Dr. William Coley. Not a brain surgeon.
With apologies to my colleagues, but infectious diseases really is the most interesting specialty in medicine. There are innumerable interesting associations and interactions of infectious diseases in medicine, history, art, science, and, well, life, the universe and everything. ID is so 42.
A recent email led me to wander the numerous interactions between infections and cancer.
There are the cancers that are caused by infection. HPV and cervical and throat cancer. EBV and lymphoma. HHV8 and Kaposi’s Sarcoma. I certainly hope I am not reincarnated as a Tasmanian Devil. (more…)
I knew humans could resemble worms, but this?
My wife and I are entering an age where our aches and pains are becoming a major ongoing topic of conversations. The pain of raising kids has transitioned into the pains of growing older. These aches and pains are, in the scheme of things, minor and intermittent.
At work I get to see real suffering and it keeps my own in perspective. And there are a lot of people who feel awful, some for obvious reasons such as cancer or AIDS, and some from ailments that are more enigmatic, such as systemic exertion intolerance disease (SEID), the illness formerly known as chronic fatigue syndrome.
Worst. Gateway disease. Ever.
In the context of SBM, SEID is a gateway disease into the world of pseudo-medicine.
A syndrome with no known cause and few effective therapies at best, those who suffer from it are easy pickings for SCAM practitioners. When you feel like crap month after month with no improvement or even an explanation for your suffering, you keep looking until you find an answer. (more…)
A new word has been added to the public’s vocabulary – the Zika virus. It seems we have one more infectious agent to worry about. Here are the facts as we currently understand them regarding the recent Zika epidemic, and also some rumors and conspiracy theories that need debunking.
The Zika virus (of the viral family Flaviviridae, an Arthropod-Borne or arbovirus) is spread through Aedes mosquito bites, the same mosquitoes that also spread dengue fever, West Nile, and yellow fever. The infections themselves are usually mild, causing fever, rash, joint pain, and conjunctivitis. Many of those infected (about 80%) may even have a subclinical infection, meaning they do not notice any symptoms.
According to the World Health Organization:
Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Diagnosis by serology can be difficult as the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever.
The little burrowing bacteria that bores into your pores to cause Lyme disease, EEEEEWWW!!! Darkfield 400x microscopy image of the 10-25µm long Borrelia burgdorferi spirochaete which causes Lyme disease (1993). Provided by the CDC’s Public Health Image Library (PHIL #6631) via the Wikimedia Commons
I hate those oh hell moments. I was up way too late last night, but who can pass up the opportunity to see Patti Smith playing Horses (and more) for the 40th anniversary of the album. Only 44? Behind the Eagles? No way. I would nudge it up a few more spaces. Hard to believe I was 18 when that album came out. Horses is one of the few albums that made the transition from vinyl to CD. It was a tremendous show, and at 69 Patt performs with the energy and passion of a 29 year old. And she sure can spit. I had the evening off, so food and drinks at Swine until well past midnight. First time my wife and I closed a bar. I am too old for this.
But as I was blearily drinking my a.m. coffee on a dreary PDX morning, I opened the browser to SBM and there was a post by Jann. Oh hell. That means I have a post due tomorrow and I had lost track of the time over the holidays. I thought my next post was next Friday. Oh. Hell. So unlike most posts which I write over a week, this one was done in about 4 hours. And I am sure it will show.
How do you diagnose an infection?
Not always so simple. You always start with a history and, for infectious diseases, an exposure history is paramount. People get what they are exposed to, so you want to know travel, animals, diet, water, sex etc. If you have ridden a horse to have sex in an Indian lake while drinking raw milk (not really an unusual history in my practice; people do the darndest things) you have exposure risks for a variety of infections. If you have not left the Willamette Valley it is unlikely that the cause of the illness is malaria, although you always have to consider that the infection came to the patient rather than the other way around. (more…)
Pictured: Superbug spawner, or savior to us all? Neither!
Recently, I was sitting in a meeting and reached for the dispenser of Purell hand sanitizer sitting on the conference room table. A colleague of mine gave a small, rueful shake of her head to the person on her other side. Apparently I had erred. I asked what was the matter, and got a brief answer to the effect of “because superbugs.” We exchanged nothing more about it; the interaction was over before the alcohol had dried from my hands.
I wouldn’t have thought anything of such an interaction with anyone else, but my colleague is a PhD student in immunology, six years older and more schooled than I, doing her doctoral research in a lab run by a physician-scientist — a specialist in infectious disease, no less. A touch ironic.
And so I noticed a need for some mythbusting: alcohol-based hand sanitizers do not breed resistant bacteria. (more…)
Pictured: Stem cells. Surprisingly, the best youth is in the chump.
Injecting animal cells into humans for therapeutic reasons has a long history. The most infamous was John Brinkley who injected goat testicles into 16,000 men in the 1920s and 30s to treat impotence. Harriet wrote a review of Charlatan: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam, which covers the topic. I wonder who would get the title today. Chopra…Gesundheit.
I had thought this therapy was consigned to the sharps container of history. Of course not. No SCAM ever fades away.
As part of my ID reading I came across the headline “Q Fever Outbreak Among Travelers to Germany Who Received Live Cell Therapy — United States and Canada, 2014.”
It surpasses the classic “Notes from the Field: Campylobacter jejuni Infections Associated with Sheep Castration — Wyoming, 2011” for foolishness, where:
…men reported having used their teeth to castrate some of the lambs.
Really. A most curious way to acquire Campylobacter. But at least the castrators were doing practical, albeit eeewwwwwwww, work. And there is an alternative to teeth, including the Burdizzo Emasculatone, which is:
an elegant little tool especially suited to crushing the spermatic cords of a variety of male mammals. It really helps to make a neat job of what would otherwise be an unpleasantly messy endeavor, and the Burdizzo achieves the goal of bloodless castration admirably.
But I digress and leave to the commenters to make completely inappropriate remarks. Only the SCAM universe can be odder than infectious diseases. (more…)
The black-legged tick responsible for spreading the bacteria that causes Lyme disease
I noted with understanding that the Doubtful News can’t take it anymore. The relentless tsunami sewage slurry of pseudo-science (who says I can’t alliterate?) has worn her down. She is:
currently experiencing a phase in which I can’t seem to bring myself to promote another ridiculous story in the media about a haunted location, scary sounds from the sky, or the latest outrage fueled by ancient superstition. You might call that… jaded. It’s been over four years now of nearly daily effort to keep track of the weird world of woo. It can wear one down when virtually or literally the same thing appears and reappears over and over as if it hasn’t already been passed around a million times.
I sympathize. I have had a touch of SCAM ennui of late. It is a bit due to the repetitiveness of the SCAMs. I still find the variations on the theme of pseudo-sciences curious. It is like infectious diseases where every case has unique and subtle diversity so no two SCAMs are the same. But there are almost 4,000 clinical trials on acupuncture and I would wager that they all have several of the same half-dozen fatal errors. It is like hand hygiene at work. We have known for, oh what, 160 years, that hand hygiene prevents the spread of disease but people still can’t do it right. We know how to do a good clinical trial but the SCAMsters just can’t seem to figure it out.
The ennui is not the seeming futility of the endeavor. I have always been comfortable with futility, secure, as an example, in the knowledge that someday I will be consumed by the bacteria I spent a career killing. Unless, of course, they get me cremated right away. I keep looking for a motto for the SfSBM; I am attracted to “Sisyphus had it easy.” (more…)
The black-legged tick, responsible for spreading Borrelia burgdorgeri, the bacteria that causes Lyme disease
As the saying goes, when you do not have the facts, argue the law. This tried and (?) true approach was successful in New York where a law was passed protecting those who are, shall we say, creative in treating patients with Lyme and ‘chronic’ Lyme.
The bill protects those from investigation of misconduct:
based solely on treatment that is not universally accepted by the medical profession.
The major bone of contention has been extended courses of IV antibiotics for ‘chronic’ Lyme, but there are a wide variety of treatments that may be used by so called “Lyme literate” doctors.
The number of therapies divorced from reality that are offered to Lyme patients is remarkable. I do not know if chronic Lyme patients have greater use of pseudo-medical therapies than other pseudo-diagnoses, but I am impressed by the offerings in a recent review:
Results. More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments.
Conclusions. Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful.
The western black-legged tick, carrier of the Borrelia burgdorferi bacteria which causes Lyme disease.
The practice of infectious disease (ID) is both easy and difficult. If you read my ID blog on Medscape you are aware of my trials and tribulations in diagnosing and treating infections.
ID is easy since, at least in theory, diseases have patterns and an infecting organism has a predictable epidemiology and life cycle. So if you can recognize the pattern and relate it to the life cycle and exposure history, you can often make a diagnosis before the cultures come back.
My favorite story is the time I was asked to see a young girl with endocarditis. The history was she had a week of fevers, headache and myalgia that went away for five days, returned for a week, went away for five days and returned yet again.
So I asked her “How was your vacation at Black Butte?”
The look of astonishment on her face as she asked how I knew she had been to Black Butte was so satisfying. (more…)
Yesterday, I spiffed up a post that some of you might have seen, describing how a particular medical conspiracy theory has dire consequences in terms of promoting non-science-based medical policy. Specifically, I referred to how the myth that there are all sorts of “cures” for deadly and even terminal diseases that are being kept from you by an overweening fascistic FDA’s insistence on its approval process is an important driving force behind ill-advised “right to try” legislation that’s passed in four states and likely to pass in Arizona by referendum tomorrow. I’m not exaggerating, either. If you have the stomach to delve into the deeper, darker recesses of alternative medicine and conspiracy theory websites, you’ll find words far worse than that used to describe the FDA, such as this little gem from everyone’s favorite über-quack Mike Adams basically portraying the FDA as Adolf Hitler. Even more “mainstream” advocates, such as Reason.com’s Ronald Bailey and Nick Gillespie, are not above using a version of this myth stripped of the worst of its conspiracy mongering for public consumption, claiming that the FDA is killing you.
Unfortunately, this sort of medical conspiracy theory is very common. Like all conspiracy theories, medical conspiracy theories tend to involve “someone” hiding something from the public. I like to refer to this as the fallacy of “secret knowledge.” That “someone” hiding the “secret knowledge” is usually the government, big pharma, or other ill-defined nefarious forces. The “secret knowledge” being hidden comes invariably in one of two flavors. Either “they” are hiding cures for all sorts of diseases that conventional medicine can’t cure, or “they” are hiding evidence of harm due to something in medicine. Although examples of the former are common, such as the “hidden cure for cancer,” it is examples of the latter that seem to be even more common, in particular the myth that vaccines cause autism and all sorts of diseases and conditions, that genetically modified organisms (GMOs) are dangerous, or that radiation from cell phones causes cancer. In these latter examples, invariably the motivation is either financial (big pharma profits), ideological (control, although descriptions of how hiding this knowledge results in control are often sketchy at best), or even some seriously out there claims, such as the sometimes invoked story about how mass vaccination programs are about “population control” or even “depopulation.” Either way, “The Truth” needs to be hidden from the population, lest they panic and revolt.