(Roughly) Daily

Posts Tagged ‘medicine

“Not with a bang, but with a whimper”*…

 

death

Death Table from Tuberculosis in the United States, prepared for the International Congress on Tuberculosis, September 21 to October 12, 1908. Image: U.S. National Library of Medicine

 

Recent history tells us a lot about how epidemics unfold, how outbreaks spread, and how they are controlled. We also know a good deal about beginnings—those first cases of pneumonia in Guangdong marking the SARS outbreak of 2002–3, the earliest instances of influenza in Veracruz leading to the H1N1 influenza pandemic of 2009–10, the outbreak of hemorrhagic fever in Guinea sparking the Ebola pandemic of 2014–16. But these stories of rising action and a dramatic denouement only get us so far in coming to terms with the global crisis of COVID-19. The coronavirus pandemic has blown past many efforts at containment, snapped the reins of case detection and surveillance across the world, and saturated all inhabited continents. To understand possible endings for this epidemic, we must look elsewhere than the neat pattern of beginning and end—and reconsider what we mean by the talk of “ending” epidemics to begin with…

Contrary to hopes for a tidy conclusion to the COVID-19 pandemic, history shows that outbreaks of infectious disease often have much murkier outcomes—including simply being forgotten about, or dismissed as someone else’s problem: “How Epidemics End.”

* T. S. Eliot, “The Hollow Men”

###

As we contemplate the end, we might send insightful birthday greetings to Nettie Maria Stevens; she was born on this date in 1861.  A geneticist– and one of the first American women to achieve recognition for her contributions to scientific research– she built on the rediscovery of Mendel‘s paper on genetics (in 1900) with work that identified the mechanism of sexual selection: its determination by the single difference between two classes of sperm—the presence or absence of (what we now call) an X chromosome.

220px-Nettie_Stevens source

 

“We can judge our progress by the courage of our questions and the depth of our answers, our willingness to embrace what is true rather than what feels good”*…

 

science

 

If one takes Donald Trump and his administration to embody modern conservatism, it is easy to see in their response to the coronavirus pandemic the right’s final divorce from science and expertise. There was the case of Rick Bright, the Health and Human Services scientist who claims that the Trump administration retaliated against him when he objected to the administration’s rapid push to distribute anti-malaria drugs that were largely untested for treating coronavirus patients. There are reports that the president for months ignored his own intelligence experts’ warnings that the virus threatened our shores. There was the ongoing drama over whether Trump would fire Anthony Fauci, who has headed the National Institute of Allergy and Infectious Diseases since 1984. And there was the president’s daily passion play—the White House press briefings where he’d stand next to scientists who grimaced as he speculated that the death toll was exaggerated and that sunlight inside the body might kill the virus.

The White House’s sorry Covid-19 track record has sparked a chorus of dissent recently distilled by New York Times columnist Michelle Goldberg, who argues that the crisis displays conservatives’ long-standing “antipathy to science,” owing to “populist distrust of experts, religious rejection of information that undermines biblical literalism and efforts by giant corporations to evade regulation.” But this narrative is too pat. While something is plainly amiss in the relationship of the Trumpian right to science, it is hardly as principled as the religious objections of, say, creationists opposing evolutionary theory. Neither is it straightforwardly hostile.

What’s more curious about the response by the president and his allies to the virus is rather their embrace of scientific expertise of a sort…

The story of the crisis is not quite that of scientists who knew the answers and one political party that just wouldn’t listen to them. Rather, it is a story of fracture—of conflict and confusion, of experts earning mistrust, of each side cultivating its own class of experts to own the other’s. It is also a perverse story of how a group of self-styled truth-telling outsiders turned science’s mythology against its institutions, warping it from a tool to fight the virus into a tool to attack the establishment.

How did we get here?…

Ari Schulman (@AriSchulman) explains how a new class of outsider experts is exploiting institutional failures and destabilizing knowledge: “The Coronavirus and the Right’s Scientific Counterrevolution.”

TotH to Byrne Hobart, who notes (in his nifty newsletter, The Diff):

… this essay obviously takes a side, but it tries to be fair to the side it disagrees with. Which means there are two Straussian readings: maybe it’s an essay about how science is on one side in an American political context, and the other side only makes vague gestures towards empiricism. Alternatively, it could be an essay on how science never answers political questions, but politics corrupts science. (Why doesn’t science answer political questions? Because you can’t build a coalition out of stating the obvious, but you can build one from denying it—if your beliefs are crazy, you can spot members of the ingroup. So most scientific questions are irrelevant to politics, and when they’re relevant, politics wins by default in the short term, even if it loses long-term. To build a coherent and healthy ingroup, you need beliefs that are crazy but don’t lead to bad decisions.)

Pair with another of Hobart’s suggestions: “On Cultures That Build” (and the reasons why, the author argues. the U.S. is not one).

* Carl Sagan

###

As we commit to learning, we might note that today is the birthday of not one but two extraordinary mathematicians:  Gottfried Wilhelm Leibniz (1646; variants on his date of birth are due to calendar changes), the German  philosopher, scientist, mathematician, diplomat, librarian, lawyer, co-inventor, with Newton, of The Calculus, and “hero” (well, one hero) of Neal Stephenson’s Baroque Trilogy…  and  Alan Turing (1912), British mathematician, computer science pioneer (inventor of the Turing Machine, creator of “the Turing Test” and inspiration for “The Turing Prize”), and cryptographer (leading member of the team that cracked the Enigma code during WWII).

Go figure…

Turing (source: Univ. of Birmingham)

Giambattista Vico was also born on this date in 1668.  A political philosopher, rhetorician, historian, and jurist, Vico was one of the greatest Enlightenment thinkers.  Best known for the Scienza Nuova (1725, often published in English as New Science), he famously criticized the expansion and development of modern rationalism and was an apologist for classical antiquity.

He was an important precursor of systemic and complexity thinking (as opposed to Cartesian analysis and other kinds of reductionism); and he can be credited with the first exposition of the fundamental aspects of social science, though his views did not necessarily influence the first social scientists.  Vico is often claimed to have fathered modern philosophy of history (although the term is not found in his text; Vico speaks of a “history of philosophy narrated philosophically”). While he was not strictly speaking a historicist, interest in him has been driven by historicists (like Isaiah Berlin).

 source

 

Written by LW

June 23, 2020 at 1:01 am

“If you don’t have a plan, you become part of somebody else’s plan”*…

 

pscil

 

 

In 1955, a bank executive and a New York society photographer found themselves in a thatch-roofed adobe home in a remote village in the Mazateca mountains. Gordon Wasson, then a vice president at J.P. Morgan, had been learning about the use of mushrooms in different cultures, and tracked down a Mazatec healer, or curandera, named María Sabina. Sabina, about 60 at the time, had been taking hallucinogenic mushrooms since she was a young child . She led Wasson and the photographer, Allan Richardson, through a mushroom ceremony called the velada.

“We chewed and swallowed these acrid mushrooms, saw visions, and emerged from the experience awestruck,” Wasson wrote in a Life magazine article, “Seeking the Magic Mushroom.” “We had come from afar to attend a mushroom rite but had expected nothing so staggering as the virtuosity of the performing curanderas and the astonishing effects of the mushrooms.”

Appointing himself as one of the “first white men in recorded history to eat the divine mushrooms,” Wasson inadvertently exposed much of the Western world, and the burgeoning counterculture movement, to psychedelic mushrooms. On the other side of the globe, the Swiss drug company Sandoz received 100 grams of the mushrooms from a botanist who had visited Sabina on one of Wasson’s return trips. They went to the lab of Albert Hofmann (see here) the Swiss chemist who first synthesized LSD. In 1963, Hofmann traveled to Mexico with pills containing synthetic psilocybin, the active compound in magic mushrooms.

“We explained to María Sabina that we had isolated the spirit of the mushrooms and that it was now in these little pills,” Hofmann said during an interview in 1984. “When we left, María Sabina told us that these tablets really contained the spirit of the mushrooms.”

Hofmann’s pills were the first indication that while people can have spiritual and transcendent experiences from eating the mushrooms themselves, they can also have such experiences with a man-made version of just one of the mushroom’s compounds: psilocybin.

This development is particularly relevant today, as scientists study psychedelic mushrooms as potential treatment options for those who suffer from severe depression, addiction, and more. In clinical trials, such as those ongoing at Johns Hopkins University and Imperial College London, participants don’t eat caps or stems. They consume synthetic psilocybin, made in a lab by chemists in a way similar to how Hofmann first made his psilocybin.

It’s a necessary hurdle: Psilocybin mushrooms can be grown relatively easily, and aren’t expensive to produce. But researchers have to source their psilocybin from highly regulated labs because natural products vary, and researchers need consistency in chemical composition and dosage in order to do controlled studies. Clinicians need to know how much of a drug they’re giving to a patient, how long it takes to kick in, and how long it lasts; they also need to be sure their drug isn’t tainted with other chemicals. It also helps to be able to mass-produce large amounts and not be threatened by variables, like weather, that affect agricultural products.

As psilocybin moves closer to becoming a legal medicine meeting all the regulatory requirements, doctors won’t be writing prescriptions for mushroom caps or stems—and this will come at a certain cost. Johns Hopkins researchers have claimed they’ve paid labs $7,000 to $10,000 per gram of psilocybin, whereas the street price of magic mushrooms is around $10 per gram. Besides the cost of chemical materials, the steep sticker price comes from the labor required to adhere to the U.S. Food and Drug Administration’s strict drug-making standards, known as Current Good Manufacturing Practice.

It’s an unprecedented moment, and psychedelic culture must reckon with what it means for a magic mushroom to become a synthetic pill, to be picked up at your local pharmacy or from a doctor. There’s some wariness in the psychedelic community about what synthetic psilocybin represents: big business, questionable investors, and patents on experiences they think shouldn’t have a price tag or a profit margin. Since it’s a known natural compound, psilocybin itself cannot be patented, but the way it’s made and used can be. Already there are organizations applying for patents for their synthesis process, and innovators coming up with new ways to make large amounts of synthetic psilocybin, all seeking protection for their intellectual property…

The truth is, there is money to be made in psychedelics, and investors are flocking to back startups in the psychedelic and mental health spaces. The current antidepressant medication market was valued at $14 billion in 2018 and is estimated to grow to $16 billion in the next three to five years. Any drug company that can compete stands to become very wealthy…

As magic mushrooms make the shift from recreational drug to mental health treatment, patients won’t be eating caps and stems, but a synthetic product made in a lab—one that pharma companies can patent and from which they can profit: “Get Ready for Pharmaceutical-Grade Magic Mushroom Pills.”

* Terence McKenna

###

As we ponder the profound, we might recall that it was on this date in 1956 that city authorities in the California beach town of Santa Cruz announced a total ban on the public performance or playing of rock and roll music, calling it “detrimental to both the health and morals of our youth and community.”

It may seem obvious now that Santa Cruz’s ban on “Rock-and-roll and other forms of frenzied music” was doomed to fail, but it was hardly the only such attempt. Just two weeks later in its June 18, 1956 issue, Time magazine reported on similar bans recently enacted in Asbury Park, New Jersey, and in San Antonio, Texas, where the city council’s fear of “undesirable elements” echoed the not-so-thinly-veiled concerns of Santa Cruz authorities over the racially integrated nature of the event that prompted the rock-and-roll ban… (source)

rock ban source

 

“Some maladies are rich and precious, and only to be acquired by the right of inheritance or purchased with gold”*…

 

gout

 

Gout is a disease caused by high levels of uric acid in the blood. Everyone has some uric acid in their blood, but when you get too much, it can form little crystals that get deposited around your body and cause various problems, most commonly joint pain. Some uric acid comes from chemicals found in certain foods (especially meat), so the first step for a gout patient is to change their diet. If that doesn’t work, they can take various chemicals that affect uric acid metabolism or prevent inflammation.

Gout is traditionally associated with kings, probably because they used to be the only people who ate enough meat to be affected. Veal, venison, duck, and beer are among the highest-risk foods; that list sounds a lot like a medieval king’s dinner menu. But as kings faded from view, gout started affecting a new class of movers and shakers. King George III had gout, but so did many of his American enemies, including Franklin, Jefferson, and Hancock (beginning a long line of gout-stricken US politicians, most recently Bernie Sanders). Lists of other famous historical gout sufferers are contradictory and sometimes based on flimsy evidence, but frequently mentioned names include Alexander the Great, Charlemagne, Leonardo da Vinci, Martin Luther, John Milton, Isaac Newton, Ludwig von Beethoven, Karl Marx, Charles Dickens, and Mark Twain.

Question: isn’t this just a list of every famous person ever? It sure seems that way, and even today gout seems to disproportionately strike the rich and powerful. In 1963, Dunn, Brooks, and Mausner published Social Class Gradient Of Serum Uric Acid Levels In Males, showing that in many different domains, the highest-ranking and most successful men had the highest uric acid (and so, presumably, the most gout). Executives have higher uric acid than blue-collar workers. College graduates have higher levels than dropouts. Good students have higher levels than bad students. Top professors have higher levels than mediocre professors. DB&M admitted rich people probably still eat more meat than poor people, but didn’t think this explained the magnitude or universality of the effect. They proposed a different theory: maybe uric acid makes you more successful.

Before we mock them, let’s take more of a look at why they might think that, and at the people who have tried to flesh out their theory over the years….

From the always-illuminating Scott Alexander (@slatestarcodex), a consideration of the case: “Give yourself gout for fame and profit.”

For the NIH’s backgrounder on gout, see here— the source of the image above.

* Nathaniel Hawthorne

###

As we feed our ambition, we might spare a thought for Charles William “C. W.” Post; he died on this date in 1914.  Post began his career as a farm implement manufacturer in Illinois, but succumbed to stress, and had a nervous breakdown.  On recovering, he moved to Texas and began a second career as a real estate developer… but fell prey again to the pressures of his work and had another breakdown.  In 1891, he checked into the Battle Creek, Michigan the sanatorium of Dr. John Harvey Kellogg (brother of cereal maker Will Keith Kellogg).

While there, Post dined on Kellogg recipes, several of which became the (stolen, some argue) seeds of his very successful third career.  Early in 1895, Post began manufacturing Postum, a grain product intended as a coffee substitute, very similar to one of Kellogg’s concoctions, Caramel Coffee Cereal.  The following year, he began to produce Grape-Nuts, which seemed very like Malted Nuts, another Kellogg item.  And soon thereafter he introduced Toasties, a dead ringer for Kellogg’s Corn Flakes.

Kellogg’s has, of course survived and prospered.  But Post’s “Postum Cereal Company” grew up to be General Foods.

220px-C.W._Post_LCCN2014696048_(cropped) source

 

 

Written by LW

May 9, 2020 at 1:01 am

“Treat persons who profess to be able to cure disease as you treat fortune tellers”*…

 

samuel-thomson-botanic-herbal_1_bec4fc40d004476659e1183b05d5d434

 

Miracle cures, detox cleanses, and vaccine denial may seem to be the products of Hollywood and the social media age, but the truth is that medical pseudoscience has been a cultural touchstone in the U.S. since nearly its founding. At the dawn of the 19th century, when medical journals were still written almost entirely in Latin and only a handful of medical schools existed in the country, the populist fervor that animated the Revolutionary War came to the clinic. And while there was no shortage of cranks peddling phony medicine on a raft of dubious conspiracy theories in the early 1800s, none was more successful and celebrated than Samuel Thomson.

Portraying himself as an illiterate pig farmer (he was neither), Thomson barnstormed the Northeast telling rapt audiences things they wanted to hear: that “natural” remedies were superior to toxic “chemical” drugs; that all disease had a single cause, despite its many manifestations; that intuition and divine providence had guided him to botanical panaceas; that corrupt medical elites, blinded by class condescension and education, were persecuting him, a humble, ordinary man, because of the threat his ideas and discoveries posed to their profits.

For decades, Thomson peddled his dubious system of alternative medicine to Americans by playing to their cultural, political, and religious identities. Two centuries later, the era of Thomsonian medicine isn’t just a historical curiosity; it continues to provide a playbook for grifters and dissembling politicians peddling pseudoscientific solutions to everything from cancer to Covid-19…

The cautionary tale of a dubious early-19th century system of herbal medicine that became a blueprint for cranks peddling cures to whatever frightens us: “The 19th Century Roots of Modern Medical Denialism.”

Pair with: “Our Health Is in Danger. Wellness Wants to Fill the Void.

[Image above: source]

* George Bernard Shaw

###

As we heal ourselves, we might spare a thought for Rachel Carson; she died on this date in 1964.  A biologist and pioneering environmentalist, her book The Silent Spring— a study of the long-term dangers of pesticide use– challenged the practices of agricultural scientists and the government, and called for a change in the way humankind relates to the natural world.

The more clearly we can focus our attention on the wonders and realities of the universe about us, the less taste we shall have for destruction.
– Rachel Carson

 source

 

 

%d bloggers like this: