Last fall as the Ebola epidemic continued unabated, experts started discussing something that had never before been bandied about: the idea of Ebola becoming endemic in parts of West Africa. Endemic diseases, like malaria and Lassa fever in that region of Africa, are constant presences. Instead of surfacing periodically, as it always has before now, Ebola in an endemic form would persist in the human population, at low levels of transmission, indefinitely.
The debate was stoked by a paper written by the World Health Organization (WHO) Ebola Response Team and published in October in the New England Journal of Medicine. The sentence that grabbed the world’s attention was saved till near the very end: “For the medium term, at least, we must therefore face the possibility that EVD [Ebola virus] will become endemic among the human population of West Africa, a prospect that has never previously been contemplated.”
What would it mean exactly for Ebola to become endemic, and how would it change things?
This article was originally published on The Conversation.
Food labels seem to provide all the information a thoughtful consumer needs, so counting calories should be simple. But things get tricky because food labels tell only half the story.
A calorie is a measure of usable energy. Food labels say how many calories a food contains. But what they don’t say is that how many calories you actually get out of your food depends on how highly processed it is.
Food-processing includes cooking, blending and mashing, or using refined instead of unrefined flour. It can be done by the food industry before you buy, or in your home when you prepare a meal. Its effects can be big. If you eat your food raw, you will tend to lose weight. If you eat the same food cooked, you will tend to gain weight. Same calories, different outcome.
For our ancestors, it could have meant the difference between life and death. Hundreds of thousands of years ago, when early humans learned to cook they were able to access more energy in whatever they ate. The extra energy allowed them to develop big brains, have babies faster and travel more efficiently. Without cooking, we would not be human.
While developing drugs to cure Ebola is crucial to end the current epidemic, a vaccine that prevents the infection altogether is the end-game for viral outbreaks – a way to protect healthcare workers on the front lines and to prevent future outbreaks.
It typically takes 10 or 20 years to develop and test a vaccine and get it to market. But in Ebola’s case, this time frame has been compressed into a matter of months, bringing pharmaceutical companies, scientists and regulators into uncharted territory, striving for a vaccine to curb the still-escalating epidemic without compromising safety.
“Never before has there been a push to develop a vaccine for an emerging public health threat in this short a time frame,” said Dr. Mark Feinberg, vice president and chief public health and science officer of the drug company Merck’s vaccine division.
Dr. Ripley Ballou, head of Ebola vaccine research for GlaxoSmithKline, concurs. “I’ve been doing this kind of work for 30 years, and this is the first time I’ve encountered anything with the compressed timeline and sense of urgency,” he said.
In the mid-1800s, English chemist William Henry Perkin serendipitously synthesized the first non-natural dye: starting with coal tar, he was hoping to produce the malaria drug quinine but instead created mauve. His discovery revolutionized the textile industry and launched the petrochemical industry. Natural dyes just didn’t have the staying power and vivid colors of the dye Perkin created. Never before had such a steadfast dye been found.
Soon after, August Hofmann (Perkin’s chemistry professor) noticed that a dye he had derived from coal tar formed a color when exposed to air. The molecule responsible was para-phenylenediamine, or PPD, the foundation of most permanent hair dyes today.
Although hair is a protein fiber, like wool, the dyeing process for textiles cannot be duplicated on the head. To get wool to take a dye, you must boil the wool in an acidic solution for an hour. The equivalent for hair is to bathe it in the chemical ammonia. Ammonia separates the protective protein layers, allowing dye compounds to penetrate the hair shaft and access the underlying pigment, melanin.
A defining feature of this Ebola epidemic has been the significant resistance of some of the affected communities to treatment and prevention measures by foreign aid workers and their own governments. Many local people, suspicious and fearful, have refused to go to treatment centers or turn over bodies for safe burial, and whole communities have prohibited the entry of doctors and health teams.
As the months have gone by that resistance has been less reported upon, and there are signs that it may be lessening. In the Forest Region of Guinea, where the Ebola epidemic started, foreign staff previously faced roadblocks, stone-throwing and violent attacks. But in the last few weeks, as the New York Times has reported, locals have opened up the literal and figurative barricades around their villages and sought outside help.
Still, the friction continues to shape the spread of the disease. Doctors Without Borders’ December briefing paper [pdf] calls the situation in Guinea “alarming,” with 25 percent more cases reported in November than October and many areas where there is “still a great deal of resistance towards Ebola response” and their teams are “not welcome.”
The solution, some say, is to reevaluate treatment and prevention tactics with the benefit of an anthropological perspective. That was the call delivered last week by a meeting of the American Anthropological Association in Washington D.C. If international staff had approached the epidemic from day one with more understanding of cultural, historical and political context, attendees said, local traditions and community leaders could have become assets rather than obstacles in the fight against Ebola.
The American Anthropological Association is asking for anthropologists to become more involved in the global Ebola response. They have started the Ebola Emergency Response Initiative to connect anthropologists who are already working in or experienced with West Africa, and to build structures and programs that help more anthropologists spend time directly involved in the Ebola response on the ground.
“We’ve worked in these places and we’re watching our friends die,” said University of Florida professor Sharon Abramowitz, one of the founders of the initiative.
Abramowitz points out that the anthropologists involved in the initiative have a total of 300 years of ethnographic experience in the affected West African nations – experience which could help medical scientists both understand and respond to the epidemic.
The Ebola virus has consistently stayed several steps ahead of doctors, public officials and others trying to fight the epidemic. Throughout the first half of 2014, it spread quickly as international and even local leaders failed to recognize the severity of the situation. In recent weeks, with international response in high gear, the virus has thrown more curve balls.
The spread has significantly slowed in Liberia and beds for Ebola patients are empty even as the U.S. is building multiple treatment centers there. Meanwhile the epidemic has escalated greatly in Sierra Leone, which has a serious dearth of treatment centers. And in Mali, where an incursion was successfully contained in October, a rash of new cases has spread from an infected imam.
Predicting the trajectory of Ebola rather than playing catching-up could do much to help prevent and contain the disease. Some experts have called for prioritizing mobile treatment units that can be quickly relocated to the spots most needed. Figuring out where Ebola is likely to strike next or finding emerging hot spots early on would be key to the placement of these treatment centers.
But such modeling requires data, and lots of it. And for stressed healthcare workers on the ground and government and non-profit agencies scrambling to combat a raging epidemic, collecting and disseminating data is often not a high priority.
This article was originally published on The Conversation.
Innovative new drugs to treat cancer frequently make the headlines, either due to great success or controversy, as pharmaceutical companies get lambasted for selling the drugs at too high a price for state systems to afford.
But alongside this high-budget pharmaceutical research is a different tactic being quietly waged in the background: investigating old, inexpensive drugs, originally designed for a variety of maladies, to see whether they might be able to treat cancer – essentially, repurposing old for new.
Repurposing Drugs in Oncology (ReDO), the international organization aimed at promoting work in this area, defines repurposing as “the use of existing and well-characterized non-cancer drugs as new treatments for cancer.” ReDO believes that such drugs “may represent an untapped source of novel therapies.” Current candidates include diclofenac, an anti-inflammatory pain relief medication; clarithromycin, an antibiotic; and cimetidine, an antacid prescribed for stomach ulcers.
Cancers are increasingly being treated on the basis of the mutations that cause them, rather than where they are located. Seemingly distinct and unrelated cancers can arise due to the same genetic defect. Developing new drugs that target these mutations in a way that largely spares healthy cells is far from serendipitous and involves complex mathematical modelling and tens of thousands of laboratory hours to achieve even a prototype drug. All of this costs time and money.
Some researchers are shunning this process and instead turning to well-established drugs to improve cancer treatment. And it is an approach that is paying dividends.
Official response to the Ebola outbreak reached new heights today, as the World Health Organization declared the Ebola outbreak a Public Health Emergency of International Concern – a status that allows them to issue recommendations for travel restrictions. “We’re going to see death tolls in numbers that we can’t imagine now,” Ken Isaacs, a vice president at the NGO Samaritan’s Purse, told a congressional hearing yesterday.
The attention on Ebola, and the urgent need for solutions, has focused attention on experimental treatments waiting in the wings – and ignited an ethical debate about whether giving untested drugs to patients is the best course of action.
Based on the most recent official reports, 1,712 people have been infected in the current outbreak. Nearly all of these cases have been in Sierra Leone, Liberia, and Guinea, but another West African country, Nigeria, reports 9 infected people, one of whom died after flying from Liberia. Also, Saudi Arabia reported a likely case after a Saudi man died following a trip to Sierra Leone. And now, the two infected Americans, both stricken with the virus while helping victims in affected areas, have been flown to Atlanta to receive treatment. This will be achieved under special quarantine conditions at Emory University Hospital, where their body fluids will be handled using biohazard level 4 laboratory precautions in which scientists wear outfits resembling spacesuits.
It’s got lots of the trappings of similar science fiction plotlines, such as TNT’s The Last Ship, the topic of my previous post. On that series a viral pandemic, whose symptom profile looks eerily similar to that of Ebola, has killed off 80 percent of humanity. The fictional virus has managed this because it’s 100 percent contagious, nearly 100 fatal, and because the fictional scientists and physicians on the series have insufficient knowledge of the virus and no way to treat or even slow the disease. Such extreme situations facilitate nail-biting drama.
A United States Navy Destroyer is sent to the Arctic and ordered to radio silence for four months. During that time, a mysterious virus – 100 percent fatal and 100 percent contagious – spreads from isolated pockets in Africa and Asia into a pandemic. When radio silence ends and the captain and his 217 crew finally learn what’s going on, 80 percent of the human population is either dead or dying, and all government control has collapsed.
Unrealistic? Perhaps. But this is the setting of the TNT hit series The Last Ship. While that fictional virus may indeed be too lethal and spread too rapidly to be realistic, one thing this nail-biting, apocalyptic story should scare us into doing is to respond faster to viral outbreaks than we’ve been able to do in the past. The real-life models for this are two coronaviruses: Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV).
First identified in humans in 2012, MERS-CoV has since caused 572 laboratory-confirmed infections, 173 of which have been fatal, and yet clinicians have no drug that targets the virus specifically. The same is true of SARS. Despite some initial, anecdotal reports suggesting that the drug ribavirin might work against this virus, and some modest success with interferon (which has a general inhibitory effect against many viruses), there is no specific anti-SARS agent.
So whether we’re talking about a virus in real life that’s killed hundreds, or the unnamed, fictional virus from The Last Ship that’s killed billions, global and national health organizations can respond via several strategies.
We tend to think of medicine as being all about pills and potions recommended to us by another person—a doctor. But science is starting to reveal that for many conditions another ingredient could be critical to the success of these drugs, or perhaps even replace them. That ingredient is nothing more than your own mind.
Here are six ways to raid your built-in medicine cabinet.
“I talk to my pills,” says Dan Moerman, an anthropologist at the University of Michigan-Dearborn. “I say, ‘Hey guys, I know you’re going to do a terrific job.’”
That might sound eccentric, but based on what we’ve learned about the placebo effect, there is good reason to think that talking to your pills really can make them do a terrific job. The way we think and feel about medical treatments can dramatically influence how our bodies respond.
Simply believing that a treatment will work may trigger the desired effect even if the treatment is inert—a sugar pill, say, or a saline injection. For a wide range of conditions, from depression to Parkinson’s, osteoarthritis and multiple sclerosis, it is clear that the placebo response is far from imaginary. Trials have shown measurable changes such as the release of natural painkillers, altered neuronal firing patterns, lowered blood pressure or heart rate and boosted immune response, all depending on the beliefs of the patient.
It has always been assumed that the placebo effect only works if people are conned into believing that they are getting an actual active drug. But now it seems this may not be true. Belief in the placebo effect itself—rather than a particular drug—might be enough to encourage our bodies to heal.