Wednesday, February 17, 2016

Uncertain Health in an Insecure World – 75

“World War Z”

In World War Z - The Oral History of the Zombie War, billions of humans die.

This 2006 novel by Max (son of Mel) Brooks sees the world overrun with plague-infected zombies. After ten bloody years, zombies still walk the ocean floors and infest remote Arctic rim islands. In the 2013 WWZ movie, Brad Pitt’s character, Gerry Lane, unsure if he too is infected, retreats from the epic carnage to a W.H.O. safe facility.  The geopolitical sweep of the story – rife with themes of isolationism, survivalism and situational ambiguity – makes it much more than just a zombie flick.

As the “Great Panic” spreads quickly from patient zero in China to Taiwan to South Africa to Palestine and Israel, a border wall (below) built between the undead and the orthodox is quickly breached. It becomes the ready excuse for a nuclear exchange between Pakistan and Iran. After the disastrous Battle of Yonkers outside New York City, the epidemic eventually crosses America, and the U.S. government flees to boats off Hawaii. Common citizens escape to the relative safety of Canada’s northern tundra, where 11 million refugees freeze or starve to death. Only the International Space Station astronauts stay safely quarantined, foraging for food from abandoned space debris.

And now, World War Zika is upon us. At least it’s newly upon The Americas.

Zika is a mosquito-borne flavivirus infection related to Dengue, West Nile virus and Yellow fever. Its previous hunting ground was Africa, since its initial 1947 characterization in Uganda. But in recent months, Zika virus has become yet another global public health crisis. In a banal statement, W.H.O. General Director Margaret Chan said the virus was “spreading explosively,” and that this was an “extraordinary event”. W.H.O. predicts up to 4,000,000 infections in The Americas in the coming year. The C.D.C. reported the first U.S. case in Hawaii in January, in a mother who was infected while pregnant and residing in Brazil in May 2015.

Most current fears are related to Zika-infected women having babies with microcephaly.

This connection was made by two busy pediatricians in Recife, Brazil – Dr. Vanessa van der Linden Mota and her mother Dr. Ana van der Linden (above). The epidemiology seems compelling – 147 cases in Brazil in 2014 before Zika was widespread, and upwards of 4,180 cases since October 2015. Some Brazilian public health experts predict 50,000 to 100,000 microcephaly cases by 2020. In a troubling antisocial response, many Brazilian fathers are abandoning the mothers of their Zika-damaged children. Pregnant women from all around the world are cancelling travel to Brazil. The 2016 Summer Olympics are bound to be impacted!

But wait! The pathophysiology of Zika-associated microcephaly remains poorly understood.

Other South American physicians are linking microcephaly to the widespread recent use of Monsanto’s larvicide, pyriproxyfen, used to treat mosquito-infested drinking water tanks (see post #51 - The Monsanto Years). In 2014, the Brazilian Health Ministry ordered the injection of these chemicals into water tanks in areas where the Aedes aegypti mosquito was prevalent (below). The Pernambuco area of Brazil, where the larvicide was widely used, now accounts for 35% of the microcephaly cases. Ecologists and activists are up in arms. Brazil’s President Dilma Rousseff recently commented, “We have to mobilize so we do not lose this battle.”

But what, exactly, are they are fighting?

Unlike many local TV Action News public health talking heads, W.H.O.’s Margaret Chan was very careful to state that, “Although a causal link between Zika infection in pregnancy and microcephaly… has not been established, the circumstantial evidence is suggestive and extremely worrisome.

So, plausible global health deniability lives!

In the 1930’s, radio carried powerful messages into living rooms across the countries of the world. It contorted public opinion – spreading fascism across much of Europe and bible thumping religious extremism across the Southern U.S. The Gallup organization was founded in 1935. Before turning to election polling, George Gallup came to understand the power of public opinion, and the underlying psychology of fear. In 1938, in an effort to boost the Mercury Theatre of the Air radio program’s ratings, Orson Welles’ re-broadcast of the War of the Worlds caused a national panic that forced a very public apology.

Fact: There is no Zika virus treatment or vaccine available.

Fact: Unlike West Nile, there is no test to identify Zika virus infections in mosquitoes.

Question: Is Zika just the latest post-infectious apocalypse?

In public health, the medium of official W.H.O. and C.D.C. public statements is the message. Tepid or terrifying, their global headlines carry weight in political and medical circles. They breathe an air of credibility into “explosively… extraordinary” crises like Zika virus, often in the absence of real facts.

In the end, the fleeing masses are confused, frightened… yes, panicked!

Max Brook's The Zombie Survival Guide (2003) states that most zombies, “move at a rate of barely one step per 1.5 seconds.” WWZ zombies, while very undead, move FAST, traveling in packs that completely overwhelm military and civilian efforts to hold the line.

When the fear of a disease goes viral, mistakes get made.

We in the Square see The Truth getting trampled by these zombie hoards. Like mosquitoes, they quickly swarm their victims, but are slow to come to the facts!


Tuesday, February 2, 2016

Uncertain Health in an Insecure World – 74

“Increasingly Poor Decisions”

IFC’s television comedy (2010-2012), The Increasingly Poor Decisions of Todd Margaret, followed the doomed business fortunes of an American in London, selling the dubious energy drink, Thunder Muscle.  New to sales and British culture, with a single employee, the situation isn’t helped by the fact that Todd is also a pathological liar. Arrested for lewdness, pardoned by influence, with his American citizenship revoked, Todd ends up in the only country that will accept him – North Korea! In exile, Todd manipulates The Supreme Leader, and ends up pushing the nuclear launch button, resulting in a post-apocalyptic finale.

Funny mistakes, eh…

Make no mistake. It’s the decisions we do or don’t make as we age that cause the common signs & symptoms of aging. In fact, the associations of aging – weight gain, memory loss, lack of energy, wrinkled skin, and chronic illness – are not simply the result of the passage of time. Sedentary living, lack of sleep, poor diet, and insufficient skin care are the increasingly poor decisions that we can proactively chose to not make.

Aging is not a disease – it is a physiological process.

But if you Google the term, “reverse physiology”, you’ll be repeatedly directed to “reverse psychology”. If you dig a little deeper into the body of anti-aging science, you too may become convinced that aging physiology can be slowed, and actually reversed! Whether interventions can actually reverse aging, or are simply restoring healthy aging processes, is hotly debated. 

Unfortunately, many of us become so zealous or impatient that we resort to increasingly poor decisions – extreme exercise regimens, severe diets, hormones or stimulant drugs, and cosmetic surgery – often with counterproductive side effects after short-lived benefits. Research shows that these quick-fix strategies are not sustainable – lies that are counterproductive to underlying human physiology.

Some scientists think the cellular pathways to cancer are also part of aging.

With aging, nuclear and mitochondrial DNA communicate less effectively, adversely affecting cellular energy production. In 2013, Harvard Medical School researchers showed that increasing the level of a protein which helps cellular DNA signaling reverses aging in mice by >75% over two years. In human longevity terms, this would equate to 60 year old cells reverting to 20 year old cells!

The term epigenetics was first coined by Conrad Waddington in Nature (1942).

Epigenetic modifications to DNA methylation and to histone protein acetylation in gene chromatin are thought to affect RNA transcription (below), negatively impacting memory consolidation and synaptic plasticity. Chromatin structure is highly dynamic, and is integral to effective transcription. High frequency synaptic patterns activate NMDA receptors, causing a calcium influx which activates ERK. ERK regulates several genes by altering transcription factors essential to memory formation. The systemic administration of sodium butyrate (NaB), which increases histone H3 acetylation, rescues certain maze-solving cognitive functions in older rats and memory formation in juvenile snails.

Declining memory and cognitive ability are linked to altered gene expression in the human brain’s hippocampus and pre-frontal cortex. Some rare childhood neurodevelopmental conditions are caused (in part) by genetic defects in DNA methylation (MECP2 gene in Rett Syndrome) and histone acetylation (FMR1 gene in Fragile X Syndrome).

The basic metabolic rate (BMR) reflects total body calorie utilization at rest.

BMR is another physiologic marker which declines with age – by 2% per decade after 20 years of age. Humans lose 30% of total muscle cells between ages 20 to 70! As muscle mass decreases in middle age (i.e., sarcopenia), the resting need for oxygen and calories for muscle contraction declines. Regardless of age, adding lean muscle mass increases BMR, although aging still reduces BMR independent of muscle mass. And dieting to lose fat without exercise to build muscle is completely ill-advised.

If middle-aged persons eat the same number of calories that they ate at age 20, fat begins to build up, leading to obesity. The average 65 year old sedentary woman has twice the percent body fat of her 25 year old counterpart (43% versus 25%). For men, the corresponding figures are 38% versus 18%. Central body fat accumulation is particularly dangerous. Australian, Canadian and U.S. diabetes prevention programs have shown that lifestyle changes such as physical activity, weight loss, and de-stressing maneuvers (i.e., yoga, deep breathing, stretching, tai chi) delayed or prevented obesity-related type-2 diabetes, especially in those aged >60 years.

Many scientists believe that aging is a phenomenon unique to humans and domesticated animals.

Aging is defined as the accumulation of diverse deleterious cell and tissue changes (loss of homeostasis) that contribute to the increased risk of disease (pathology) and death. The major domains of research into the causes of aging are free radical damage, altered immunity, increased inflammation, and mitochondrial dysfunction (see above). Aging is likely multi-factorial, with each of these pathways being altered in different ways and to varying degrees.

Most scientists have long viewed the physiologic process of aging as immutable.

But many scientists have studied reversing aging physiology. One of the physiologic markers of aging is heart rate variability (HRV), which reflects a delicate balance between the health of the parasympathetic and autonomic nervous systems. HRV changes during breathing, postural shifts and sleep are primarily controlled by the vagal nerve, which loses function with advancing age. The related loss of HRV is a predictor of higher cardiovascular death rates (often sudden cardiac death). In autoimmune diseases such as diabetic neuropathy, and with the infiltration of fatty deposits into the carotid artery near the vagal nerve, blood vessel inflammation reduces HRV. Regardless of weight loss, HRV changes independently predict type-2 diabetes development in pre-diabetics.

You can’t manage what you can’t measure. Wearable fitness tracking technology has exploded!

There are dozens of commercially available wearables and mobile device apps that capture heart rate “little data” 24/7. Some can even record a medical grade ECG tracing. A few can derive HRV data – Hexoskin, OMSignal, Scanadu Scout, Zensorium Tinke, etc. The safe but not yet FDA-approved Thync device (above), worn on the temple where its impulses activate the adjacent central nervous system, increases alertness in a fashion compared to “digital Red Bullor produces relaxation when operating in “chill vibe”. Placing the FDA-approved Quell wearable device (below) on the calf of patients with chronic pain sends neural signals from the peripheral to the central nervous systems, releasing natural pain-relieving natural opioids – neuropeptides called enkephalins. Quell also tracks disrupted sleep patterns, which improve as pain is diminished.

Can we discipline ourselves to lead healthy lifestyles, which if sustained, have demonstrable anti-aging benefits in the long run?

Individual confidence is a big part of good decision-making. Todd Margaret had low self-esteem issues.

In the Square, there is growing confidence in the empowering science and technology of “reverse physiology”.            

And we're not laughing at increasingly poor decisions any more!