Expertise

The attitude of many laypeople toward medical science can be summed up as "all you have to do is."

Never mind those silly experts, who actually went to medical school and all.  All you have to do is (choose one or more):

• take vitamins (two favorites are C and D)
• spend more time outdoors
• get more exercise
• get more exposure to sunshine
• drink more water
• stop eating meat
• eat more probiotics
• eat more protein
• eat less protein
• eat less processed food
• eat less sugar
• eat less salt
• eat less, period

Now, mind you, I'm not saying these are bad ideas, with the exception of eating both more and less protein, which are hard to do at the same time.  Most of us could use more exercise and eating less sugar and salt, for example.  It's just that the "all you have to do is" attitude tries to boil down all medical conditions to some easily understandable, easily treated set of causes, and avoids the scary truth that human health is complicated.

Sometimes so complicated that even the experts are stumped.

One of the weirdest examples of that latter phenomenon is a ten-year-long epidemic that happened in the early twentieth century, which directly caused at least a half a million deaths worldwide, and that even so most people haven't heard of.  It's called encephalitis lethargica, but that's really only a description of its symptoms; encephalitis means "brain swelling," and lethargica -- well, that one's obvious.  The first cases in the epidemic (although as you'll see, perhaps not the first cases ever) happened in 1915, and just about all of the patients experienced the same, very odd progression of symptoms:

• first, sore throat, headache, and lethargy
• double vision and an uncontrollable upward motion of the eyes ("oculogyric crisis") 
• upper body weakness, spasms, and neck rigidity
• "sleep inversion" -- the drive to sleep during the day and be awake at night
• temper tantrums, psychosis, and hypersexuality
• "klazomania" -- compulsive screaming
• catatonia

The most commonly effected were males between the ages of five and eighteen, but people of all genders and ages could (and did) get the disease.  The mortality rate was high -- about half of the known victims died within a year of onset -- and of the ones who survived, a great many had neurological problems for the rest of their lives, with many of them exhibiting emotional disturbances and/or Parkinsonism.

The disease is sometimes called Economo's disease, after Austrian neurologist Constantin von Economo,  who along with French pathologist Jean-René Cruchet wrote several papers describing the pathology, symptoms, and treatments (the latter, mostly unsuccessful) for it.

Medical journal photographs from 1920, showing Constantin von Economo (upper left) along with four patients suffering from encephalitis lethargica [Image is in the Public Domain]

To cut to the punch line: we still have no idea what caused it.

Initially, it was thought to have something to do with the Spanish flu, which happened around the same time -- possibly an autoimmune reaction triggered by the flu virus -- but that hypothesis was ruled out because there seems to be no correlation between the disease and previous flu exposure.  Also, the Spanish flu pandemic ended in 1919, while the epidemic of encephalitis lethargica went on until 1926.  (This by itself doesn't eliminate a connection; odd immune reactions occurring long after exposure are relatively common, such as shingles turning up years after contracting, and recovering from, chicken pox.)  The brilliant writer Oliver Sacks, in his book Awakenings, stated that the most likely culprit was an enterovirus, a group that contains the causative pathogen of another multi-symptom disease -- polio -- as well as the Coxsackie viruses, thought to play a role in such autoimmune diseases as type 1 diabetes, myalgic encephalomyelitis, and Sjögren's syndrome.  This contention, however, is still considered speculative at best.

While the 1915-1926 outbreak was the most serious, medical historians have identified other epidemics that may be encephalitis lethargica in Europe -- 1580, 1674, 1712, and 1890.  Because there's no certainty of the cause of the 1915 outbreak, it's hard to be sure these are the same disease, but from the symptoms they sound similar.

The reason I bring all this up today is more than just a chance to talk about a biological oddity.  It's to point out that human physiology, and all the things that can go wrong with it, are complex topics.  Emergent diseases like encephalitis lethargica are scary precisely because they strike suddenly and hard, then can vanish before we have much of a chance to study them (and potentially prevent subsequent outbreaks).

And -- the crucial point -- when they do, we need the best-trained minds in medical science to have every tool at their disposal.

Which, in the United States, we don't.  At the moment, the head of the Department of Health and Human Services is a loony anti-vaxxer who is still trying to connect vaccines to autism despite massive study after massive study showing there's no correlation, much less a causation.  His latest salvo was touting putting cane sugar back into Coke as a major victory in "Making America Healthy Again," despite the fact that it's hard for me to see how anything involving drinking Coke would foster better health.  There's a real concern that because of his policies we may have significant shortages of the flu and COVID-19 vaccines this fall, raising the specter of unchecked epidemics.  Research into cancer treatment -- including an mRNA vaccine that shows great promise in treating deadly pancreatic cancer -- have had their funding pulled.

Oh, but according to RFK Jr., that's not a problem.  "All you have to do" to remain healthy is spend more time outdoors and take vitamins.

This is the man in charge of our health policy today.

Look, I know all too well that there were serious problems with the American medical system even before RFK was appointed.  Overpresciption of antibiotics, opioids, antidepressants, and anxiolytics.  Necessary medical procedures being denied by avaricious insurance companies.  Getting the runaround from GP to specialist and back again, with the result that treatment can be delayed weeks to months.  My wife's a registered nurse; don't think I'm unaware of the issues.

But.  If I were to develop a serious medical condition, I'd still want trained experts working on it.  Why on earth would I not?  How does it make sense to doubt medical expertise, when we trust expertise of just about every other sort?  No one gets on an airplane and says, "To hell with training, I'm okay if the plane is piloted by a plumber who has never flown before."  When your house's wiring needs work, you don't say, "I'm fine hiring an accountant to do the job.  He'll do just as well as an actual electrician."  People of all professions work long and hard to acquire their skills and knowledge, and by and large, we trust that they know what they're doing within their given fields.

So why have we been told that medical researchers are somehow the only ones who are lying to us?  And why do so many believe it?

I wish I knew the answer to that.  Maybe it's just because with something as complex and potentially scary as our health, we tend to flail around for something, anything, to make it simpler and more reassuring.  And it's a sad truth of life that sometimes the answers evade even the experts.  The outbreak of encephalitis lethargica is just one of many examples.  But when the next mystery disease strikes -- or even some of the familiar ones -- we want the best shot we have to respond quickly and effectively.

And for that, we need trained doctors and researchers, not anti-science ideologues.

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Viral assassins

In yesterday's post, we looked at viral remnants in our own DNA and their possible role in long-term memory formation.  Today, we'll consider the possibility of using viruses in a different way -- to fight bacterial infections.

As I mentioned yesterday, labeling a virus as "alive" is highly debatable.  They certainly don't seem to respond, at least not in the way a living thing ordinarily does -- moving toward or away from a stimulus.  They're so un-life-like that they can actually be crystallized in a test tube, which makes them more like strange, self-replicating chemicals than they are like organisms.

Which is what makes the research that was published in Cell this week even more astonishing.  In "A Host-Produced Quorum-Sensing Autoinducer Controls a Phage Lysis-Lysogeny Decision," by Justin E. Silpe and Bonnie L. Bassler, we learn about a type of bacteriophage (bacteria-killing virus) that seems to be able to sense its prey, and launch an attack when the colony is at its most vulnerable.

Model of a typical bacteriophage [Image is licensed under the Creative Commons Adenosine, PhageExterior, CC BY-SA 3.0]

The prey bacteria is Vibrio cholerae, and it's certainly a deserving target.  It causes cholera, which makes water reabsorption in the intestine run backwards -- the host begins to dump water and blood solutes into the intestine, resulting in diarrhea so severe that an adult can dehydrate and die within twelve hours.  With quick treatment, the survival rate is quite good; without it, over half of infected people die, usually within two days of the onset of symptoms.

The virus that Silpe and Bassler were studying, VP882, can wipe out entire colonies of Vibrio cholerae by detecting a set of molecules responsible for quorum sensing, which is how colonial bacteria are able to respond to their environment differently depending of how many are nearby.  When the number of quorum-sensing molecules is low, the virus and the bacteria coexist peacefully.  When it reaches a certain threshold -- meaning there are lots of bacteria there -- the virus suddenly becomes virulent, attacks the bacteria, and wipes out the entire colony.

Other microbiologists have been quick to see the implications.  If VP882 is capable of killing a colony of cholera bacteria swiftly and efficiently, it could potentially be useful as a therapy.  And if it works for killing Vibrio cholerae, why couldn't it work for attacking other kinds of bacteria?  "If you have a lung infection, you might not be able to diagnose what bacteria [are] responsible in time and choose the right phage," said Mark Mimee of the Massachusetts Institute of Technology.  "To get around that, people use cocktails of different phages.  But manufacturing cocktails and adhering to drug regulations is too expensive...  [But] a single recombinant phage—yeah, that would be really interesting."

In other words, create a single viral assassin that could take out any sort of bacteria you wanted.  Silpe and Bassler were able to get VP882 to respond to signals from other bacterial species, including E. coli and Salmonella, but it remains to be seen if you could engineer one kind of phage that could take on any species of bacteria.

It remains to be seen if this would be a good idea.  In a normal, healthy human body, there are right around the same number of human cells and bacterial cells -- on the order of thirty trillion.  Having a normal intestinal and skin "flora" is critical for good health.  It's been shown that in order to treat intractable cases of ulcerative colitis and infection with Clostridium difficile (another bad guy of the bacterial world), there is a good chance that a fecal transplant will help.

Yes, that's exactly what it sounds like.  I'll leave the details of the procedure to your imagination out of respect for my more delicate readers, but suffice it to say that it results in replacing the sick person's intestinal flora with that of a healthy person -- and has a remarkably high cure rate.

So my question is -- apropos of the viral research by Silpe and Bassler -- if you are given a dose of phage intended to treat (for example) strep throat, what's to stop the phage from wiping out all the other bacteria they come into contact with?  I know the chemical signals differ -- that's how they modulated the kill switch for the virus with the three species of bacteria they worked with -- but it seems like there's a huge possibility for this to go very, very badly.  Yes, the therapy would have to be tested exhaustively and approved by the FDA, but the whole thing is a little worrisome, whatever its promise.

In any case, this highlights how little we understand the unseen microscopic world we're immersed in.  Viruses may not be the unresponsive little blobs we thought they were.  And as for VP882 -- it will be fascinating to see where this goes, and if we might have another weapon in our medical arsenal -- a virus that attacks bacteria.

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One of the best books I've read recently is Alan Weisman's The World Without Us.  I wouldn't say it's cheerful, however.  But what Weisman does is to look at what would happen if the human race was to disappear -- how long it would take for our creations to break down, for nature to reassert itself, for the damage we've done to be healed.

The book is full of eye-openers.  First, his prediction is that within 24 hours of the power going out, the New York Subways would fill with water -- once the pumps go out, they'd become underwater caves.  Not long thereafter, the water would eat away at the underpinnings of the roads, and roads would start caving in, before long returning Manhattan to what it was before the Europeans arrived, a swampy island crisscrossed by rivers.  Farms, including the huge industrial farms of the Midwest, would be equally quick; cultivated varieties of wheat and corn would, Weisman says, last only three or four years before being replaced by hardier species, and the land would gradually return to nature (albeit changed by the introduction of highly competitive exotic species that were introduced by us, accidentally or deliberately).

Other places, however, would not rebound quickly.  Or ever.  Nuclear reactor sites would become uninhabitable for enough time that they might as well be considered a permanent loss.  Sites contaminated by heavy metals and non-biodegradable poisons (like dioxins) also would be, although with these there's the possibility of organisms evolving to tolerate, or even break down, the toxins.  (No such hope with radioactivity, unfortunately.)

But despite the dark parts it's a good read, and puts into perspective the effect we've had on the Earth -- and makes even more urgent the case that we need to put the brakes on environmental damage before something really does take our species out for good.

Diagnosis by zodiac

Every once in a while, I see a piece of valid scientific research that makes me cringe, because I know how the woo-woos are going to interpret it.

I know, I probably shouldn't care.  Let 'em think what they'll think (since they're going to anyway), and don't lose any sleep over what the wingnuts believe.  But given that I've been at this blog for five years now, I suppose that's a forlorn hope.

Take, for example, the research published a couple of weeks ago in The Journal of the American Medical Informatics Association by Mary Regina Boland, Zachary Shahn, David Madigan, George Hripcsak, and Nicholas P. Tatonetti, of Columbia University, that shows that for some diseases, susceptibility is correlated with birth month.  They used data on 1,688 medical conditions in over 1.7 million patients, and found that 55 of the disorders were "significantly dependent on birth month."  Boland et al. state:

We present a high-throughput algorithm called SeaWAS that uncovers conditions associated with birth month without relying on a priori hypotheses.  SeaWAS confirms many known connections between birth month and disease including: reproductive performance, ADHD, asthma, colitis, eye conditions, otitis media (ear infection), and respiratory syncytial virus.  We discovered 16 associations with birth month that have never been explicitly studied previously...  Seasonally-dependent early developmental mechanisms might play a role in increasing lifetime disease risk.

So are you seeing where this is going, yet?  Because as soon as I read the abstract, I said, "Uh-oh."

Wait till the astrologers get a hold of this.

To their credit, the researchers anticipated this.  Co-author Nicholas Tatonetti said, in an interview with Time magazine:

Astrology puts a lot of stock on what month you were born in, and that really hurts this type of research, since there isn’t much scientific evidence to support that.  But seasonality is a proxy for variable environmental factors present at the time of your birth, and we are learning more about the very large role that environment, and gene-environment interactions, plays in our development.  This could be one way to start mapping out those gene-environment effects.

Which is right on, except that I'd change "there isn't much scientific evidence" to "there is zero scientific evidence."  But it's clear that the authors realized what was going to happen.

Let's start with The Washington Post, which in their article on the research, included the faceplant-inducing statement, "The scientific community has long since discarded astrology as pseudoscience.  Yet new scientific research suggests your "sign" actually may have more to do with your health than you might think."  Even though they went on to say that the researchers explicitly stated that their results have nothing to do with astrology, you know that zodiac buffs are going to remember this line and virtually nothing else.

Then we head further out into the ozone layer with the always-entertaining Natural News, which had the following to say:

While many people believe astrology is responsible for everything from your choice of spouse to career decisions, others maintain that one's birth month is nothing more than a date on a calendar. The latter group suggests that astrology is essentially hogwash, reserved for those who are so desperate for guidance that they resort to such "entertainment." They don't feel that whether one is a Leo or Capricorn should dictate a person's actions, much less help someone gain insight about their health. 

However, according to a new Columbia University study, these hesitant folks might want to consider changing their mind.

The title of the article?  "A Scientific Basis for Astrology."

Then, there's the inclusion of the study on a site called Interesting Studies in Astrology. which begins with the following:

Many sceptics insist on 'irrefutable scientific proof' before they can entertain the possibility of a connection between the celestial and the terrestrial...

Over the past fifty years, scientists and astrological researchers are discovering a growing body of objective evidence of correlations between celestial positions and terrestrial life. These statistically significant results have been published in peer reviewed journals (including Correlation, a specialist astrological journal). Ironically, some of the strongest evidence has come from experiments backed by sceptical groups.

The Boland et al. study -- i.e., actual science -- is then thrown in amongst horseshit like a "study" that allegedly found that more redheads are born when "Mars is ascending."

So the whole thing is just upsetting.  Here we have a thorough and careful piece of research that gives an interesting lens into how the timing of conception and birth can interact with environmental factors to influence later health issues, and it gets twisted into support for a worldview that claims that the reason I like shrimp curry is because I'm a Scorpio.  (I didn't make this up.)

I know, you can't control what people think, or how they'll interpret things.  But confirmation bias -- the tendency of people to overemphasize minuscule pieces of evidence when they're in favor of a belief they already had -- is crazy-making.

Of course, I probably only think that because on the day I was born, Saturn was in Capricorn.  You know how that goes.