[Intrepid Homoludens]

You can die NOW from tuberculosis, AIDS, pneumonia, avian flu, and other deadly diseases plaguing the world. You can also still contract polio (there are new cases being reported in India and Indonesia). To put it bluntly, your chances of dying from microorganisms today are more or less as high as it was 100 years ago.

preview video

There are new strains of tuberculosis in countries like Peru that are resistant to ANY known vaccines and antibiotics. There are also countless potentially deadly microorganisms yet to be discovered. One of them killed a 21-year-old American college football player who was otherwise in perfect health at the prime of his life. He caught it from scraping himself during a game of football.

I just finished watching a 2 hour show on PBS, the first of 3 installments of Rx For Survival: A Global Health Challenge. It "examines what makes us sick, what keeps us healthy, and what it would take to give good health the upper hand."

...infectious diseases that had nearly been conquered, such as tuberculosis, have come surging back, while devastating new diseases such as AIDS, SARS and West Nile Virus have emerged. Microbial resistance to many modern drugs is rising, threatening people everywhere. And in our world of globalized travel, the latest epidemic is only a plane ride away.

It was hard to watch. I saw a young mother in Peru suffering from a new strain of drug resistant tb. She was beautiful and loved her son so much, but not even the most cutting edge medicines could help her. She died, and shortly after her little son was diagnosed with tb. Another tb victim, a 21-year-old student, was suffering the side effects of the same treatment. He weighed just 66 pounds, but he survived and was cured.

In India and Nigeria mothers are refusing to let health workers immunize their babies against a new outbreak of polio, and many children end up paralyzed for life. A single baby left unimmunized could contract and reignite the plague to spread far beyond its village and into other countries, possibly even reaching Europe and the U.S. Why are parents not immunizing their kids? Ignorance and religion. Just to let you know, you are not immune just because you live thousands of miles away. With plane travel and global trade prominent, a single person unknowingly infected with, say, avian flu, could come in contact with people in your country, spreading the sickness.

This television event looks at the most critical and emerging threats to global public health and chronicles the leaders who, against all odds, deliver the goods.

Awesome program so far, makes you really think hard about what it means to be as healthy as you can today......and how fragile even that can be.

So what are your thoughts about the state of disease today?

[squarejawhero]

I don't know, but I do know I feel more paranoid for reading that and worrying about contracting a disease is the last thing I want to do right now.

What I am pissed off about is how impolite and dangerous people are when they catch diseases like flu. When the epidemic hits, how many people are going to catch it because some idiot doesn't bother to sneeze into a hanky, or cough openly without putting their hand in front of their mouth? People mistake these little things as being polite. But they're not, nowadays they could save lives.

Many of these diseases don't spread quickly because it's hard to contract them, or the spread is so rapid and the death rate so high that it can't stretch further than the immediate community. The most deadly diseases are the ones that can spread via air and have a long hibernation period as it allows them to be carried further, only for the carrier to break out in a flu-like virus which allows it to be spread before it kills them off. Something like ebola has this pattern, but its nature makes it hard to contract without direct fluid contact with the patient. That said, its initial diagnosis does seem like flu, so within a closed community, it's something very dangerous indeed.

Staying healthy, making sure you're eating properly and getting the nutrients and vitamins you need does help combat minor infections. But the proof has shown that it doesn't matter how old or healthy you are, some people are more prone to certain infections. The new avian flu strain, as it stands, can only be contracted by ingesting, but it doesn't care how healthy you are as it infects the lung tissue.

New diseases will always be found and continue to develop, it's just the way this planet has always worked. It's all about succession, whether it's kings or species. Who knows, perhaps it's Gaia's way of maintaining balance after us humans have started to ruin this green planet?

[Fairygdmther]

Originally Posted by squarejawhero

I don't know, but I do know I feel more paranoid for reading that and worrying about contracting a disease is the last thing I want to do right now.

What I am pissed off about is how impolite and dangerous people are when they catch diseases like flu. When the epidemic hits, how many people are going to catch it because some idiot doesn't bother to sneeze into a hanky, or cough openly without putting their hand in front of their mouth? People mistake these little things as being polite. But they're not, nowadays they could save lives.

Many of these diseases don't spread quickly because it's hard to contract them, or the spread is so rapid and the death rate so high that it can't stretch further than the immediate community. The most deadly diseases are the ones that can spread via air and have a long hibernation period as it allows them to be carried further, only for the carrier to break out in a flu-like virus which allows it to be spread before it kills them off. Something like ebola has this pattern, but its nature makes it hard to contract without direct fluid contact with the patient. That said, its initial diagnosis does seem like flu, so within a closed community, it's something very dangerous indeed.

Staying healthy, making sure you're eating properly and getting the nutrients and vitamins you need does help combat minor infections. But the proof has shown that it doesn't matter how old or healthy you are, some people are more prone to certain infections. The new avian flu strain, as it stands, can only be contracted by ingesting, but it doesn't care how healthy you are as it infects the lung tissue.

New diseases will always be found and continue to develop, it's just the way this planet has always worked. It's all about succession, whether it's kings or species. Who knows, perhaps it's Gaia's way of maintaining balance after us humans have started to ruin this green planet?

When you talk about covering your mouth with your hand during a sneeze or cough - you didn't finish it. If you don't then wash your hands, then everything you touch is going to be covered with those germs. In the absence of handwashing facilities, it may be safer to cough toward your armpit or into your clothing (under a jacket, for instance) than using your hand.

Another issue is exposure to disease. We need minimal exposure to contagious diseases to "prime" our immune systems to respond in the case of a major exposure. A complete protection against disease causing germs will leave us more vulnerable. This is getting to be an issue due to resistant antibiotics and hand soaps that are anti-microbial.

Lynsie

[Intrepid Homoludens]

One major problem that impedes progress is that of education. People are simply ignorant, superstitious (yes, even today), in denial, or just plain stupid and wreckless. One crucial tool is to inform them, not just once but over and over, to help create a culture of awareness. Take for example the incidents in Indonesia, where because one child, already infected, developed polio after the initial vaccination (it takes 3-5 vaccinations to develop immunity), her mother assumed it was from the vaccine, half the community refused to have their babies immunized. This causes the possibility of new outbreaks of polio.

Parental Fears Snarl Efforts Against Polio in Indonesia · NPR.org, 11/1/05

Last March, Indonesia saw its first polio case in 10 years. Now, 300 children have been crippled and 60,000 infected. Before health officials can stamp polio out, they'll have to win over parents distrustful of the vaccine.

If your baby gets polio, he or she will most likely never be able to walk ever again.

[squarejawhero]

@FGM - Yeah, I realised later that paragraph was truncated but I er... needed a bath. But you're right. Even so, people don't even do that... and I find it such a stupid attitude to have.

@Trep - I agree, some of the spread of these diseases is through complete ignorance and lack of education. Like the two brothers who contracted Avian Flu after eating raw duck entrails, a speciality from their part of China. I have NO idea what was going through their heads at the time, as they even knew Avian Flu was around and being spread to humans from birds - so why the hell did they eat it? In some parts of Africa some consider diseases curable through sex, so you can imagine how that worked out.

[Intrepid Homoludens]

big R keeps antibacterial soap by the kitchen and bathroom sinks. I never use it, I prefer my natural sandalwood soap.

Originally Posted by squaresie

@Trep - some of the spread of these diseases is through complete ignorance and lack of education. Like the two brothers who contracted Avian Flu after eating raw duck entrails, a speciality from their part of China. I have NO idea what was going through their heads at the time, as they even knew Avian Flu was around and being spread to humans from birds - so why the hell did they eat it? In some parts of Africa some consider diseases curable through sex, so you can imagine how that worked out.

There were incidents in villages in India where the polio vaccination teams were being threatened by village elders, who for some stupid ass reason thought the vaccines caused impotence. Go figure.

[squarejawhero]

Soap kills germs anyway. There's been a lot of new anti-bac washing up products here in the UK of late, but they're exactly as effective as using normal detergent.

[Intrepid Homoludens]

Well, regular soap kills some germs, yes. It washes most of them away, anyhow. The problem with antibacterial soap and alcohol based soaps is that they kill ALL germs, even the beneficial ones. They're more likely to leave you more vulnerable than plain soaps.

I also know of the whole craze in Japan where people are practically gorging on antibiotics, overdosing on them. Because of it the bugs are getting smarter and stronger and more resistant. So those people end up getting sick in new ways. And yeah, those bugs can easily spread to other people - like American or British tourists, for example.

[squarejawhero]

Oh, the antibiotic thing is a huge worldwide issue. A couple of years ago doctors stopped prescribing them so readily over here - are they still dishing them out in Japan then, for every little infection?

[Melanie68]

People who are not immune compromised have so little faith in their immune systems. We don't need everything antimicrobial. You have to realize, there are more bacteria in and on us than we have cells in our body. They are part of our normal bacterial flora that actually keep the pathogenic bacteria at bay. Constant antimicrobial use is shifting this normal bacterial flora and allowing the more pathogenic organisms to take hold.

The classic triad (and I can't find a good picture) is one of the person, the environment and the pathogen. One of the biggest failures in medicine has been this intense focus on the pathogen. More and better drugs have been developed to combat viruses and bacteria but in all that progress, little attention has been paid to the state of the patient (basic nursing care such as cleanliness, good nutrition, calm environment) that can improve their overall health and immune system. The environment is also important. Not to make it completely sanitary but basic cleanliness, handwashing, etc. (as mentioned before) can do more to stop the spread of disease. I think these things are addressed but not to the extent that they can be. Of course, extensive antibiotic use not just in animal feed but injudicious use of antibiotics for viral infections has increased microbial resistance.

I always find it fascinating that while in large animal practice, I would perform abdominal surgery in the barn and these animals rarely got complications. I once did a Cesaerian section out in the open field and that cow did fine. But, these cows come to the vet med teaching hospital for abdominal surgery where everything is autoclaved, drapes are used and everyone is completely scrubbed and gowned and some of these animals have horrid complications if infected by a multi drug resistant bacteria that is lurking in the surgery room.

The people who are most devastated by these diseases are also in countries (Africa, India) where HIV/AIDS is the most rampant and devastating. Couple this with poverty and stress that accompanies that and the poor nutrition and they don't stand a fighting chance.

I think if we are to combat this, attention needs to be paid to HIV/AIDS, to poverty and nutrition as well as working on patient care and judicious use of sanitation.

[Jeysie]

I'll add to Square's complaints about impoliteness the fact that people don't properly stay home when they're ill, either.

At least in the kind of jobs I usually work, people tend to come in to work sick because of heavy work loads and lack of sick days. Or, customers go out shopping while they're ill. The net result being that, because of the confined environment, everyone else in the place gets sick, too.

I still remember one infamous time when I used to work at a clothing store where one of my co-workers was walking with a heavy and very obvious case of chicken pox! I complained about it to both the worker and my bosses and they basically told me "Oh, well, everyone's probably had it already by now." (I personally *had* already gotten chicken pox a few years earlier when I was 14, but you know, what about the customers? Morons.)

Peace & Luv, Liz

[colpet]

Originally Posted by Melanie68

People who are not immune compromised have so little faith in their immune systems. We don't need everything antimicrobial. You have to realize, there are more bacteria in and on us than we have cells in our body. They are part of our normal bacterial flora that actually keep the pathogenic bacteria at bay. Constant antimicrobial use is shifting this normal bacterial flora and allowing the more pathogenic organisms to take hold.

The classic triad (and I can't find a good picture) is one of the person, the environment and the pathogen. One of the biggest failures in medicine has been this intense focus on the pathogen. More and better drugs have been developed to combat viruses and bacteria but in all that progress, little attention has been paid to the state of the patient (basic nursing care such as cleanliness, good nutrition, calm environment) that can improve their overall health and immune system. The environment is also important. Not to make it completely sanitary but basic cleanliness, handwashing, etc. (as mentioned before) can do more to stop the spread of disease. I think these things are addressed but not to the extent that they can be. Of course, extensive antibiotic use not just in animal feed but injudicious use of antibiotics for viral infections has increased microbial resistance.

I always find it fascinating that while in large animal practice, I would perform abdominal surgery in the barn and these animals rarely got complications. I once did a Cesaerian section out in the open field and that cow did fine. But, these cows come to the vet med teaching hospital for abdominal surgery where everything is autoclaved, drapes are used and everyone is completely scrubbed and gowned and some of these animals have horrid complications if infected by a multi drug resistant bacteria that is lurking in the surgery room.

The people who are most devastated by these diseases are also in countries (Africa, India) where HIV/AIDS is the most rampant and devastating. Couple this with poverty and stress that accompanies that and the poor nutrition and they don't stand a fighting chance.

I think if we are to combat this, attention needs to be paid to HIV/AIDS, to poverty and nutrition as well as working on patient care and judicious use of sanitation.

Well said.
Microorganisms live and evolve along side of us. Left to our own devices, our immune system usually rallys to the challenge. Inevitably there will be germs that mutate enough to devestate the population, but the hosts that remain will be stronger for the challenge.
Many pathogens are more opportunists than truly deadly in their own right.
They rely on weakened host defences to cause disease. Though antibiotics and vaccines are useful, ultimately the strength of the host determines the efficacy of these measures. Erratication of germs is an impossibility. All that does is create monster strains that are more of a problem that their ancestors.

[DomStLeger]

I don't want to add to the doom mongering but we're in a unique and worrying position at the moment.

For the last 60 years or so economically developed countries have largely managed to bring infectious diseases within their borders under control. In the UK, for example, terrible diseases like TB are no longer endemic thanks to the development of TB drugs and the childhood BCG vaccine program. Meanwhile other infectious diseases, such as common Staph and Strep infections have been very easily treated with antibiotics, and an infection is no longer regarded as deadly and dangerous state that it once was.

However now we find ourselves in the position where significant resistance is developing to drugs. TB drugs are becoming less effective and we now have strict protocols on how to treat it, moving through the various drugs available in stages (trying the drugs with the most resistance first to help and reduce the chance of the better drugs being resisted after unnecessary use) and combination therapies.

MRSA (Methicillin Resistant Staphylococcus Aureus) has become something of a media obsession recently, and while the media tends to blow things out of all proportions it is actually something we should be worried about. Staph Aureus is a very common bacterium, carried by many people symptomatically (eg: in the nose). However, overuse of antibiotics (in hospital, in the community and in agriculture) and bacteria's extraordinary ability to mutate and exchange DNA has to lead to resistant strains forming. These strains, as I'm sure you've heard, are very difficult to clear and in hospital if you become infected you have to be isolated as much as possible.

What you may not know is how close we are to running out of drugs to treat this bacterium. Basically we have run out of antibiotics to try and we are now in the position where we have one antibiotic left that does seem to work well and doesn't have much resistance to it - Vancomycin. This drug is good but it's held in reserve as a last resort because the truth is if resistance develops we will have little (if anything) left to to use.

The stories you hear about MRSA are the tip of the iceberg. It's basically endemic in many UK hospitals now. And the pessimistic view is that we have 5 years left before antibiotics become useless in a majority of infections.

The good news is that there are new anti-bacterial therapies on the way (for example genetically engineered viruses for bacteria) but the bad news is they are some way off and when they do arrive they will likely be very expensive. We could be on the cusp of a period when infectious diseases become endemic again and we have as many options in dealing with them as the physicians of 1900.

There is an old Chinese insult - "May you live in interesting times"... I think we're just a few years away from interesting times.

Originally Posted by Intrepid Homoludens

You can die NOW from tuberculosis, AIDS, pneumonia, avian flu, and other deadly diseases plaguing the world. You can also still contract polio (there are new cases being reported in India and Indonesia). To put it bluntly, your chances of dying from microorganisms today are more or less as high as it was 100 years ago.

preview video

There are new strains of tuberculosis in countries like Peru that are resistant to ANY known vaccines and antibiotics. There are also countless potentially deadly microorganisms yet to be discovered. One of them killed a 21-year-old American college football player who was otherwise in perfect health at the prime of his life. He caught it from scraping himself during a game of football.

I just finished watching a 2 hour show on PBS, the first of 3 installments of Rx For Survival: A Global Health Challenge. It "examines what makes us sick, what keeps us healthy, and what it would take to give good health the upper hand."

...infectious diseases that had nearly been conquered, such as tuberculosis, have come surging back, while devastating new diseases such as AIDS, SARS and West Nile Virus have emerged. Microbial resistance to many modern drugs is rising, threatening people everywhere. And in our world of globalized travel, the latest epidemic is only a plane ride away.

It was hard to watch. I saw a young mother in Peru suffering from a new strain of drug resistant tb. She was beautiful and loved her son so much, but not even the most cutting edge medicines could help her. She died, and shortly after her little son was diagnosed with tb. Another tb victim, a 21-year-old student, was suffering the side effects of the same treatment. He weighed just 66 pounds, but he survived and was cured.

In India and Nigeria mothers are refusing to let health workers immunize their babies against a new outbreak of polio, and many children end up paralyzed for life. A single baby left unimmunized could contract and reignite the plague to spread far beyond its village and into other countries, possibly even reaching Europe and the U.S. Why are parents not immunizing their kids? Ignorance and religion. Just to let you know, you are not immune just because you live thousands of miles away. With plane travel and global trade prominent, a single person unknowingly infected with, say, avian flu, could come in contact with people in your country, spreading the sickness.

This television event looks at the most critical and emerging threats to global public health and chronicles the leaders who, against all odds, deliver the goods.

Awesome program so far, makes you really think hard about what it means to be as healthy as you can today......and how fragile even that can be.

So what are your thoughts about the state of disease today?

Yep. It's a thread, alright.

[Intrepid Homoludens]

Originally Posted by DomStLeger

What you may not know is how close we are to running out of drugs to treat this bacterium. Basically we have run out of antibiotics to try and we are now in the position where we have one antibiotic left that does seem to work well and doesn't have much resistance to it - Vancomycin. This drug is good but it's held in reserve as a last resort because the truth is if resistance develops we will have little (if anything) left to to use.

More bad news is that a lot of pharmaceutical companies aren't investing as much money in R&D for vaccines. It's because this field isn't as commercially viable, the returns in investment could take years, if not decades. They'd rather go where the money is.

The average time period it takes for a new drug from discover to research to government approval to commercial availability is, what, ten years? And that's more towards the minimum amount of time. For every 5,000 possibilities for a new drug, only 1 might make it through.

[Melanie68]

Vaccines on the Road to Recovery Maybe this will give you some hope.



Typically drug development is 10-15 years. Very promising drugs are fast tracked (those are often cancer chemotherapeutics or cancer vaccines that show great promise).

I'm not sure about numbers but thousands of drugs are tested in vitro to see if they will even hit the target that the company is looking for (e.g. a receptor on a cell). Many of these compounds fail and are dropped. The compounds that do hit the target are then checked for carcinogenicity in bacteria (can they mutate DNA) and mammalian cells (can they break and rearrange chromosomes). If they fail, they are often dropped unless it's an incredibly promising drug. Then these drugs go into short term (90 day) studies to see if any toxicity (typically cardiovascular, liver most commonly) develops and then you need to figure out if that toxicity is mouse/rat specific or if it could manifest itself in humans during Phase I trials. Recently, pharmaceutical companies like Bristol Meyers Squibb and others have started a Discovery Toxicology Division to find those compounds that will show toxicity in short term studies using smaller numbers of animals (<10). That way, drugs that may cause problems are discarded and animals, money and time are saved. Long term studies (2 years) are done on mice and rats to check for carcinogenicity.

Spoiler:

When I finally get my PhD, I'll work in the safety study area evaluating those studies

When all those are passed satisfactorally an application is then made to the FDA to test the compound in humans. Phase I (check for safety, establish doses, look for side effects), Phase II (efficacy and further safety evaluation in larger numbers of people) and Phase III (efficacy, side effects and compare the new drug to existing treatments) trials are conducted in people. Finally an application is made to the FDA to market the drug. The number that I commonly hear is for every 5 compounds that enter clinical trials, only 1 makes it to the market place.

Sorry if I confused anyone with all this verbiage.

[SakSquash]

I never wash my hands....EVER. Not even after flea markets. If I can survive that, I can survive this.

[Intrepid Homoludens]

Thanks for the clarification, Melanie. I got the weird '5000 potentials = 1 good drug' from the first episode of the program. I think it has to be more than 1 drug passed but my memory needs jogging.

I just finished the second and third episodes about 20 minutes ago. Amazing! Ever heard of river blindness? It takes about 15 years to develop in an infected human living in communities near water (mostly in Africa but there are reported cases in South America). Actually the river is not what causes the blindness, it's a certain type of parasitical worm. Flies catch the worm, and when a fly bites a human he is infected. Eventually the body's immune response to the worms can lead to eye opacities, eventually causing blindness by the time the victim reaches adulthood.

In the 1980s/90s the pharmaceutical company Merck did R&D and developed a drug (Mectizan?) to combat this river blindness. Unfortunately the average citizen in any given village couldn't afford the $1 a year it costs for one dosage (a couple pills), so in the end Merck decided to give it to everyone for free for as long as they need. But the real problem was geography - how to get the medicine to the people who lived miles and miles away from even the farthest dirt roads. The answer - hire a charismatic health workers who know the villagers intimately and teach the communities to set up a self sustaining system where they can take care of each other.

The next episode chronicled the spread of West Nile Virus - INSIDE THE UNITED STATES. Just a few years back crows in New York City started dropping dead. From then on the entire country - OUR country - was swarmed with this deadly disease. Hundreds were infected, dozens died. The cause? A virus traveling inside mosquitoes. That virus is thought to have hitched a ride in a mosquito that hitched a ride onto - yep, you guessed it - an airplane, from Africa.

[Melanie68]

I probably gave you more than what you wanted. Once I start, I can't shut up.

I watched the show tonight. The malaria segment just broke my heart. Africa loses the number of children in one day (3,000) that is equal to the number of people who died on 9/11.
Bill Gates, as reviled as he is, gives a lot of money to malaria research. Obviously much more needs to be done in terms of the environment (mosquito control) and getting effective medications to the people who need them (and can't afford them).

As for the river blindness, Ivermectin is an incredible drug. I hate to toot my own horn (and I think ColPet would agree with me), that veterinary medicine is not just important for animals. What is understood about disease in animals can often be applicable to humans. To toot the horn of my specialty - Veterinary Pathology - the segment on West Nile virus featured Tracy MacNamara who found the link between the encephalitis in birds and people. A lot of people think we just deal in animals but we understand many of the comparative aspects of disease so what is learned can be applied to understanding human disease. That's why I love what I do.

[Intrepid Homoludens]

The malaria story featured that one health worker, a woman, who supervised a small hospital of babies and children. She said that every single day 2-5 babies die. I couldn't sit there without tears welling up in my eyes listening to that.

Yeah, that river blindness medicine got its start from pet pills!! Makes sense, it kills worms.

You know what really pissed me off? That those f#&king morons at the CDC in New York refused to listen to that one scientist's hypothesis that the dead crows and those people who died from their brains swelling up must have been related. It had to take a few more deaths for them to finally take notice! ARRGH!!!