Thursday, November 20, 2014

Robert Hooke's Microscope

Robert Hooke's Microscope at the
National Museum of Health and Medicine
photo by CM Doran 2013
Imagine the world explored when Robert Hooke looked into this beautiful microscope.

The card reads:
Microscope, Christopher Cock (London), 1665
This microscope was used by Robert Hooke of the Royal Society, author of Micrographia and first person to apply the cord 'cell' to microscopic structures.

Monday, November 10, 2014

Reversion: Unintended Consequences

Today, Reversion by Amy Rogers at Science Thrillers is released:  a lab worker on an illicit drug mission, hiding in a cave with bats; a clinical trial of gene therapy at a foreign medical tourism destination (because it was not approved in the States); and assorted characters ranging from sweet and valiant to pure sociopathic. What could possibly go wrong?

The science of rabies, gene therapy, and mutations (to only name a few topics) are well portrayed:
"Disabling the virus was standard procedure when using a virus as a tool in gene therapy. Yes, her clinical trial used a rabies virus, but the virus was designed to be nothing more than a courier that delivered a package of DNA to a specific cellular address. It didn't behave like natural rabies, and it definitely did not make the patient sick. She'd taken great pains to guarantee the safety of her genetically-engineered virus. She had deleted the genes that allowed it to cause disease, and she had crippled the virus's reproduction. Outside the laboratory, it could not copy itself. Which was the reason Gunnar needed to be treated on a regular basis. The gene therapy virus died off, was cleared from his body, and had to be replaced over and over."
Contained within Reversion are Negri bodies and Batten's diseaseat odds with each other. A happy coincidence for the reviewer is that they were discovered in the same year, 1903. This coincidence is not a part of the story, but the lab bench "aha" moment (you will have to read the book to find out what that is) makes this coincidence sublime.

Reversion illustrates multiple ethical dilemmas such as the loss of subjectivity in clinical trials, for-profit medicine, and primate research. In addition, experiments inherently have some error. What effect does the power of nature have on error? 

The power of nature is a great theme, and was also portrayed in Dr. Roger's first well-done book, Petroplague. But Reversion is a more mature read, in content, and in story construction. 

The cover of Reversion shows Mayan glyphs, bats, and virus particles. The drug cartel certainly provides a Mayan underworld tone to the story (this reviewer will not be able to look at an MRI machine the same). But, also setting the tone is Lyssa, Greek Goddess of madness, rage, frenzy, and rabid animals; and there is allusion to King Midasa gift with consequences. The mythological stories are undercurrent, not central to the story. 

Reversion has Sameer, Vargas, and Lyle. They are the most strong characters who seemed either the most sincere, pathetic, or mysterious. The main protagonist, Dr. Tessa Price,  was well-defined, with a misguided sense of duty and an unreasonable fear of needles (read to find out where that gets her). She grows, but maybe not enough to end her story, or Gunnar's story.

Reversion is undeniably a satisfying read, and truly deserves a large audience. It is published by the new Science Thrillers Media, which now has four titles, and is also an invention of Dr. Amy Rogers. Readers have a lot to look forward to with her works.

Saturday, August 2, 2014

Glimpse of Smallpox

Extinction brought to you by all the hard efforts of research and vaccination.
CM Doran 2013: Preserved foot of smallpox victim at
National Museum of Health and Medicine;
Silver Spring, Maryland

Thursday, February 13, 2014

Second Annual Contest for Inflammatory Language!

Inflammatory Language is a series of primers on inflammation science. Care to contribute? The first place winner will receive a copy of ...

The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World by Steven Johnson 

The 2013 winner was Dr. Monica Lalanda of Medicoacuadros. Her illustrations were included in Inflammatory Language: The Rain in Spain.... She received a signed copy of The Best Science Writing Online 2012.

This contest is a great opportunity for students, but anyone can contribute.

Carefully select 300-500 words (or less) and/or an illustration that conveys inflammation. It can be humorous, political, or encompass pop culture or current events, but must be professional. It also needs to be appropriate for viewing/reading by most people.

The overall goal is to accurately inform readers.

Submissions can be sent to thefebrilemuse[at]gmail[dot]com. Please include your byline and link to your website, if you have one. Thank you in advance, and good luck! I look forward to reading your submissions.

Deadline:  March 15, 2014 **Contest now closed** no acceptable submissions this year (3/17/14 CMDoran)

Thursday, November 21, 2013

Explore the Source: Epidemiologists at Work

this book and provided me a reviewer's 
copy. They gave no renumeration or 
editorial guidance for this review.
African Water Pump H53
Acrylic byMariah Hamman
posted: Eckhart Public Library 2012

How to save millions of people? Hire epidemiologists—medical detectives who investigate: foodborne and food industry illness, increased and unexplained mortality rates, higher than expected rates of pneumonias and fevers, and global migration of highly resistant organisms, among many other events. Often they work behind the scenes—behind newspaper headlines with sensational ledes.

Epidemiologists are day-to-day, often meticulous personnel at local, state, federal, and global health organizations who observe patterns of disease, discuss their concerns with colleagues, involve experts from several disciplines and organizations, talk to patients and families affected by illness, enter data into databases and analyze it, study maps, use statistics and graphs to see patterns, and discuss and publish their findings so that others can learn. They are detailed people who love medicine, who love to solve puzzles, and who help to control outbreaks and prevent reoccurrences.

Alexandra M. Levitt in Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic viruses, and Drug-Resistant Parasites (Skyhorse Publishing, September 2013) asks:
"What type of person is ready and able to pit his or her wits against the endless inventiveness of infectious microbes?"
She answers this question by highlighting epidemiologists—their lives, the people they work with, and their science.

John Snow (the father of epidemiology) was an inquisitive person too, who in 1854 instructed the Broad Street Directors to remove the pump handle from the Broad Street pump as it was, according to his astute observations, allowing people to drink Cholera-contaminated well water. He observed and documented and analyzed what was happening to people of Victorian Soho London. In the words of Steven Johnson, author of Ghost Map: The Story of London’s Most Terrifying Epidemic—and How it Changed Science, Cities, and the Modern World,“…[It was the] first time a public institution had made an informed intervention into a Cholera outbreak based on a scientifically sound theory of the disease.”  His scientific methods and communication of his conclusions saved hundreds of lives at that time, and it could be argued that his methods, that live on now, have saved millions more. His search for source (the pump!) and his action (remove the pump handle!) led to epidemiology.

Much like Maryn McKenna’s 2004 book Beating Back the Devil: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service, the people and the circumstances in which they live are central to the story. However, McKenna’s book focuses, with a more finessed narrative, on the training and experiences of the Center for Disease Control’s Epidemic Intelligence Service. Dr. Levitt’s well-written book provides a more state and local epidemiologist’s perspective on what an epidemiologist does.

Each epidemiological case has clues, a beginning. In this book, there are seven chapters and an epilogue, with eight beginnings that draw the reader in:
“Medical detective Annie Fine was reluctant to venture out to Queens for a routine check on a few encephalitis patients at a neighborhood hospital in Flushing.”
“Patrick J. McConnon, the U.S. CDC Regional Southeast Asia Coordinator for Refugees, was sick to his stomach, dreading the decision he had to make.”
“In March 1981, the coroner’s office of the Province of Ontario alerted the Toronto police to four suspicious deaths in cardiology Ward 4A of the hospital for Sick Children, a hospital that specializes in caring for babies with complex heart disease.”
“On Monday, August 2, in the bicentennial year of 1976, an official of the Pennsylvania chapter of the American Legion reported something strange: same-day obituary notices for four middle-aged legionnaires, briefly sick with an influenza-like illness, who had attended a convention in Philadelphia during the third week in July.”
“Medical detective Craig W. Hedberg first learned about the rise in food poisoning cases from a microbiologist at the Minnesota state lab lab [sic] who visited his office in late September, 1994.”
“In September 2007, an attending physician at the Austin Medical Center (AMC) in Austin, Minnesota, examined a patient with numbness, tingling, fatigue, and weakness in the legs and feet—symptoms that suggested damage to the peripheral nervous system, the network of nerve cells that transmit information between the brain and spinal cord (the central nervous system) and other parts of the body.”
“Dr. Thomas Hennessy remembers the spring of 1993 as green, lush, and beautiful, in the special way of desert lands after rain.”
“Because new microbes continue to emerge, we must always be prepared for the unexpected. As this book goes into production, international investigations are underway—one in the Middle East and one in China—involving new respiratory diseases with high fatality rates and the potential for global spread.”
The epidemiologist investigates as seen here in Chapter 3: Sorrow and Statistics:
“What could medical detectives do that the Sick Kids doctors and the police had not already done? The doctors had focused on the details of each baby’s illness, finding a natural reason for each death. The police, on the other hand, had focused on a particular suspect, seeking legal evidence to build a case against her. The epidemiologists viewed the evidence from a different angle. Unlike the police or the doctors, they looked at all of the deaths at once, as part of a single mission, trying to figure out what all of the cases had in common—somewhat like an FBI analyst examining deaths linked to a single serial killer.”
Epidemiologists come up with a potential source (an aha! Or a “pump handle” moment) and take action, like in Chapter 6: Red Mist:
“Staring spellbound at the head table and its workers—who looked both strong and vulnerable—Lynfield said to Wadding, ‘Kelly, what do you think is going on?’ Wadding responded by deciding, then and there, to stop using air-blasting machinery to harvest brains. On the spot, he ordered the device dismantled and brought to his office. He also agreed to provide the head table workers with additional protective equipment.”
Sometimes epidemiologists stumble upon a new organism, as Chapter 4: Obsession or Inspiration details:
“Armed with the new culture technique and silver stain, the CDC scientists demonstrated unequivocably [sic] that the new microbe was a gram-negative bacterium rather than a ricketssial bacterium, although it turned out to be closely related genetically to Coxicella burnetii—the rickettsia that causes Q fever. (Gram negative bacteria are characterized by an inability to take up certain dyes because of the structures of their cell walls) It was named Legionella pneumophila (“lung-loving”), in honor of the American Legionnaires. Although many affected groups do not want the stigma of having an organism or disease named after them, the leaders of the American Legion decided that the name would honor their fallen colleagues.”
The science in Deadly Outbreaks is rich and understandable. It may be a bit tough for the uninitiated, however, but the people-centeredness of the stories will bring in most curious readers. There are two infectious disease errors I assume (given Dr. Levitt’s expertise in infectious disease) were due to unnoticed autocorrect functions within the word processing program used to write the book: Typhoid Mary was said to have typhus. She was a Salmonella typhi carrier, not a typhus carrier. And mycoplasma was once misspelled as micoplasma.

What will appeal to many readers is that Dr. Levitt is well read and steers the reader to interesting and lesser known resources:
“…Hedberg remembers working long but productive hours to make sure more people did not become sick. He also recalls that once the tainted meat was off the market and things began to wind down, MDH [Minnesota Department of Health] shut down the investigation for a week to give him time off to get married. A few years later, this unusual foodborne outbreak became the topic of the last New Yorker article by Berton Roueché, the author of Eleven Blue Men, a classic collection of outbreak stories from the 1940’s and 1950’s5
Deadly Outbreaks also has a note section in the back, with further references. There are several photographs of the people involved in the investigations as well as short biographies of each.

Deadly Outbreaks is an important addition to the science literature, as it highlights epidemiologists via a new perspective, and it details who they are and how they do their work: from clues, to source, to action.

Tuesday, May 7, 2013

Inflammatory Language: The Rain in Spain...

Sanidad publica
Illustration by Monica Lalanda 2012
...austerity, that is...falls on many of us (in the UK, Ireland, Greece and many other European Union countries including the Baltic States, and also the US). Austerity has finally pushed Spanish doctors into working together (a historically rare occurrence) to fight the break-up of their national health system. The UK is at risk as well.

In February, The Febrile Muse asked readers to submit to Inflammatory Language either a 300-500 word article and/or illustration that conveys inflammation. It could have been humorous, political, or encompassed pop culture or current events. The overall goal was to accurately inform readers. 

Dr. Monica Lalanda was the first to submit her work. She submitted three illustrations from her blog:  Medicoacuadros. Dr. Lalanda is a Spanish Emergency Medicine doctor who trained and worked in the UK before going back home. She fights for a better world with her stethoscope, her words, and her drawings, and strongly believes in a good public health service. She is married to a surgeon and has two kids. Please read her blog. It is passionate, and places her patients and vocation at the center of healthcare. I'm sure doctors, pharmacists and other health care professionals will be able to identify with her illustrations, such as this one: 

A punto de estellar (to burst)
llustration by Monica Lalanda 2012
Now, how does this relate to Inflammatory Language? Well, obviously financial tensions are inflammatory. Yet, my original intention was to focus on the science of inflammation and infection. After reading more submissions, and reading about the sequester (not to be confused with quarantine or isolation here), it hit me how healthcare systems and cuts to resources--to detect, research, control and treat infections was inflaming passions.

We all know that good accessible healthcare leads to the control and treatment of infectious disease. I will go a step further to say that we (physicians, pharmacists, nurses, scientists, and science writers) have an ethical obligation to worry and work against the unintended effects of austerity, sequester, and challenges to our health systems--on many levels, but for our sake here, on the prevention and treatment of infectious disease. 

What evidence do we have that austerity measures have already affected infectious disease? These four things are just the tip of the iceberg..... Feel free to add to the list in the comment section--a later post can expand upon the evidence.

  • In Greece, drastic cuts to condom and needle exchange programs has lead to more HIV infections
  • Also in Greece, overall infectious diseases morbidity/mortality in men has increased.
  • No statistics done to find an association, but look at resistance pattern for Klebsiella pneumonia--appears to be higher in countries that have made drastic cuts to healthcare (austerity measures)
  • Disease-carrying insect control has been drastically cut in Florida, where an uptick in home-grown Dengue fever seen in 2009 (before Mr. Scott took office) and 2010; Globally, dengue fever cases are up (in non-tropical areas too) and severely underestimated.

Angry Doctor
Illustration by Monica Lalanda 2012
Infectious diseases can spread globally, and a great deal of resources need to be in place (in all countries) to prevent widespread disease. An outbreak, if not contained, can spread to other countries, undetected until it is too late. And in the case of resistance, inadequate containment/treatment in one country may lead to inadequate treatment in others.

It will take global resources to prevent a backslide in protecting our people from infectious disease. It is imperative that we consider:

  • The Healthcare labor-force
    • Nursing shortages have been associated with increased mortality in patients due to urinary tract infections and pneumonia
    • Number of clinical pharmacists in hospitals inversely related to medication errors
  • Access to healthcare and nutrition
    • When patients have limited access to healthcare, emergency rooms become overburdened. 
    • Limited access either results in inappropriate use of ER departments and/or delayed treatment (if patient goes nowhere).
    • Sequestration will lead to cuts in public health (the extent of cuts has been debated)
    • Decreased meals for seniors, due to sequestration
  • Vaccinations
  • Sexually transmitted diseases and HIV/AIDS testing/treatment services
    • Decreased HIV testing and for other STDs
    • Decreased treatment programs
  • Infection control and antimicrobial stewardship  
    • Surveillance agencies need resources (sequestration has led to cuts at the Centers for Disease Control, CDC)
  • Resistance
  • Food and water inspection
    • less inspection of foodwater, and more antibiotic use in animals may lead to more food and waterborne illness.
Embedded image permalink
Dr. Lalanda won this book!
Thank you for your submission.
Photograph by Monica Lalanda 2013
By working together, as healthcare professionals, as scientists, as writers and illustrators, we should fight for the resources to do what is right and just (because we have the information)...for humanity, not our individual pockets.

I realize that there is only so much money to go around, but we have made tremendous gains in the prevention and treatment of infectious diseases. When you only look at infectious diseases and what needs to be done to take care of our people in the best way possible, I see the Tea party as least real tea has antimicrobial properties.

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