of diseases. One thing that we, as public health students, must take into account is that tackling the distribution and allocation of supplies is just one aspect of global health that we need to focus on. Beyond that, we must also look into the environmental, political, and social stabilities of the country to determine how to best implement methods in the hopes of improving the health of the community.

Fewer Mammograms Being Done

This article discusses the costs and benefits of annual mammogram screenings of women in their 40s. Studies have shown that fewer women are getting annual mammograms after a report in 2009 said mammograms for these women are not absolutely necessary. This has led to a decrease in the number of women receiving mammograms. There are plenty of arguments from both sides about the necessity of these mammograms, but there is no doubt that the rate of younger women receiving them has decreased dramatically over the past couple of years.

I believe the media and other outlets played an important role in the effect this report had on the population. The report in 2009 said that women should discuss the benefits of screening with their doctor, but in the media, it was portrayed that it is totally unnecessary for women in their 40s to be screened annually. While it may be true that as a whole women do not need to be annually screened this young, it is important to note the effect of the media on our views and beliefs about certain topics. Too often, the media is our source of information that shapes our opinions instead of researching and looking into the topic for ourselves.

Another important issue to consider is the effectiveness of mammograms of younger women. The article says that out of all the biopsies done on women in their 40s at an Ohio hospital, 15% turned out to be cancerous. In public health, it is important for the correct information to be distributed and the article addresses this fact as well. It states that even though the number of mammograms being done has decreased, doctors are now discussing the benefits and risks instead of just recommending mammograms for all women. This is a positive step because universal testing does not always make sense, and giving women the correct information and allowing them to make their own, well informed decision is important.

Topics like this always make me interested in what is the best course of action in these situations. Annual screening of all younger women would undoubtedly save some lives that are lost if they are not tested and the cancer is not caught soon enough. How do medical professionals and public health officials make these decisions about at what point saving the few lives is worth the cost? Overall though, I think doctors discussing issues such as this with their patients and allowing them to make an informed decision is a positive step.

Asthma Numbers Rise in US

I wasn't too surprised to see the article in the New York Times describing the increase in the numbers of asthma sufferers in the United States; it seems like something that you hear mentioned far more now than even a few years ago. However, when looked at in the context of global health, this has significant and dangerous implications.

The levels of asthma in the country have now reached 1 in 10 for children and 1 in 12 for adults according to the most recent figures. Looking at the prevalence of asthma in populations across the country, figures have increased since 2003 for all racial groups as well as gender and age groups. This suggests that the problem of asthma is not just affecting individuals with a particular lifestyle, but everyone.

One of the most alarming parts of this report is that the increased numbers of people with asthma occurred at the same time as a general decrease in the number of smokers in the country. Before this information, many scientists assumed that smoking was the leading cause of asthma increases. What this suggests is that there are environmental triggers causing the disease. These could include environmental pollutants, traffic exhaust, plastics, and use of pesticides.

This has a major tie-in to the topic of environmental health that we looked at in class. When people don't live in a healthy environment, their overall health deteriorates, which also causes a rise in the cost of treating the general population. The article mentioned that people should be better informed about how to treat their asthma, but I consider this to be a very superficial solution. If asthma levels are universally rising, it seems like the root cause of this increase is something that would be work investigating and solving.

Burkina Faso Tests Malaria Vaccine

The African Malaria Network Trust (AMANET), recently embarked on a phase IIb clinical trial of GMZ2, a newly developed vaccine against Malaria. (See article)

Malaria is a major health concern for Burkina Faso. On average, each Burkinbe child under age five will fall ill with Malaria twice a year. On April 29th, Burkina Faso's national malaria research center began vaccinating volunteer subjects. This clinical trial is part of a multi-national program funded by the European an Developing Countries Clinical Trials Partnership (EDCTP). Burkina Faso is the second site in Africa to begin testing the vaccine on human subjects. Clinical testing of the vaccine has been underway in Gabon since November of last year. The next two nations to carry out clinical trials of GMZ2 are Ghana and Uganda.

If effective, vaccinations against malaria could save a significant number of disability-adjusted life years globally. Do you think plasmodium falciparum will mutate too rapidly for the vaccine to be benificial in the long term? After having gained insight from our mock World Health Assembly session on Polio, can you think of any difficulties that might arise if health authorities decide to try to vaccinate all populations at risk for Malaria?