Archive for the ‘Public Health’ Category

While I appreciate the idea behind the new site iTherapy it does have a few issues with actual human interaction, for example take this exchange between me and the bot:

Human: I knows eh!
TARA at iTherapy.com: Are you Canadian? I am learning more about you all the time.: said knows.

Human: I already said I wasn’t Canadian
TARA at iTherapy.com: Perhaps I misunderstood. What were you?

Human: Well at one point I was a ball of cells called a gastrula
TARA at iTherapy.com: Well that’s okay. Do you often use a computer there?

Human: Well yes, we’re so advanced in New Zealand we’ve made uterus based computing the future
TARA at iTherapy.com: How about that. How much time do you spend online? Do you think I am advanced in New Zealand we made uterus based computing the future too?

Well, at least it gives it a go I guess. But it’s not going to be an adequate replacement for a human being any time soon I’m afraid.

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So it seems that Bush and company have decided that they are no longer forcing much of their AIDs money to go into abstinence only campaigns. Instead they now require ‘justification’ if less than 50% of money doesn’t go into abstinence or faithfulness campaigns, which may sound reasonable but it will depend in my view on how stringent they are (and what conditions they stick on that). The ABC (Abstinence, Be faithful and use Condoms) campaign in Nigeria showed this can be a very effective approach, but preaching abstinence and faithfulness alone is utterly worthless for doing much of anything. If this is just another way of enforcing more money into going into campaigns that clearly don’t work well rather than sensible sexual education and prevention campaign (and that means encouraging things like condom use) then it’s just going to make things worse.

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All I can do is sigh

It seems that one of our hospitals once again makes a grievous mistake and everyday New Zealanders pay the price for it:

Dr Roman Hasil botched eight of 32 32 tubal ligations (sterilisation procedures), resulting in six pregnancies.

In his report Commissioner Ron Paterson censures the doctor and the DHB for “serious failings in the care of women at the hospital.”

A new report blames the health board for not making background checks which would have revealed the Czech trained doctor had spent time in jail overseas before coming to New Zealand from Australia.

Really, I don’t believe further commentary is really required but it does make me wonder if we should be making a stronger attempt here in New Zealand to hold onto our own doctors that we train (many of whom disappear overseas immediately themselves due to better wages and working conditions).

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Nature and HIV pessimism

This news article in Nature, entitled, HIV can ‘never be cured’ caught my interest pretty much immediately as it describes some interesting new research on the HIV virus and for its unusually pessimistic title. For one thing, it’s true that HIV is a very tricky virus to get rid of because it attacks the immune system that a vaccine and the host needs to actually destroy the virus to begin with. Additionally, as if things weren’t bad enough, HIV is pretty crafty and likes to hide in a wide variety of places such as inside T-cells (the generals of the immune system for a rough comparison), follicular dendritic cells (which store antigens for restimulating memory T-cells) and apparently even the gut (1). Being able to infect the gut causes a few problems, one of which is that the current top of the line anti-retroviral drugs don’t seem to be able to destroy this gut reservoir of HIV. This leads to a continual re-infection of the rest of the body from the HIV population in the guts lymphoid (immune) tissue.

While a serious problem, I don’t view this as making HIV ‘incurable’ by any stretch, just it makes things considerably more complicated. It should mean rather than being a result that makes us more pessimistic, instead it should be taken as a result that bolsters our understanding of how HIV causes an infection and better design a vaccine/new drug regimen. For example, armed with this knowledge a potential vaccine may have aspects that help target mucosal immunity and could [theoretically] inspire the gastrointestinal part of the immune system to help destroy the virus: or even prevent the early reservoir from being able to form abrogating an infection. Likewise, current anti-retroviral treatments could have new drugs or altered existing drugs that can target the virus in the gut lymphoid tissue, helping to further prevent reinfection with the virus.

It should be conceded that HIV being able to form a relatively protected reservoir in the gut does make life a whole lot more difficult, I don’t think it’s a result that warrants undue pessimism by any stretch. Knowing something you didn’t know before and couldn’t account for, doesn’t make HIV any more ‘incurable’ than it was before, instead it should be taken as a new way of thinking and attacking the problem at hand. Statements like declaring it ‘incurable’ are not going to help anyone anytime soon.

1) Chun, T.-W. et al. J. Infect. Dis. doi:10.1086/527324 (2007).

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Herceptin court case

From what I understand of Herceptin, I can’t quite understand why we don’t fund a full (one year) course of the drug. Neither can a group of women with breast cancer, who are taking New Zealands drug funding agency Pharmac to court to find out and have had a small win:

Eight breast cancer survivors have won the right to see “commercially sensitive” documents on the first day of their high court appeal against Pharmac.

They are challenging Pharmac’s decision not to fund a full course of Herceptin treatment for New Zealand women diagnosed with her-2 positive breast cancer.

The government currently funds the treatment for nine weeks, with doctors advising women to continue privately funding the drug if they can afford it.

I hope they do win. Herceptin has a good record (again, from what I know of it anyway) and should be funded for the amount of time it takes to be effective.

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[This is a repost from my previous blog that’s semi-relevant to another topic I’m going to bring up in the near future on this blog. It’s also a cheap way of getting postcount++ while I don’t have the time to make a totally new post. Enjoy!]

Cannibalism is one of those practices that, at least as far as humans go isn’t very high on the list of things that are socially acceptable. One of the numerous problems with cannibalistic practices is the transmission of diseases, after all what infects dinner is just as easily going to infect the cannibal. It should be reasonable common sense as a result not to feed a farmed animal the remains of their fellow animals. This would greatly aid the spread of an infectious microorganism through a herd and possibly even rapidly increase virulence (which is often directly correlated to the ease of transmission).

The case example of why this practice shouldn’t be performed, with any animal, is the dramatic outbreak of bovine spongiform encephalopathy (BSE) in Britain. BSE was found to be spread by an infectious protein called a prion, which is predominantly found in the brain and spinal matter of the remains of cattle. Worse, these parts were frequently fed back to other cattle as a supplement to their feed, providing an easy method of transmission for the infectious prions. The worst part of the entire discovery was not just that other cattle could be infected in this manner, but the potential spread of the disease between beef from infected cattle and humans. This led to the culling and suffering of a large number of animals and an overall ban on British beef that lasted a considerable time.


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Although I have been in the land of the blogging dead for some time now, I’ve still been following and taking a great amount of interest in the British Governments response to the bovine tuberculosis epidemic in England. My previous posts and some background can be found on my old blog (Part I, Part II, Part III and Part IV), but a quick summary before I go into the meat of this post is probably a good idea (and nobody wants to follow around a billion links all over the place!).

Essentially, England has somewhat of a crisis on its hand as the incidence of bovine tuberculosis, caused by Mycobacterium bovis rises dramatically and the tuberculin skin testing method used to control the organism in most places fails. Why does a method that has worked to eliminate M. bovis from the cattle population worldwide successfully fail in England, New Zealand and a few other specific places? It turns out that M. bovis does a clever trick of infecting a secondary animal that provides it with an external reservoir making it much more difficult to eliminate. In New Zealand, bovine tuberculosis is found in possums, which often live near bush on the edges of farmland and subsequently die in a paddock where cattle may fossick around the infected corpse. In Britain, the principal animal that carries bovine tuberculosis is the badger, but unlike in New Zealand where we’re quite happy to shoot possums on sight as they are a pest, the badger is a beloved native animal and has a considerable conservationist movement behind it. This of course, does not sit well with farmers that are watching bovine tuberculosis rates go through the roof cutting into their already strained profits. Due to the emotions, public debate and several scientific studies that severely muddied up the water, the British government is finding a tough time to deal with the issue.

Jumping forward to more recent times, I noticed a relatively recent Nature editorial that discussed the issue and took an opportunity to have a go at David King, the UK governments chief scientific advisor:

Back in February 1998, the Independent Scientific Group on Cattle TB (ISG) was set up under the chairmanship of John Bourne, a prominent animal-health specialist, to advise the government department that was responsible for the issue at the time. After much deliberation and the submission of several peer-reviewed papers (such as C. A. Donnelly et al. Nature 439, 843–846; 2006), the ISG issued its final report on 18 June this year. Its conclusions were robust: “Badger culling cannot meaningfully contribute to the future control of cattle TB in Britain.”

King then proceeded to consider the ISG’s report along with, in his words, “other scientific evidence”, with the help of five specialists of his choosing. On 30 July he gave his report to the secretary of state with a startlingly different conclusion. “Removal of badgers,” it states, “should take place alongside the continued application of controls on cattle.” This report was made public on 22 October.

“Other scientific evidence” indeed. If I had to think of what this was, straight of the top of my head, it was more than likely the “four counties” trial in Ireland, which in stark contrast to the C.A. Donnelly et al. paper, found that complete badger culling was actually a highly effective way of reducing the incidence of bovine tuberculosis. Noticing that there was a response to this, I was a little disappointed to see that the Irish studies on badger culling were not the reason for the decision, but rather the interpretation of the existing studies was. David King responds:

 Although the scientific conclusions produced by my experts differ from the main conclusion of the ISG report, they nonetheless follow directly from the ISG’s data, which clearly show that carrying out badger removal over a large area and a sustained period of time, together with cattle removal and other controls, would deliver an overall reduction in TB incidence in cattle herds. This is the only effective course of action until efficacious vaccines become available.

Interesting enough, as the original Donnelly et al. papers did demonstrate that badger culling did have a positive effect in reducing bovine tuberculosis incidence. The contention really was between completely exterminating all badgers in the zone you wanted to control bovine tuberculosis in; or if you could get away with only culling a certain amount of the population: not culling as a general rule, which even the original studies demonstrated was effective. It is somewhat curious to me why Nature were so critical of David King and made the implication that he had ignored the data, because the data as I read it did support a badger cull to begin with: it just depended on how many badgers were culled. Of course, I’ll state immediately that it’s been some time since I read these studies in depth and had a really good feel around the subject area, so I may have missed something in the period between my original posts and now. This does give me a good excuse to look at the original data again and write that long since overdue fifth part of the series that looked specifically at this issue (boy, do I wish I had it done now).

David King also makes a pretty salient point:

On the basis of the scientific evidence, I do not believe that we can control TB in cattle — and badgers — without removing the sources of infection in both species. Other countries have been unable to control TB in cattle without addressing the wildlife reservoir (N. E. Tweddle and P. Livingstone Vet. Microbiol. 40, 23–39; 1994)

Quite true.

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