Health and Medicine – Page 16

Swine Flu Update

swine-flu-leaflet Swine flu (H1N1) information leaflets are being delivered to households across the UK today. I suspect they do nothing but increase fear and confuse people, especially as the WHO/UN are about to lower the swine flu alert level.

In the UK, 27 people now have the virus, with 23 in England and four in Scotland and the first P2P transmission in the UK has been reported. But, what happened to the thousands, if not millions, affected we were warned of by the media and government and WHO and UN over the last few weeks? It just hasn’t happened, thankfully.

The leaflets will, of course, explain exactly what is swine flu (I wonder whether they will explain why we now have to call it H1N1 though), who is most at risk, what are the symptoms, and what people can do to reduce their risk of catching the disease.

There was a panic on Monday when the WHO was set to raise the alert level, but it didn’t happen they are maintaining it at Phase V, one below the red alert Phase VI, and may lower the panic level in coming days.

I suspect that the average person reading the government leaflet will disregard it as contradictory with what they are now hearing in the news. They may also see it as simply yet another kneejerk reaction from politicians who always to pander to the media biases rather than making their own scientifically informed decisions.

In my original swine flu article, I rather flippantly advised readers to forget avian influenza and to switch their worries to pigs. But, there was a serious thought behind my silliness because a single disease should not be the focus of fear. Emergent diseases could appear in almost any host animal at any time and cross the species barrier through random mutation.

Indeed, it’s certainly not only pigs, birds, and humans, that catch flu. Horses, and even whales and seals, get a form of the disease. But influenza is not the only virus.

If a second wave of swine flu does not evolve in the Northern autumn this year, there’s no reason to assume that some other respiratory virus, perhaps akin to SARS, perhaps avian, or something entirely different will appear. Will we be prepared for the onset of a previously unknown respiratory, or other, infection spreading from some obscure mammal in central Asia or elsewhere? Or, will the media incite mass hysteria through scaremongering once again?

How will a swine flu pamphlet look in six months time? Confusing and useless, that’s how. The scaremongering that has gone way beyond any seen at the time of SARS and certainly way beyond the avian influenza concerns, will ultimately look like a story of “cry wolf” when the next virus emerges.

The WHO told us a week or two ago that we could no longer contain swine flu, but as it turns out there really was no need to contain it in the first place. It appears (in this wave) not to be as virulent as first feared, mortality rates even in Mexico City are far lower than one would have expected of a serious illness with the number of dead from H1N1 being revised downwards several times already.

Flu experts from Cambridge, the National Institutes of Health, and The Cleveland Clinic will be talking about the science behind the news of the swine flu outbreak at a free webinar on Friday.

All that said, the UK’s chief medic Liam Donaldson, has warned against complacency because flu viruses can change character “very rapidly”. It is too early to assume the swine flu outbreak is a mild infection just because no-one in the UK has died, he says.

For years we have been warned that a lethal flu pandemic to match the Spanish Flu of 1918 was long overdue. Birds, and now pigs, have so far failed to deliver, but what’s that unidentified, flea-bitten rodent running around the market square? Is the tiny creature the harbinger of doom? Will we ever conquer infectious disease?

O’Dowd, A. (2009). Confirmation of first person to person transmission of swine flu in UK expected soon BMJ, 338 (may01 1) DOI: 10.1136/bmj.b1838

Raspberry Ripple Galaxy

galactic-rasberry-flavor Recently, an innocuous-seeming press release was released by German astronomers announcing that they had found two of the most complex molecules ever in space – n-propyl cyanide, more commonly known to chemists as butyronitrile, and ethyl formate. Now, butyronitrile is a nasty poison with a characteristic odour and I’m sure you’d get a whiff of bitter almonds as you lay dying should you breathe it in too deep or get a mouthful of the stuff. Ethyl formate is altogether different.

Ethyl formate, The Guardian’s science correspondent Ian Sample found out (I think already knew) is the fragrant ester molecule that gives raspberries their distinct flavour. It also smells vaguely of rum. Having latched on to this fact, Sample went to town on his galactic press release suggesting, in a Pythonesque manner, that your galaxy smells of raspberries.

It was a great hook for his popular science article in the paper, of course, and the idea was subsequently picked up by other outlets that had initially missed the raspberry flavour additive. With my SpectroscopyNOW deadline looming, I reasoned that the research was valid enough, ignoring the raspberries, for the news channel and set about explaining the ins and outs of the discovery and its relevance.

If complex molecules such as ethyl formate and butyronitrile can be found in space then perhaps the building blocks of proteins, amino acids, might also be present, which could lend evidence to space as being the seeding ground for the precursors to life on earth and perhaps extraterrestrial life too.

I contacted the leader of the astronomical team that had made this startling discovery to find out more details about the research. Arnaud Belloche of the Max Planck Institute for Radio Astronomy (MPIfR) in Bonn, Germany, was unsurprisingly quick to point out that the raspberry connection was essentially a journalistic invention of The Guardian and has no bearing on the research at all.

“We did not report on the flavour of raspberry or the smell of rum,” he told me, “For us, astronomers, it is unimportant. What is important is that these two molecules are quite complex compared to the other molecules discovered in space, and that their discovery suggests that even more complex molecules are likely present in the interstellar medium.”

He did, however, concede that the reference to raspberries and rum makes the story more interesting for the lay public. “It is fine to mention it, but it should be made clear that it is astronomically irrelevant.” Of course, that much should be immediately obvious to most readers of SpectroscopyNOW.

It does raise an interesting point about science journalism. Is it stretching the truth, or dumbing down, too much to mention that the molecules found in outer space have a link with the flavour of raspberries? How far should we go to make rather technical and esoteric science appeal to a lay audience? Surely, it would have been enough that these complex molecules were found in space and may have a bearing on the origins of life on earth.

Perhaps not. A press release blankly referring to two chemicals with names obscure to non-chemists would usually have little impact. It was picked up by some outlets. However, it was only once Ian Sample had made the raspberry connection and used the Monty Python Holy Grail insult allusion (if your galaxy doesn’t smell of raspberries then your mother certainly still smells of elderberries) that more of the wider media jumped on to the idea of a galaxy smelling faintly of raspberries and rum and took it mainstream.

Indeed, we have a control to test this, because the same team use the same data lasts year to reveal that the same galactic gas cloud also contains aminoacetonitrile. This molecule is a
likely chemical precursor of the amino acid glycine, which has perhaps a much greater bearing on the origins of life than the raspberry flavouring, but unfortunately has none of the fruity allusions.

Which headline would grab you?

Scientists Spot Amino Acetonitrile in the Middle of Milky Way

Make That A Raspberry Pan Galactic Gargle Blaster

You can read my full write-up complete with overblown flavouring-enriched title in the May 1 issue of SpectroscopyNOW.

Finally, I asked Belloche for his predictions of when we might discover amino acids in space and get a true feeling for the notion of cosmic dust seeding the primordial earth.

“I guess we’ll have to wait many years…” he told me, “A simple estimate we did in
our publication on aminoacetonitrile (Belloche et al. 2008, A&A, 482, 179)
suggests that the abundance of glycine, if present in the interstellar
medium, is well below the best upper limits derived so far, by maybe one
or two orders of magnitude, so it will be hard (but not impossible!) to
find it.”

His prediction doesn’t leave a bitter taste in the mouth, but nor does it come up tasting of raspberries.

The Spicy Disciplinarian

Four more fascinating research discoveries feature in my column on SpectroscopyNOW this week, covering research into the medicinal effects of curry powder, cyst analysis, why nicotine does not kill instantly, and bristling nano balls.

The spicy disciplinarian – Solid state NMR has been used to explain why curcumin, one of the physiologically active components of the yellow spice turmeric has wound healing and other medicinal properties.

Atomic cyst assistance – Researchers in Turkey are using atomic absorption spectroscopy to analyse the levels metal ions and phosphorus in samples of fluid from breast cyst. They have observed a marked difference between the ratios of ions in the two main types of cyst one of which is more closely associated with the development of breast cancer.

Nicotine’s smoking gun – Years of structural work and wider studies have finally culminated in an explanation for nicotine’s overwhelming affinity for brain receptors and the addictive molecule’s almost total disregard for the nicotine receptors found in muscle tissues.

Bristling nano balls – A mathematical analysis of inorganic nanoparticles explains why they form complex structures with a layer of hydrophilic polymer chains.

Developing Health

developing-health Compulsory licensing is one of those euphemisms that hide a whole raft of issues. By definition – it is “authorisation to a government or company to make and sell a pharmaceutical drug without the permission of the patent holder”, which makes the intent clear.

In its most obvious form, compulsory licensing is what occurs when a government allows a third party to produce a patented product or process without the consent of the patent owner. At first glance, it would seem to be nothing more than infringement of intellectual property rights. After all, one cannot imagine companies agreeing to a legal compulsory licensing system for music, movies, or even software. Of course, that’s the point, the breach of the patent becomes legal when a government says it is. So, if it seems unethical and immoral from the point of view of the companies, is there any justification, or compulsory licensing simply piracy at the national level?

Compulsory licensing seems to be an implicit flexibility in patent protection included in the WTO agreement on intellectual property, the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement, and applies to public health only. But, we’re not talking about movies, music, and software. This flexibility is about allowing the developing world to develop healthily and the sidestepping of patents on pharmaceutical and other medical products.

Fundamentally, compulsory licensing overrides the patent protection a pharmaceutical company may have for its product and legalises the manufacture of generics for the benefit of that nation’s poor and sick. Usually, it is reserved for drugs that are simply too expensive for developing world countries to afford. Despite the cost, these are essential for treating the very diseases, such as malaria and HIV/AIDS, with which the poorer nations are worst afflicted.

Indian lawyers, Sagarika Chakraborty and Angira Singhvi, writing in a forthcoming issue of the International Journal of Intellectual Property Management, suggest that compulsory licensing has not yet been used extensively in the developing world as an instrument of public policy and in some instances has simply been a tool of economic abuse. However, used properly compulsory licensing could promote widespread health improvements, they say, and might allow the term ‘developing’ to become ‘developed’ in many parts of the world.

They argue that developing nations are not the primary markets for drug companies. Moreover, they currently represent a very small proportion of sales. Even in the absence of compulsory licensing that TRIPS should have little detrimental impact on profits. Of course, India has a burgeoning middle class and as it develops could begin to represent a vast untapped market for the pharmaceutical industry. If the pharmaceutical industry were to ignore compulsory licensing during this period of development it could find its potential markets compromised as wealth accrues in such countries. Conversely, working with developing nations now could accumulate goodwill for the future.

But, given that drug companies have essentially neglected so-called third-world diseases for decades, seeing no billion-dollar blockbusters in regions such as Africa, South America, and Asia, they have little ammunition to now enforce their patents in those places. It is likely that as that middle class emerges, they will have grown entirely accustomed to pharmaceutical generics that they may never accede to purchasing the expensive patent-protected versions.

Some companies are facing the issue of compulsory licensing head on. They are already taking tiny steps to circumvent TRIPS by offering discounts to developing nations on select drugs and essentially becoming generics manufacturers of their own products. In 2000 Pfizer offered fluconazole to South Africa for free to treat opportunistic infection in AIDS sufferers. This kind of action could counteract the putative market loss as nations develop, providing much needed publicity and branding.

Cynically speaking, these steps have perhaps been spurred on by the philanthropic actions of the likes of the The Bill & Melinda Gates Foundation and their promise to tackle malaria. They may have been triggered by the work of prescription drug retrieval charities like Intercare, and others which collects returned prescription medicines and supplies them free of charge to a network of health centres in Africa. Alternatively, various national changes, such as Brazil’s AIDS control program that breaks the patent on Merck’s AIDS drug Efavirenz, the Doha-enforcing amendments to Chinese Patent Law in December 2008, Thailand’s Foreign Business Act and international condemnation of the industry position may also have acted as a spur to push the compulsory licensing debate forward.

“A lot of drug companies are getting increasingly nervous about the ability of developing countries to override their patent rights in the interest of public health,” says SpicyIP. “The biggest worry for drug companies, however, is that countries will abuse compulsory licenses, employing them in the absence of any public health crisis, simply because the government wants to pay less for drugs.” Similar concerns are reported by Intellectual Property Watch.

TRIPS and the WTO’s DOHA Declaration, essentially allows developing and underdeveloped countries to sidestep patent law and “use without authorisation of the right holder”. Unfortunately, the Declaration does not clarify key terms, such as “public health”, say Chakraborty and Singhvi, which means the field remains open to interpretation that might the pharmaceutical industry and developed countries rather than those it aims to help.

Patent and IP pundit Tom Giovanetti recently highlight the issue of compulsory licensing and how it might affect the American motor industry and the development of green technologies. “Those who argue against patents inevitably are disingenuous about the innovation of the patent system itself,” he says.

“The true genius of the patent system is that, in exchange for your temporary market power, you must disclose your invention. In other words, a patent does not lock knowledge away. In fact, patents are the ultimate tools for technology transfer. Everyone gains immediate access to the knowledge–they just don’t get to copy the invention. They can build on it, they can improve it, but they cannot immediately copy it,” adds Giovanetti. That perhaps simply adds another brace to the argument put forward by Chakraborty and Singhvi for pharmaceuticals in the developing world.

Drug firms have argued that giving away free drugs is detrimental to R&D. R&D costs hundreds of millions of dollars, takes ten to fifteen years to bring a product to market, and patent protection is therefore vital for company survival.

This is true, say Chakraborty and Singhvi, but not in the developing world, where R&D for “third-world” diseases is minimal. ‘We argue that compulsory licensing is a fundamental tool that developing countries may use in certain conditions to ensure that poor people have access to necessary medicines,’ the say.

Sagarika Chakraborty, Angira Singhvi (2009). Compulsory licensing for access to medicines in the developing world Int J Intellectual Property Management, 3 (2), 110-126

Urine clues for prostate cancer

A biomarker for prostate cancer has been identified in urine. Details of the molecule sarcosine is published later this week in the journal Nature.

Arul Chinnaiyan and colleagues profiled the metabolites present in the urine of prostate cancer patients compared and compared it to those of healthy individuals. They found that sarcosine – a derivative of the amino acid glycine – was present at higher levels in the urine of patients with aggressive prostate cancer. The team went on to show that simply adding sarcosine to cultures of benign prostate cells was enough to turn them into invasive cancer cells capable of spread, indicating that the molecule may have an important role in disease.

This is the first time a biomarker for prostate cancer has been detected in urine. Follow up research is now needed to develop a non-invasive approach to testing. The researchers hope that their findings could one day be used to aid prostate cancer diagnosis and may offer new opportunities for therapeutic intervention.

10.1038/nature07762

Online Health in the Developing World

sri-lanka Following on from Monday’s post about health information on twitter, it seemed a nice coincidence that I came across a research paper focusing on healthcare information available in the developing world.

The web is still relatively young and yet many people can barely remember a time when they could not simply click a mouse and gain access to health and medical information. Apparently, hundreds of millions of people regularly access the internet for the sole purpose of finding healthcare information, news about the latest medicines, and advice on every ailment and illness you can imagine and some you can’t.

According to Mahinda Kommalage and Anoj Thabrew, of the Faculty of Medicine at the University of Ruhuna in Sri Lanka, most research into such internet use has focused on health information in developed countries. There have been thousands of scientific papers published on this topic by Western researchers, but a mere handful of results on PubMed cite locations such as Sri Lanka, Nepal, and Bangladesh in keyword searches together with the word “internet”. Moreover, of the six results for “Sri Lanka and Internet”, just one study from 1999 is actually about a health website.

Kommalage and Thabrew suggest that given the enormous growth of Internet usage across the globe almost irrespective of geography, it is quite surprising that so little research into medical and health information sites in developing countries has been carried out. This is particularly worrying given the almost total lack of controls and regulations on medical information on the web.

The researchers have focused on health education websites in Sri Lanka in a survey of what is available. Their first discovery relates to the size of the website most (almost 90%) have fewer than 100 pages, which is barely enough to cover the basics. Moreover, while the quality of local non-commercial sites was higher than those owned by businesses fewer than one in ten provided health education content for the general public.

The notion that the internet might help the developing world improve its health status is not new. As long ago as 2000, the British Medical Journal published an article from WHO scientist Tessa Tan-Torres Edejer entitled “Disseminating health information in developing countries: the role of the internet”. A rare few related papers can be found with a little Googling, including one from Johns Hopkins’ Madhav Goyal and colleagues writing in JAMA who lament the fact that in poor nations invaluable healthcare information rarely reaches those who need it most.

I asked Gabriel Guimaraes a Physician at ASEFE in Brazil about the issue and he points out that the internet does reduce the differences. “This question has so many possible answers,” she says, “We could either talk about the evidence based medicine and everything related to it (MedLine, NCBI and Cochrane’s Metanalysis), which in Latin America would also relate to SCIELO database, or health record software which would relate for example to Health Informatics Societies (like SBIS), or about telemedicine. Anyway there is not much difference between developing and developed because we are talking about recent technology which has almost simultaneously started for every country.”

But, his conclusions do not bear up to the scrutiny of Kommalage and Thabrew, at least for Sri Lanka.

“The total number of websites has not increased compared to the increase in internet usage in Sri Lanka during the last few years,” the researchers say. If their findings apply to the wider developing world then the internet represents a massively underutilised health education resource in parts of the world where improved health education could be used to reduce significantly the incidence of many lethal diseases, such as malaria, HIV/AIDS, and parasitic infections.

For anyone interested in what is being done to redress the balance, check out antropologi.info blog and Health Information for all 2015. The raison d’être is the following fact:

Tens of thousands of people die every day, often for the simple reason that the parent, carer or health worker lacks the information and knowledge they need to save them.

Somewhat related to this post but more about scientific research than information is SciDev.net. Also of interest: Uneca, science with Africa.

Mahinda Kommalage, Anoj Thabrew (2008). The use of websites for disseminating health information in developing countries: an experience from Sri Lanka Int. J. Electronic Healthcare, 4 (3/4), 327-338

Health and Medicine on Twitter

My good friend Jo Brodie who works at DiabetesUK and twitters as @JoBrodie was crucial in helping publicise my recent scientists on twitter page. She recently gave the list a shout out on the PSCI-COM science communicators discussion group and added a few science tweeps of her own and a few in the health and medical communications area. So, here, with permission is Jo’s list:

Jo points out that if you’re “watching” an event unfold, there is usually a hash-tag associated with that event, whether it’s Obama’s Inauguration, the plane in the Hudson, the Mumbai bombings, or anything else of wide interest. For example, if the events at a conference are being live-blogged, then everyone talking about the event will usually use the agreed hash-tag e.g. #scienceconference, #scio09, #sciblog08. This makes the event easily searchable on twitter and is captured with all the other feeds mentioning that term. “Trending”, i.e increasingly popular terms are displayed on the twitter search page, or you can have them show up above the array of friends on the twitter page using a Greasemonkey script in Firefox.

You could also check out a ranked list of 100 health tweeps. Nice to see sciencebase ranking in the top 40.

*My add to Jo’s list.

I’m also occasionally adding to this list of medical types on twitter. Feel free to tweet it or leave a comment with your twitter ID:

Michael Bach
Cindy Oohlala
Eric Robertson
Terry Simpson
SwanL
Laikas
Bertalan Meskó
SearchMedica
vene2ia

For those unfamiliar with Twitter, a fairly useful slideshow:

Twitter for health and healthcare

View more presentations from Health sciences Libraries. (tags: activism modification")

Green Mercury Light Bulbs

With regulations set to ban incandescent light bulbs, the illuminating invention we’ve used since the nineteenth century, a replacement is needed. LEDs hold promise but are dim compared with the bulbs they seek to replace. Compact fluorescent tubes, are a bright idea. They are essentially a miniaturised version of the strip lighting by which shoppers and workers everywhere have been lit for decades. These CFLs use a fraction of the power to produce the same level of light as their incandescent ancestors and so are often touted as eco-bulbs in popular commentary.

Unfortunately, as the ban on incandescent tungsten bulbs spreads, so to are news stories in the media warning of the mercury content of CFLs and how breaking one in a child’s bedroom could expose them to serious risk of neurological damage and require a costly cleanup.

Just this week, the same warnings have been trotted out in various outlets including prominent website NowPublic.* To lend some credence to the NowPublic story, the writer cites the case of Brandy Bridges, from Maine, who apparently, went through a nightmare when a CFL broke in her daughter’s room. More fool her. The case was described on the Hoax Slayer site way back in May 2007 (so how this is suddenly now news, I don’t know). Hoax Slayer as the name would suggest, takes popular received wisdom and reveals the inner truth. Apparently, except for the immediate area of carpet on which the bulb had broken, mercury levels were way below the WHO safety limits on this substance.

[* I’m not even going to start on the EMF concerns and references to “dirty electricity” the NowPublic article talks about.]

“CFLs do contain mercury (Hg) but an environmental cleanup crew is not required if a CFL breaks,” Hoax Slayer asserts.

The amount each bulb contains is tiny, especially if you compare it to the amount in countless mercury thermometers used to measure body temperature, or help you decide whether to open or shut your greenhouse windows.

Indeed, mercury sealed within the glass tubing of a CFL amounts to about 5 milligrams, a small full-stop, or period, worth. No mercury is released when the bulbs are intact or being used. The mercury is present in the bulb as a vapour that glows when an electrical discharge is passed through it, giving the bright white light. Those mercury thermometers of which millions have been placed under childrens’ tongues to take their temperature for decades contain several hundred milligrams mercury. You would need 100 CFLs to equate to that amount of mercury. When faced with a feverish child how many people worried about the mercury thermometer breaking and leaking liquid mercury into their child’s mouth?

Mercury is expensive, so CFL manufacturers, ever looking for ways to cut costs, are constantly striving to boost the efficiency of their products but at the same time reduce the mercury content. It’s more about profit than safety concerns. Nevertheless, the next generation of CFLs which will be marketed this year, according to the US National Electrical Manufacturers Association, will have even less than a minute amount of mercury in them.

What to do if you break a CFL

The EPA provides information on what to do if a fluorescent light bulb (compact or strip) breaks, or indeed a mercury thermometer for those yet to go digital or liquid crystal. Basically, clean up involves opening a window, leaving the room for quarter of an hour, and then cleaning up the debris as best you can without using a vacuum cleaner, while wearing disposable rubber gloves and using a piece of stiff cardboard as a scoop or duct tape to pick up smaller fragments. A disposable wet wipe could then be used to clean the affected area. You must then put the debris in a plastic bag seal it, and then dispose of the waste according to local rules. Finally, wash your hands and then vacuum the area where the bulb was broken. All sounds very simple and sensible and pretty much what you would do if you broke an incandescent bulb, but with a little extra caution regarding that small amount of mercury.

Timely, then a review of mercury toxicity is published this week in the International Journal of Environment and Health. In the paper, Iman Al-Saleh
of the Environmental Health Section, at King Faisal Specialist Hospital & Research Centre, in Riyadh, Saudi Arabia, discusses the three chemical forms in which mercury is usually found: elemental (liquid mercury, amalgams, or vapour), organic (bound to a carbon-containing material), inorganic (mercury salts).

“Diet, especially fish and other seafood, is the main source of exposure of the general public to organic mercury. Dental amalgam is the most important source for elemental mercury vapour in the general population. Inorganic mercury compounds are known as mercuric salts, which are sometimes used in skin-lightening creams and as antiseptic creams and ointments,” says Al-Saleh.

Thiomersal, thiomerosal

Thiomersal, sodium ethylmercurithiosalicylate, is the sodium salt of an organic mercury compound and represents another exposure route. Thiomersal is known as thimerosal and Merthiolate in the US and was commonly used as an antibacterial agent in vaccine packaging. Presumably, thiomersal has saved thousands of lives by preventing potentially lethal Staphylococcus infections in those being vaccinated.

Nevertheless, it is use is now being phased out in the developed world through safety legislation, but it is still in use in Saudi Arabia, Al-Saleh points out, and elsewhere.

Al-Saleh’s extensive review of research into mercury toxicity does suggest that there is a need to evaluate antenatal and postnatal exposure to different forms of organic and inorganic mercury, especially given concerns regarding delayed neurological development in different age groups. This ongoing research will provide science-based evidence, rather than hearsay and scaremongering, regarding mercury exposure and provide healthcare providers and policymakers with the facts. Spurious anecdotes about paranoid parents panicked by environmental cleanup firms out to make a fast buck should not figure in this evidence.

Iman A. Al-Saleh (2009). Health implications of mercury exposure in children International Journal of Environment and Health, 3 (1), 22-57

Autism Saliva Test

autism I recently reported on the spit test being developed for autism spectrum disorder (ASD). It’s in the very early stages of development (this is not an antenatal test), but the details were certainly of interest to the target audience on the SpecNOW site.

Of course, the mainstream media picked up on the news of the possibility of such a simple test for autism too and the publication also coincided with literary revelations about Paul Dirac, the twentieth century physicist often labelled the British Einstein, and a debate in The Guardian newspaper concerning the possibility of antenatal testing and independent research by Cambridge University’s Simon Baron-Cohen. Although Baron-Cohen’s work is not looking for an antenatal test for autism, it has certainly led to a call for a public debate on the ethics of such a test.

Obviously, in the course of writing my SpecNOW item I contacted Massimo Castagnola of the Università Cattolica in Rome, Italy, whose team is behind the saliva test and asked him about its potential.

“The analysis of saliva, at least at the moment of the research, cannot detect a subject with autism spectrum disorder (ASD),” he told me, “Diagnosis of ASD is always a task of complex neuropsychiatric tests, made by a specialist in infant neuropsychiatry.” Indeed, Baron-Cohen is on record as saying: “Autistic traits are also normal – it is just a matter of how many of these you have.”

Castagnola explained how his team had discovered that a specific modification of salivary peptides (known as hypo-phosphorylation) is present in the saliva of a small subgroup of ASD patients. Nevertheless, the presence of these abnormal peptides, which suggest a biochemical history of failed protein activation in the patients has high statistical significance).

He pointed out that, “The analysis of a larger group of patients and controls will be necessary in order to confirm the results. Interestingly, low levels of phosphorylation of salivary peptides were observed by us in a previous study performed on saliva of pre-term newborns.”

Phosphorylation, a metabolic process that activates many proteins is under the control of an enzyme known as Golgi-casein kinase. This is a pleiotropic enzyme, which is expressed in several tissues other than salivary glands, including the brain.

“Our hypothesis is that the observed hypo-phosphorylation could be connected to a defect of the kinase, and the defect could reflect not only in hypo-phosphorylation of salivary peptides [which has no effects on the mouth], but also in the hypo-phosphorylation of proteins involved in brain development either during foetal growth or in the first months of life. This is a clue for the molecular basis of disease, at least for a subgroup of patients,” Castagnola told me.

Importantly, hypo-phosphorylation of salivary peptides is not necessarily indicative of ASD, as I mention in my SpecNOW article. Only 18 out of 27 had this characteristic of their salivary peptides. But, hypo-phosphorylation might be present because of another medical problem that may have neurological and/or multifactorial origin.

“Diagnosis of ASD is complex, and ASD is almost certainly a multi-factorial disease,” Castagnola adds, “It would be important to have an early biochemical marker, able to discriminate between different groups of ASD patients.”

There are, however, no practical therapeutic consequences of the Italian research at the moment. “If future research provides further information, we hope that salivary analysis could be useful in order to address a subgroup of ASD patients toward specific therapies,” Castagnola says. “In principle, the non-invasiveness of the test should allow its wide use.”

However, even if such a test were demonstrated to have clinical efficacy, there is currently no therapy that could be applied to follow up detection of salivary hypo-phosphorylation state. Perhaps also of concern is that some ASD patients tend not to be cooperative, have a delicate neuropsychiatric asset, and using the test could disturb the patient. “The test, at least at the moment, should be performed only in very specialistic centres that would go in deep on the molecular basis of the disease,” adds Castagnola.

In the Guardian discussion, which is not related directly to the saliva test work, piece, Michael Fitzpatrick suggests that worrying about antenatal testing is premature, because there are dangerous procedures being performed on children now. Apparently, the anti-vaccine lobby and others claim that autism in boys is associated with premature puberty and with toxic levels of mercury, from vaccines and environmental pollution (Baron-Cohen’s research has not yet proven a connection between exposure to high levels of testosterone during foetal development). These testosterone and toxic metal theories have led to the emergence of some very dangerous quackery including chelation therapy to remove heavy metals from the body (of course chelates will also mop up vital trace elements too) and the use of testosterone inhibitors. The claims of at least one advocate, Mark Geier, have been dismissed as intellectually dishonest in a 2006, court case, reports Fitzpatrick.

Indeed, Baron-Cohen has written to The Guardian in an effort to rebalance what he sees as problems with the reporting in The Guardian of his research. His study, published in the British Journal of Psychiatry was not, he says, about prenatal screening for autism, and indeed did not test children with autism. “The aim of the study was simply to understand the basic mechanisms causing individual differences in autistic traits in an otherwise typical sample,” he says. But, maybe he protests too much, the BPS press release quotes him as saying such a test would require thousands not hundreds of subjects and then adds, “Our ongoing collaboration with the Biobank in Denmark will enable us to test that link in the future.” So it certainly looks like his team is working towards an antenatal test for autism.

Moreover, a BBC article by Baron-Cohen published before The Guardian reports and discussion certainly makes that clear. From his introduction: “The prospect of a prenatal test for autism, allowing couples to choose whether to have a baby with the condition, is coming closer. And with it also comes the possibility of a prenatal drug treatment being developed.” In that article Baron-Cohen warns that “caution is needed to ensure associated talents, like numerical abilities, are not lost if the test or a ‘cure’ become available.”

Massimo Castagnola, Irene Messana, Rosanna Inzitari, Chiara Fanali, Tiziana Cabras, Alessandra Morelli, Anna Maria Pecoraro, Giovanni Neri, Maria Giulia Torrioli, Fiorella Gurrieri (2008). Hypo-Phosphorylation of Salivary Peptidome as a Clue to the Molecular Pathogenesis of Autism Spectrum Disorders Journal of Proteome Research, 7 (12), 5327-5332 DOI: 10.1021/pr8004088

Catching Obesity

Obesity overweight UPDATED: Is it possible that obesity, like the common cold is infectious? You’d think so if you believed research that’s been carried out over the last decade and hits the tabloid headlines again this week.

The research suggests that a highly infectious virus might be behind some cases of obesity. There is constant talk of an epidemic of overweight in the developed world. Overindulgence, lack of exercise, sedentary lifestyles are usually blamed. Occasionally, the words genetics or glands are mentioned, but rarely is the obesity epidemic thought of as a disease like, flu or winter vomiting virus, a disease you can “catch”, in other words. But, this research detracts from those genuine causes of overweight and might even do more harm than good, giving those with a less than healthy appetite another excuse to over indulge and avoid raising their heart rate above the average.

The research is highlighted today in several UK news papers and apparently lends weight to the idea that a highly infectious cold-like virus, known as AD-36 could cause obesity in some people.

It’s perhaps not surprising that, aside from the Daily Telegraph, most of the other outlets that report this work without real commentary are tabloids, the Daily Express, the Daily Mail, and Fox News, for instance. The original research is by Nikhil Dhurandhar of the Pennington Biomedical Research Centre in Louisiana and colleagues and will also be highlighted on the supposedly reputable BBC Horizon TV program this evening in an episode that attempts to answer the question, Why are thin people not fat?

Dhurandhar’s answer to that question is that those people simply haven’t yet caught the obesity bug. Apparently, the “virus goes to the lungs and spreads through the body. It goes to various organs and tissues such as the liver, kidney, brain and fat tissue…causes fat cells to replicate.” Moreover, the team’s latest paper published 22nd January 2009 in the journal Obesity, suggests that fat cells, known as 3T3-L1 cells, accumulate fat molecules (lipids) faster than normal when a person is infected with AD-36.

None of this is new, however. Dhurandhar and colleagues have been searching for an obesity “bug” for at least a decade. They published preliminary results in 1996 and 1997 and since then have apparently tested their theory in chickens, mice and marmosets. My good friend Tabitha Powledge wrote about the theory back in 2000 for Salon). Dhurandhar’s work on the viral theory of obesity also hit the news in the summer of 2007 when he reported details to the 234th national meeting of the American Chemical Society. At the time, the studies revealed that almost a third of people with obesity were infected with the AD-36 virus compared to just over one in ten of lean individuals. But does the presence of such a virus truly imply some obesity is due to catching an infection?

Last year, R.L. Atkinson of the Obetech Obesity Research Center, in Richmond, Virginia, reviewed the field and concluded that, “a portion of the worldwide epidemic of obesity since 1980 could be due to infections with human adenoviruses” (Int J Pediatr Obes. 2008;3 Suppl 1:37-43). More recently, Dutch researchers Vincent van Ginneken, Laura Sitnyakowsky, and Jonathan Jeffery, discussed Dhurandhar’s work in the journal Medical Hypotheses and agree with the findings: “We postulate that AD-36 may be a contributing factor to the worldwide rising problem of obesity,” they say, “We suggest the extension of comparative virological studies between North America and Europe, and studies between discordant twins (both dizygous and monozygous).”

The key phrases are “could be due” and “may be a contributing factor”.

It is very unlikely that, even for a proportion of individuals, will the viral theory prove to be the cause of their obesity. This is not the straightforward case we saw with peptic ulcers and the discovery of Helicobacter pylori. Even the link between gum disease bacteria and heart problems, while tentative, is more substantial.

It’s ironic that this research should come to the fore (again) within a week of the European Union giving the go ahead for pharmacists to sell the obesity drug Orlistat over the counter (OTC).

It is possible that for a small number of people the best defence against obesity would be to avoid catching this so-called obesity bug? Best way to avoid bugs? Enjoy a good diet, do not overindulge, and get plenty of fresh air and exercise and perhaps follow the how to avoid colds and flu tips too. Good nutrition, moderation and exercise will cover you for the biggest obesity risk factors, boost your immune system to a degree, and help you avoid adenoviruses infection. It’s a well-padded strategy, I’d say.

Miloni A. Rathod, Pamela M. Rogers, Sharada D. Vangipuram, Emily J. McAllister, Nikhil V. Dhurandhar (2009). Adipogenic Cascade Can Be Induced Without Adipogenic Media by a Human Adenovirus Obesity DOI: 10.1038/oby.2008.630