Category Archives: health

A ruler among science books

Though I’d read the excerpt adapted for the New York Times magazine, picking up The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, with its regal and imposing title, was just a little intimidating. But open the first page and the language propels and compels the reader to follow the disease, its history, and those who have faced it, both doctors and patients.

This is the story of cancer infused with historical depth, scientific rigor, caring, compassion, and luscious language. Mukherjee crafts the text with such skill, infusing human stories, history, and a physician’s perspective among the timeline of cancer as it’s affected human life and health. As I worked my way through this book, I found myself underlining sentences, many of them juxtaposing the hauntingly beautiful with the terrible.

Cancer, Auerbach argued, was a disease unfolded slowly in time. It did not run, but rather slouched to its birth.

Or when describing Susan Sontag’s leukemia:

“A moody, saturnine leukemia eventually volcanoed out of Sontag’s marrow.”

Although I’ve never done cancer research, I’ve learned a lot about it in my reporting. But what I’ve learned is episodic: a cellular pathway, a policy point, or a set of treatments. This volume pulls those episodes together like jewels on a necklace, creating a comprehensive picture and an understanding of a disease that’s as powerful and compelling as the stories of the patients. Not only was this book beautiful to read, but I’ll be better at reporting about cancer because I’ve read it.

Image: Human melanoma cell dividing. Credit: Paul J.Smith & Rachel Errington. Wellcome Images

Share

The role of great sources

influenza virus particle: CDC Public Health image library, Credit: Cynthia Goldsmith; Content Providers: CDC/ Dr. Erskine. L. Palmer; Dr. M. L. Martin

Though my writing life ranges from writing health stories for teens to writing about research topics and careers issues for scientists, the sources that I speak with for the former type of article generally don’t overlap with those for the latter. Until now.

Last spring, I was working on an article about the common cold, and I asked a group of writer buddies: do you know a virologist who could talk about the common cold? I need someone who can leave out the jargon– someone who’s the best of what we all look for in an interview. The recommendation– Ben tenOever— a researcher who actually works on influenza viruses at Mount Sinai School of Medicine. But he gave me a great interview– explaining viruses, how they work in terms that teens could understand. My favorite analogy that didn’t make it into the story: “If you consider the Empire State Building to be the size average cell in the nose, the virus would be the size of a fist.” The resulting story was published in December– in Weekly Reader’s Current Health 2. [sorry, it’s not available online]

But Ben’s also a young scientist on the rise– studying both how the immune system responds to viral infection and a new bioengineering strategy for developing flu vaccines– more on that in my most recent article for Science Careers. Talking with him, particularly in person, I noticed his enthusiasm, about science in general, viruses, and his own research projects. Science is a tough business, but it’s clear from talking with him how much he loves the hunt for new discoveries– combing through new data and figuring out what it means.

It’s incredibly rare that I find a scientist who is so good at tuning his descriptions and who also effuses energy and enthusiasm with every analogy or anecdote. What fun that I get to tell their stories.

Share

Pop goes the antioxidants

fresh popped kernels courtesy of my kitchen
popped kernels fresh from my kitchen

Summer’s distracted me from blogging, but I just returned from the American Chemical Society meeting in Washington, DC. That meeting is a huge mishmash for me– a combination of catching up with former chemistry colleagues, meeting up with current writing colleagues, and getting myself back up to speed on what’s new with molecules.

Though it’s a small story in the broader sense of the ACS meeting, as a popcorn fan, I can’t help but be excited that my favorite salty snack– popcorn– also packs the highest per-gram punch of polyphenols, a class of antioxidants. Before anyone goes crazy, no, we shouldn’t all switch to a popcorn diet, particularly one that’s covered in butter, real or artificial.

Fortunately, I’m an old-fashioned gal when it comes to my kernels. I like them popped fresh in a little oil on a stove, just like Mom made before we had a microwave. Some of my most vivid memories of childhood road trips include riding down either I-95 or I-10 and the tug-of-war with my sister over who got to hold the large Charles’ Chips tin containing fluffy, crunchy saltiness that Mom had popped before we left home.

popcorn on the stove, just like Mom used to make
popcorn on the stove, just like Mom used to make

Back to the science, though– the popcorn was part of a larger study by Joe Vinson and his colleagues at the University of Scranton looking at antioxidants in whole grains. Like other plant-derived foods, whole grains have antioxidants and those chemicals could be part of the reason that these foods are healthy. Not a particularly new idea, I’ll admit. But as I’m crunching on a fresh pot of snack food, I don’t mind feeling just a little less guilty.

Share

Tackling tuberculosis

Global health has been on my mind again recently. An article I wrote for Nature Reviews Drug Discovery (subscription required) examines efforts to find new drugs for tuberculosis.

Scanning electron micrograh of TB bacterium/ image: CDC/Dr. Ray Butler, credit: Janice Haney Carr
Scanning electron micrograph of TB bacterium/ image: CDC/Dr. Ray Butler, credit: Janice Haney Carr

TB is a wily organism that finds a way to wall itself off in the body. Under the best circumstances, knocking out “the best” TB, the drug susceptible variety, requires 6 to 9 months of antibiotics. That’s a long time to stay on drugs, particularly in a developing country where the health clinic could be miles away. But if people start treatment without completing it, drug resistant disease can develop. With multi-drug resistant (MDR) or extensively drug resistant (XDR) disease, that prognosis is far more uncertain. The treatments being given in these cases don’t have much scientific validation to show that they work. In some cases of XDR TB, doctors are cutting out portions of diseased lung tissue from patients because there’s not much else that they can do.

My article mostly talks about the drug discovery challenges: how do you find a new drug for an old disease particularly when half a century ago we thought this problem was solved. But there’s another piece of this story that didn’t make it into the article: how do you then do the clinical studies to test these drugs among the people who need these drugs most?

In countries where health care systems are already taxed and where doctors and nurses may not be trained to carry out clinical trial protocols, there’s an additional wrinkle. TB treatments– somewhat uniquely– are written into health care policy in countries around the world. Almost all other diseases  have recommended treatments, but the final decision belongs with the medical professionals who see the patients. What does that mean for TB clinical trials? Many more layers of red tape to set up a clinical trial. Not only do researchers have to work out trial protocols with the hospitals, they also have to get approvals from local and national authorities to modify the existing TB treatment protocols. I was amazed at the amount of coordination that’s involved.

Learn more about the search for new TB treatments at the Global Alliance for TB Drug Development.

Share

Exploding Color

NYC fireworks July 4, 2008 by Barry Yanowitz via flickr
NYC fireworks July 4, 2008 by Barry Yanowitz via flickr

Yesterday, we plotted how best to see the NYC fireworks display tonight with the least amount of inconvenience. In other years, we’ve had friends with roof access and good proximity. And a few years ago, we lived in an apartment in New Jersey that sat on a hill facing Manhattan with a bay window vantage point of much of New York Harbor.

That view was my favorite feature of that apartment, which we paid for in sweat equity– a climb up narrow stairs to the third floor. Any time of the year, but particularly on summer evenings, we might hear pops and crackles and head to the window to see where the colored bursts might appear next. Though we usually had no idea of the reason, the sky exploded in color just for us.

As a chemist I know that the palette of those bursts is all about burning different metal ions to produce fountains of shimmering color. And there’s a downside: some of the chemicals– such as perchlorates– in traditional fireworks can cause health and environmental problems. While researchers are working on greener solutions, conventional pyrotechnics are still cheaper.

Even if it means fewer displays, I hope more fireworks shows will “go green”– and red and blue and purple. Even if fireworks occur less often, the “added color value” would be worth it.

Share

MotW: Acetaminophen (and House’s Vicodin habit)

Acetaminophen structure via Wikipedia (benjah-bmm27)
Acetaminophen structure via Wikipedia (benjah-bmm27)

More FDA warnings for cold sufferers– and really anyone who takes pain relievers– to keep in mind. Acetaminophen– the molecule at the left– is found in Tylenol and a whole host of other pain relievers, cold medicines and prescription drugs. At lower doses, it’s safe, but at higher doses can cause liver damage and even liver failure. The tricky thing? The molecule is included in so many different medications that it’s possible to take too much without realizing it. If you’re sick and have a headache, that Tylenol combined with acetaminophen in a cold remedy might have just tipped the dose over the recommended levels.

An FDA advisory committee issued the warnings, but  it will be interesting to see what the agency decides to do to help prevent further problems. It’s possible that some prescription painkillers such as Percocet and Vicodin, which mix acetaminophen with narcotics, might be taken off the market.

I must admit that the Vicodin tidbit led me to more frivolous thoughts about Gregory House, the fictional doctor from the TV series. Considering everything else that has managed to go wrong with him, I’m a little surprised that the  producers haven’t written liver failure into the plot line considering his Vicodin problem. Or did I miss it? Will the writers have to find a new painkiller addiction? Will he finally kick the habit?

So– I guess I’m wondering out loud– could the FDA wind up changing both our pharmacy shelves and the plot lines of TV? My brain is lurking somewhere in that nebulous space between pop culture and medicine today.

The practical stuff, news stories and FDA info:

The fun stuff: I couldn’t find a good video clip about House’s Vicodin habit, but this video/song montage was the next best thing. Enjoy!

Share

The global cancer challenge

copyright iStockphoto.com/SchulteProductions
copyright iStockphoto.com/SchulteProductions

The policy side of my reporting head has also turned to health issues over the last year or so, particularly global health. From a Western perspective, it’s easy to take for granted the scope of care and treatments that are available. But the developing world is light-years away from even hoping to have access to so many of the (not even cutting edge) medical innovations that we often take for granted.

My growing interest in global health policy and a talk by Franco Cavalli at a symposium on translational cancer research at Hunter College in January, led me to take on the issue of global cancer control planning in my article that was just published in the Journal of the National Cancer Institute (subscription required). Here are some of the stats that impressed me as I was working on the article:

  1. More than half of the expected 27 million cancer cases in 2030 are likely to occur in low and middle income countries.
  2. At least 80% of the world’s population lives in areas not covered by cancer control registries, that keep track of basic data about cancer, who gets it, what types and the outcomes. It’s incredibly difficult to figure out any sort of policy solution when policymakers don’t have a real handle on the problem.
  3. Most countries in Subsaharan Africa have no radiotherapy machines available to treat cancer.

Providing better cancer care in these countries is first and foremost about developing a plan, and then figuring out how to bring in the resources to support their needs. Without a clear plan, any resources provided don’t get used in the most effective way.

I learned a lot about Tanzania’s cancer control planning. Although an extremely poor country with a number of problems to solve, it’s humbling to realize that even with their challenges– not enough facilities to meet demand and a shortage of trained medical professionals– the situation there is probably better than in most neighboring countries. As another example, India seems to have more overall resources, but planning is regionalized and care is more available in urban areas than in rural ones.

It’s these moments that make me stop and realize how fortunate I am– I was born to educated, middle-class parents in a country with a functioning (albeit sometimes dysfunctional) health care system. The tricky challenge in the developing world is finding the solutions that fit the needs of individual countries– physically and culturally– and bringing in the right combination of government, NGOs and others to put those solutions into practice.

A related note: over the last few weeks, Denise Grady of the New York Times has published articles about women’s reproductive health in Tanzania (here and here) with detailed first-hand reporting.

Share

Molecule of the Week: Zinc gluconate

The Molecule of the Week is the active ingredient in Zicam, the nasal gel cold remedy that the FDA warned consumers to stop using this week. What’s the problem? Some users have reported losing their sense of smell after using the gel. On Tuesday, the FDA stepped in and issued a warning letter to Matrixx Initiatives about Zicam:

According to the labeling accompanying the Zicam Cold Remedy intranasal products, each of these products “reduces” the “duration of the common cold” and the “severity of cold symptoms,” including specifically “sore throat • stuffy nose •sneezing • coughing • congestion.” These claims make these products drugs, as defined by section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act (the Act), 21 U.S.C. § 321(g)(1), because they are intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or to affect the structure or function of the body of man or other animals.

The FDA has urged consumers to stop using zinc gluconate products that involve application inside the nose. Zinc lozenges are not part of the warning. It’s a healthy reminder: just because a remedy is “homeopathic” doesn’t mean that it’s also safe. Chemical activity comes with the molecule itself– it doesn’t matter whether it was made by a living organism or synthesized in a lab.

Zinc gluconate structure from Wikimedia Commons
Zinc gluconate structure from Wikimedia Commons

The molecule itself is interesting– like two sugar-like wings around a central zinc ion. The gluconate “wings” are oxidized forms of the sugar glucose, in case that name looked familiar. Zinc ions bind to electron-rich atoms (like those oxygens) on many types of biological molecules.

I’ll be interested in the follow-up investigation into Zicam and further scientific evidence. I’m not willing to put my sense of smell on the line until researchers know more.

Reuters Health: US tells Zicam maker to stop selling some products

Share

Molecule of the Week: Water

Rippling water drop, copyright iStockphoto.com/deliormanli
Rippling water drop, copyright iStockphoto.com/deliormanli

It’s been a rainy week in New York City, and my office next to our front porch and my container garden has me thinking about that ubiquitous wetness. It’s been soaking my plants, and after a quick errand on Friday afternoon, its dampness lurked for hours on the hem of my jeans.

It’s easy to take the wonder of water for granted because it’s everywhere, but its physical properties are anything but ordinary. Almost all solids of any substance are more dense than their liquid counterparts. But if ice were more dense than liquid water, ice cubes wouldn’t float in cool drinks on a summer day. Ice wouldn’t freeze at the tops of cold lakes (no ice skating), and polar ice caps would be more like suboceanic ice cushions. If water were a normal liquid, the Earth would look really weird.

Water molecule, via Wikipedia/Booyabazooka
Water molecule, via Wikipedia/Booyabazooka

The molecule itself is bent, lending hexagonal elegance to snowflakes. In a liquid the molecules glom to each other, not quite like superglue. But that watched pot (that seemingly never boils) needs lots of energy to release water into steam.

For those of us who’ve built molecules for a living, water is often our enemy, something that can get in the way and keep the right components from getting together. But Nature incorporates water beautifully, using the molecule as a structural tool and as a critical player in the reactions that make life work. Forced to take some tricks from Nature in my own graduate work (my highly charged molecules wouldn’t dissolve in any other solvent), working in water was like learning a related foreign language. I learned some basic grammar and vocabulary, but fluency of water chemistry is a challenge beyond the synthetic lab. By Nature’s standards, I was, perhaps, third rate.

I missed the AMNH’s exhibit on Water when it was in NYC (but I think it’s still touring, check your local science museum). As climates change, ice melts, sea levels rise, more intense storms brew in the oceans, water sits at the heart of the environmental challenge. According to the World Health Organization, as of 2002, nearly 20 percent of the world’s population didn’t have access to healthy, sanitized drinking water supplies.

Three atoms hooked together connect to the inner workings of life, health, the environment and public policy.

Share

Molecule of the Week: Vitamin D

Structure of Vitamin D by Sbrools via Wikipedia
Structure of Vitamin D by Sbrools via Wikipedia

Over the last several months I’ve gotten press releases just about every week about Vitamin D, usually talking about studies that show health problems connected to Vitamin D deficiencies. A lot of this discussion about “the optimal dose” of Vitamin D is still under debate, though. The main problem is that it is possible to get too much. Stay tuned because hopefully scientists will hammer out more definitive answers to this question soon.

In the meantime, though, the biochemistry of Vitamin D is pretty unusual, particularly when you compare it with other molecules that we call vitamins. Vitamin D actually functions as a hormone, a chemical messenger within the body. It’s particularly important for helping the body use calcium to build bone. 

However, Vitamin D production in our bodies depends on sunlight. We need UV light from to transform a molecule that looks a lot like cholesterol (a steroid molecule like testosterone, which I guestblogged about this week) into the Vitamin D that we need. We can store extra in fat deposits and many animal fats are a dietary source of Vitamin D.

From the number of studies that indicate Vitamin D deficiencies, my guess is that most people probably are lacking in Vitamin D even though it’s fortified in milk and found in animal fats. And even  natural production can vary a lot. Lighter skinned people tend to make more than darker skinned people. Based on where you live, how much time you spend outdoors, your genes and your age, your production will vary, too. On top of that, you don’t want to expose yourself to so much sun that you’re putting yourself at risk for skin cancer.

But Vitamin D is also a fat-soluble vitamin, which means that the body has a hard time getting rid of it if you make too much. Taking too much of a water-soluble vitamin, such as Vitamin C, isn’t usually a problem. Any extra will just get flushed out with your urine. But too much Vitamin D buildup in the wrong place can lead to calcium deposits.

So, I’ll be interested in what the experts decide is the optimal daily intake and how many health issues might (or might not) be related to levels of Vitamin D.

Share