the new ussr illustrated

welcome to the Urbane Society for Skeptical Romantics, where pretentiousness is as common as muck

Posts Tagged ‘medicine

a bit more on cell cultures, cell mortality and patients’ rights

leave a comment »

Human connective tissue in culture, 500x. Image courtesy of Dr. Cecil Fox (photographer)/National Cancer Institute.

Canto: Well, we’ve followed up Meredith Wadman’s The vaccine race with Rebecca Skloot’s The immortal life of Henrietta Lacks, which intersects with Wadman’s book in describing cell cultures and their value in modern medicine and genetics. So are ready to talk about all this again?

Jacinta: Yes, this book tells a compelling history of the Lacks family as well as a story of the ethics around human cell cultures, based on the HeLa cell line taken from the cervix of Henrietta Lacks in 1951, shortly before she died of cervical cancer.

Canto: A very aggressive adenocarcinoma of the cervix, to be precise, though the tumour was misdiagnosed at the time.

Jacinta: Yes, her bodily state and her sufferings make for grim reading. And the cells were taken sans permission, in a pioneering era of almost no regulation and a great deal of dubious practice.

Canto: The wild west of cell and tissue culturology.

Jacinta: George Gey, the guy who ordered these cells to be taken, was a great pioneer in cancer and cell culture research, but he and others found it very difficult to keep human cells alive in vitro, so he was much surprised and delighted at his success with Henrietta’s tumour cells.

Canto: They were the first ever cells to live beyond the Hayflick limit, though that limit wasn’t spelt out by Hayflick until 1961.

Jacinta: And wasn’t accepted for decades after that. And the reason for their apparent immortality, a rare thing in untreated cells, was their cancerous nature. Human cancer cells contain an enzyme known as telomerase, which rebuilds the telomeres at the ends of chromosomes. Normally these telomeres, often described as like the protective caps at the ends of shoelaces, shorten and so become less protective with each cell division.

Canto: So if we could stop cancer cells from producing telomerase, you’d stop all that metastasising…

Jacinta: Sounds easy-peasy. And if we could introduce telomerase into non-cancerous cells we could all live forever.

Canto: Bet they haven’t thought of that one. So if this cell line was cancerous, how could they be of so much value? How could they be of any use at all, since the aim, I thought, was to produce ‘clean’ cells, like the WI-38 cells Hayflick produced ten years later? Remember how they had so many problems with monkey cells, which were full of viruses?

Jacinta: Well, forget viruses for the moment, the exciting thing about the HeLa cells was that they stayed alive and multiplied, which was rare, and so they could be experimented on in a variety of ways.

Canto: But did they use the cells for vaccines? The 1954 Salk polio vaccine was tested using these cells. How can you do this with cancerous cells?

Jacinta: Well it was the suitability of these cells for mass-production that made them ideal for test-driving the Salk vaccine, and of course their prolific nature was tied to their cancerous nature – Henrietta’s cancer seemed to be horribly fast-spreading, it was just about everywhere inside her at her death. Her cancer was caused by the human papilloma virus (HPV) and I’ve read that this may have had something to do with their prolific nature. She also had syphillis, likely contracted from her philandering husband, and this suppresses the immune system, allowing the cancer cells to multiply more rapidly. But even though they were cancer cells they shared many of the properties of normal cells, including the production of proteins and susceptibility to bacterial and especially viral infections. Of course you would never inject HeLa cells into humans, but their malignancy is an advantage in that you get the results of say, viral infection of cells as they reproduce, much more quickly than with normal cells, because of their reproductive rate. It seems old George Gey hit the jackpot with them, though he never made any more money out of them than the Lackses did.

Canto: They initially used rhesus monkey cells to test their antibody levels in response to Salk’s killed polio virus, but they were too hard to get and too expensive, and the HeLa cells were an excellent alternative because they were easily infected by the virus… and they reproduced with unprecedented alacrity.

The malignancy of immortality (or vice versa). A HeLa cell splitting into two new cells. The green spots are chromosomes. Courtesy Paul D. Andrews)

Jacinta: Yes, that’s to say, they readily produced antibodies, and so could be experimented on to produce the level of antibodies to create immunity. But growing cell cultures in vitro and maintaining them in a viable state, that’s been a decades-long learning process. Tissue culture these days is big business, which has led to the murky ethical questions about tissue ownership that Skloot refers to at the end of her book.

Canto: Yes but I for one am quite clear about that issue. I’m more than happy for researchers to use any tissue that comes from, say, a biopsy done on me. Is that tissue mine, when it’s removed from my body?

Jacinta: Well, is it? Think of locks of hair kept from a loved one – something that happens a few times in Skloot’s book. Wouldn’t you be moved by a lock of hair that you knew came from someone you loved but who was no longer around? Wouldn’t you feel you had hold of a part of her? Not just a memory of her?

Canto: Interesting. I think I’d be in two minds about it. I’d think, yes, this is her hair, a small part of her, and that would bring all the emotion of identity with it. But then, what I know about science and cells tells me this is just hair, it’s not what makes her her. It’s nowhere near it. Our hair is discarded all the time.

Jacinta: If you had some of her brain cells? Or heart tissue haha?

Canto: Nothing but ultra-ultra minuscule parts of the whole. And essentially meaningless when disconnected from that whole. But this misses the point that the value of this tissue for research outweighs by far, to me at any rate, the sentimental value that you’re talking about.

Jacinta: But for some people, and some cultures, the intactness of the human entity, after death say, is of deep-rooted significance. Are you not prepared to respect that?

Canto: But we slough off our trillions of cells all the time. Even as a kid I was told we replace our cells every seven years. Of course it’s much more varied and complicated than that, but the general point of constant renewal is true.

Jacinta: Yes but they’re your cells, with your DNA in them, nobody else’s.

Canto: Well people are prepared to be operated on, which inevitably kills or removes cells, and in doing so they give themselves up to experts in healing their bodies and often saving their lives, so it would seem to me pretty mean-spirited not to allow those experts to make use of what’s removed, which is of no obvious use to them.

Jacinta: I think you have a good argument there, but what if these mad scientists use your cells for some nefarious purpose?

Canto: Well, call me a trusting soul, but why would they do that? And what nefarious purpose could they use them for?

Jacinta: Well it mightn’t even be nefarious. With the modern commercialisation of cell and gene technology, they might find your tissue perfect for developing something patentable, out of which they make shitloads of money while preventing independent research on the tissue, so using your cells in a way that you might strongly disapprove of. But you wouldn’t have the slightest say, as things stand today. Rebecca Skloot describes examples of this kind in the Afterword to her book. There’s been a raging debate about commercialisation and gene patents and patients’ rights for some time now in the USA, and no doubt elsewhere, with scientists and other stakeholders ranged along the spectrum. In fact, these are the last words of Skloot’s book, published in 2010:

2009: More than 150,000 scientists join the American Civil Liberties Union and breast cancer patients in suing Myriad Genetics over its breast-cancer gene patents. The suit claims that the practice of gene patenting violates patent law and has inhibited scientific research.

Canto: Right. As her investigations reveal, it’s not just about patients wanting a share of the loot from research on their cells, and so using the courts to bog everything down and hinder that research, it’s often about researchers themselves wanting to cash in, and patients joining with other researchers to try to free up the system for the common good. So how’s the Myriad Genetics case going, and how’s the situation regarding patient rights in this field, several years on?References

Jacinta: Well in the case of Myriad, it was all highly complex and litigious, with suits and countersuits, which the company mostly lost, in particular in a landmark (and unanimous) Supreme Court decision of 2013, in which they found that ‘merely isolating genes that are found in nature [in this case the BRCA-1 and BRCA-2 genes] does not make them patentable’. But of course this wasn’t so much about patients’ rights in the material that was once part of their bodies. It’s not all about money – though much of it is, and if you don’t want the money landing in lawyers’ pockets, the best thing is to have clear guidelines, disclosure, and fully developed and complex consent procedures. My impression from doing a fairly shallow dive on the issues is that we’re a long way from sorting this out, in an increasingly complex and lucrative field. Our own federal government’s NHMRC has a booklet out, available on PDF, called ‘Ethics and the exchange and commercialisation of products derived from human tissue: background and issues’, which is already six years old, but I don’t see anything in the legislative pipeline.

Canto: Looks like an issue to be followed up, if we have the stomach for it.

Jacinta: It pays to be informed, that’s one obvious take-away from all this.

References
Rebecca Skloot, The immortal life of Henrietta Lacks, 2010
Meredith Wadman, The vaccine race, 2017

Written by stewart henderson

July 3, 2017 at 12:22 pm

some more stuff we’ve learned about vaccines

leave a comment »

Vaccinology, I would say that it’s not rocket science. It’s a lot harder than rocket science.

Alan Schmaljohn, virologist, 2014

 

Canto: So, reading The Vaccine Race, by Meredith Wadman – maybe we should just do book reviews? – I find myself getting excited, or confused, by a passage, and wanting to do more research, and then forgetting about it…

Jacinta: It’s probably pretty normal to forget 95% of what you read within a week or so of having read it. You just hope the things you retain are the principal things.

Canto: Yeah well, I was probably hoping the book would help me get my head around how vaccines work, as well as providing juicy and inspiring tales of heroism and malpractice in the history of vaccine development, and it has helped, but I think I’d need to read half a dozen such books and watch a dozen videos before it penetrated my thick skull…

Jacinta: Yes, for example, when I found myself reading, well into the book, about Leonard Hayflick’s human diploid cells, taken from the lungs of an aborted foetus, which were used to provide a sort of base for creating vaccines against all sorts of diseases, most notably rubella, I thought ‘obviously the author has explained human diploid cells, probably in great detail, before, but I can’t recall a whit’…

Canto: That’s what comes of reading too many books at once, and spreading your focus. You know it’s a myth that women can multi-task better than men, but the major finding of research is that multi-tasking is bad for everyone. Let’s resolve to read books one at a time, from start to finish.

Jacinta: Resolved. Anyway, diploid cells are just standard human cells, with 23 pairs of chromosomes. The only other human cells are haploid sperm and eggs, with 23 unpaired chromosomes. Hayflick’s cell line, gathered in the fifties, was ‘cleaner’ than the cells previously used from other animals, such as monkey kidney cells, which contained many viruses. I used the index.

Canto: So these cells were taken from the lungs of a foetus, and Hayflick was able to produce a cell line from them, that’s to say a line of almost endlessly reproducing cells, I’m not sure how that worked, but these cells, which had to be free of every virus or pathogen, would then be somehow injected with, say, the rubella virus, in some sort of reduced form, so as to produce antibodies in those who are vaccinated. The trick with vaccinology, it seems, is to produce a safe vaccine with no side effects, or minimal side effects, but with enough potency to produce a reaction, thus producing antibodies to the antigens in the vaccine. The vaccine must contain antigens, must have some potency, otherwise it’s useless. And every immune system is subtly different, so producing a one-size-fits-all vaccine is in many respects a monumental undertaking. I may have this completely wrong by the way.

Jacinta: Probably only partially wrong, let’s not be absolutists. What about this difference between killed vaccines and live vaccines. Can we talk about that?

Canto: Well first I want to understand how a ‘cell line’ is produced. How were Hayflick’s famous WI-38 (human diploid) cells produced in a constant stream from the lungs of a single legally aborted foetus in 1962?

Jacinta: Let me try to summarise Wadman’s description of the process from this online article. The tiny lungs were minced up and then placed in a container with a mix of enzymes that separated them into individual cells. These cells were separated again into small glass bottles, and a ‘nutrient broth’ was added, causing the cells to divide. thus began the most thoroughly described, studied and utilised human cell line to date, from which was created vaccines for rubella, rabies, adenovirus, measles, polio, chicken pox and shingles.

Canto: A nutrient both? You mean ‘at this point a miracle happens’?

Jacinta: Well, this was a well-established miracle, only previously it was done with non-human cells, and still is. Monkey and canine kidney cells, chicken embryo fibroblasts, hamster ovary cells… Of course using human cells was bound to be controversial.

Canto: So – obviously the cells in these tiny lungs would’ve gone on dividing had the foetus survived, so microbiologists had worked out a way, of making this happen – mitosis, isn’t it? – outside the host. How long have they been able to do this?

Jacinta: Well the first vaccine was created by Edward Jenner in the late eighteenth century, but they weren’t actually culturing cells then. Cell culture is a broad term meaning a process of growing cells – obviously by cell division – outside of their natural environment, usually in a lab. A cell line (e.g. Hayflick’s WI-38 cells) is ‘a population of cells descended from a single cell and containing the same genetic makeup’, to quote Wikipedia. Cell culture started with the maintenance of cell tissue independent of the host animal in the late nineteenth century, but techniques advanced rapidly in the 1940s and 50s to support virology and the manufacture of vaccines. A key event was the growing of poliovirus in monkey kidney cells in 1949, for which John Enders, Tom Weller and Fred Robbins won the Nobel Prize. Their methods were used by Jonas Salk and others to produce the first polio vaccine.

Canto: But the problem with using monkey kidney cells was that they potentially carried their own viruses, right? Which may or may not be harmful to humans, and how would they know? Without using human guinea pigs?

Jacinta: Human subjects, yes. And there’s also the question of the potency of the virus being used, presumably to stimulate the production of antibodies. Is it just a question of stimulating enough antibodies? And isn’t there an obvious danger of infecting subjects with the virus itself? Presumably a killed virus solves that problem, but is it really effective?

Canto: Yes, Wadman’s book has been fascinating on the politics of the vaccine race, but I’m still left much confused – probably due to stupidity or inattentiveness – as to how some vaccines work better than others, and how a cell line – I know it’s essentially about exponential growth – can produce enough material for millions of vaccine doses.

Jacinta: Yes it’s about exponential growth, and it was once thought that, given the right conditions, these cells could go on multiplying ad infinitum, to immortality so to speak, but it was Hayflick who showed this not to be true in a much-cited paper. Even so, the number of replications of individual cells assured a sufficient supply of cells for generations. And since then, much more has been discovered about cell ageing and its causes, what with telomeres and telomerase, but that’s another story. As to why vaccines developed from the WI-38 cells have been so much less problematic than others, it clearly has much to do with their being ‘clean’ human foetal cells, with no other lurgies lurking.

Canto: So let me get this clear. The WI-38 cells are provided to different labs that are wanting to create a vaccine for, say, measles. Or that have already created a vaccine, or at least have isolated the virus – but then of course viruses can’t be isolated, they need cells to survive in. So they get the WI-38 cells, and then they inject them with the virus – killed or attenuated – and then they start trialling it on rats or mice or something, trying out different strengths of the virus, without really having much idea whether the dose will translate to humans, so they must find some willing volunteers (or, in the early days, orphaned or intellectually disabled kids) to experiment on, making sure they err on the conservative side initially, then upping the dosage? I’m no doubt simplifying and speculating wildly here.

Jacinta: yes and I’m no wiser  than you, but it’s a good thing we have people taking these risks, and working so hard in this field –  with clearer ethical guidelines than before – because millions of lives have been saved by vaccines, and so much has been learned about our immune system in the process of developing them.

 

Wadman, Meredith. The Vaccine Race. Doubleday 2017.

https://www.historyofvaccines.org/content/articles/human-cell-strains-vaccine-development

http://www.nature.com/news/medical-research-cell-division-1.13273

https://www.ncbi.nlm.nih.gov/pubmed/25903999

https://en.wikipedia.org/wiki/Cell_culture

Written by stewart henderson

June 11, 2017 at 7:39 pm

Traditional Chinese medicine? You must be joking

with 4 comments

bear bile, a TCM that tortures and kills bears and prevents humans from receiving effective treatments - just one of the horrors of TCM

bear bile, a TCM that tortures and kills bears and prevents humans from receiving effective treatments – just one of the horrors of TCM

If we don’t know what’s in them, it’s very difficult to predict the interactions, … that’s obviously of great concern if they are been given to children, or pregnant women, the potential outcomes there are very serious.

Murdoch University biochemist Dr Garth Maker

There’s nothing particularly positive to say about naturopathic treatments generally – some of which (homeopathy, reflexology, iridology, acupuncture and cupping, to name a few) are not so much ‘natural’, whatever that means, as examples of comprehensively failed hypotheses (hardly worthy of the name). But so-called traditional Chinese medicine is on the lowest rung, considering how much damage it has done, not only to humans but to other species that have been horribly exploited in its name. The latest damning finding about what is actually contained in many of these unregulated pills will probably barely create a ripple amongst the anti-science crowd, but nevertheless it needs to get as much publicity as possible. You never know, maybe someone, somewhere will take notice (and we’re fighting a real battle here, because if you go online to find out about TCM, you’ll find the whole internet disturbingly skewed towards the positive). Please, if only for the sake of the children exposed to this crap by ignorant parents, let’s do something about this. It’s an effing outrage.

Written by stewart henderson

December 13, 2015 at 11:36 pm

introducing canto and jacinta: solutions for the post-antibiotic era?

leave a comment »

Florence Nightingale

Florence Nightingale

Jacinta: Well hello Canto, let’s welcome each other to the Urbane Society of Skeptical Romantics, where we like to talk… and not much else.

Canto: Very productive and constructive talk Jacinta, but the proof will be in the pudding.

Jacinta: Well I hope it’s not a recipe for disaster. What shall we talk about today?

Canto: Well I’m thinking medicine today – the discipline, not the stuff you consume.

Jacinta: Well I don’t consume much medicine at the worst of times, being fit, positive, eternally youthful and beautiful.

Canto: That’s okay, I’ll take your share – so you know there’s a bit of a crisis with antibiotic resistance.

Jacinta: Yes, natural selection in action, or is that human-induced, unintended-consequence-style artificial selection?

Canto: Well I’m not intending to delve into the natural v artificial quagmire here, or even into the science of antibiotics. I’ve just been reading about a couple of alternative ways – one old and one new – of killing off nasty infecting bacteria in hospitals. Ever caught one of those secondary infections in hospital Jass? No of course you haven’t.

Jacinta: Last time I was in hospital I was the infection – had to be forcibly removed from the victim by a crack team of medicos and placed in isolation until deemed safe to take my chances at thriving and multiplying along with my fellow bugs.

Canto: Well I’m sure they made the right decision.

Jacinta: The jury’s still out. Tell me of the ways.

Canto: Remember Florence Nightingale?

Jacinta: One of my heroes, apart from her valetudinarianism. Though I suspect that might just have been her way of keeping everyone at a distance so she could get on with things in her way. She was a voluminous correspondent just like Darwin, another sufferer from mysterious ailments. So what about her?

Canto: She revolutionised nursing and hospital treatment, sanitation and such, right? One of her many insights was that patients convalescing from the Crimean battlefields benefitted enormously from throwing open the windows of the rather unhygienic field hospitals set up for them. Nightingale wards were built to her design, with high sash windows kept open to renew the air around the sick. This worked a treat, though it took more than a century to verify the effect experimentally, using E coli in an open rooftop environment. The bugs died within 2 hours in the open air, but in an enclosed environment they lived on.

Jacinta: Right, so this has obvious relevance to those horrible superbugs they talk about…

Canto: Like MRSA?

Jacinta: Yeah. What’s that?

Canto: Multi-resistant, or more accurately methicillin-resistant staphylococcus aureus.

Jacinta: Yeah, golden staph, just as I thought. So that’s interesting. I don’t see modern hospitals blowing in the wind really. Sounds far too hippy for the 21st century. Isn’t it all tightly controlled and air-conditioned these days? Recycled air and legionnaire’s disease? Okay, only kidding, I’ve not heard of any hospital outbreaks of that, but these hospital superbugs must surely be caused by a contaminated environment, yes? Should we bring back Nightingale wards? And why did they go out of fashion?

Canto: Well, not only did she get fresh air right, she had the windows faced to let in as much sunlight as possible, and it was only learned later that sunshine was a great germ-killer, especially in the case of tuberculosis, which ravaged all the crowded cities…

Jacinta: Yeah and picked off all those writers, like Chekhov, and the Brontës, and D H Lawrence, and Keats. Didn’t he write an ode to Florence Nightingale?

Canto: No no that was another nightingale, but at its height TB was killing one in five in the cities; but it’s probable that the sunlight was boosting levels of vitamin D, which in turn boosts the immune system. So by the turn of the century, fresh air and sunlight was all the go. TB patients were wheeled onto balconies, to be exposed to the bracing elements.

Jacinta: Ah, but of course all that changed with the discovery of antibiotics.

Canto: Right, and thanks to these miracles of modern medicine, rotten air and dark dankness came back into fashion, sort of. I mean, all sorts of infections were being vanquished by these pills and it seemed as if diseases would fall like ninepins.

Jacinta: I suspect you’re oversimplifying..

Canto: Well it must’ve seemed that way to the general public. And of course fresh air could turn into howling winds, and sunlight into clouds and rain. Controlled temperatures and conditions might’ve seemed safer, and the cleansing power of aircons was over-estimated.

Jacinta: Oh yes… Climat air-conditioning, Breezair, Bonaire – more than an air-conditioner, a tonic to the system.

Canto: But now of course the diseases are returning in resistant forms, and we’ve hit a wall in terms of antibiotic manufacture. There’s very little new stuff coming on-stream. And now, hospitals are being seen as a problem again, just as in Ms Nightingale’s day.

Jacinta: Yes, but there are new post-antibiotic treatments in the pipeline, such as phage therapies, in which bacteria are destroyed by genetically engineered viruses, and drugs that…

Canto: Okay Jass, that’s for another conversation, and these new treatments are a bit futuristic as yet. Meanwhile, we need to heed Ms Nightingale’s hygienic advice. Apparently, the recent emphasis on simple hand washing has been paying huge dividends, in reducing the incidence of MRSA and Clostridium difficile.

Jacinta: So we were getting complacent, forgetting the basics?

Canto: Well, we’d been lulled by the success of modern medicine into thinking the old precautions needn’t apply. And further studies have confirmed the cleansing power of even the mildest breezes, and hospitals have begun to open up in response.

Jacinta: But not only that, we now know more about good old-fashioned sunlight and its curative powers, don’t we?

Canto: Okay, the stage is yours.

Jacinta: Well, there was some breakthrough research done using standard UV lamps in a TB ward. Guinea pigs were used (I mean real guinea pigs), and their signs of infection were drastically reduced. Now, there are some regions of the world with high rates of TB, and of HIV, which of course weakens their immune system and makes them susceptible…

Canto: I thought TB was just about eradicated.

Jacinta: Well it’s now resurgent in some parts, so we’re back to looking at other modes of prevention. So UV lighting is proving very effective, but not applied directly, because direct exposure is quite dangerous – think of tanning beds and the like. But what is interesting is that they’ve experimented with different UV wavelengths – ultraviolet light covers the spectrum from 10 to 400 nanometres – and found a sweet spot at 207 nm. At that wavelength the UV light is absorbed by proteins and penetrates a little way into human cells but doesn’t reach any DNA to effect mutations. But it does affect bacteria, drastically. They absorb the light and die.

Canto: Very clever.

 

Jacinta: Quite. This sweet spot technology was first used in operating theatres, to kill airborne bacteria that could immediately settle in open incisions and the like. There’s a suggestion now that UV lamps at that wavelength should be deployed in all hospitals.

Canto: So that’s one solution, but getting back to fresh air, has anyone found a solution that eliminates the drawbacks? I mean, knocking equipment around, bringing in pollution and pathogens from outside, not to mention patients falling out of windows?

Jacinta: Well, some of those risks could easily be minimised, but there are more technological fixes. The production of hydroxyl radicals has been shown to kill bacteria…

Canto: Hydroxyl radicals? WTF?

Jacinta: Molecules with a short lifespan, produced in the atmosphere when ozone, the unstable allotrope of oxygen, reacts with water. This reaction is catalysed by organic molecules in the air, and a while back a company managed to build machines that produce these hydroxyls, for use in hospitals. They were quite effective, but the company went bust. So we’re back to good ventilation and getting patients out on balconies. And perhaps locating hospitals out of the way of cities.

Canto: Okay, so back to the future.

Jacinta: Or forward to the past.

Canto: Well thanks for this charming discussion and we look forward to many more.

Here’s an interesting commercial video about how a hydroxyl generator works
https://www.youtube.com/watch?v=a_V9HbBVM6Q
hat-tip to: Frank Swain, ‘A breath of fresh air’ in New Scientist Collection: Medical Frontiers.

Written by stewart henderson

August 9, 2015 at 9:02 am

something to send you to sleep

leave a comment »

sleep-apnea-machine.jpg

sleep apnoea mask – looks great, feels even worse?

I went to a Science in the Pub talk last night, not knowing what to expect. The three speakers were all researching sleep, and the focus was mainly on insomnia and sleep apnoea. How fortunate, for I’m having a problem with insomnia at the moment. I may well have a problem with apnoea too, but because I sleep alone I can’t monitor it. Sleep apnoea is about blocked airways that reduce the intake of oxygen, causing sleep disturbance. Here’s an extract from the Better Health Channel on the subject:

In most cases, the person suffering from sleep apnoea doesn’t even realise they are waking up. This pattern can repeat itself hundreds of times every night, causing fragmented sleep. This leaves the person feeling unrefreshed in the morning, with excessive daytime sleepiness, poor daytime concentration and work performance, and fatigue. It’s estimated that about five per cent of Australians suffer from this sleep disorder, with around one in four men over the age of 30 years affected.

So it’s much more common among older males, and it correlates with excessive weight and obesity. Some years ago, when I had a sleeping partner, she expressed a concern about what she thought might be my sleep apnoea, but since then I’ve lost a lot of weight, and my overall health – apart from my bronchiectasis – has improved, so I don’t intend to worry needlessly over that, but it was interesting to hear about the CPAP mask and other treatments being offered, including the possibility of surgery to the uvula and tongue. Also that the evidence is mounting about the long-term effects of sleep apnoea, upon the heart particularly, though not surprisingly with obesity, confounding factors are hard to control for. The problem I’m having at the moment, though, is ‘advanced circadian rhythm’ insomnia, which has only been happening over the past few weeks and which I’m hoping will sort itself out. Our roughly 24-hour circadian rhythms, our body clock, when running at its best, gives us at least eight hours sleep, optimally between 11pm and 7am, though there is enormous individual variation, and huge variation in tolerance of sleep deprivation, possibly due to genetic factors. Amongst the many varieties of body clock-related sleep disorder, two were focused on last night; delayed-phase and advanced-phase circadian rhythms. The terms are largely self-explanatory. In the delayed-phase type, you stay up late and find it hard to get up in the morning, a common teenage problem (or habit). In the advanced-phase type, which I’m now experiencing for the first time in my life, you find yourself falling asleep alarmingly early, and then waking up – and being alarmingly wide awake, at 4am or sometimes even earlier.

The Circadian Sleep Disorders Network is a great place to learn about the problems, and possible solutions for having a body clock that’s out of synch with the day-night cycle or with your work or other commitments. These problems can lead to all sorts of stresses, but what I took from last night’s session, though it was never explicitly stated, was that your attitude to wonky sleep patterns might be causing more stress than the patterns themselves. In my case, though it’s irritating, I tell myself I needn’t stress over it as I have to get up around 6am for work anyway, and as long as I’m awake and fully operational until 5pm, or 7pm for cooking and eating dinner, it’s no big problem. I’ve not noticed excessive daytime sleepiness or poor concentration (but maybe I’m not concentrating enough). Though I do hope it will right itself, just because being abnormal feels – abnormal. Then again, I’m abnormal in so many other ways that are far more stressful.

Advanced-phase sleep disorder is apparently much less common than delayed phase, though that might just be that it’s less often reported precisely because it doesn’t disrupt work routines. The main treatment is the use of bright light, though I’ve found myself falling asleep in the bright light of the lounge room, or in my bedroom with a bright reading lamp left on. But there’s more to it than just leaving the light on. Here’s a summary from the Sleep Health Foundation:

Bright light visual stimulation should occur in the evening before you go to bed. The light should be brighter than normal indoor lighting. You can obtain it from specialized light boxes, or portable devices that you can wear, e.g. eye glasses. A few examples can be found by a web search for “bright light therapy”. You may need an hour or two of bright light therapy before bed. Some will benefit from nightly use for a week. Others will need longer, sometimes several weeks, to get maximum benefit. It is best used late in the evening, perhaps turning the bright light device off half an hour before bed.

Something to think about if this keeps up. Another treatment is with melatonin, the ’sleep hormone’:

One option is to take a 2mg slow release melatonin tablet (Circadin™) as close to your new (later) bedtime as possible. A second option is to take a small dose of melatonin (0.5 mg), about half way through your sleep period. This could be at a time when you wake up on your own. To change your hours of sleep, you should gradually delay your bed time (e.g. 20 minutes later each night) until you get it to the time that you want. As you delay your bedtime, you will also be delaying the time of your bright light exposure and melatonin intake.

Obviously, neither of these treatments are simple or guaranteed to be effective. Cognitive behaviour therapy was suggested by the experts, if these approaches were unsuccessful, but I know next to nothing about that. For now I’m not too worried, I just hope the problem goes away without my noticing.

Written by stewart henderson

July 5, 2015 at 10:12 am

it’s all about evidence, part 2: acupuncture and cupping

leave a comment »

a picture of health

a picture of health

Okay, having been sick myself with my usual bronchial issues, I haven’t made much progress on researching the ‘alternative’ treatments offered by Wesley Smith and his colleagues at the Wellness Centre. I must admit, too, that I’ve found it a bit depressing focusing on these negatives, so I’ve been working a bit on my Solutions OK blog (a few posts still in preparation) which focuses on being positive about global issues.

So before briefly dealing with acupuncture, I’ve discovered accidentally through looking up Mr Smith that ‘wellness centres’ or ‘total wellness centres’ are everywhere around the western world, including at least one more in Canberra itself. It seems that this is a moniker agreed on by practitioners of holistic medical pseudoscience world-wide, to create a sense of medical practice while avoiding the thorny issue of medicine and what it actually means. But maybe it does partially mean treating people kindly? I’m all for that. Laughter is often quite good medicine, especially for chronic rather than acute ailments.

It’s an interesting point – ‘alternative’ medicine is on the rise in the west, and the WHO informs us that by 2020, due to its own great work and that of other science-based medical institutions, the proportion of chronic ailments to acute ones will have risen to over 3 to 1. It’s in the area of chronic conditions that naturopathy comes into its own, because psychology plays a much greater part, and vague ‘toxins’ and dubious ‘balance’ assume greater significance. That’s why education and evidence is so important. There are a lot of people out there wanting to smile and seduce you out of your money.

Acupuncture 

There’s no reason to suppose acupuncture is anything other than pure placebo. It’s similar to homeopathy in that it proposes a treatment involving physical forces that, when tapped, can produce miraculous cures, and it’s also similar in that these forces have never been isolated or measured or even much researched. In the case of homeopathy, Samuel Hahnemann, its inventor, conducted ‘research’, but with no apparent rigour. See this excellent examination of his approach.

Acupuncture posits Qi (pronounced ‘chee’) as an energy force – apparently invisible and undetectable by mere science – which operates under the skin and is ‘strongest’ at certain nodes where experts insert needles to stimulate it. There’s not much agreement as to where exactly these nodes are, how many there are, or how deep under the skin they’re to be found. Is everybody’s Qi the same? Is the Qi of other mammals identical? If you haven’t enough Qi, can you have a Qi transfusion, or will you be contaminated by the wrong Qi and suffer a horrible death? Amazingly, acupuncture practitioners have no interest whatever in these life and death questions. Why has nobody thought to operate on a patient and withdraw a sample of her Qi, considering that the stuff has been known about since ancient times? It’s a puzzlement. And with that I’ll say no more about acupuncture.

Cupping

Cupping, or cupping therapy, is fairly new to me – I mean I’ve heard about it over the years but I’ve never bothered to research it. It was apparently used in Egypt 3,000 years ago, and it’s considered a part of TCM (traditional Chinese medicine). How it got from Egypt to China is anyone’s guess, but when used there, it’s associated with our old friend, the non-existent Qi. Yes, according to TCM, much disease is due to blocked Qi, and cupping is one way to fix it.

Briefly, there are two kinds of cupping, wet and dry, with wet cupping being the more ‘invasive’ and used for more acute treatments. The idea is to create a vacuum which draws the skin up in the cup and increases the blood flow. The cup, or the air inside it, is heated, and when the cup is applied to the skin and allowed to cool, the air contracts, ‘sucking up’ the skin. With wet cupping the skin is actually punctured, so that those nasty but never-quite-indentifial ‘toxins’ can ooze out. By the way, next time you go to your naturopath to get your toxins removed, ask them for a sample, and don’t forget to ask them to name those toxins. Perhaps you could look at them under a microscope together.

There’s very little in the way in the way of evidence to support the effectiveness of cupping, and as you might expect, the best ‘evidence’ comes from the most poorly controlled trials. Serious and obviously dangerous claims have been made that cupping can cure cancer. Here’s the American Cancer Society’s response:

“There is no scientific evidence that cupping leads to any health benefits….No research or clinical studies have been done on cupping. Any reports of successful treatment with cupping are anecdotal. There is no scientific evidence that cupping can cure cancer or any other disease.” 

If cupping was effective, this would be easily provable. No proof has been offered in thousands of years, and there’s no credible scientific mechanism associated with the treatment. You’ve been warned. It’s your money. Why hand it over to these parasites?

the myth of holistic medicine

with 2 comments

c275d1_17119416af49cb1b20f5a8118865d4ea.jpg_srb_p_600_298_75_22_0.50_1.20_0.00_jpg_srb

It does get my goat rather that so-called naturopaths, in spite of having varied and often contradictory therapies, love to call themselves practitioners of holistic medicine. It’s a feel-good term that, like spirituality, seems to make a virtue of its own vagueness. Of course, holistic medicine can be defined in a superficial sense – it’s treating the whole person, right? But how does that work in reality, and how do naturopaths manage it?

Well, the obvious answer is, they don’t. It’s nothing more than a propaganda term.

Clearly, holistic, whole-person treatment would be fabulous if it could be achieved, but it would entail not only knowing the whole anatomy and physiology of the client, but her psychology and her entire medical history from birth, and even before. Would there be any other way of treating ‘the whole person’?

Personalised medicine may in fact become the way of the future – I’ve heard as much – but that has nothing to do with naturopathy. That has to do with science – your personal microbiome, your heart rhythms, your cholesterol, your triglycerides, your lung function, your bowel movements, your bone density (not to mention your sequenced genome), taking more responsibility for those things as far as is possible and in co-operation with healthcare providers. Naturopathy is something else altogether – it’s about herbs instead of pills (unless they’re homeopathic), ‘age-old’ treatments such as reflexology and TCM rather than invasive tests and vaccinations, getting in tune with or detoxifying your body rather than taking impersonal prescriptions to your local impersonal pharmacist.

So the question is – how did taking an entirely chemical herbal treatment from a naturopath come to seem more holistic than taking a chemical such as theophylline prescribed by your specialist?

I don’t see how a naturopath would or could treat a client as a ‘whole person’ any more than a conventional GP could. Limited info, limited time, it’s the same whether your treatments are science-based or traditional. But I do know at least one happy client who swears by her naturopath, who really does treat the whole person, unlike the medical establishment, according to her. I haven’t pressed her to explain this, but I have my own nasty theory. The woman is clearly obese, and wouldn’t take kindly to being told so, and she’s found a practitioner whose greatest skill is to tell her everything but what she most needs to hear. At last, someone who really understands her, who really listens and accepts her own expertise about her own body. And it must be said that many doctors, full to the brim of years and years of training and practice, do sometimes treat their clients in an offhand or specimen-like way. The psychological effects of healthcare practice are surely underestimated. So many people, but especially the unhealthy, want to be seen as, or made, whole. ‘Holistic medicine’ therefore, makes for a very effective propaganda label.

Yet many treatments that eagerly make use of the holistic banner are about as far from being individualised as can be imagined.

Acupuncture supposedly manipulates your ‘chi’ or ‘qi’, a system of energy flow that, if it existed, could be individualised to the client. Some clients might have a different chi from others, just as we have different blood types, different hormonal levels, different cholesterol levels, different insulin levels, etc, all of which can be measured. But acupuncturists don’t measure our chi levels and give us a read-out. Why ever not? Surely that would be the holistic, personalised thing to do. The fact is, nobody, in the supposedly thousands of years of acupunctural history, has ever thought to isolate this energy force and describe its wave function or the molecules or particles associated with its action. Nobody has even shown the slightest curiosity about the physical properties of what is advertised as a fundamental energy source in humans and perhaps all other living things. That’s fucking amazing – the only amazing thing I can say about acupuncture. Yet, apparently, there are particular points in the body where chi is more abundant, and that’s where you should stick your needles, and at a certain depth, otherwise you won’t be in touch with the chi. So acupuncture depends entirely upon chi being a physical, measurable entity…

Say no more. Your chi can’t be personalised and made a part of your whole-person profile because it doesn’t exist.

Homeopathy also likes to travel under the holistic banner, and you’ll find it advertised in all those brochures featuring glowingly healthy individuals, often dressed in white, meditating or staring lovingly at the sky-spirits. The trouble is, homeopathic treatments are designed to treat the illness, not the individual. The bogus ‘law of similars’ involves swallowing pills which are supposed to contain material ‘like’ whatever it was that made you sick. If that doesn’t sound very scientific, don’t blame me. It’s obviously a problem if you don’t know what made you sick, but the solution is simple. Just pay attention to your symptoms – say itchy skin or funny-coloured urine – and take pills containing a substance that produces similar symptoms. But hang on, won’t that just make you more sick? No, not at all, because the offending substance will be diluted to infinitesimal proportions. Okay, but won’t that render it useless? Ah but you’re clearly unaware of the ‘law of infinitesimals’ which defines a substance as increasing in potency the more it’s diluted. Welcome to the world of homeopathy, where the more truth is watered down, the more obviously true it becomes.

But the point I wanted to make here, before becoming entranced by the homeopathic mindset, was a simple one. Far from treating clients as ‘whole people’, it is solely concerned with physical symptoms. A homeopathic treatment would work just as well on a horse or a hedgehog as on a human. The client’s humanity, let alone her particular history or psychological make-up, isn’t a factor. It’s as far removed from holistic medicine as you can get.

I could go on – reflexology, iridology, reiki, chiropractic – these are all bogus, and the fact that they all jump eagerly onto the holistic bandwagon is further evidence of their crappiness. Holistic medicine is an impossible ideal, though personalised medicine, where you take personal responsibility to educate yourself about and keep records of your own health and physical maintenance, in collaboration with health specialists, is a great way to go. And that involves a lot more than just holding hands in a smiley circle.

Written by stewart henderson

March 28, 2015 at 12:38 pm