Survival of the Sickest

Researchers at Exter and Oxford in the UK have just published a study about the importance of having a good breakfast (see NYT article here). That is if you’d like to have a baby boy. It seems that having a high calorie breakfast can increase the odds of having a boy, regardless of the weight status of the mother. From an evolutionary perspective this of course makes a lot of sense since signs of increased nutrition are important since baby boys need more calories to survive.

In Survival of the Sickest I talked about a situation where a significant increase in short term stress occurred, such as right after the Great Hanshin-Awaji earthquake in 1995 can skew the birth rate towards females. From an evolutionary perspective this makes sense, since increased in perceived environmental stress can signal that it may not be the most opportune time for boys, since they can be more expensive calorically to maintain.

I had a really interesting conversation with a friend recently who used to be in the military. We got to talking about some of the “friendly fire” incidents both in Afghanistan and Iraq, and it got me thinking of the biological equivalent.

This can be rather problematic, not just for our immune system but for soldiers as well. “Friendly fire”, the term given to cases of mistaken identity or itchy trigger fingers that cause soldiers to kill their own. We face a similar threat as humans when we are attacked by microbes. For the immune system, it works best to shoot first and ask questions later.

There are many parallels to our immune system which is charged with the duty of protecting us from the constant stream of invaders that we face at every moment throughout our lives. Just like most secret government agencies, we rarely know what the immune is up to until something goes wrong.

Unfortunately, the nature of modern warfare (the advent of fire by wire etc.) no longer requires a person to actually “see” their opponents. And so this becomes one of the added costs of modern warfare, having the ability to respond quickly, as easily as sending a thoughtless email, can in the end cost innocent lives.

The immune system normally detects invaders by what’s on their surface and uses it as a kind of bar code to identify friend or foe. So if you’re a sneaky microbe you can use some markers (such as those found on blood groups A, B or AB, type O lacks this) and hide out to avoid detection and cause infection.

Now there’s a condition that we unfortunately don’t know that much about called Multiple Sclerosis (MS), that exemplifies what happens when the body turns against itself. In the case of this condition, the body’s immune system (think armed forces) specifically strip the myelin off of certain neurons in the brain and spinal cord.

Symptoms of course vary depending upon how much friendly fire might be occurring, and can range from numbing to even loss of vision. It’s unknown why (certain genes have been implicated) but women and people of European descent seem to be particularly prone to MS.

Most of the treatments used such as the corticosteroid prednisone, modulate the immune system, dampening it’s response. Turning off the immune system completely of course may not be the most viable option because then that person is completely open to picking up any type of infectious agent and simply dying.

A unique balance needs to be struck, which for the most part can work such as the use of electronic devices that identify something or someone as “friendly”. In the case of MS it might be best to return to asking simple questions such as why does weather seem to play such a prominent role for some.

Super-bugs are everywhere. Once found mainly in hospitals, antibiotic resistant organisms are taking up residences wherever they can.

When I was a first year medical student a very astute infectious disease consultant warned us about the dangers of neckties.

Apparently, it’s quite easy for many health practitioners to forget that they shouldn’t straighten their ties before or after seeing patients. Fixing a tie can easily act as safe houses for unwanted germs transferring them to unsuspecting patients.

I also remember this doctor specifically because he wore a classic physicians long sleeved coat that looked two sizes too big. I kept wondering what all that extra material was for, and how it must get in the way while he was examining patients.

Not a good thing if you want to keep from spreading pathogens, especially since his bread and butter cases were infectious disease patients.

One superbug in particular is really good at hitchhiking on excess baggage, such as clothing, and its name is methicillin resistant Staphylococcus aureus or MRSA. To avoid having hospital staff shuttle MRSA around, infecting other patients, according to the Guardian (thanks for the link Matt), long sleeve coats are to be banned in English NHS centers.

Health practitioners are to be bare sleeved to promote proper hand/wrist washing to help stop the spread of germs like MRSA. I’ve always been a big believer in public health initiatives and wonder how long it will take for other countries to join the “sleeveless club”.

I think if hospitals want to get their staff excited to implement such changes they should start by giving away Hawaain shirts.

According to researchers from the University of Michigan it is in fact possible to feed the world by using organic farming methods. Organic farming is not only better for the environment through its practice, there is hope that we will not erode the quality of our farmland. But the results of the University of Michigan’s study surprised me a little since, along with many others, I was under the impression that organic foods and farming were a luxury that most of the world can not afford. Not true according to Ivette Perfecto, professor at U-M’s School of Natural Resources and Environment, one of the study’s principal investigators. Here’s what she had to say as to why some of think that organic farming is not a practical option:

Sounds a lot like big tobacco to me.

I’ve been getting a lot of emails asking me about cancer connections, most likely prompted by media reports. If you’ve read such headlines before and are wondering if they’re true, there’s now an easy way to find out. The people over at silentspring.org have put together a database that you can browse that summarizes studies that have looked at such links. Just select a chemical and you’ll get the latest information.

Have you ever tried doing crossword puzzles while you’re really tired? In one word frustrating, at least you can come back to it later after some much needed sleep. But medicine and crosswords are not the same. Studies have already shown that if you sleep deprive medical residents they perform poorly in areas such as concentration and judgment, just the skills you need to take care of someone who is critically ill. To address this problem in 2003, work for residents was supposed to be limited to 80 hours a week and 24 hours at a stretch. But even with these work hour requirements in place, many residents are still sleep deprived. Why do we spend billions of dollars on health care and drug discovery, to only then have sleepy physicians make simple and sometimes deadly mistakes in health care delivery? I just don’t get it. Until of course you figure that the work that medical residents do at sub par pay subsidizes the system.