Health Spectator

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 28-year-old female from Tabanan District, in Bali Province, developed flu symptoms on August 14, was hospitalized on August 18, then died in hospital on August 21. She was a poultry trader.

Case investigators found that she collected poultry from villages where outbreaks of avian influenza had occurred.

Of the 105 cases confirmed to date in Indonesia, 84 have been fatal.

Researchers now have proof that a virus may be involved in human obesity, according to a paper just published in the International Journal of Obesity. A virus had been shown to cause obesity in animal subjects, but the link between the virus and humans remained unproven.

Dr Richard L. Atkinson (Obetech Obesity Research Center, Richmond, VA) and other researchers tested both obese and thin volunteers for antibodies to adenovirus-36—the suspected agent—as well as three other viruses not believed to be linked to obesity. They not only searched for antibodies to the virus, but checked serum lipid (cholesterol and triglyceride) levels as well. They also measured the body mass index (BMI) of the individuals and their percentage body fat.

The researchers also included 89 pairs of twins in their study, enabling them to compare differences between twins who tested differently for exposure to Ad-36.

Animal experiments had shown that when infected with Ad-36, stem cells turned into fat cells. It is well known that increasing the number of fat cells in the body enhances the likelihood that the individual will be overweight.

The present study was designed to test for an effect of the virus on humans.

When all the data were analyzed, the scientists found that 30% of the obese versus 11% of the thin subjects had been exposed to the adenovirus. Among twin pairs in which one twin had been exposed to the adenovirus and one had not, the exposed twins showed higher percentage body fat and BMI.

Perhaps the most surprising effect of the adenovirus confirmed in this study is that while it increases fat accumulation, it lowers serum triglyceride and cholesterol levels.

As expected, the study showed no correlation between human obesity, cholesterol or triglyceride levels and exposure to the adenoviruses known as Ad-2, Ad-31, and Ad-37. Heretofore, this class of viruses has been associated primarily with minor infections such as colds, respiratory infections, and pink eye.

The hypothesis that multiple sclerosis is a genetically enabled disease in which immune cells attack the nervous system has been confirmed through a human genome-wide study that will be announced in tomorrow’s edition of the New England Journal of Medicine.

Assuming further genetic and functional studies confirm these results, the risk factors for contracting MS will be laid squarely on the human leukocyte antigen (HLA) region of human chromosome 6, along with specific alleles (gene variations) in the interleukin-2 receptor alpha gene (IL2RA) and the interleukin-7 receptor alpha gene (IL7RA).

Alleles in the HLA region have been linked to several other autoimmune diseases, including rheumatoid arthritis, lupus, and ankylosing spondylitis. The HLA genes generally encode proteins that form part of the cell membrane and are therefore responsible for the body’s ability to differentiate between its own and foreign cells. They also affect antigen formation and therefore indirectly influence the functioning of an important group of immune cells known as T cells.

Impairment of regulatory T cells—also known as suppressor T cells—allows the body to attack its own tissues and is a major factor in multiple sclerosis and other autoimmune diseases.

The New England Journal of Medicine is reporting that a man was injured by lightning while jogging and wearing an iPod. Doctors from the Vancouver General Hospital in Vancouver, B.C. report that the man suffered punctured eardrums, a broken jaw and second-degree burns on his chest, head, and left leg.

They attribute his broken jaw to the fact that the man was wearing the iPod, which caused the lightning strike (a side flash from a nearby tree) to pass through his head, causing a violent contraction of his jaw muscles. They stated that usually in lightning strikes of this nature, the high resistance of human skin keeps the flash traveling on the outside of the body.

The combination of body sweat and the metal from the iPod headset, however, caused the lightning to penetrate the jogger’s body, resulting in more substantial injuries.

Andrew Speaker, the lawyer who boarded international airline flights with what was believed to be “extensively drug resistant tuberculosis” has had his diagnosis downgraded to “multi-drug resistant tuberculosis” by the National Jewish Medical and Research Center in Denver, Colo. While that distinction might appear to be splitting hairs, it is important for two reasons, according to Charles Daley, head of the center’s infectious disease division.

“Number one, it allows us to change the way we treat him,” Daley said, “and if someone has become infected by Mr. Speaker… we now have some drugs available to… treat them and prevent them from developing TB.”

“However,” Mitchell Cohen, Director of the Coordinating Center for Infectious Diseases at the Centers for Disease Control (CDC) pointed out, “MDR TB remains difficult to treat. It will require approximately two years of medication and relatively toxic drug regimens to achieve the desired outcome, very different from drug-susceptible TB.”

Cohen then went on to discuss the public health issues at stake.

He first explained that the CDC and the National Jewish Medical and Research Center used different methods to test Speaker’s dominant strain of TB. He pointed out that the augur proportion method used by the CDC “is the approved standard of the Clinical and Laboratory Standards Institute,” then added that the “CDC acts as the TB reference laboratory not only for the United States but also internationally. ” He then reiterated that the CDC tests “found resistance to both first- and second-line TB medications, meeting the definition of XDR [extremely drug resistant] TB.”

Unfortunately, Cohen said, the initial bronchoscopy specimen obtained by a hospital in Atlanta was no longer available for retesting.

Cohen then cautioned that “there is a tendency to want to think about XDR TB and MDR TB as two different illnesses. ” In fact, he said, “they are only describing a level of drug resistance found in the bacteria attained from the patient specimen. This is a serious illness that can be transmitted to others, and thus puts others at risk for getting a difficult-to-treat disease.”

Most tellingly, Cohen pointed out that “the public health response to drug-resistant TB infections, either MDR TB or XDR TB is the same under the World Health Organization’s TB and airline travel guidelines that were published in 2005.” He then emphasized that “Without question, people with these infections should not be flying on commercial airlines.”

CDC continues to recommend the follow-up and retesting of passengers and crew who traveled on the transatlantic flights with Andrew Speaker and says it “will continue to ensure the well-being of patients who may have been exposed and infected by this patient,” according to Cohen.

Yogis and Buddhists, among others, have long known the benefits of meditation and mindfulness. Now, Western science is not only confirming those benefits, but attempting to find clues to how it works.

Studies currently being published in the journal Psychological Science by UCLA psychologist Matthew Lieberman and his colleagues seem to indicate that naming negative emotions helps us handle them better. Lieberman and his colleagues used magnetic resonance imaging (MRI) to identify regions of the brain that were active during their experiments. Meanwhile, they had subjects, whom they showed faces of people expressing strong emotions such as fear and anger, pick either a name for the person or a name for the emotion.

Only when they spoke the name of a negative emotion did the subjects’ brains react with more activity in the right ventrolateral prefrontal cortex region and less in the amygdala. The amygdala is a portion of the brain that processes strong emotions such as fear, anger, and panic. The right ventrolateral prefrontal cortex region, on the other hand, controls impulses. Thus, the experiments seem to indicate that naming or talking about a negative emotion helps calm the individual and helps him gain control.

Putting the brakes on

This may be an explanation, the researchers hypothesize, for why talking therapies help people to feel better: Simply talking about the emotion helps “put the brakes on.”

Some meditation teachers advise putting a label on a thought or emotion that we want to get rid of while meditating. In such forms of meditation, the goal is to divest the self of ego-based images and emotions, especially destructive emotions such as greed and anger. The naming process seems to form a separation from the emotion; otherwise, the meditator may begin to identify with that emotion, temporarily becoming one with it, as commonly occurs in day-to-day life.

Previous research has shown that depression often results from negative emotions or thoughts spiraling out of control, particularly in the elderly. One particularly bad practice to which many are prone is called rumination, which one researcher described as “problem solving gone awry.” In rumination, one can go from pondering what has gone wrong to cause the current situation and wind up in repetitive negative thought patterns, which result in depression.

Other workers point out that not all rumination leads to depression. In 2003, Treynor, Gonzalez, and Nolen-Hoeksema differentiated between “reflective pondering” and “brooding.” They described reflective pondering as “a purposeful turning inward to engage in cognitive problem solving to alleviate one’s depressive symptoms.” Brooding, on the other hand, they saw as representing “a passive comparison of one’s current situation with some unachieved standard.”

These same authors found that a brooding response style was associated with an increased risk for future depression while a reflective pondering response style was not. In general, it appears that the practice of comparing one’s current situation with some abstract ideal or even with another person’s situation is psychologically dangerous: it can lead to depression.

As it happens, Buddhist teachers have for centuries discouraged their disciples from making mental distinctions or judgments. One of the techniques they have long taught—mindfulness, or staying in touch with the present moment rather than turning thought inward—has in recent years caught the attention of psychological researchers, who find that it serves to cut off rumination, and as a consequence, results in greater mental health, while avoiding depression.

China is once again in the news over food contamination, this time regarding contaminated fish exported to the U.S. for human consumption. USA Today is reporting that “in the past 13 months, at least two dozen shipments of catfish, eel and tilapia from Meihua [China] were rejected for entry into the USA by the Food and Drug Administration,” based on FDA records.

The irony is that some of the shipments were rejected because they were contaminated with an antifungal that protects fish but is not allowed by the FDA because it increases cancer rates in lab animals. Others were rejected because of “suspected” contamination or for other contaminants.

But the FDA, meanwhile, is battling food contamination closer to home. Robert’s American Gourmet (Sea Cliff, N.Y.) is recalling the snack food Veggie Booty after the FDA linked the snack to salmonellosis outbreaks in 17 states. So far, 51 people have been infected, mostly children.

Symptoms of salmonella poisoning include fever, nausea, diarrhea, and abdominal pain. The infection is especially troublesome among children, the aged, and those with weakened immune systems, who have been known to die from the effects of salmonella.

Although Robert’s American Gourmet is still saying that the link between the salmonellosis and the snack food is unproven and circumstantial, an FDA source states unequivocally that “an ongoing investigation has identified Veggie Booty as the source of a multi-state outbreak of salmonellosis.”

The ongoing investigation began in March.

Reuters is reporting that a Senate panel has voted today to approve a path for getting generic biologic drugs to market faster. Biologics—unlike synthetics—are drugs that are derived from living things and are consequently often quite difficult and expensive to make. Because their manufacture is so sensitive to the slightest changes in starting substances or altered processes, there has to date been no mechanism in the U.S. for generic biologics to be produced, unlike the case with the more common “small molecule” drugs such as aspirin.

Perhaps the most commonly known examples of biologics would be vaccines. Less well known would be epoeitin alpha, a member of the class of erythropoietic proteins, marketed as Procrit (sold by Johnson and Johnson) and as Epogen, sold by Amgen.

The entire subject is fraught with controversy, with manufacturers who hold patents for biologics arguing that they cannot be duplicated in the same way that small-molecule drugs subject to traditional chemical manufacturing techniques are.

The area is also one with strong political overtones, as evidenced by the current Senate bill’s authors: Senators Edward Kennedy (D, Mass.), Hilary Clinton (D., N.Y.), Mike Enzi (R, Wyo.), and Orrin Hatch (R, Utah). No doubt democrats see a political windfall in breaking into the previously sacrosanct area of biologics.

The current Senate version of the bill would require generics manufacturers to run at least one clinical trial to demonstrate that their version of the drug was medically no different from the name-brand equivalent. However, a provision that may alarm the name-brand manufacturers allows the FDA to waive the clinical testing by relying on animal testing or other data.

What’s more, the FDA would have the power to declare a copycat drug as interchangeable, meaning that it could be substituted for its name-brand equivalent.

In order to qualify to become a generic, a drug must have been manufactured for at least 12 years and its patent must have expired. Most of the current controversy centers on the 12-year manufacturing requirement. Traditional drug-industry supporters see the time as too short, while generics manufacturers and consumer support groups argue it is too long.

By now, most readers have heard of Andrew Speaker, the attorney infected with a dangerous form of tuberculosis who left the U.S. to be married in Greece despite attempts by health officials to keep him from traveling. Speaker was portrayed but not named in our May 30 report of the incident.

Since that time, Speaker has testified before Congress by phone and apologized publicly for the health scare he caused, claiming that doctors had told him he was not contagious. Emails obtained a few hours ago by the Associated Press portray a different view of the story.

The AP reports that Speaker’s father, also a lawyer, claimed not to know how to reach him when contacted by the CDC. His then-future father-in-law was urged by a CDC researcher to stop the wedding. Instead, he flew to Greece to attend it. The father in law, Robert Cooksey, is a CDC microbiologist.