March 27, 2009

Revisiting Antibiotics Usage in Farming

I've blogged before about the therapeutic use of antibiotics by the cattle, swine, and poultry industries:

[T]he hog industry alone uses three times the amount of all antibiotics used to treat human illnesses... when we count poultry and cattle, nontherapeutic use of antibiotics in livestock rises to eight times total human usage.
Now Bill Niman and Nicolette Hahn Niman have written a short piece for Atlantic on the issue, following up on Nicolette's new book:
Over the past several years, each of us have toured numerous industrial-style animal operations, and they were not pretty. We saw pigs confined in metal buildings living on hard, slatted floors and fed daily rations that include such unsavory ingredients as bone meal, blood meal, and drugs, including antibiotics. Stepping into these buildings, we were immediately enveloped by the stench of rotting eggs. The pigs spend 24 hours of every day in crowded conditions standing over their own liquefied manure, bathing in the odor of decaying feces and continually breathing its fumes...

[F]eeding farm animals daily drugs began in poultry production in the 1950s, both as a means to speed animal growth and as a way to control diseases -- an increasingly daunting problem in the crowded confinement buildings that were coming into vogue at the time. Today, confinement operations commonly feed antibiotics to pigs, as well as chickens and turkeys.

It seems to me that the language "therapeutic use of antibiotics by the cattle, swine, and poultry industries" is too antiseptic, too kind, too easy to favorably misinterpret. Let me reword that:

In the interest of holding down their expenses, many farmers who raise cows, pigs, chickens, and turkeys in disease-encouraging conditions give these animals antibiotics to keep them from becoming sick and to induce them to grow faster. This practice, which totals eight times the total usage of antibiotics by humans, is contributing to the spread of antibiotic-resistant illnesses, including Methicillin-resistant Staphylococcus aureus (MRSA), which may now be responsible for more deaths in the US than AIDS.

When are we going to put an end to this?

March 07, 2009

"Children Can Fall into Bucket and Drown"

From a story in this week's Economist providing a perspective on President Obama's health care plans from West Virginia:

Obamaworld is buzzing with ideas to help people keep fit. Taxes on booze, cigarettes and sugary drinks, which are low by rich world standards, could rise. There is talk of making companies install gyms in the same way as they do fire escapes. Some favour giving people a "nudge" (the title of a recent book popular among Obamaites) to live more healthily. For example, people eat less if restaurants serve smaller portions; children eat better if the school cafeteria puts healthy food at eye level.

The cultural obstacles to all this, however, may be greater than Mr Obama's lean, sporty advisers understand. Consider the shoppers at the Save-A-Lot supermarket in Hamlin, West Virginia. At the beginning of the month, when the food stamps arrive, they snap up buckets of lard so big that the label says: "Warning -- Children can fall into bucket and drown." The manager, Key-Ray Adkins, shrugs: "People now say lard isn't good for you. But it's what we grew up with."

Buckets of lard large enough to drown in? For home use?

Words fail me.

October 14, 2007

Exercise and Fitness Update

Back in June, I blogged about my decision to begin exercising every single day. Over four months have gone by, and the time seems right for an update.

I did end up missing a day in July, after 18 weeks straight of exercise. I didn't mean to -- I was traveling, was tired from lack of sleep, and thought at the time that I had walked enough that day to count. When I thought about it a few days later, I realized that the walking hadn't been nearly enough, so I counted the day as a miss. I've missed two more days since then. Both were deliberate -- days on which I felt bad for some reason and didn't feel up to powering through it. In each case, I felt much better the next day and resume my normal workout schedule, so I assume I made the right decision both times. That makes three days off in the last 31 weeks. I'm averaging just under an hour of exercise every day (59 minutes per day, to be exact, since I began). So how is it going?

The good news is that my physical condition continues to improve. My resting heart rate keeps falling, and it's taking more and more effort to get my heart rate up during exercise. I can tell from playing soccer that I'm faster than I was at the beginning of the year. And I'm fairly sure I'm stronger than I've ever been, based on how much I can lift now.

But perhaps the best news is that -- as I noted in my previous entry -- exercise is now a way of life for me. It's what I do, every day. The two days I deliberately took off were difficult decisions for me. I agonized over each of them. And there have been many more days that I felt low for one reason or another but never considered skipping exercise.

On the negative side, while I was losing about a pound a week through late July, I've plateaued and haven't lost any weight since then. I can tell from my clothes that I'm continuing to lose inches -- in fact, I have a large stack of too-large clothes in the back of my car, waiting to be dropped off at the Goodwill store later today. But that's a slow process, and I have weight yet to lose, so I have to get on track. I've been doing research on my own, and talked with the nutritionist at my gym, and have a multi-point plan that I'm starting to implement:

  • Interval training. I had settled into a routine of 60 minutes or so on the elliptical, always set to level 18 (out of 25). The problem is that as my aerobic fitness increased, my heart rate went down. I had metabolic tests done at the gym and found that my body is now accustomed to working efficiently when my heart rate is at 70-80 percent of maximum. This means I need to spend time with my heart rate at 80-85 percent of maximum, which in turn means interval training. I started a couple of weeks ago and can definitely see the difference when I'm on the elliptical machine.
  • More weight training. I've been good about lifting weights at least twice a week, but I need to be more consistent about lifting at least three times a week. There's abundant evidence that weight training in combination with cardiovascular training is the best way to become (or stay) fit. This has been difficult due to my travel schedule, but I think I'm on track now.
  • Better nutrition. I've been careful about how much I eat, but not necessarily about what I eat. I'm not a junk food junkie, but I'm definitely a quick food junkie. I enjoy cooking for other people, but not for myself alone. As a result, far too often I've come home from work and had cereal (healthy organic cereal, but cereal just the same) for dinner. Or a few energy bars, or a protein shake. Not good. I haven't made the jump to cooking for myself yet, but what I have done is started buying healthier ready-made frozen entrees from Trader Joe's, so there's always something in the freezer that's healthy, balanced, and can be ready in a few minutes. I'm also making a point of eating more salads, as well as servings of fruits and vegetables. This is coming along.
I'm also considering lowering the amount of calories I allow myself each day, but I have a trip to Paris coming up in a couple of weeks, and so I think I'm going to wait until after that to do so. (Though I will be hitting the gym while there -- there looks to be a beautiful facility just a few blocks from the apartment in which I'll be staying.)

One more potential change for me is to introduce more variation into my cardiovascular workouts. With the hot, humid summer we had here in North Carolina, bicycling dropped off my list. That left me with one soccer game each week and six days of elliptical training. I haven't seen any studies showing the effect of more or less variation in workouts, but my hunch is that more variation must be a good thing, if for no other reason that it leads to working more and different muscle groups, rather than the same well-trained muscle groups over and over again. The weather is beautiful here now, so I'm going to go back to bicycling once a week, and I'd like to take up swimming once a week as well. I'm also considering running again -- my knee isn't great, but after months of self-guided therapy (based on current research papers), it's doing better, and I think I might just be up to a run once a week.

In the end, I'm as convinced as ever that exercising every day is a good thing. At least it has been for me.

June 29, 2007

This Is Good News

This was a pleasant surprise in the news today:

Even in middle age, adopting a healthy lifestyle can lower the risk for heart disease and premature death within years of changing habits, researchers reported on Thursday.

Middle-aged adults who began eating five or more fruits and vegetables every day, exercising for at least 2 1/2 hours a week, keeping weight down and not smoking decreased their risk of heart disease by 35 percent and risk of death by 40 percent in the four years after they started.

"The adopters of a healthy lifestyle basically caught up. Within four years, their mortality rate and rate of heart attacks matched the people who had been doing these behaviors all along," said Dr. Dana King at the Medical University of South Carolina, who led the research.

Excellent! It should be noted, however, that it's not easy:

When [study participants] had picked up all four habits, they enjoyed a sharp decline in heart disease risk and in death from any cause.

It took all four -- having just three of the healthy habits yielded no heart benefits and a more modest decrease in overall risk of death.

June 03, 2007

Consistency and Exercise

Four months ago, I decided it was time to do something about my diet and fitness. Over the prior six months or so, I had lost track of these issues, eating food that was bad for me (and too much of it), and exercising inconsistently at best. I can't say what led me to make the change, but looking back, I'd say it was a feeling that grew, the growth unnoticed like a child you see every day until suddenly you look up one day and realize they're taller than you. I woke up one otherwise unremarkable day and knew it was time.

Starting that day, I began rigorously keeping track of my diet and staying within guidelines I set for myself. I also began exercising five days a week, a mix of cardio work at the gym, a weekly soccer game, a weekly bicycle ride with my daughter, the occasional long walk, and lifting weights here and there. The results were good, but after a few weeks, I began to think I might feel and do better if I could exercise every day.

For as long as I can remember thinking about exercise, I've always assumed that days off were necessary components of an fitness regimen. Everything I can remember reading about exercise programs preached the idea of days off for all except elite athletes. But is that really good advice? Do we really need days off? I found myself not so sure, and wondering what would happen if I exercised daily without fail for an extended period of time. And I had always assumed that if I tried to exercise every day, I'd be setting myself up for failure. But is that true?

As it happens, other people have been thinking similarly. One blogger writes:

The first few times I tried to install exercise habits, they fell apart. Attempting to exercise three or four times a week, simply didn't stick. What eventually did the trick was making it a daily habit. It may seem counterintuitive that exercising more frequently is an easier habit to install, but when you look into the mechanisms that create habits, it makes sense.
And other blogger writes:
The problem with trying to make exercise a habit, and it's something that we've all faced, is that you usually try to exercise 3 or 4 times a week... and that makes creating a new exercise habit difficult. The reason is that the more consistent an action is, the more likely it is to be a habit.
These entries were written after I made my decision, but it was nice to see people agreeing with me after the fact.

So, 12 weeks ago, I began exercising every day. I didn't make any other radical changes to my exercise habits, with the exception that I set a goal of lifting weights three times a week as part of my program. A typical week might look like this:

  • Monday: soccer game
  • Tuesday: weightlifting, elliptical trainer
  • Wednesday: elliptical trainer
  • Thursday: weightlifting, elliptical trainer
  • Friday: elliptical trainer
  • Saturday: weightlifting, elliptical trainer, walking
  • Sunday: bicycle ride
(I should note here why it is that running isn't a part of my program. I enjoy running, and ran my first half-marathon early last year, but have been suffering from a persistent case of tendinopathy in my left knee since then. Supervised physical therapy hasn't helped. After reading through the latest medical journal articles, I'm trying eccentric patellar strengthening at home, which seems to be helping, but very slowly. Until it's better, my orthopaedist's advice is to avoid impact activities as much as possible -- so the only running I do is during my soccer games. which I refuse to give up.)

At first, my goal was to see if I could go three weeks in a row without missing a day -- I couldn't remember doing that since I was in the Army over 20 years ago. When I reached three weeks, my goal became eight weeks -- I figured the longest stretch of daily exercise I might ever have had was that long, while I was in basic training back in 1980. Now I'm at 12 weeks and figure it's time to blog about what I'm doing.

So far, the results have been great. I'm losing a pound a week. I'm wearing clothes I hadn't put on in a few months. I have more energy. I'm sleeping more consistently. I'm feeling faster during soccer games and on bicycle rides -- I assume partly because my cardiovascular fitness is improving, and partly because I have less weight to move around.

I've also seen good results from the weightlifting. I had been lifting now and then for a couple of years, but never with consistency, and never tracking what I was doing. Now I'm lifting three times a week, and keeping a log of everything I do. I push myself to make progress -- even a little -- every session. I think I'm stronger than I've ever been, and I'm starting to see muscles appear in new places, which is nice.

All that said, I think the most important change has been in my attitude towards exercise. I don't think of it as something that I need to try to work into my day; I think of it now as a given, as something I will do no matter what. It's not always easy, I have to say. It means going to the gym at 5:00 AM because I know I'm going to be busy all day, or going at 11:00 PM because I've just flown in from a long trip. It means planning ahead, ensuring that no matter where I am, no matter what I'm doing, I have the opportunity and ability to exercise. Sometimes it just means exercising when I what I really feel like doing is going home, having dinner, and crawling into bed. But I always feel better for having exercised, both physically and mentally.

I wrote about the goals I've had: three weeks in a row, eight weeks in a row. I find myself no longer thinking in those terms. I don't feel like I need a goal like that to motivate myself on a daily basis. As one of the bloggers mentioned above wrote, "the more consistent an action is, the more likely it is to be a habit". Daily exercise is a habit for me now, something I don't consider skipping. Of course, the day will come when I'm sick or injured and simply unable to do anything physical. I'm not looking forward to that day, but at the same time, I don't worry about it being the first step down a slippery slope. If I can't help missing a day or two, I believe I'll get right back out the next day and keep going. It's what I do now.

March 19, 2007

Antibiotics, Farming, and the Presidential Primaries

In my previous entry, I discussed the non-therapeutic of use of antibiotics for livestock, and the nearly-unbelievable statistics that the US livestock industry uses eight times as much antibiotics as are used to treat all human disease -- and this while the resistance of bacteria to antibiotics is growing rapidly.

All this would normally lead me to say that politicians -- including those currently running for President -- looking for issues on which most Americans can agree should get out in front on this and propose far-reaching restrictions on the use of antibiotics in in agriculture. This is the kind of issue that most people don't know about, but if they did, they'd react forcefully to it: "What? We give livestock eight times as much antibiotics as we do humans even though they're not sick? And more people are dying every year because of antibiotic-resistant bacteria? Why hasn't anyone said anything about this? Someone needs to end it!"

On the other hand, our Presidential primary voting system means that candidates spend most of the year before an election -- as in this year -- pandering to the residents of Iowa, a state that poorly represents the country as a whole. According to the US Census Bureau, in 2000, the population of the US was 75.1 percent white, 12.3 percent black or African-American, 3.6 percent Asian, and 12.5 percent Hispanic or Latino (of any race). Meanwhile, Iowa was 93.9 percent white, 2.1 percent black or African-American, 1.3 percent Asian, and 2.8 percent Hispanic or Latino (of any race). Perhaps more to the point, while 20.6 percent of Iowa residents were employed in the agricultural sector in 2002, the comparable statistic for the US as a whole was 14.3 percent.

In other words, Iowans are 1.44 times more likely than Americans as a whole to be employed in agriculture. They're also 1.25 times more likely to be white, 5.86 times less likely to be black or African-American, 2.77 times less likely to be Asian, and 4.46 times less likely to be Hispanic or Latino.

This is not to say that the people of Iowa are less wise than Americans as a group. This is not to say that the people of Iowa are less honest, less prudent, less thoughtful, or less concerned with the future of their country. I'm sure the people of Iowa are, more or less, as wise, honest, prudent, thoughtful, and concerned as the average American. But representative they are not. And as long as Iowa (and New Hampshire, for that matter) continue to exert influence on Presidential candidates so far out of proportion to their population, then we will continue to have Presidential candidates who -- for example -- are scared to say anything that could be construed as anti-farming. Even something as blatantly obvious as ending the abuse of antibiotics by the livestock industry.

March 18, 2007

Antibiotics and Farming

I've long been troubled by the idea that as antibiotic-resistant bacteria spread, the farm industry is allowed to give antibiotics to cattle, swine, and poultry merely to accelerate their growth and reduce mortality due to unhealthy living conditions. But "Pig Out", an op-ed piece in The New York Times this week, opened my eyes:

Of the 60 million pigs in the United States, over 95 percent are continuously confined in metal buildings, including the almost five million sows in crates. In such setups, feed is automatically delivered to animals who are forced to urinate and defecate where they eat and sleep. Their waste festers in large pits a few feet below their hooves. Intense ammonia and hydrogen sulfide fumes from these pits fill pigs' lungs and sensitive nostrils. No straw is provided to the animals because that would gum up the works (as it would if you tossed straw into your toilet)...

The stress, crowding and contamination inside confinement buildings foster disease, especially respiratory illnesses. In addition to toxic fumes, bacteria, yeast and molds have been recorded in swine buildings at a level more than 1,000 times higher than in normal air. To prevent disease outbreaks (and to stimulate faster growth), the hog industry adds more than 10 million pounds of antibiotics to its feed, the Union of Concerned Scientists estimates. This mountain of drugs -- a staggering three times more than all antibiotics used to treat human illnesses -- is a grim yardstick of the wretchedness of these facilities.

Once more, for emphasis: the hog industry alone uses three times the amount of all antibiotics used to treat human illnesses. We haven't even gotten to cattle and poultry yet. This is from a report by the Union of Concerned Scientists (UCS):

[T]he quantities of antibiotics used in animal agriculture dwarf those used in human medicine. Nontherapeutic livestock use in chickens, pigs, and cows accounts for 8 times more antibiotics than human medicine, which is using only 3 million pounds per year...

Until now, health officials and citizens had to rely on incomplete industry estimates to design effective responses to the antibiotic-resistance problem. According to the new UCS report, "Hogging It: Estimates of Antimicrobial Abuse in Livestock", the total use of antibiotics in healthy livestock has climbed from 16 million pounds in the mid-1980s to 25 million pounds today. Of that, approximately 10 million pounds are used in hogs, 11 million pounds in poultry, and 4 million pounds in cattle.

So when we count poultry and cattle, nontherapeutic use of antibiotics in livestock rises to eight times total human usage.

Keep Antibiotics Working is an advocacy group founded to reduce and eliminate the nontherapeutic use of antibiotics in livestock. They have a page on the scientific evidence for the idea that "that bacteria are developing antibiotic resistance as a result of antibiotic use in animal agriculture". By my count, this page lists 31 studies that address the links between agricultural abuse of antibiotics and increased antibiotic resistance in human pathogens -- as well as dozens of other studies on related topics.

What is the human toll of this? A report by Keep Antibiotics Working notes the following:

  • Resistant bacterial infections increase health care costs by at least $4 billion per year in the U.S.
  • One out of six cases of Campylobacter infection, the most common cause of food poisoning, is resistant to fluoroquinolones, the drugs most often used to treat severe food-borne illness. Just six years ago, before fluoroquinolones were approved for use in poultry, such resistance was negligible.
  • Campylobacter accounts for 2.4 million illnesses and over 120 deaths each year in the U.S.
  • One out of three cases of human infection by a particular strain of Salmonella bacteria is resistant to more than five different antibiotics. Salmonella causes 1.4 million illnesses and 580 deaths annually in the U.S.
  • Nearly all strains of Staphlococcus infections in the U.S. are resistant to penicillin, and many are resistant to newer drugs.
In the case of Campylobacter, one could infer that at least some of the 120 people who die from it each year in the US die because the fluoroquinolones they're given are ineffective against the infection, as a result of use in the poultry industry. This is an inference, but I'd be surprised if it weren't true. The same could be true of some portion of the 580 people who die from Salmonella each year in the US. (See the original article linked above for citations for all these statistics.)

When are we as a country going to become angry about this and put a stop to it?

May 04, 2006

The Beverage Industry Does the Right Thing

From a story in USA Today (yes, you guessed it -- I'm on the road) on the beverage industry's agreement to remove sugared drinks from schools:

Under the voluntary agreement:
  • High schools will no longer sell high-calorie soft drinks during the school day but will offer water, low-fat and fat-free milk, diet soft drinks, low-calorie sports drinks, light juices and diet and unsweetened teas.

  • Elementary schools will sell only water and up to 8-ounce servings of 100% juice with no added sweeteners, and fat-free and low-fat milks. Middle schools have the same standards but with 10-ounce servings.
This really is tremendous news. I've blogged before on the dangers of sugared soda, and I've long been offended by the prevalence of such drinks in schools. It stunned me to see how easy it was for the beverage industry to buy the loyalty of so many school districts, who were all too willing to sacrifice student health for more funding.

Having said that, I think the industry deserves more credit than they're getting. When someone does the right thing, we should offer praise, not the criticism they're receiving:

The beverage industry's agreement to remove sugary soft drinks from public and private U.S. schools over the next three years... is drawing mixed reactions from kids and critics.

Barry Popkin, nutrition professor at the University of North Carolina-Chapel Hill, says, "This is an important, useful first step, but it's quite shocking how long it took them to react." ...

"The soft-drink industry has been losing battles in local school districts and in state legislatures and simply saw the inevitable -- being kicked out from all schools," says Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale University...

"The soft-drink industry's announcement is about as voluntary as a shotgun wedding. They see the writing on the wall and are trying to prevent further legislation and litigation," says Margo Wootan of the Center for Science in the Public Interest.

To Mssrs. Popkin, Brownell, and Wootan, whatever your feelings for the beverage industry may be, however pitched your battles with them may have been, this is a time to be magnanimous -- not because doing so would be polite (though it would be), but because there will be other battles to fight, with this industry and others, and you will want to be able to point to how graciously you reacted when you won in the past. As it stands, were I on the other side of an issue with you, your reaction to this announcement would give me pause before cooperating with you in the future.

April 05, 2006

John Burns' Heart Arrythmia

Yesterday, I was chatting with the ever-delightful Xeni Jardin. She was facing one of her looming deadlines, and made a joke about brewing her 20th pot of coffee for the day.

I asked Xeni if she had heard the story of John Burns, the former New York Times Iraq correspondent and Pulitzer Prize winner, who had fallen ill after returning from Iraq. She hadn't. I heard it in an interview of Burns by Terry Gross on Fresh Air in November of 2003. I can't find anything else about it, and there's no transcript, so for Xeni's reading pleasure (and yours), here's a transcribed version. It's near the end of the interview, and Gross has just asked Burns about his medical problem.

John Burns: I called my wife from the border as I was crossing back into the other world [from Iraq into Jordan] and told her that I'd never been so happy in my life to get away from a place. I felt terrific.

Within half an hour, I didn't feel terrific, and by the time I got to Heathrow, I felt very unterrific indeed, and she took me straight to public hospital, where I spent some time where they diagnosed a case of heart arrythmia, which I have to say immediately this is an extremely common thing. Millions of people, millions of Americans, have this problem. It's the broken ankle of the heart business. The most common cause is stress, and I saw a number of cardiologists as we looked for a fix for this, which we eventually found, I'm glad to say.

And eventually I found myself sitting talking to a man who called himself an electrician, a specialist in the electricity of the heart. And he had a report from another cardio saying, you know, this chap's endured cruise missiles, and arrests by the secret police in Iraq, and one thing and another, and so it's not surprising that this would happen.

This fellow looked at me and he said, "Tell me something. What were you eating in Baghdad during all of this?" And I said, "There wasn't a lot to eat, which is good for me, because I need to lose the weight." "What were you drinking?" And I said, "Well, I'm not a drinker. A couple of vodkas now and then and that's about it. So I was drinking tea." "How much tea?" And I said, "Oh, 25 or 30 cups a day."

And he put a big line through the report that said cruise missiles, secret police, and he said, "My friend," -- he's an Irishman -- he said, "my friend, if you had been a bank manager, sitting right here" -- this conversation took place in England -- he said, "you'd be here right now. That amount of caffeine is one of the most reliable triggers for heart arrythmia."

It never struck me that tea could be an addictive, that it could be a narcotic, in fact. The problem is that if you work for The New York Times as a foreign correspondent, you're working hours and hours ahead of New York, which means working deep into the night. The first edition of The New York Times in New York is something like four or five o'clock in the morning in Baghdad. And I was responsible at that time for running our operations there, so I never got to bed before about six and then slept for two or three hours. And the tea kept me going. And to tell you, a life without tea, would it be worth living? I'm not sure.

I made a compromise with the electrician. He said three cups a day. I kinda double that, and everything seems to be fine.

March 11, 2006

Sugared Soda = Type 2 Diabetes

I've been meaning to blog about this for over a year now, but it's no less interesting now than it was in 2004, and most people with whom I've talked about it haven't heard ot it, so here goes.

According to a long-term study of 91,000 women (story here, study press release here, drinking even one sugared soda per day dramatically increases one's chances of developing adult-onset diabetes. From the story:

The doctors behind one of the nation's most comprehensive public health studies have concluded what most dieters already know: Chugging down sodas packs on the pounds.

The study of more than 90,000 women also suggests that increased consumption of sodas and other sugary drinks may significantly increase the chance of getting adult-onset diabetes, according to the study published Wednesday in the Journal of the American Medical Association...

The study shows that women who drank one or more sugary drinks a day had an 83 percent greater chance of developing type 2 diabetes than women who drank less than one a month...

Even though researchers adjusted their findings to account for increases in other kinds of foods and snacks, including red meat, french fries, sweets and fruit, and for levels of exercise, smoking rates and other lifestyle issues, the study's authors said it comes down to drinking sodas.

The press release provides more specific information on the link:

More than 91,000 participants who had filled out biennial food frequency questionnaires between 1991 and 1999 were chosen for the study from the Brigham and Women's Hospital-based Nurses' Health Study II. During the eight-year span of the study, 741 new cases of type 2 diabetes were diagnosed. Those who reported drinking sugar-sweetened sodas more than once per day showed an increased risk for type 2 diabetes of more than 80 percent compared to women in the study who drank less than one per month, independent of lifestyle factors such as smoking, alcohol, physical activity, and dietary habits. Those who drank more than one fruit punch per day showed a nearly doubled risk for type 2 diabetes compared to those in the study who reported drinking less than one per month. The researchers also assessed intake of fruit juice (orange, pineapple or apple juice) and found no increased risk for type 2 diabetes.
In a story on the soft drink industry's response (hint: they didn't like the study), a theory is proposed for what's happening:
[I]n addition to extra calories, the beverages might also increase diabetes risk because their high amount of rapidly absorbed sugars causes a dramatic rise in glucose and insulin concentrations in the body, said Dr. Walter Willett, one of the study's co-authors.

"I think there is a very practical implication of this study, both for weight control and for type 2 diabetes -- keep soda consumption low," said Willett, chairman of the Department of Nutrition at the Harvard School of Public Health.

Fruit juice consumption was not associated with diabetes risk, and diet soft drinks were not statistically significant, but sugared fruit punch showed similar results to sugared soda.


  • Bad: Coke, Pepsi, Snapple
  • Good: Diet Coke, Diet Pepsi, Diet Snapple, pure fruit juice

March 05, 2006

More on Longevity Research

The cover story of this month's issue of Scientific American, "Unlocking the Secrets of Longevity Genes", is co-authored by David Sinclair and Lenny Guarente. Both have started pharmaceuticals (Sirtis and Elixir, respectively) and both are professors, Sinclair at Harvard and Guarente at MIT. I mentioned Sinclair in an earlier blog entry.

If there's one thing that's clear from the recent news in longevity research, it's that it has gone mainstream. Researchers are making breakthroughs, founding firms, attracting capital, and writing for major magazines.

Sinclair and Guarente seem optimistic but not wild-eyed:

Both our labs are running carefully controlled mouse experiments that should soon tell us whether the SIRT1 gene controls health and life span in a mammal. We will not know definitively how Sirtuin genes affect human longevity for decades. Those who are hoping to pop a pill and live to 130 may have therefore been born a bit too early. Nevertheless, those of us already alive could live to see medications that modulate the activity of Sirtuin enzymes employed to treat specific conditions such as Alzheimer's, cancer, diabetes and heart disease. In fact, several such drugs have begun clinical trials for treatment of diabetes, herpes and neurodegenerative diseases.

And in the longer term, we expect that unlocking the secrets of longevity genes will allow society to go beyond treating illnesses associated with aging and prevent them from arising in the first place. It may seem hard to imagine what life will be like when people are able to feel youthful and live relatively free of today's diseases well into their 90s. Some may wonder whether tinkering with human life span is even a good idea. But at the beginning of the 20th century, life expectancy at birth was around 45 years. It has risen to about 75 thanks to the advent of antibiotics and public health measures that allow people to survive or avoid infectious diseases. Society adapted to that dramatic change in average longevity, and few people would want to return to life without those advances. No doubt, future generations accustomed to living past 100 will also look back at our current approaches to improving health as primitive relics of a bygone era.

There's a less technical, broader round-up of longevity research, "The Aging Enigma", in a recent issue of Harvard magazine, in which Sinclair has a slightly differently-nuanced view:

David Sinclair... does not rule out changes to the human maximum, although he believes that “We are not going to see any super-long-lived people in our lifetimes.” Progress against age-related disease could add five to 10 years on average to human life span. “Who wouldn’t be happy,” he asks, “with an extra five years?”

February 26, 2006

Bill Sardi on Resveratrol

I've blogged recently (here and here) on the latest news about resveratrol, now known to increase lifespan in at least one vertebrate species (a type of fish, courtesy of a just-published study out of Italy). Curious to learn more, I corresponded with Bill Sardi, founder of Longevinex, makers of what is to my mind the best available resveratrol supplement on the market:

Me: Your summary noted that the study used "100% trans resveratrol stored at 4°Centigrade (39° Fahrenheit) in the dark". Is Longevinex 100 percent trans resveratrol? And does this mean that I should store it in my refrigerator?

Bill: 100% trans resveratrol costs a fortune; Longevinex provides trans resveratrol 50% extract from polygonum cuspidatum (Asian giant knotweed) and from red wine grapes (French). Store in cool place. Refrigerator may cause misting.

Me: Does the study offer any information relevant (even vaguely) to dosage information in H. sapiens?

Bill: Maybe... possibly 600 mg per day. Lower doses didn't work. But we know low-dose resveratrol in red wine results in the French having the longest living human population. The resveratrol was placed in a fish tank, possibly destroyed by light, air, etc., before consumption. The resveratrol in red wine is preserved in a dark, airtight bottle and then consumed. This may make a big difference.

Bill: So you know, the FDA is probably going to step in and block any high dose resveratrol pills. We can produce a 250 mg resveratrol pill now, but it would cost $3.00 per day.

Thanks to Bill for permission to reproduce our e-mail exchange here.

February 16, 2006

Resveratrol in Mice

In my blog entry on resveratrol yesterday, I mentioned a forthcoming study of its effectiveness on mice. It's being done at the Harvard Medical School by David Sinclair, associate professor of pathology and co-founder of Sirtris Pharmaceuticals.

In an interview on NewsHour in January 2005, Dr. Sinclair discussed his approach to the mouse study:

DAVID SINCLAIR: Right, so we're at the point where we need to test this first of all in mice and those studies are just beginning now. And then if that works, we really want to go either into humans if it's safe, or to try it in primates as well. But we're at the point where we are in mammals and we'll know within a year or two if we're right about this.

TOM BEARDEN: That soon?

DAVID SINCLAIR: Sure, I mean a mouse's lifespan is about two years. We're going to be feeding our molecules out, so-called calorie restriction, the medic molecules that we call them, we're feeding these to elderly mice that are halfway through their life and we'll know within a year or less if we're having an effect.

Presuming the study started at about the time of the interview, the control mice should be dying right about now. As for the mice on resveratrol, we'll just have to wait for the research to be published. We could know sometime this year.

February 15, 2006

More Evidence for Resveratrol

I've blogged about resveratrol before (here and here). It has already been shown to increase lifespan in yeast, fruit flies, and worms. Now we have the first evidence (via Fight Aging!) that it increases lifespan in vertebrates:

A new study shows an ingredient found in red wine, which has previously shown to prolong the life of worms and fruit flies, may extend the lifespan of vertebrate animals like fish and possibly humans.

Researchers found adding resveratrol, an organic compound found in grapes and particularly in red wine, to the daily diet of short-lived fish prolonged their lifespan and delayed the onset of age-related memory and other problems...

In this study, published in Current Biology, researchers examined the effects of resveratrol on a small type of fish that lives only three months in captivity.

The results showed that adding the red wine ingredient to the daily diet of the fish prolonged their expected life span and slowed the progression of age-related memory and muscular problems.

Researchers found fish fed the lower dose of resveratrol lived an average of 33% longer than fish fed their normal diets, while those fed the higher dose of the red wine ingredient lived more than 50% longer.

An abstract of the original article can be found here, but it doesn't mention the specific statistics quoted above (which admittedly sound conveniently fractional).

I've been taking resveratrol for about a year now. Not that I'm an expert, but Longevinex seems like the best brand out there. Interestingly, they have a good bit of detail on the study -- more than in any of the news stories I found:

Researchers continue to demonstrate, in higher life forms, that lifespan is increased with the feeding or resveratrol, widely known as a red wine molecule. The most recent report, involving killfish, the highest life form yet to be tested, reveals increases in lifespan ranging from 27-59% when research-grade resveratrol was added to fish food. Lifespan was increased in a dose-dependent manner in this species of fish that has the shortest median lifespan of any vertebrate, about 9 weeks.

Equally remarkable was the impact resveratrol had on the quality of life of killfish. After 50 passes through a shuttle-box learning test, 73% of the time young fish navigated the test compared to just 42% success rate among old fish and a remarkable 74% success rate among old fish fed resveratrol! Researchers in Italy who conducted the study said "resveratrol-fed fish showed remarkable preservation of learning and prevention of age-related brain degeneration."

The jury is still out, obviously. A study of resveratrol's effects on mice will provide the first look at its effectiveness on mammals. But so far, to the best of my knowledge, every species studied has shown significant lifespan gains with resveratrol. That's good enough for me, for now, at least.

August 25, 2005

"...Pulling Their Teeth Out with Pliers"

From the article "The Moral-Hazard Myth", appearing in the 29 August issue of The New Yorker:

Americans spend $5,267 per capita on health care every year, almost two and a half times the industrialized world's median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year -- or close to four hundred billion dollars -- on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy -- a country that switched to Japanese cars the moment they were more reliable, and to Chinese t-shirts the moment they were five cents cheaper -- has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.
When are the American people going to realize how fundamentally broken our health care system is and demand change?

June 25, 2004

More on the No Sidewalks-Obesity Link

I've blogged before about the link between unwalkable towns and obesity. Now comes word from Nature of a recent conference focused on this very issue:

Public-health officials in the United States are proposing a new and drastic way to fight the onslaught of obesity: they want to redesign entire towns to make them exercise-friendly...

Many recent health campaigns urge people to walk, cycle or be otherwise active during the day. But that's easier said than done; in a typical US housing estate, the only way to reach workplaces, shops and schools is by car. Many streets lack pavements, and cycle paths are virtually unheard of.

To really fight the flab, US public-health officials are now realizing that they may have to change the entire layout of towns. The suburban mansion and sport-utility vehicle (SUV) may fulfil the American dream, they say, but it is taking an unforeseen toll on health.

One study from last year compared the health of people living in foot-friendly city areas with that of those dwelling in sprawling, car-dependent suburbs. People's average weight and level of hypertension rose along with the degree of sprawl...

To tackle the problem, obesity experts, town planners and architects, among others, came together in Washington DC last week to focus on obesity and the built environment. Delegates were queuing up to attend the conference, says organizer Allen Dearry of the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina. "It struck a nerve," he says.

I'm about to move from the small town of Apex (population 20,212) to the larger town of Cary (population 94,536). I've never seen a greenway in Apex (though supposedly they exist), and there are no sidewalks that traverse it. Meanwhile, Cary is criss-crossed with greenways, and has an extensive (though incomplete) network of sidewalks.

The irony of this is that I've had to give up walking for exercise -- to try to let the inflamed cartilage in my knee heal, I'm avoiding any lower-body impact exercise (running, walking, etc.) aside from soccer, which I refuse to give up. On non-soccer days, it's the elliptical machines at the gym for me. But still... it will be nice knowing the trails and sidewalks are there when my knee is better.

March 07, 2004

Aspirin, Selenium, and Cancer

During my flight to Seattle, the person seated next to me had his laptop open and was editing a highly technical medical document. I noticed some of the language in it, took a guess, and asked him, "Are you a cancer researcher at the Hutch?" ("The Hutch" is the nickname for the Fred Hutchinson Cancer Research Center in Seattle.) He replied that he was. I picked his brain about the latest news in the war on cancer.

He didn't talk about wonder cures or magic bullets, but he did talk about chemotherapy-type treatments with fewer side effects. More relevant to me (and most readers), he talked about research efforts focused on preventing cancer in the first place. Apparently the evidence for aspirin as an anti-cancer agent continues to grow. (A New England Journal of Medicine study linking daily aspirin use with lowered rates of polyps that could lead to colorectal cancer can be found here.) The other agent he discussed was selenium, which is being studied extensively for cancer-preventing qualities. (There's CNN coverage here, and more detailed information here.)

His bottom line was that he takes an aspirin a day, for its effects in preventing both heart disease and cancer, and that he doesn't take a selenium supplement because he gets enough in his diet and from the environment, but if that weren't the case, he would take selenium daily. I'm already using aspirin but will add selenium to my repertoire, unless I'm already getting enough of it (200 micrograms) in my multivitamin, which I'll check when I return home.

February 04, 2004

Joi Ito on ADD

Joi Ito recently blogged about discussing Attention Deficit Disorder (ADD) with David Smith over dinner in Japan:

Today, I had dinner with David Smith who has ADD. I think his ADD is worse than mine. We talked about a mutual friend who has, as David puts it, "terminal ADD". We talked about the hyper-focus that ADD provides and ways that you can use ADD to do things many people can't do. Harnessing ADD, rather than neutralizing it has interesting benefits. We talked about how modern society has allowed many people, who might have been dysfunctional in the past, to make valuable contributions to society. It's interesting how labels and the notion of disease can cause people to blame these things for their problems instead of trying to figure out how to turn these bugs into features. I realize that some people really do have diseases and I'm not trying to belittle their struggle. What I'm saying is that before we label ourselves and start taking therapy and drugs we ought to think about how all of these elements interact to create the human being that we are and place this in the unique context that each of us are in.
What follows is an edited and expanded version of a comment I wrote on the topic in his blog.

When my oldest son (now 16) was in elementary school, his teacher -- a good teacher and a good person -- wanted to have him evaluated for ADD, based on his behavior in the classroom. The school principal -- a good principal and a good person -- concurred with her. My son's mom, my then-wife, did a great deal of research into ADD as a result. We spent a lot of time talking about her research and what she had discovered.

We came to the conclusion that for any given aspect of human behavior you want to look at, you can view individuals' behavior as lying somewhere along a spectrum, as opposed to being in one bucket or another. But spectra are confusing for people. We don't want to know that our child is a little more this or a little less that. We're used to binary medical diagnoses: benign or malignant; infected or cured; broken or healed. We like to think in simple terms, so we make buckets. We've created one called "ADD."

As it happens, there are all sorts of incentives for everyone to place a child into the ADD bucket:

Pharma: Sell more drugs.

Physician: Generate more income.

Principal: (in some cases) Obtain more school funding.

Teacher: (in some cases) Move child into separate class.

Parents: Reduce feeling of responsibility for acts of misbehavior by child.

Child: Reduce feeling of guilt for letting down parents.

Who doesn't have an incentive to label a kid as ADD? No one.

In the end, we decided to decline an evaluation for our son, so that he wouldn't be labeled as ADD, and to home school him for a while so that he could get more one-on-one attention. It's impossible to say whether that helped; after re-entering the public school system a couple of years later, it wasn't as if he was problem-free. But now, in the 10th grade, he's an honor roll student. I can still see signs of behavior in him that some would label ADD, and that doesn't bother me at all -- it's just part of who he is.

Now, as it happens, I count both Joi and David Smith as good friends, and have known them for quite a while now -- Joi for a few years now, and David since the late 1980s. Do they have some behavioral traits that could be considered ADD-like? Sure. But those traits are part of them, part of who they are. Without those traits, they wouldn't be the people I know -- and I like them as they are.

There are plenty of human behaviors that can be frustrating, even exasperating to others at times. But that shouldn't give us license to label those behaviors, declare them undesirable, and try to medicate them away -- especially when we're making decisions for children not yet ready to make them for themselves.

January 16, 2004

Endless Shrimp

Red Lobster is promoting its "Endless Shrimp" special, in which patrons can stuff themselves full of shrimp until their internal organs plead for mercy. Here's their Web ad:

"Seafood is good for you -- a lot of seafood is even better." Pardon me? Did the ad wizards at Red Lobster just attempt to confer health benefits on shrimp-gorging? I think they did.

The television commercials for this special have a disclaimer at the end:

Limited time offer. Offer not available in Canada.
I pointed this out to a friend, who asked me why the offer wouldn't be available to Canadians. It's just that, generally speaking, and especially where I lived (Vancouver), one doesn't see all-you-can-eat restaurants or offers in Canada. In fact, thinking back to my time there, I can't remember one. Good for them.

Anyway, I can't help but wonder if, when one can't possibly eat any more shrimp, does the waiter come by with a mint, saying, "It's only wah-fer thin?"

September 08, 2003

Sanity Prevails

Sanity has prevailed:

For a second time this year, a federal judge threw out a lawsuit Thursday that alleged McDonald's Corp. misled consumers into believing its food was nutritious and part of a healthy diet.

U.S. District Court Judge Robert Sweet said the plaintiffs failed to adequately support allegations that McDonald's violated New York's consumer protection laws and made no allegations that they witnessed any deceptive advertising on the part of the fast food chain.

The Manhattan judge noted in particular that the lawsuit, brought on behalf of two New York children, failed to back allegations that any injuries suffered resulted from McDonald's representations about its French fries or hash browns.

In January, Sweet tossed out an earlier version of the lawsuit that claimed McDonald's food caused health problems in children.

In that ruling, he said, consumers "cannot blame McDonald's if they, nonetheless, choose to satiate their appetite with a surfeit of supersized McDonald's products."

"If a person knows or should know that eating copious orders of supersized McDonald's products is unhealthy and may result in weight gain ... it is not the place of the law to protect them from their own excesses," Sweet wrote at the time.

On Thursday, Sweet rejected a request that the plaintiffs be permitted to file a new version of the lawsuit in U.S. District Court in Manhattan.

The full text of Judge Sweet's ruling can be found here.

August 27, 2003

Sirtuins Again

Here's the opening paragraph (the rest requires a subscription) of the sirtuin paper in Nature that I blogged about earlier (here and here):

In diverse organisms, calorie restriction slows the pace of ageing and increases maximum lifespan. In the budding yeast Saccharomyces cerevisiae, calorie restriction extends lifespan by increasing the activity of Sir2 (ref. 1), a member of the conserved sirtuin family of NAD+-dependent protein deacetylases. Included in this family are SIR-2.1, a Caenorhabditis elegans enzyme that regulates lifespan, and SIRT1, a human deacetylase that promotes cell survival by negatively regulating the p53 tumour suppressor. Here we report the discovery of three classes of small molecules that activate sirtuins. We show that the potent activator resveratrol, a polyphenol found in red wine, lowers the Michaelis constant of SIRT1 for both the acetylated substrate and NAD+, and increases cell survival by stimulating SIRT1-dependent deacetylation of p53. In yeast, resveratrol mimics calorie restriction by stimulating Sir2, increasing DNA stability and extending lifespan by 70%. We discuss possible evolutionary origins of this phenomenon and suggest new lines of research into the therapeutic use of sirtuin activators.
I admire the understated style of so many scientific papers: "We... suggest new lines of research into the therapeutic use of sirtuin activators." If this research is successful, those words could turn out to be profound.

Of course, the classic example of this is Watson and Crick's paper describing the structure of DNA:

We wish to suggest a structure for the salt of deoxyribose nucleic acid (D.N.A.). This structure has novel features which are of considerable biological interest...

It has not escaped our notice that the specific pairing we have postulated immediately suggests a possible copying mechanism for the genetic material.

August 26, 2003

More on Sirtuins

As it turns out, the link I guessed at in my previous entry -- that work on sirtuins might be connected to previous work on caloric restriction -- was correct. There's a far more comprehensive article from the Washington Post:

Scientists have found for the first time a way to rev up a potent "anti-aging" enzyme in living cells, an advance they said could speed the development of drugs to extend human life span and prevent a wide range of geriatric diseases.

The novel approach has significantly increased the life spans of yeast and human cells in laboratory dishes and extended the lives of flies and worms -- organisms that, on the level of molecular biology, age much as humans do. Indeed, the researchers said, the compounds seem to have the same anti-aging effect as a drastic reduction in calories, the only strategy ever proven to extend life in mammals but one that most people find difficult to stick to...

[T]he findings strengthen an increasingly popular notion among many scientists that the cellular enzymes at the core of the experiments -- called sirtuins -- are universal regulators of aging in virtually all living organisms and represent a prime target for new anti-aging drugs...

For years researchers have known that life span can be extended by 50 percent or more in many kinds of creatures, including flies, worms and mice, if the animal is fed a diet that is nutritious but contains about 30 percent fewer calories than usual. Recently scientists found that the life-extending benefits of calorie restriction do not occur if the animal has been genetically altered to lack sirtuins, indicating these enzymes are crucial to this process.

Now scientists are coming to understand sirtuins' role in that life-extending response. In people, they seem to halt the normal cellular cycle that ends with old cells committing suicide and instead help rejuvenate them by beefing up their DNA repair processes and stimulating production of protective antioxidants.

"What we think is that if a cell is at a point of deciding whether to live or die, these sirtuins push toward the survival mode and let the cell try a little harder and longer to fix itself," said Sinclair, who has a financial stake in a new effort to develop sirtuin-related products with BIOMOL Research Laboratories of Plymouth Meeting, Pa.

Leonard Guarente, a researcher at the Massachusetts Institute of Technology in Cambridge, is also enthusiastic about the compounds' potential as anti-aging aids.

"We're very keen on the idea that this is it" -- that sirtuins are the central regulator of the aging process -- Guarente said. He is a founder of Elixir Pharmaceuticals of Cambridge, Mass., which, like Sinclair and BIOMOL, hopes to capitalize on chemicals that can boost sirtuin activity.

The goal is to make drugs or nutritional supplements that can fool the body into thinking it's living on a radically calorie-reduced diet, in effect allowing people to eat their cake and live longer, too.

BIOMOL can be found on the Web here. Elixir Pharmaceuticals can be found here.

August 25, 2003

Anti-Aging Discovery

An interesting report from the BBC:

Substances found in food and wine may be able to extend human life, according to new scientific research.

Scientists in the United States found that the substances -- called polyphenols -- can prolong the life of yeast cells significantly. They seem to work inside human cells too.

Polyphenols are produced by many plants -- perhaps the best known is resveratrol, found in red wine...

Now researchers at Harvard University have discovered that the chemicals can prolong the life of yeast by about 70%.

They do this by a mechanism which was previously unknown, by increasing production of enzymes called sirtuins...

The researchers also found that resveratrol increases sirtuin production in human cells in the lab; and, most compellingly, that it appears to prolong the life of flies and worms.

"Everyone's been interested in the polyphenols because of their anti-oxidant properties," said Dr Konrad Howitz, one of the team...

"But this mechanism with the sirtuins is new and I guess people are going to go back to the epidemiological data on heart disease and cancer and figure out how much is down to the anti-oxidant mechanism and how much to the sirtuins."

It is too early to conclude that the researchers have found an elixir of human life -- further work is needed, and the first step is to see if resveratrol can make mice live longer.

That experiment is scheduled to start in a few months' time, and should give results in less than a year.

If polyphenols do give mice extra life, and if that extra life is healthy, the stage will then be set for human trials of something which scientists have dreamed of for centuries -- a pill or potion to make us live longer.

Interestingly, some of the same team members have a citation for a paper in Nature some years back on the anti-aging effects of caloric restriction. A Holy Grail of the field would to be to find a substance that would give the benefits of caloric restriction without actually requiring it. This could be it.

Could we finally be closing in on useful anti-senescence treatments? It seems possible.

July 23, 2003

Taking Medicines for Granted

My friend, the talented Cory Doctorow, writes today about switching to a new, much cheaper drug to treat his acid reflux condition. By way of introduction, he writes:

I take a pill every day, one of a class of drugs called Protease Pump Inhibitors (PPI), for acid reflux (really wicked-bad heartburn). There are a lot of different ones -- Nexium, Prilosec, Aciphex, and so on -- but they all do the same thing: keep me from being in intense pain for more than half my waking hours. They're also all horrendously overpriced -- $3-5 a pill. I have health insurance, but my monthly co-pay is $25/month, and every single time I refill my prescription my asshole insurance company gives me some kind of run-around: I have to call them, call my doctor, whatever.
I'm going to call Cory on this. PPIs "keep [him] from being in intense pain for more than half [his] waking hours," but at the same time are "all horrendously overpriced -- $3-5 a pill." What am I missing here? If I had a condition that caused me to be in intense pain for more than nine hours a day, $3-5 per day would seem eminently reasonable to relieve the pain.

Put another way, if I had Cory's condition, PPIs didn't exist, and a pharmaceutical company said to me, "We think we can develop a drug to relieve your pain, but it will cost you $3-5 per day," I'd sign up in a heartbeat. But human nature being what it is, we take for granted that which we already possess, and so once I had the medicine, I'd probably grumble about the price, just as Cory is doing.

(By the way, I believe Cory meant to say proton pump inhibitors, which are used to treat gastroesophageal reflux disease. Protease inhibitors are used to treat HIV.)

May 27, 2003

Women's World Cup to the US

A few weeks ago, I blogged about FIFA's decision to move the Women's World Cup out of China due to SARS concerns:

As much as I'd love to see the women play here, Australia would be a great choice. I've never been, but its reputation for hospitality is well-known, and in the wake of the 2000 Olympics, they have wonderful sporting facilities. Also, while the 1999 Cup was held in the US, Australia has never hosted it. Anyway, given how political FIFA is, and given the appearance of taking an event away from China and moving it to the US, it seems almost certain they'll award it to Australia.
So much for my prognostication. FIFA has moved the Cup to the US:
America was preferred to five other countries which offered to step in to host the event, after the tournament was moved from China because of the Sars virus...

Fifa president Sepp Blatter said the success of the tournament when it was last held in the United States four years ago had influenced the decision.

"The Women's World Cup in 1999 was so successful that Fifa is delighted to see the event return to the United States," said Blatter in a statement.

Given that the World Cup obviously had to move somewhere, I'm happy that it's coming here. I didn't attend any of the Cup games in 1999, but I've seen many of the players in the WUSA (the women's professional league), and the quality of play is extremely high. I'd recommend it to anyone who enjoys soccer.

May 25, 2003

The Origins of the Flu

The CBC's excellent news show The National had an in-depth report Friday night on the apparent origin of SARS in the masked palm civet (covered by the New York Times and the Wall Street Journal).

The reporter interviewed Laurie Garrett, author of a book with the prescient-sounding title
The Coming Plague: Newly Emerging Diseases in a World Out of Balance
. She had this to say about influenza as an example of ongoing animal-to-human disease transmission:

We now know that influenza is actually an aquatic migratory bird virus. So what you have happening is, aquatic birds flying over these tethered ducks [outside homes and farms in southern China] and the bird droppings infect the tethered duck. The tethered duck then passes its virus to the pig, and then the farmers become infected from exposure to an ailing pig. That's why every year, the new mutant strains of influenza always come out of China.
I never understood the influenza cycle before -- I only had this vague impression that new flu strains came from Asia. It's good to finally understand how it works (even if only at a superficial level).

May 24, 2003

SARS Flares in Canada

The news on the SARS front has been generally good of late. The number of active cases in Hong Kong has been decreasing steadily since 18 April, while the number of active cases worldwide has been decreasing since 11 May.

Unfortunately, Canadian health authorities are now investigating up to 25 possible new cases of SARS in Toronto:

Dr. Donald Low, director of microbiology at Mount Sinai Hospital, said dozens of people have been asked to go into quarantine after possible exposure to SARS at the North York General Hospital.

The news comes just after five suspected SARS cases surfaced at the St. John's Rehabilitation Hospital in the city's north end.

Word of a potential new outbreak in Toronto prompted the U.S. Centers for Disease Control to reissue a travel alert Friday.

Low told reporters that SARS may have been spread by an elderly patient who developed pneumonia after an operation for a fractured pelvis at North York General.

A month ago today, I blogged an exchange between Case Ootes, deputy mayor of Toronto, and Denis Aitken, chief of staff for the director general at the World Health Organization. Ootes was complaining about the fact that the WHO's travel advisory was based in part on the export of two cases of SARS from Canada to other countries. Aitken responded:

Let me say that one case was enough to start this thing in Canada. It came from Hong Kong. In Hong Kong one case was enough from Guangdong to start the case in Hong Kong, the whole outbreak in Hong Kong.
And one case was apparently all it took for SARS to flare in Canada once again.

May 04, 2003

China, Taiwan, and SARS

From a story yesterday in the Wall Street Journal:

China on Saturday agreed to let the World Health Organization visit Taiwan in its fight against severe acute respiratory syndrome, putting aside politics after reports the island's number of SARS cases has doubled in a week.

China didn't explain its decision, but the official Xinhua News Agency quoted a Ministry of Health spokesman, Liu Peilong, as saying Friday that the mainland was monitoring the epidemic's development in Taiwan and was "concerned about the health and well-being" of the people. The report didn't give any other details...

China, where at least 190 people have died from SARS, has been accused of not doing enough to fight SARS and its change toward Taiwan may have been part of its recent effort to appear more cooperative. China earlier rejected direct WHO help for the island and blocked its efforts to join the United Nation agency.

What wasn't clear from either this story or a story on the same topic in the New York Times -- and what I want to know -- is exactly how China has been blocking Taiwan's requests for assistance. How is it that one country can disallow a UN agency from helping another country, absent a permanent Security Council member vetoing a Security Council resolution?

May 03, 2003

Moving the Women's World Cup

A few days ago, I drafted (but didn't finish) a blog entry in which I predicted that FIFA would move the Women's World Cup 2003 -- previously scheduled to be held in Shanghai, 23 September-11 October -- to another venue on account of SARS. I woke up this morning, opened up Movable Type to finish the entry, and found they had beat me to it:

The 4th FIFA Women's World Cup 2003, due to be staged in PR China from 23 September to 11 October, will be transferred to another country in view of the current health threat in China, which is greatly affected by the SARS epidemic...

To date, the USA and Australia have expressed interest in staging the competition. The FIFA administration will be clarifying the situation over the next few weeks, especially with regard to the timing of the championship. The final competition should, ideally, coincide with the timing of that originally planned for China...

At the same time the Executive Committee announced that the 2007 Women's World Cup would be awarded to China.

As much as I'd love to see the women play here, Australia would be a great choice. I've never been, but its reputation for hospitality is well-known, and in the wake of the 2000 Olympics, they have wonderful sporting facilities. Also, while the 1999 Cup was held in the US, Australia has never hosted it. Anyway, given how political FIFA is, and given the appearance of taking an event away from China and moving it to the US, it seems almost certain they'll award it to Australia.

This isn't the only change in sport as a result of the SARS epidemic:

The women's ice hockey world championships, scheduled to be played in China, was canceled, and the world badminton championships, to be held in Birmingham, England, has been postponed because of the large number of Asians expected to compete.

On Friday, the International Cycling Union moved the world track cycling championships to Europe.

More news on women's soccer can be found here.

April 28, 2003

Eradicating SARS in 2003?

From SARS Watch, an excellent and highly recommended site tracking SARS, an op-ed piece from the Wall Street Journal:

As summer approaches and the SARS epidemic declines, there will be an understandable urge to celebrate. But we must eschew premature celebrations and self-congratulations. History teaches us that the devastating 1918 influenza epidemic began with a modest "herald wave" in spring that faded away during the summer, only to explode and wreck global devastation the following fall and winter. It is possible that SARS, now seeded around the globe, could follow a similar pattern and fade away this summer, only to erupt again next winter.

The coming summer lull in SARS affords an extraordinary opportunity. If we can detect, diagnose and effectively isolate every contagious case during the period when the infection rate is at its lowest, it is possible that we can truly eradicate SARS, not just for the short term, but permanently.

Epidemic-control efforts should not simply be maintained, but doubled, and redoubled again. New diagnostic tests should be mass produced and made freely available around the globe. Epidemiological teams should investigate every possible case, even in the poorest communities. Face-saving politicians who hide local epidemics must be cajoled, or more forcefully convinced, to cooperate. Special efforts must be made to detect and quench new outbreaks in the Southern Hemisphere. With skill, determination, and luck, we might be able to break all the chains of transmission before the onset of winter offers the virus a chance to spread more rapidly again...

[A] halfhearted effort at controlling the epidemic would guarantee failure. But if the U.S. is prepared to lead a world-wide coalition of nations in joining forces with the World Health Organization with the goal of doing everything possible to eradicate SARS, this extraordinary goal might just be achievable.

The full article is well worth reading.

April 24, 2003

Toronto-WHO Smackdown

On NewsHour last night, the deputy mayor of Toronto, Case Ootes, faced off against Denis Aitken, chief of staff for the director general at the World Health Organization, moderated by host Ray Suarez:

Ray Suarez: Denis Aitken, the WHO has added Toronto to a list that includes Chinese provinces and the Chinese capital Beijing. Why?

Denis Aitken: Because Toronto now meets the three criteria that we have for ensuring that we try to keep down the international spread of the disease.

The three criteria are that there's a large number of cases, that secondly there's evidence of transmission now unfortunately outside of the hospital community and the local family of those into the wider community, and finally that we have had a case of an exportation of the disease from Canada.

Ray Suarez: Deputy Mayor Ootes, given those criteria what was Toronto's reaction to the WHO's announcement of a travel warning.

Case Ootes: Well, we were obviously very upset and have launched a protest through our federal minister of health that the action by the World Health Organization is not justified given the situation in Toronto which is completely different from the situation in China...

Ray Suarez: What about the third criterion Mr. Aitken mentioned, that now there is evidence that cases have been exported from Canada to other countries?

Case Ootes: I think he's talking about two cases, and to issue a warning based simply on that, that has the economic impact on the lives of people in this city, seems to be an action that doesn't... isn't merited by the facts...

Denis Aitken: Let me say that one case was enough to start this thing in Canada. It came from Hong Kong. In Hong Kong one case was enough from Guangdong to start the case in Hong Kong, the whole outbreak in Hong Kong.

Score one for the WHO.

Toronto and SARS

Toronto has been the city hardest hit by SARS outside of Asia. Yesterday the WHO took a dramatic step, adding Toronto to its list of cities and regions for which it warns against all non-essential travel:

Hoping to slow the spread of SARS, the World Health Organization on Wednesday warned against "all but essential" travel to Toronto and parts of China, including the capital, Beijing -- a move immediately decried by one of Toronto's chief microbiologists as "ridiculous."

The statement from the WHO extends a previous warning that urged people not to travel to the Chinese province of Guangdong and to the Hong Kong Special Administrative Region.

"As a result of ongoing assessments as to the nature of outbreaks of severe acute respiratory syndrome (SARS) in Beijing and Shanxi province, China, and in Toronto, Canada, WHO is now recommending, as a measure of precaution, that persons planning to travel to these destinations consider postponing all but essential travel," the group said in a statement issued from Geneva.

The reaction of Toronto's health officials and city leaders was of outrage:

Anne McLellan, federal Health Minister, said Canada takes "very strong exception" to the decision.

"I am just shaking my head here in disbelief," said Dr. Colin D'Cunha, Ontario's commissioner of public health.

"Our team is very disappointed with the WHO's warning. We believe this decision was made without consulting the province. We believe it is an over-reaction."

Others were harsher.

"It's a bunch of bulls---," said Dr. Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital, who has been at the forefront of Canada's SARS battle. "The impact on the city -- you won't be able to take this mark off."

But while Toronto is angry at the WHO for their travel warning, one of Canada's own provincial leaders is considering doing the very same thing:

Alberta Premier Ralph Klein mused yesterday about whether he'd let his government's employees travel to Canada's largest city...

The Alberta Premier said yesterday that he had cancelled a trip to China because of SARS fears. All of his government's employees are now prohibited from travelling to China, Vietnam, Singapore, Hong Kong, Taiwan and Macao.

Mr. Klein said the province is also considering whether to impose a similar ban on travel to Toronto.

Personally, I think the reaction of Toronto officials puts them in danger of looking like Chinese officials a week or two ago: in denial about the true nature of the threat they face. A more considered response would be to say something like, "While we disagree with the WHO's assessment of the seriousness of the situation here, we will work with them over the next three weeks to continue the process of containing SARS in Toronto and demonstrating to the world that our city is safe for travelers."

April 22, 2003

Big, Evil Sugar

Via boing boing comes a story in the Guardian on the US sugar industry's opposition to new nutritional guidelines from the World Health Organization:

The sugar industry in the US is threatening to bring the World Health Organisation to its knees by demanding that Congress end its funding unless the WHO scraps guidelines on healthy eating, due to be published on Wednesday.

The threat is being described by WHO insiders as tantamount to blackmail and worse than any pressure exerted by the tobacco lobby.

In a letter to Gro Harlem Brundtland, the WHO's director general, the Sugar Association says it will "exercise every avenue available to expose the dubious nature" of the WHO's report on diet and nutrition, including challenging its $406m (£260m) funding from the US.

The industry is furious at the guidelines, which say that sugar should account for no more than 10% of a healthy diet. It claims that the review by international experts which decided on the 10% limit is scientifically flawed, insisting that other evidence indicates that a quarter of our food and drink intake can safely consist of sugar.

"Taxpayers' dollars should not be used to support misguided, non-science-based reports which do not add to the health and well-being of Americans, much less the rest of the world," says the letter. "If necessary we will promote and encourage new laws which require future WHO funding to be provided only if the organisation accepts that all reports must be supported by the preponderance of science." ...

The Sugar Association objects to the new report having been published in draft on the WHO's website for consultation purposes, without what it considers "a broad external peer-review process". It wants a full economic analysis of the impact of the recommendations on all 192 member countries. In the letter to Dr Brundtland, it demands that Wednesday's joint launch with the Food and Agriculture Organisation be cancelled...

The industry does not accept the WHO report's conclusion that sweetened soft drinks contribute to the obesity pandemic. The Washington-based National Soft Drink Association said the report's "recommendation on added sugars is too restrictive". The association backs a 25% limit.

The Sugar Association is proposing to withhold all US funding from the WHO -- yes, the people fighting to contain SARS and numerous other worldwide health threats -- if they don't agree that people should feel free to consume one-quarter of all their calories from added sugars. This goes beyond audacious self-interest. This is -- and I don't use the term lightly -- evil.

This is just the latest example of the destructive self-interest practices of the US sugar lobby. They have long sought and received unfair trade protections that cost US consumers billions of dollars, as described in this 2002 article from the Cato Institute:

Through its sugar program, the U.S. government guarantees a minimum price to domestic sugar growers by restricting imports and by buying and storing excess production. The result of this intervention is a domestic sugar price that is typically two or three times the world market price. The losers are millions of American families that consume sugar, along with sugar-using industries such as candy-makers, and sugar growers in mostly poor countries.

As with other protectionist policies, the biggest losers are consumers. American families pay for this program every time they buy Christmas candy and cookies, a bag of sugar, soft drinks or candy bars. A report by the U.S. General Accounting Office estimated that, in 1998, American sweetener users paid an extra $1.9 billion a year because of the U.S. sugar program...

Also paying the price for the sugar program are taxpayers and the environment. To mop up overproduction caused by price supports and protection, the federal government bought nearly 1 million tons of sugar last year only to store it in government warehouses. The buying and storing of excess sugar will cost taxpayers an estimated $2 billion over the next 10 years. Taxpayers are also paying billions of dollars to help clean up the Florida Everglades, where excess sugar production in the region has disrupted water flows and dumped pollutants such as phosphorus in waterways.

The sugar program has caused damage beyond our borders. The depressed global sugar prices caused by U.S. protectionism cost sugar producers in poor nations an estimated $1.5 billion a year in lost export earnings. Our stubborn refusal to open our sugar market has complicated the efforts of U.S. trade negotiators to open foreign markets to American exports, including services, manufactured goods, and farm products such as soy beans and corn in which we enjoy a natural competitive advantage...

The U.S. sugar program is a classic case of concentrated benefits and diffused costs. A small number of sugar growers receive enormous benefits, while the costs of providing those benefits are spread across the U.S. economy, specifically to consumers and confectioners. Consequently, U.S. sugar producers have a strong incentive to lobby and fund campaigns of U.S. policy-makers. Dominated largely by two companies in Florida (Flo-Sun and U.S. Sugar), the sugar lobby has been a major financial contributor to incumbent politicians.

Enough is enough. Big Sugar must be stopped.

April 20, 2003

Atkins' Worst Week

As if it wasn't bad enough for Dr. Robert Atkins that he died this past week, by coincidence, an article published in the latest issue of the Journal of the American Medical Association claimed, in examining 107 previous studies, to find no consistent correlation between low carbohydrate intake diets (as he so famously espoused) and weight loss:

There is insufficient evidence to make recommendations for or against the use of low-carbohydrate diets, particularly among participants older than age 50 years, for use longer than 90 days, or for diets of 20 g/d or less of carbohydrates. Among the published studies, participant weight loss while using low-carbohydrate diets was principally associated with decreased caloric intake and increased diet duration but not with reduced carbohydrate content.
Found on Slashdot here (press release here).

April 12, 2003

After SARS

An article from the Wall Street Journal on an aspect of SARS not much discussed: its aftermath.

Doctors count Chu Thi Phuong among the fortunate.

On March 28, the 42-year-old Vietnamese office cleaner and mother of three was discharged from a Hanoi hospital. She had survived SARS...

[S]he and her family are confronting the stigma of a disease with no clear scientific origin and no proven cure. "Sometimes I go out and the local kids see me and hold their noses," Ms. Phuong said...

Her nine-year-old son has trouble finding after-school playmates. Her four-year-old son was banished to an outdoor courtyard by a fearful day-care worker. Even Ms. Phuong's closest friends are keeping their distance...

For Ms. Phuong, the emotional pain will soon be compounded by financial hardship. At month's end she will lose her $100-a-month salary at Gilwood Co. Ltd., a New York garment company, which confirms that it is relocating its Hanoi office elsewhere in Vietnam because of SARS jitters. "I don't know what to do now," Ms. Phuong said...

Johnny Chen, an American merchandise manager from Gilwood's Shanghai office, came to town on Sunday, Feb. 23, after a short stay at the Metropole Hotel in Hong Kong. The hotel was later pinpointed by the World Health Organizations as a center for infection after a doctor who had treated SARS in southern China stayed there and spread the virus to other guests...

Wednesday morning, Feb. 26, another Gilwood employee told her Mr. Chen was ill. Ms. Phuong went out to get him some hot rice porridge and an extra blanket. Gilwood colleagues returned to the office later in the day and found Mr. Chen sprawled in the bedroom with a raging fever. Ms. Phuong helped bring Mr. Chen to the Hanoi French Hospital, the lone international hospital here in Vietnam's capital.

At first, Ms. Phuong visited Mr. Chen's bedside each day. "He was a stranger here," she said. "I'm a maid at the company, so I had to take some responsibility."

Ms. Phuong made him fresh orange juice, fed him some meals and whisked away his dirty clothes; she even paid his laundry bills. When Mr. Chen's condition became critical, she made a list of his possessions, which included $2,400 in cash, two cameras, a portable music player and a mobile phone.

Five days into this vigil, she began feeling sick herself.

After three visits to hospitals, Phuong was finally recognized as a SARS case and admitted. As she slowly recovered, she learned that Chen had died in Hong Kong. Finally she was able to return home, but there was no job awaiting her:

After Mr. Chen's affiliation with Gilwood became known, Gilwood's Vietnamese suppliers were afraid to do business at the firm's Hanoi office. Gilwood decided to relocate in Hung Yen province, more than 40 miles from Hanoi, where a contractor is churning out jeans...

She pities her nine-year-old boy's loneliness, now that his friends won't say they won't let him play at their houses after school...

Her medical bills total eight million dong, or $520, a sum equivalent to five months' salary at her Gilwood job. Gilwood agreed to pick up that tab, but that hasn't eased her worries about finding a new job.

I hope that, with the publicity from this story, Gilwood comes to realize that this woman became sick almost certainly because of her care -- which went far beyond the job description of a maid -- for one of its employees. Paying her medical bills is a good start, but to leave her jobless seems cruel. They should offer to relocate Phuong and her family to their new factory location, or at a minimum give her a generous severance package. A small amount of money by American standards could make a huge difference in this woman's life.

Is this the sort of social stigma that will face recovered SARS patients elsewhere in the world, including in developed countries?

April 11, 2003

SARS, Aircraft, and Evolution

From a New York Times story filed from Hong Kong:

Health officials announced here tonight that a man infected with a new respiratory disease had flown from Hong Kong to Munich, Barcelona, Frankfurt, London, Munich again, Frankfurt again and then back to Hong Kong before entering a hospital.

The Hong Kong Department of Health appealed for passengers and air crews from all seven flights to consult medical professionals. A health department spokeswoman said it was not yet known whether the man, who is 48, had infected anyone else on the flights with the disease -- severe acute respiratory syndrome, or SARS.

All the flights were on Lufthansa. The airline said in a statement tonight that it had disinfected all the planes and was contacting the air crews and passengers...

Airlines have been saying that the filters aboard modern planes do a good job of removing viruses from the air. But according to the health department here, at least 13 people have fallen ill with SARS so far after they shared a flight from Hong Kong to Beijing last month with an elderly man who had been infected with the disease while visiting his brother in a hospital here...

Travelers have continued to board planes while feeling ill despite strenuous warnings from the World Health Organization and national health agencies that they not do so.

In the case that was announced tonight, the man flew on Lufthansa Flight 731 on March 30 from Hong Kong to Munich, and traveled the next day on Flight 4316 to Barcelona, according to an itinerary that was released here by the health department. He developed symptoms while in Barcelona.

The man then traveled on Flight 4303 to Frankfurt on April 2 and on to London the same day on Flight 4520. He went to Munich the next day on Flight 4671, then headed for Frankfurt on April 4 on Flight 265. He connected with Flight 738 the same day back to Hong Kong, arriving on April 5.

The man checked into a hospital here on April 8 and was confirmed today to have SARS.

Some years ago, I had the great pleasure of meeting the evolutionary biologist and author Richard Dawkins over dinner at his house in Oxford. At the time, the Ebola virus was in the news. I had just read The Hot Zone by Richard Preston, whose first chapter -- in which a Kenyan man in the near-final stages of Ebola, vomiting blood as his internal organs begin to disintegrate, boards a flight to Nairobi to seek treatment -- is the scariest thing I've ever read.

"Would it be possible," I asked Dawkins, "for a virus to evolve specifically to take advantage of modern aircraft ventilation systems? Could a virus evolve that would use aircraft as more than just transportation for its human hosts?"

Dawkins thought for a moment, then replied.

"Yes, I believe it would be possible."

I hope people listen to the warnings and stop flying if they have symptoms of SARS. I understand well the desire to go home when one is sick, but to do so is to put the world at risk.

April 06, 2003

SARS Growth

Via David Smith, a statistical graph and predictions for the SARS epidemic by Ted Kaehler:


The number of reported cases of SARS in the world is doubling every 11 days. This is implied by the slope of the blue curve, using the data available on April 5, 2003. There will be 100,000 cases on about June 1, 2003. A million cases will be reached on about July 6, 2003, and ten million on about August 11, 2003. These predictions will change every day as new data changes the slope of the curves. Only world cases after March 25, 2003 are used to compute the slope, because that is when China began reporting...

Epidemics usually follow S-shaped curves. The predictions here are based on pure exponential growth. When the middle of the S-shaped curve is reached, the rate of infection will slow, and exponential growth predictions will no longer be useful. The reported data shows that the epidemic is still in an exponential growth phase.

The $64,000 question is, when will SARS transition out of its current exponential growth phase and into the middle of the S-shaped curve? After 10,000 cases? 100,000 cases? 1,000,000? 10,000,000?

The page with the graph and all the statistical forecasts can be found here.

April 05, 2003

China Apologizes

Just as I was about to post a truly scathing entry on China's response to SARS, word comes that they are apologizing for their conduct to date:

China apologized Friday for not doing a better job of informing people about severe acute respiratory syndrome as an international medical team went to the city where it believed the mystery illness may have first broken out.

The admission, extraordinary for a government that rarely acknowledges fault, came after escalating criticism abroad -- and one day after the health minister explicitly said China had followed its own rules in dealing with the problem.

"Today, we apologize to everyone," said Li Liming, director of the Chinese Center for Disease Control.

"Our medical departments and our mass media suffered poor coordination. We weren't able to muster our forces in helping to provide everyone with scientific publicity and allowing the masses to get hold of this sort of knowledge."

Will the highest levels of the Chinese government stand behind this apology, or will China revert to form and disavow any culpability in the matter? The next few days will tell.

I'll hold my more direct attack until we have a clear idea of what China's official stance will be.

April 04, 2003

Still More on China and SARS

Also from the Times, also from yesterday, another article on Chinese stonewalling on SARS:

In early March, when a new mystery illness started hopscotching around the globe, Chinese health officials looked on in silence, as if to say, "This has nothing to do with us."

At that point, China was already four months into an outbreak that officials later acknowledged was the same disease, severe acute respiratory syndrome, or SARS. Yet they insisted that the situation was fully under control, shared none of their data and declined to join international investigations.

Only in the face of intense international pressure are the Chinese now releasing valuable information to scientists from the World Health Organization, who were allowed in the country just a few weeks ago.

This week, the Chinese government announced its count of new SARS cases for March, bringing China's caseload to 1,190, with 46 deaths -- the highest figures for any nation. It also announced that the W.H.O. team had permission to travel to the southern city of Guangzhou, the epicenter and origin of the epidemic...

By January, Chinese doctors in Guangdong Province already understood a lot about the disease's spread and how to control outbreaks. If three months ago, they had shared that experience or allowed international experts in to aggressively look for the germ responsible, would so many be dying from Canada to Vietnam today?

How much plainer can the question be asked?

More on China and SARS

From an article in the New York Times yesterday:

Speaking at the first news conference held by the Chinese government on the outbreak, which is thought to have started last November in Guangdong Province, Zhang Wenkang, China's minister for health, rejected a travel advisory issued the previous day by the World Health Organization, which is based in Geneva.

"It is safe for people to come to China to work, travel or attend conferences," Mr. Zhang said. "I'm not an agent for an airline trying to sell plane tickets to travel in China."

His assurances directly conflicted with the first disease-related travel advisory the World Health Organization has issued in its 55-year history. They also highlighted ongoing tensions with international medical investigators.

Beijing has hampered the free movement of medical investigators, released few statistics on the disease and has long insisted that the outbreak is "under control."

But officials of the agency insisted today that the disease, severe acute respiratory syndrome, or SARS, is not under control.

"The numbers released by Chinese authorities yesterday were far higher than we expected," said Peter Cordingley, a spokesman for the World Health Organization. "It is imperative that we exercise all caution until we understand the situation in Guangdong."

The evidence of Chinese obstructionism -- leading to an accelerated spread of SARS and a resulting increase in the number of deaths -- seems to mount by the day.

April 03, 2003

Thanks, China

The Wall Street Journal reports today on the Chinese front in the war against SARS. I quote extensively from this article because of the import:

China revealed that a lethal strain of pneumonia has caused an additional 12 deaths and hundreds of new cases, and said it would allow a team of foreign specialists to visit the area where the outbreaks first occurred.

Wednesday's developments suggest that China's leadership -- facing its first major challenge since taking office earlier this year -- is seeking to address sharp criticism of its handling of the outbreak as economic and political fallout grows.

The World Health Organization said severe acute respiratory syndrome, or SARS, has spread to five Chinese provinces and Beijing, infecting a total of 1,190 people and causing 46 deaths since November. Included in the tally were figures released Wednesday by the southern province of Guangdong, which put its latest death toll at 40. The WHO, which is sending a team of doctors to Guangdong, also issued a rare alert urging travelers to avoid the province and Hong Kong, two of the hardest-hit areas.

China has come under fire at home and abroad for its rigid control of information and slow response to the epidemic. Besides its halting disclosure of new SARS cases, Chinese authorities took five days to grant the WHO's request to visit Guangdong. In a rare rebuke from the state-controlled media Wednesday, the English-language China Daily newspaper blamed local authorities for failing to inform the public about the outbreak...

In seeking explanations for China's actions, some analysts note the paradox facing Beijing. China's open door to investment has launched more than two decades of growth and prosperity. But that growth has led authorities to fear releasing information that might rattle the public and scare off the foreign investment on which the economy increasingly depends. Though it has been unwilling to concede that its public-health failures may be responsible for the disease's global spread, Beijing is now realizing the cost of that policy, these analysts say...

An account of the spread of SARS makes clear that if Chinese authorities had acted differently, the outbreak might have taken a different course and more might now be known about the disease. The virus, which spreads through close contact with an infected person and incubates for as long as 10 days, seems to have first appeared in Guangdong in November, about the same time that new local Communist Party Secretary Zhang Dejiang was taking over the leadership of the province. Authorities quickly clamped down on reporting by the domestic media after nervous residents in southern cities began to stockpile medical supplies.

Guangdong authorities remained silent about the illness until Feb. 11, when provincial officials revealed the scope of the outbreak, reporting 305 recorded cases and five deaths from atypical pneumonia; they also said that the outbreak was under control.

Provincial authorities belatedly admitted on March 26 that by the end of February -- 15 days after Guangdong's assertion that the outbreak was under control -- cases in their province more than doubled, to 792 from 305, with 31 deaths.

During those 15 days, as alarm mounted over the new disease, Secretary Zhang, a Politburo member who outranks the minister of health, tried to calm public fears. On Feb. 14, he ordered provincial officials to educate the public to "voluntarily uphold social stability, not believe in rumors, not spread rumors" and to focus on the party's goal of building China into a "comparatively well-off society." According to the media outlet of the Guangdong party committee, the Southern Daily, police summoned the operators of leading Web sites and ordered them to carry only positive reports about the fight against the illness.

This approach wasn't limited to Guangdong. When Beijing authorities admitted on March 26 that there were SARS cases in city hospitals, the news didn't get front-page treatment in local newspapers the next day. Under orders from the city's propaganda authorities, the capital's stable of papers, normally fierce rivals, all ran the same brief three-paragraph story tucked away on their inside pages, and all under the same reassuring headline: "Imported atypical pneumonia in our city has been effectively controlled."

It was only on March 28 -- more than four months after the first known case -- that the government told the WHO it would make SARS a "Category B" disease, meaning that provincial health officials would be obliged to notify central health authorities of cases. But as of Wednesday, according to Wu Kejun of the Department of International Cooperation at the Ministry of Health, "the ministry has required local governments to report to the central government about SARS cases once in a while, but how to classify SARS is still under discussion." ...

Even Wednesday, there were signs Beijing could do more. Chinese Health Minister Zhang Wenkang broke the general silence on the issue in a state-television interview, but he said the outbreak was "under effective control." State TV also said recently anointed Premier Wen Jiabao Wednesday called for measures to "eliminate the epidemic situation in a few areas at its roots."

There was some good news. Health Ministry officials agreed to nominate Chinese doctors to WHO expert teams, and have promised to provide the WHO with daily updates on a province-by-province basis on the progress of the disease, though there was no indication of when these might begin.

For me, the most important sentence of this article is:

An account of the spread of SARS makes clear that if Chinese authorities had acted differently, the outbreak might have taken a different course and more might now be known about the disease.
It is unbelievable to me that it has only been in the last two days that China has agreed to allow WHO doctors into Guangdong. I don't especially fault the Chinese leadership for issuing calming words and urging people not to panic -- the public health authorities in Toronto did the very same thing yesterday in response to a convention cancellation and a travel warning from the government of Australia. What is unforgivable is China's refusal to cooperate fully with the international health community until so much time had passed after the seriousness of the problem had been recognized.

As of today, the WHO reports 2,270 cases of SARS to date, with 79 of those resulting in deaths. The question we have to ask -- and can never truly know -- is how many of those deaths could have been avoided had the Chinese government cooperated fully in the fight against SARS from the very first moment.

This Isn't Good

A CDC director on SARS:

Dr Julie Gerberding, a director of the US Centers for Disease Control (CDC), said on Thursday that a massive scientific drive to beat the illness may be too late to prevent a major outbreak across every continent of the world...

In an unprecedented move on Wednesday, the WHO told travellers to postpone non-essential trips to this part of China, or Hong Kong, where there have been hundreds of probable cases and dozens of deaths.

There have been 72 probable cases of Sars in the US so far, but Dr Gerberding fears that the worst could yet be to come.

In the New England Journal of Medicine, she wrote: "A very sobering question remains -- are we fast enough?

"Can we prevent a global pandemic of Sars?"

"If the virus moves faster than our scientific, communications and control capacities, we could be in for a long, difficult race.

"The stakes are high, and the outcome cannot be predicted."

From BBC News.

March 29, 2003

Healthy Happy Meals?

In a story related to a previous entry, McDonald's has announced they're going to be making Happy Meals healthier:

McDonald's, the world's largest restaurant chain, will include choices such as fruits and vegetables in its children's Happy Meals, and plans to pay for public-service advertising promoting fitness and health.

Children's meal options might also include low-fat yogurt and fruit juices, new Chief Executive James Cantalupo said. McDonald's restaurants worldwide will tailor menus in each market to local tastes, working with nutrition experts to make the changes, he said.

McDonald's new advisory council on healthy lifestyles will work with the U.S. Department of Health and Human Services and the World Health Organization to educate consumers on nutrition and fitness, and allocate money for programs...

Several McDonald's markets already offer healthier options, including Australia with toasted-cheese-and-tomato sandwiches, raisins and orange juice. Restaurants in the U.S. already offer low-fat milk and noncarbonated drinks.

When my kids were little, we used to take them to McDonald's fairly often. It wasn't that we liked the food or thought it was nutritious; it was that McDonald's offered a place where they could eat something they'd like and play for an hour or so, giving us a little down time. It would have been nice if they had had healthier Happy Meals back then, but better late than never. Let's just hope that parents take them up on the new healthy options when they become available.

February 05, 2003

Second-Hand Smoke, GMOs, and Europe

Thomas Friedman begins a recent column on the situation in the Middle East with the following anecdote:

Last week I went to lunch at the Hotel Schweizerhof in Davos, Switzerland, and discovered why America and Europe are at odds. At the bottom of the lunch menu was a list of the countries that the lamb, beef and chicken came from. But next to the meat imported from the U.S. was a tiny asterisk, which warned that it might contain genetically modified organisms -- G.M.O.'s.

My initial patriotic instinct was to order the U.S. beef and ask for it "tartare," just for spite. But then I and my lunch guest just looked at each other and had a good laugh. How quaint! we said. Europeans, out of some romantic rebellion against America and high technology, were shunning U.S.-grown food containing G.M.O.'s -- even though there is no scientific evidence that these are harmful. But practically everywhere we went in Davos, Europeans were smoking cigarettes -- with their meals, coffee or conversation -- even though there is indisputable scientific evidence that smoking can kill you. In fact, I got enough secondhand smoke just dining in Europe last week to make me want to have a chest X-ray.

I imagine that a European might respond by saying something like, "You can choose not to smoke, and you can choose to walk away from smokers, but if you don't know that your food contains GMOs, you have no choice to make." True, but Friedman's basic point is still right: there's no scientific evidence that GMOs are harmful, and yet Europeans are making a big fuss over them while continuing to smoke like fiends, indoors and out.

In the early 1990s, while serving as the original product manager for Adobe Acrobat, I went on pre-launch press tour across Europe. Except in the UK, where technology journalists expected one-on-one interviews, each day's schedule would be the same:

  1. Wake up, shower, and pack.
  2. Check out of hotel.
  3. Meet in hotel conference room to set up demo machines.
  4. Brief all area journalists at once.
  5. Dine with journalists at hotel restaurant.
  6. Catch taxi to airport.
  7. Fly to next city.
  8. Check into hotel.
  9. Meet colleagues for dinner.
  10. Catch up on work, work out, or just go to sleep.
The problem was that during activities 4, 5, 7, and 9 (and 6, depending on the taxi driver), we were inescapably exposed to cigarette smoke -- especially during the briefings, which were typically held in small, poorly ventilated rooms. Most of the journalists we met smoked, and many did so more or less continuously. By the end of the two-and-a-half week tour, I was absolutely miserable.

It has been a while since I've done a press tour in Europe, so I wasn't sure if things had changed in the meantime. Apparently they haven't.

February 03, 2003

Sleeping When Overtired

From Popular Science, a question and answer on sleep difficulties:

Why is it so difficult to fall asleep when you are overtired? ...

There is no one answer that applies to every individual. But many people fail to note the distinction between fatigue -- physical tiredness -- and sleepiness, the inability to stay awake. It's possible to feel "tired" physically and still be unable to fall asleep, because while your body may be exhausted, you don't feel sleepy. To fall asleep, you need adequate time to unwind, even if you feel fatigued. It's not so easy to simply "turn off."

According to Carl E. Hunt, director of the National Center on Sleep Disorders Research in Bethesda, Maryland, most people do not allow themselves sufficient deceleration.

Lack of sleep complicates matters even more. Experts say adults need at least 7 to 8 hours of sleep a night to function properly. When you get less sleep than that on consecutive nights, you begin to accrue "sleep debt." As sleep debt increases (and functionality decreases), your body experiences a stress response and begins to release adrenaline. Now a vicious cycle has been created: You experience the feeling of being more and more tired, but your body is increasingly stimulated. "Power sleeping" for more hours on weekends is only a temporary solution. "There is no substitute for getting a good night's sleep on a regular basis," says Hunt.

Most of us, however, don't get the sleep we need. According to the 2002 National Sleep Foundation, Americans sleep an average of 6.9 hours per night during the week, and 58 percent of adults experience symptoms of insomnia a few nights a week or more.

This sounds like the story of my life, except for the "power sleeping" part, which I'm unable to do. Last week, after a night of poor sleep at home followed by another on the road, I arrived back home at 1:00 AM after a five-and-a-half-hour drive. I was falling asleep in the car (while taking a turn as a passenger, thankfully), but I couldn't for the life of me sleep once I got home. There are few things in the world more frustrating than being exhausted and wanting to sleep but unable to do so.

July 08, 2002

Atkins Revisited

There's a long, extremely detailed, and wonderfully informative article on low-fat versus low-carbohydrate diets, "What If It's All Been A Big Fat Lie?", in Sunday's New York Times Magazine. Has the medical establishment failed to properly investigate the type of diet originally advocated by Dr. Robert Atkins in 1972? Can we trace our current obsession with low-fat diets not to medical evidence but to a Senate committee's decision?

If the alternative hypothesis [that low-fat diet contribute to obesity] is right -- still a big ''if'' -- then it strongly suggests that the ongoing epidemic of obesity in America and elsewhere is not, as we are constantly told, due simply to a collective lack of will power and a failure to exercise. Rather it occurred, as Atkins has been saying (along with Barry Sears, author of "The Zone"), because the public health authorities told us unwittingly, but with the best of intentions, to eat precisely those foods that would make us fat, and we did. We ate more fat-free carbohydrates, which, in turn, made us hungrier and then heavier. Put simply, if the alternative hypothesis is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates, and that can lead to obesity, and perhaps even heart disease. ''For a large percentage of the population, perhaps 30 to 40 percent, low-fat diets are counterproductive,'' says Eleftheria Maratos-Flier, director of obesity research at Harvard's prestigious Joslin Diabetes Center. ''They have the paradoxical effect of making people gain weight.''
Is this true? I've believed in (and usually followed) the low-fat theory for years now, usually (though not always) with success. After losing a good deal of weight 12 years ago, I've kept most of it off most of that time... though it has certainly been hard. When Ray Kurzweil wrote glowingly of ultra-low-fat diets in The 10% Solution for a Healthy Life, I thought I had all the validation I would ever need. Could it all be wrong?

At last, multiple studies of Atkins-type diets are underway. Though some early results have been reported, we may not have reliable, reproducible results from large-scale tests for another five years or more. What do we do in the meantime?