Tuesday, 25 August 2009

Dig deeper

Pandemic flu may have fallen off the news agenda but over the summer more scientific evidence has been gathering of how our underlying health could be a crucial factor in its severity.
Most people know about MRSA - and some avoid hospital out of fear they may get it there - but few people are aware of community associated MRSA.
CA-MRSA infections are known to be circulating among healthy members of the community and yet they have never been tested for in the UK population. The USA has undertaken studies and found that one in every 100 people carries CA-MRSA.
The SA in the abbreviation is Staphylococus aureus, a rather nasty family of microbes.
When the lungs of the young victims of the 1918 Spanish flu were studied, they were found to have been destroyed by a pneumonia which killed them within 72 hours. The weight of evidence since then has led infectious disease specialists to conclude that the extra factor in these swift deaths was Staph aureus.
One study by epidemiologists Noymer and Garenne of US 1918 flu deaths postulated that the Staph infection could have taken hold in the chest because apparently healthy people had undiagnosed tuberculosis, which makes little 'pockets' in the lungs.
Now two brand new studies by virologists - in Rotterdam, and Atlanta, Georgia - have found out exactly how different the pandemic H1N1 virus is from seasonal influenza virus - it particularly attacks the lungs.
Seasonal flu virus bound to the cells in the nose but they observed that pandemic H1N1 binds much deeper, in the trachea, bronchi and bronchioles of the lungs.
The US team also found the virus bound to cells in the intestine, explaining the nausea and vomiting associated with swine flu.
New Scientist magazine reported on this discovery: 'Individuals differ in the way they react to viruses. A virus that binds deep in the lungs can trigger potentially fatal pneumonia if the person infected mounts a strong inflammation in response to it.'
So where does that leave people with an autoimmune disease, like sarcoidosis or rheumatoid arthritis, where the immune system is apparently overreacting? Or people who always have sudden and severe reactions in the chest or gut whenever they take antibiotics?
These unknowns are part of the 'evolving threat' from community infections, and the NHS is ill-prepared for it, according to an expert.
Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham, said last month: 'It took the UK over 10 years to start to get to grips with the problems of hospital MRSA infections and we are still fighting this war. We are not yet ready to fight the next one against CA-MRSA infections.'
He complains that the NHS is: not testing for this known community health risk factor; has not got enough intensive care beds to cope with even a low number of cases of swift-acting pneumonia in swine flu patients; and has failed to invest in laboratories and advanced diagnostic testing.
He is trying to raise £1.4m in charitable donations to fund new research in to infections because of the lack of public funding.
Meanwhile 37,000 people have died in the last ten years from MRSA or another serious infection C.diff. That's twice as many deaths as those from road traffic accidents - and the extra treatment costs incurred by these infections in the NHS is £1 billion each and every year.
Infectious disease specialists have been asking for UK investment in advanced laboratory testing for a long time now.
Emeritus Professor at the University of Aberdeen, Hugh Pennington warned in a Radio 4 investigation last year that the current system of two main laboratories for the whole country, with results delivered at a snail's pace, was inadequate. The national Health Protection Agency lacks enough resources to track infections.
He told File on Four: "The scandal here is that we know what to do, the technology's there to spot these things as they are appearing and we know how to react to them. It would be quite wrong if we allow these things to develop and of course history tells us that if we do neglect these bugs, we neglect them at our peril."
Can someone in charge of NHS resources please wake up and smell the coffee?

Sunday, 16 August 2009

Herpes - not so simple(x)?

Reading the latest Private Eye magazine column by M.D. (the comedian doctor Phil Hammond) on herpes simplex outbreaks has provoked bemusement.
I think M.D., despite his new role as patron of the Herpes Viruses Association, may have shown a disservice to the many people with cold sores or genital blisters as he wittered on about how, back in the olden days, people would panic unnecessarily about the herpes family of viruses being linked to a sexually transmitted disease.
He declaimed those who made a stigma out of the virus: 'Herpes does far more psychological damage than physical.' Then, continuing on his juicy theme, he helpfully put down transmission and cause of facial cold sores to...oral sex.
So much for trying to get rid of the stigma!
The HVA website is clear that, while all mucous membranes are particularly vulnerable, the virus can be passed through any skin to skin contact with friction, including via the hands. White lesions on the hands, caused by herpes simplex, are called whitlows.
Amid normal day-to-day conversation I have encountered no one of my generation or younger embarrassed to talk of obvious cold sores on their faces or of the known cause - herpes.
M.D.'s cheerful obsession with sexual transmission of herpes seems to say more about the stage of life reached by his (male) generation.
M.D. concludes of genital sores: 'They're only cold sores and they go away without treatment.' Really?
Other physicians in the US and elsewhere accept that a notable proportion of people continue to have chronic outbreaks of herpes simplex. A common suggestion is that it results from underlying suppression of the immune system.
Information on the HVA website tells us that 'three quarters of people with herpes simplex are unaware of it' and that the virus can cause - or the diagnosis be confused with - thrush, repeated cystitis-like symptoms, skin lesions on the buttocks, piles, lower back pain, nerve pain, flu symptoms and more.
Research worldwide has found herpes simplex (plus other viruses and bacterial infections) in patients with fibromyalgia and chronic fatigue.There are also several studies that have found herpes simplex surrounding plaques in the brains of Alzheimer's patients; findings which require further investigation.
Anyone with unexplained nerve pain at the neck, or persistent muscle pains might like to know these facts. Not that I am putting such conditions down to herpes - I don't give simplistic answers like M.D.
At the HVA's AGM the genitourinary specialist Dr George Kinghorn explained that the relationship between Type 1 (symptoms from the neck up) and Type 2 (from the waist down) of the virus is much less clear cut than previously thought. And he notes that symptoms and severity 'will also depend on a variety of individual susceptibility factors, our genetic make-up certainly has an effect'.
Inherited genetic factors could be one area of further study. So too could the genetic damage caused to human cells by forms of persistent bacteria like streptococcus and E.coli, which molecular scientists are now revealing to be much cleverer at changing their surrounding human environment than we first believed.
Investigation is needed in to what, I think, is a complex rather than a simplex subject.

Wednesday, 5 August 2009


Sadness today when I received the US Food and Drug Administration's new warning about TNF blockers, which are prescribed for a variety of autoimmune disorders including rheumatoid arthritis.
Eleven children died of cancer, they announced, and 37 more got either lymphomas or other malignant conditions after they received tumour necrosis factor blockers, which alter the immune system.
Almost nine out of ten of those children affected were also taking another immunosupressive drug like methotrexate.
Two more separate FDA studies show today that 26 people died of leukaemia after taking the drugs, and 69 people receiving them for autoimmune or rheumatic illness suddenly developed serious psoriasis. Twelve of these were hospitalised and most recovered after TNF blockers were stopped.
Physicians are being warned in future to discuss with the patient's family the possibility of getting leukaemia alongside the need for treatment of the original autoimmune condition.
I find these drugs' 'side effects' shocking. What could possibly be the link between altering a sick person's immune system and subsequently getting either cancer or an apparently unrelated condition?
My sincerest condolences go to those families whose dreams for their children have been shattered.

Monday, 3 August 2009

Cancer and bacteria

Have you noticed recently how there is increasing talk of vaccines against cancer?
As lay people, this might seem rather confusing. We know that the medical establishment have urged us for a long time to have all our immunisations for infectious diseases.
We are also made aware that cancer organisations have worked for decades, putting millions of pounds in to cancer research which is increasingly complex and often focused on inherited genetic causes.
Cancer Research UK makes its opinion crystal clear on its website: 'Cancer is not in any sense an infectious disease.'
So how come the major research breakthroughs (setting to one side more effective drugs to slow down, but not cure, cancers) have been in cancers like cervical or liver cancer, where the cause is shown to be a specific virus.
Cancer Research UK, while relaying some helpful virus-specific advice on its website, still plays this down incredibly by saying: 'Cancer...represents a very rare accident of long-term infection with such a virus.'
But now lets hear from Paul Ewald, evolutionary biologist and the first recipient of the George R. Burch Fellowship in Theoretic Medicine and Affiliated Sciences:'Back in 1975, mainstream medicine agreed that about 0.1% of human cancer cases were caused by pathogens. When it came to the rest of cases, their view was that they were probably caused by a combination of inherited predispositions and mutagens.
'Then in 1985, the percentage of cancer cases they tied to pathogens was 3%, and they continued to make the same argument about the remaining cases. In 1995 the percent of pathogen-induced cancer cases was accepted to be around 10%.
'Now, we’re at 20%. Still, mainstream medicine contends that the other 80% of cases do not have an infectious cause, but the question is – do you believe them anymore?'
Another very recent and conclusive addition to this crowd of infectious connections to cancer came in a study published in May by the Institute of Genetics and Molecular Medicine at the University of Edinburgh (Attaching and Effacing Escherichia Coli downregulate DNA Mismatch Repair Protein In Vitro and are associated with colorectal adenocarcinomas in humans: Oliver D.K. Maddocks et al).
In a brilliant paper, worthy of a Crystal Mark from the Plain English Campaign, it persuasively 'demonstrates for the first time' the link between cancer of the colon and bacteria able to attach themselves firmly to cells inside the colon. Up to 100 were found hiding in a single cell.
Not only that, but the research scientists also say their study has uncovered the mechanism the bacteria uses to shut off the colon cells' ability to protect themselves against dangerous genetic mutation. This may be how the bacteria possibly causes colon cancer, but proof will only come from further study.
Interestingly, they note a 'striking similarity' with the bacteria helicobacter pylori, which also interferes with the mechanisms of gastric cells and causes stomach cancer. For a long time H.pylori as the known cause of stomach ulcers was ignored by the medical establishment too, while doctors still hector patients about helping themselves by avoiding stress (for pity's sake!).
With more and more research like University of Edinburgh's study coming to light - but repeatedly ignored by frontline medical staff - how long do we have to wait in pain and ill health before our doctors take a closer look at the infections we have each collected in our bodies? Until it's too late?

Saturday, 1 August 2009

Life too complicated?

I always appreciate the news according to The World Tonight, especially on Robin Lustig's watch. It is vital that we take in a broad sweep of the issues which are important to our everyday lives.
And I think The World Tonight is often the best at this - by miles, in comparison with other BBC news output for the UK. Lustig has recently posted on his blog his theories about why the current swine flu is a 'flu scare'. Of course, most of his concerns about scaring people lie with how it is presented by health experts and the media.
But he makes this point: 'We live in a complex, confusing, technologically-challenging world.... We lie awake at night and worry: do I know enough, understand enough, to make the right decisions for myself and my family?...But the answers are usually as confused as the questions.'
Lustig may have noted that people are generally less willing these days to accept what they are told by officialdom, but something is else is also going on.
Because the modern world - particularly medical science - has advanced to such a detailed state, we as humans have an overwhelming urge for someone to tell us 'it's OK - we know what's happening'. And we invariably turn to an expert in the particular area of concern, whether it be a cancer doctor or an infectious disease specialist, for that essential reassurance.
So what would be the result if a virology expert turned round and admitted about the current H1N1 flu strain:'Actually this is so globally complex and new that we don't have any idea how this will develop or how to effectively protect ourselves.'
And, though we do have a few pointers for how the pandemic may move and change, it seems true to say the experts have little idea where this may all be heading, or why it is happening now.
But it is 'only flu' as Lustig and others protest. 'Just wash your hands!'
Again that heartcry for simplicity and reassurance erupts.
The official advice that people with 'underlying health conditions' need to be careful about coming in to contact with the virus is a simplistic message masking a whole new world of unknown factors.
Evidence is emerging from international biomedical expertise of even greater complexities in our bodies than we have ever imagined, involving a community of many more genomes than our human genome!
The Human Microbiome Project states that 'within the body of a healthy adult, microbial cells are estimated to outnumber human cells by a factor of ten to one. These communities, however, remain largely unstudied, leaving almost entirely unknown their influence upon human development, physiology, immunity, and nutrition' (my emphasis).
Please - take a deep breath and don't panic.
Yes, we still have some way to go to understanding what it is happening at a bacterial and virological level.
But, if we as patients - as well as that lumbering medical establishment, so slow to adjust - take a step back from the detail of our bodies then we may start to observe a few patterns in the complex mesh of human metabolic processes.
Too often we rush to doctors who prescribe the necessary treatment for the current complaint - stop that pain, cut that part of the body out, try this prophylactic treatment.
But how come several different symptoms, noted in different parts of the body by different specialists,are happening in the same body?
Should I be considered so dilettanteish for mentioning that, for example: an infected wound requiring amputation is attached to a diabetic body with increasing vision defects; or gastroenteritis suddenly occurs in a person with a heart condition given antibiotics for pneumonia; or a teenager with early onset arthritis in their joints also suffers with chronic fatigue and acne?
Surely if we push and pull our bodies around in a blinkered manner, as specialist doctors tend to, the microbial communities within will break out in to a fist fight too - and may enlist some viral thugs to join forces.