Bravo Barney Frank

Grasp basics (and a bit more) of pharmacology

What exactly happens when you take an aspirin? Why do you have to continue taking certain medications instead of just taking them once? What exactly is the difference between pharmacodynamics and pharmacokinetics?
If you’ve ever wanted to better understand what that little pill does to your body–and what your body does to that little pill–you’ll enjoy the Interactive Clinical Pharmacology website.
This site was developed by the the Department of Clinical Pharmacology at the Christchurch Hospital and School of Medicine in New Zealand.
What I appreciated in particular was the ability to interact with the website’s animated illustrations. This allows you to grasp a bit easier certain complex aspects of pharmacology. But fair warning: the website does presume, as the authors put it themselves, “a basic understanding of physiology and pharmacology”.
Interactive Clinical Pharmacology

Incredible animation on angiogenesis at Amgen

Beyond a certain point of growth, cancer cells, like any other cells, need blood vessels to provide them with nutrients and dispose of waste.
Angiogenesis is the process by which new blood vessels are formed in living tissue. Although the term, in and of itself, is not obligatorily attached to cancer, it is usually used in this sense; that’s to say the ability of cancer cells to invoke the creation of new blood vessels in tissue, thus assuring their nutritional needs and allowing them to continue to grow.
Controlling angiogenesis as a method of cancer treatment is thus a major field of current research.
The therapeutics company Amgen has put up an absolutely amazing Flash animation explaining the process of cancerous angiogenesis. This is really, really well done and an excellent illustration of just how powerful the web can be for educational purposes.
Don’t be frightened off by their use of medical terminology: the supporting animations are so well done that even a novice can keep up and learn a lot on this promising therapeutic path for cancer treatment.
Bravo Amgen!

Pioneering New Frontiers in Tumor Angiogenesis

Targeting cellular mechanisms for the treatment of HIV

An article by Readinger et al entitled “Selective targeting of ITK blocks multiple steps of HIV replication” and published (free access) in the May 6th edition of the Proceedings of the National Academy of Sciences has been receiving a certain amount of press recently and for good reason.

Most therapeutic approaches to the treatment of HIV infection have been—and continue to be—built on the idea of attacking mechanisms of the virus itself. Highly Active Antiretroviral Therapy (HAART) is an example of this. However, antiretroviral resistant strains of HIV are appearing, thus reducing the efficacy of these treatments.

One potential path for increasing the arsenal of HIV treatments is to target cellular mechanisms that are essential to HIV infection. Indeed HIV, as is the case with all viruses, must hijack cellular mechanisms in order to reproduce itself. In their article, Readinger’s team reports on their research into a cellular protein called “Inducible T cell kinase”, or ITK for short. This cellular protein is essential, at least in vitro, for T-cell activation and appears to play a key role in several steps of HIV replication. Its inactivation, which they experimented using ITK-specific siRNA or a chemical inhibitor with the charming name of BMS509744, may thus be of therapeutic importance.

Squeaky ceramic hip replacements

The New York Times published an article today on a subject that would be kind of funny if it wasn’t so serious.

Apparently a number of patients who received new ceramic hip replacements, which (were thought to(?)) have the advantage of a longer duration period than their steel and plastic counterparts, are experiencing squeaking from the implants during even normal movements. One fellow in particular has found this particularly irritating: “It can interrupt sex when my wife starts laughing,” he said.

These sometimes irritating and at least distracting sounds could signal more important problems. Healthcare professionals are concerned that the lifespan of the implant may not be as good as expected, but the main fear of some doctors is that the implants may break, leaving a mess of ceramic shards in the surrounding tissues.

Nevertheless, orthopedic surgeons are suggesting a watchful waiting approach, unless the squeaking is accompanied by more serious complications. Indeed, undergoing a second surgery to fix the problem may be worse than the problem itself.

Read the article: “That Must Be Bob. I Hear His New Hip Squeaking.” (strangely in the business section)

Oh really? What a surprise!

From the Reuters Science and Health category:

“Experts say sex abstinence program doesn’t work“

To summarize, the article reports on studies and reports from medical experts indicating that Bush and Republican supported sex abstinence programs are not reducing teen pregnancies or sexually transmitted diseases (STDs) nor are they increasing the age when sexual activity begins. They also emphasized that these programs may be doing more harm than good by not providing sufficient knowledge to teenagers on how to avoid pregnancy and STDs if they should have sexual relations.

These health professionals from the American Public Health Association, U.S. Institute of Medicine, American Psychological Association and American College of Obstetricians and Gynecologists recommend instead comprehensive sexual education programs, that provide America’s youth with knowledge they need to make intelligent decisions, including abstinence, concerning sexual activity.

Did you notice how this ties in with my “blogging American Unreason” series (see the preceding two posts)? Indeed this is a perfect—but oh how it’s a perfect—example of American anti-rationalism and anti-intellectualism in living action. Check out this quote taken from the second page of the Reuters article:

“Rep. John Duncan, a Tennessee Republican, said that it seems ‘rather elitist’ that people with academic degrees in health think they know better than parents what type of sex education is appropriate. ‘I don’t think it’s something we should abandon,’ he said of abstinence-only funding.”

Did you notice how he doesn’t try to demonstrate falsehood of the rational argument the “people with academic degrees in health” are stating, he just accuses them of being “elitist”. You have there ad hominem anti-intellectualism combined with anti-rationalism. That’s bad enough, but then he goes on to pander to parents by saying that they know better about sexual education than medical experts do. This is political manipulation: I think it is safe to say that most reasonably intelligent adults with kids, when they think about it, would say that sexual education of their children requires the engagement of both the parents and the schooling system. Duncan’s panders to knee-jerk reactions in fundamentalist and uneducated Americans, and hopes that the others will just go along out of laziness. And note as well how he says he “thinks” that abstinence-only funding should not be abandoned. He “thinks” it because he cannot provide rational, tangible evidence of its efficacy and furthermore he is confronted with rational, tangible evidence of its non-efficacy. The poor thing.

“Thinking” and “believing”, and their diverse bed-partners are red-flag words; they mean that the person is speaking without knowledge and/or expressing an opinion (which comes down to the same thing). That’s a reality of the human experience and everyone not only has the right to do so, but in certain cases the obligation to do so. Nevertheless, we all need to be able to make the difference between opinion and scientifically-established evidence. The latter is not necessarily ‘proof’, and researchers will be the first to tell us that, but it’s already a much more legitimate argument than “I think”.

But here in particular, we have an illustration of anti-rationalism that is, in all probability, doing harm to American youth. When is America going to put aside its puritan anti-rational silliness concerning sex? Why are Americans (parents, in particular) so freaked out about the human body, and why are the trying to “protect” their kids from knowing how it works? The result of this bury-your-head-in-the-sand approach is a first-place finish for teen pregnancy rates in the industrialized world (be sure to scroll down and look at the chart).

Knowledge is power, especially when it’s about our kids and their future.

: : : : : : : : : : :

Vulgarizing the “top 5″ most promising new cancer treatments

In my work I’m sometimes called upon to vulgarize medical information. It’s an exercise that isn’t as easy as it seems; having the ability to knock down medical complexity to something even grandma can understand demands not only a good control of medical knowledge, but a good command of common English also.

I was taking a look at this article, “Top 5 Viable New Cancer Treatments” at Wired.com and just loved how the author, Aaron Rowe, explained the foray of vaccines into the treatment of cancer:

“In some instances, the scientists take whole cells from a tumor, kill them, and then douse them with molecules that are known to anger the immune system before injecting them back into a patient.”

I found that the idea of molecules “angering” the immune system is really a great way of expressing the concept of immune system stimulation in a simple way; it’s an excellent “image” for those who are not familiar with the immune system.

Bravo from Wandering electrons to Aaron. Keep up the good work!

Exploring the “Visible Body” Beta

Do you remember the “visible body” models we had as kids? You know, the little guy with his organs exposed… you were supposed to be fascinated by the science of it all when your grandmother gave you one as a birthday present, but instead you said, “I wanted a GI Joe”, embarrassing the living daylights out of your mom.

Well, that’s what I did.

Anyhoo, if you remember, they were pretty limited; you could pop out the liver, the lungs and the heart, maybe the eyes if your Grandma offered you the high-end model (mine didn’t), but, well, let’s just say that it was a dive into human anatomy at the uninterested 6 to 10 year-old crowd level.

Let’s fast forward now to the 21st century and imagine what could be done with the same concept, but using the power of the web, 3-dimensional modeling and one heaping dose of serious. What do you get?

www.visiblebody.com

This interactive, 3-D, web-based program is still in Beta, but already the potential is enormous! According to its developers, the current setup is designed for use at an undergraduate gross anatomy course level, which may be a bit generous as a description, at least for the moment. But for us non-doctors, there’s already a (very) good amount of information, and it’s all free. You will be asked however to create an account and I recommend that you use your junk-mail address, as they are sufficiently honest to say “We collect personal information on this site” right on the home page.

They’re currently staying a little vague as to the future of the project. I think even more detailed models are to come, but they may be pay-for additions. However I do get the impression that the basic model will stay free for use.

As I mentioned, it is a Beta, and it will be interesting to see what happens as the project evolves. I for one would like to see a little bit more precision in the tissue rendering and especially the addition of a regional anatomy function; currently you only have the choice of a system-based approach. Also, certain systems are not yet complete. For example, the lymphatic system does not go any further than the thymus and the spleen; no lymphatic vessels or nodes for the moment. But already, I know of no other web-based human gross anatomy tool that gives you this level of overall performance, at least not for free.

Be sure to watch the introductory video here. It’ll save you a bit of time when you fire up the puppy for the first time (fair warning, I managed to spend half a day on the website!).

Further reading:
Vanessa Ruiz had the opportunity to interview the CEO of Argosy Publishing, Andrew Bowditch, on the development and future of this project. She has published the interview on her blog “Street Anatomy“:

Under the Skin of Argosy’s Visible Body

Other good things to know:
The program currently runs in and is compatible only with the Internet Explorer browser. Upon installation, two plug-ins will also be added: a Macromedia Flash Player and the Anark Client version 4. The latter will appear in your Control Panel and in Add/Remove programs. Don’t delete it thinking it’s just junk!

Early cancer diagnosis and insurance coverage

A study to be published in The Lancet Oncology has apparently confirmed the fact that Americans without insurance or insured by Medicaid are much less likely to benefit from early cancer detection.

Read: when they do finally have their cancers diagnosed, it’s already in stage 3 or 4 and their hopes of living another 5 years are extremely low, compared to those who have a cancer diagnosed in early stages.

Of course, for a difference to be found the cancer in question must have an early screening technique, such as those for colon or breast cancer, or have clear early warning signs, such as in bladder cancer or melanoma.

Logically, no difference could be found for those cancers that do not have early screening techniques or signs, such as ovarian or pancreatic cancers.

Although the results of this study come, unfortunately, as no surprise, it was important to quantify this phenomenon and I do hope that this study will find a springboard in this year of presidential elections.

Further reading:

Study Finds Cancer Diagnosis Linked to Insurance at the New York Times.
Late-Stage Diagnosis More Likely Among Uninsured at the American Cancer Society website.

As of this writing, The original article has not yet appeared at The Lancet Oncology website, but it should show up pretty soon. It will be however a pay-article on the web. Try your local library for free access to the original article.

Is your doctor down in the dumps?

The British Medical Journal is highlighting this month an article by Fahrenkopf et al entitled “Rates of medication errors among depressed and burnt out residents: prospective cohort study“. When I read the title of this research article my first thought was here’s another “Duh study”; I mean wouldn’t you expect depressed and burned out doctors to make more errors?