Dallas Buyers Club - Ethical?

I recently watched the film, Dallas Buyers Club with Matthew McConaughey. It depicts a cowboy who is diagnosed with HIV that led to AIDS. The only available treatment at the time in the 1980s was through double-blind FDA trials with AZT. This drug has an azido group that prevents formation of phosphodiester linkages needed for DNA replication (Yogita et al., 2012). This causes chain termination and thus brings viral replication rates down. The decrease in DNA replication is also what made this a valuable cancer drug. But without the assurance that he would receive the drug, and without the assurance it would even work, he took treatment of his health condition upon himself.

Ron Woodroof (who McConaughey played) went to Mexico and received alternate treatment. Eventually, he found himself shipping these medications back to the US. Here is where the Buyer Club comes into play. Those suffering from HIV/AIDS, without any medications could then purchase a membership, and the drugs would be a part of the fee. So technically, he was never selling the non-FDA approved drugs. 

He died six years after diagnosed, although doctors only gave him months to live.

After reflecting on the movie, I could not help but think of our ethical discussions from class. He broke the law to import drugs for other individuals. His intentions were to help them. Although, he did make a profit doing it. Was he being ethical while maneuvering around the legal and medical systems in place? If you were a physician in this circumstance, what could you do to help? Woudl you help? Which of the four biomedical ethical principles did he personify, if any? Should he have just purchased enough for himself instead of buying it for others?

References:
Blair, E. (2013, November 1). The Dallas Cowboy Behind The Real 'Buyers Club'. Retrieved from https://www.npr.org/2013/11/01/242309799/the-dallas-cowboy-behind-the-real-buyers-club.

Kolata, G. (1988, July 10). IDEAS & TRENDS: A Market for Drugs; AIDS Patients and Their Above-Ground Underground. Retrieved from https://www.nytimes.com/1988/07/10/weekinreview/ideas-trends-a-market-for-drugs-aids-patients-and-their-above-ground-underground.html.

Yogita, G. et al., 2012. PharmGKB summary: zidovudine pathway. Pharmacogenetics and genomics. 

If we can help, shouldn't we?

My inspiration to write this blog post came when I was watching the documentary “Inside Bill’s Brain: Decoding Bill Gates.” In the Netflix documentary, one key point that is addressed is Bill Gates “obsession” with the complete eradication of poliomyelitis. While many of us are way too young to even comprehend the fear and damage caused by this virus, there are still countries today (Nigeria, Pakistan, and Afghanistan) where mothers live in fear of their beautiful creations contracting a very preventable disease (CDC.gov/global health, 2019). I found it very inspiring that while most people have chalked up the virus to being totally eradicated, a man like Bill Gates has refused to stop his efforts until the virus is actually completely eradicated.

This documentary brings light to two arguments. The first is that with the last documented case of polio in the USA 1979, then why should we spend billions of dollars to eradicate a disease that is pretty much eradicated (Bill and Melinda Gates Foundation, 2019). While the other view is through the people in these 3^rd world countries who have to live in this fear of their children developing this preventable disease. Bill and Melinda Gates have spent over $2 billion—yes that’s a B—on the eradication of poliovirus (Davis Guggenheim, 2019). They have spent this money because they believe that our current vaccine process is not sustainable and with the complete eradication, we could save about $40-50 billion globally. (Bill and Melinda Gates Foundation, 2019) It is for the beneficence of everyone that Bill and Melinda fight on. With the poliovirus still found even in small amounts in these epidemic countries, it can be spread to surrounding countries with less effective vaccines according to the World Health Organization (2019).

            After some reflection, I ultimately decided that Bill Gates and his wife Melinda’s efforts to eradicate the poliovirus was not only the right thing to do, but also was the most financially responsible option. I used the Jesuit biomedical ethical values to analyze what was best for the general population. I believe the biggest ethical value represented by the Gates Foundation is justice. They are being fair to the entirety of the global nations, even those living in 3^rd world countries. It is our responsibility as future health care providers to serve everyone regardless of their socioeconomic status or if they live in a 3^rd world country.

Reference:

Bill & Melinda Gates Foundation. (2019). Polio. [online] Available at: https://www.gatesfoundation.org/what-we-do/global-development/polio [Accessed 30 Sep. 2019].

CDC.gov/global health. (2019). Polio Eradication. [online] Available at: https://www.cdc.gov/polio/index.htm [Accessed 30 Sep. 2019].

Inside Bill's Brain: Decoding Bill Gates. (2019). [film] Directed by D. Guggenheim. World Wide: Netflix.

World Health Organization. (2019). 10 facts on polio eradication. [online] Available at: https://www.who.int/features/factfiles/polio/en/ [Accessed 30 Sep. 2019].

National Football League or Not For Long? The downfall of professional football

The NFL has released multiple statements assuring football lovers alike that football has nothing and will have nothing to do with the increasing large number of former athletes suffering from traumatic brain injuries. They have gone so far as to intimidate and defame the characters of the scientists working to solidify a link between certain sports and traumatic brain injury.

See article from the Union of Concerned Scientists: https://www.ucsusa.org/intimidating-scientists-documenting-link-between-pro-football-and-traumatic-brain-injury

While a serious athlete myself, I am not so easily fooled into thinking the thousands of headers that I have endured have had no effect on my long term brain health. Therefore, when presented with an opportunity to study the brains of former NFL players I jumped at the opportunity.

Background: The Invisible Brain Injury Project, is an ongoing project being done by a local Denver company- Cerescan. Cerescan known for being a brain imaging clinic specializing in SPECT (single proton emission computerized tomography) imaging is using their scanning tools to track the process of potential traumatic brain injury treatments. SPECT imaging, similar to fMRI measures functionality of the brain. fMRI follows the haemodynamic changes in a brain following an activity (Logthetis, 2008). Haemodynamic relates to how blood flows within a certain organ. SPECT also follows blood flow but more specifically cerebral profusion. Cerebral profusion is greatly affected after suffering a traumatic brain injury (Werner & Engelhard, 2007). Therefore, a treatment option targeting improving cerebral profusion was sought out. This lead to a partnership with a company producing near-infrared light therapy options. Near-infrared light has proven to not only stop induced apoptotic cell death in neurons but increases cellular ATP and reduces expression of reactive oxygen species/nitrogen species in neurons (Liang, Whelan, Eells, Wong-Riley, 2008). Therefore, it was identified as a perfect potential treatment option. 

 Brief Study overview: SPECT imaging was used on all participants (all of whom were former professional football players) to diagnose them with a traumatic brain injury to first be accepted into the treatment trial.  Then all participants began treatment.  Each participant came in 3 times a week for 6 weeks to receive the treatment of near infrared light therapy. Following completion, each participant received another SPECT imaging brain scan to determine whether or not the near-infrared light treatment was successful.

Overall outcome: All participants showed increased blood flow in areas that prior to treatment had decreased blood flow attributed to traumatic brain injury. All participants reported improved symptoms; i.e. better focus, better management of emotions, and less sensitivity to light and sound. 
One participant regained their ability to read and was able to finish getting their college degree. 

Knowing that every single professional football player which volunteered for the study ended up being diagnosed with a traumatic brain injury using SPECT imaging, should the NFL come clean and admit that professional football strongly correlates with traumatic brain injuries? If so, is the NFL truly responsible for the traumatic brain injuries many players receive? Knowing now that some treatment options are available should the NFL start using these treatment options while players are still in the league, or should players have to seek out their own treatment options after retiring from professional football?

The study is currently in the process of getting published, so check back for more updates!


References:
Logothetis, Nikos K. (2008) What we can do and what we cannot do with fMRI. Nature. 453, 869-878. Retrieved from https://www.nature.com/articles/nature06976.

Werner, C., Engelhard, K. (2007) Pathophysiology of traumatic brain injury. BJA: British Journal of Anaesthesia. 99 (1), 4-9. Retrieved from https://doi.org/10.1093/bja/aem131.

Liang, H.L., Whelan, H.T., Eells, J.T., Wong-Riley, M.T.T., (2008). Near -infrared light via light emittign diode treatment is therapeutic agent rotenone- and 1-methyl-4-phenylpyridinium ion-induced neurotoxicity. Neuroscience. 153(4), 963-974. Retrieved from https://doi.org/10.1016/j.neuroscience.2008.03.042.

Do You Even Vape, Bro?

As of this past week, the Center for Disease Control are advising the public to not use e-ciagrettes due to the outbreak of lung injury associated with “vaping” (Science, 2019).  According to the CDC, there have been about 805 lung injury incidences, including twelve deaths (2019). 

Vaping is intended to help smokers quit smoking traditional cigarettes. The liquid used for vaping contains nicotine which is the addictive drug found in cigarettes and tobacco products making smoking hard to quit (CDC, 2019). By putting nicotine in vape liquid it can get the smoker to start smoking vape instead of traditional cigarettes that contain harmful toxins (Blaha). 

Now, there are vape pens, also called E-cigarettes, that contain other drugs such as tetrahydrocannabinol (THC) and cannabinoid (CBD) oils found in marijuana. Out of the 805 lung injury cases, about 77% involved vape containing THC (CDC, 2019). NBC news did an investigation to find that black market THC vape contained vitamin E acetate and hydrogen cyanide which could be the cause for these lung injuries (Ferguson et. Al., 2019). 

However, more information is needed to determine which exact product or substances is responsible for this outbreak. In Colorado, where marijuana is legal, THC based vape is widely used. As a public service announcement, I suggest getting your THC vape cartridges through legitimate dispensaries and not from the black market (well, duh). 

Another crucial problem is that there have been an increase in teenage vaping where it is now a national epidemic (Huey & Granitto, 2019). What is alarming about this is that many of these teenagers start vaping without any smoking history and then become addicted due to the nicotine intake. This situation contradicts the intended use for vaping and now there are teenagers who start traditional smoking because of initial vape usage.  

What are your thoughts on "vaping"? How should "vaping" be portrayed in our society today, especially in a state where marijuana usage is widely accepted?

References:

Blaha, M. J. (n.d.). 5 Vaping Facts You Need to Know. Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping.

Ferguson, C., McFadden, C., Dong, S., & Schapiro, R. (2019, September 27). Tests show bootleg marijuana vape tainted with hydrogen cyanide. NBC News. Retrieved from https://www.nbcnews.com/health/vaping/tests-show-bootleg-marijuana-vapes-tainted-hydrogen-cyanide-n1059356

Huey, S. W., & Granitto, M. H. (2019). Smoke screen. Journal of the American Association of Nurse Practitioners, 1. doi: 10.1097/jxx.0000000000000234

News at a glance. (2019, September 13). Science , 365(6458), 1062–1063. doi: 10.1126/science.365.6458.1062

Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping. Center for Disease Control and Prevention (2019, September 27). Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.

Is Smartphone Use Hurting Your Health?

Is Smartphone Use Hurting Your Health?

I was sitting in class on a normal Tuesday when my professor was explaining the assignment for the weekend. We were to turn in our smart phone’s on Friday and spend the weekend living deliberately without technology and our phones would be returned to us on Monday. Thinking about completing this assignment filled me with a sense of absolute dread, I did not want to give up my phone. My thoughts immediately began racing, my heart rate sped up, and I started to panic a little. I felt surely something awful would happen this weekend in which I didn’t have my phone. Maybe I would get injured and have no way of contacting EMS, perhaps someone in my family would get hurt and I wouldn’t be able to receive that news, or perhaps I would miss an important email from the internship I started in just two weeks. My complete panic about being separated from my technology got me thinking; I was so worked up into a tizzy over the thought of losing my phone, what would happen to my mind and body when I did not have my phone? What is this technology doing to my health? Is it harmful for me to use technology and feel the way I feel about it?

In todays current time almost everyone over the age of 20 uses a smartphone. 95% of millennials and Generation Z own or have access to a smartphone 1. During a poll nearly half of all American’s reported they “could not live without” their smart phone 2. This constant access to technology keeps people connected to their family, friends, and brings the vast knowledge fo the internet to our fingertips but how is it affecting our physiological and mental health?

I designed a study to test the affects of technology use on physiological health, in this case specifically overnight blood pressure. Increased overnight blood pressure is the leading blood pressure related cardiovascular health risk 3. Considering 40% of all deaths are cardiovascular related, it is an appropriate measure of physiological consequences to one’s lifestyle 4.
 Participants in the study took a battery of surveys including the Perceived Stress Scale, MBTI personality test, Social Media and Technology Usage Attitudes Scale, Need to Belong Scale, and Fear of Missing Out Scale. They were then asked to wear a 24-hour ambulatory blood pressure monitor that recorded blood pressure every 20 minutes during the day and every 30 minutes overnight.
After testing 68 participants the results were in, use of technology is having significant health affects on blood pressure. Participants who reported higher anxiety around not having access to their technology and/or a greater dependence on technology had increased overnight systolic blood pressure. Additionally, participants who reported greater perceived stress using technology had increased overnight heart rate. This pilot study pioneers the effort in determining the health effects of our ever increasing technology usage. It remains to be seen what the long-term health affects of this increased blood pressure and heart rate are but we know one thing for certain, technology use is not as harmless as it seems.

References:
1. Alt, D. College students’ academic motivation, media engagement and fear of missing out. Computers in Human Behavior. 2002; 49:111-119.
2. Anderson, M., & Jiang, J. Teens, social media & technology 2018. Pew Research Center, 2018; 31.
3. Fagard, Robert H., Hilde Celis, Lutgarde Thijs, Jan A. Staessen, Denis L. Clement, Marc L. De Buyzere, and Dirk A. De Bacquer. "Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension." Hypertension 51, no. 1 (2008): 55-61.
4. American Heart Association. "Heart disease and stroke statistics 2017 at-a-glance." Geraadpleegd van: https://healthmetrics. heart. org/wp-content/uploads/2017/06/Heart-Disease-and-Stroke-Statistics-2017-ucm_491265. pdf (2017).

Bacteria's Great Escape

Bacterial cells have an extra layer beyond the plasma membrane known as the cell wall that is composed of peptidoglycans (Williamson, Collatz, & Gutmann, 1986). This wall provides stability by regulating the cell's osmolarity (Williamson, Collatz, & Gutmann, 1986). Beta-lactam antibiotics are a group of antibiotics including Penicillins and Cephalosporins that attack the cell wall to kill bacteria (Williamson, Collatz, & Gutmann, 1986). The first beta-lactam antibiotic was discovered in 1928 and since then these antibiotics have effectively been used to treat a wide variety of diseases (Kong, Schneper, & Mathee, 2010). However, as society has learned, bacteria are highly adaptable and have started to become resistant to certain antibiotics (Kong, Schneper, & Mathee, 2010).

A recent study examining elderly patients with urinary tract infections was able to show that some bacteria switched from the walled-form to the L-form, in which bacteria no longer have a cell wall, when in the presence of beta-lactam antibiotics (Mickiewicz et al., 2019). While many of the cells died once they lost their cell wall, some of the cells continued to grow and divide after this occurred (Mickiewicz et al., 2019). Additionally, these L-form bacteria were eventually able to regain their cell wall to provide a source of infection (Mickiewicz et al., 2019).   

This research could have many implications in how we treat infections going forward. This phenomenon might partially explain why diseases such as urinary tract infections have recurrences (Mickiewicz et al., 2019).  If the bacteria lose their cell wall and go into the L-form, beta-lactam antibiotics will no longer be able to attack the cell wall and therefore be an ineffective treatment. Additional antibiotics that attack the inside of the bacteria might need to be given closely after the beta-lactams to prevent further incidence of the disease.

Kong, K.-F., Schneper, L., & Mathee, K. (2010). Beta-lactam Antibiotics: From Antibiosis to Resistance and Bacteriology. APMIS : Acta Pathologica, Microbiologica, et Immunologica Scandinavica, 118(1), 1–36. https://doi.org/10.1111/j.1600-0463.2009.02563.x

Mickiewicz, K. M., Kawai, Y., Drage, L., Gomes, M. C., Davison, F., Pickard, R., Errington, J. (2019). Possible role of L-form switching in recurrent urinary tract infection. Nature Communications, 10(1), 4379. https://doi.org/10.1038/s41467-019-12359-3

Williamson, R., Collatz, E., & Gutmann, L. (1986). Mechanisms of action of beta-lactam antibiotics and mechanisms of non-enzymatic resistance. Presse Medicale (Paris, France: 1983), 15(46), 2282–2289.

Welcome to the family: Redondoviruses

Okay now, let's talk about viruses. Viruses are found wherever there is life and have been around since the plague of Athens (now that’s old) (Papagrigorakis, MJ et al). Viruses are small infectious agents that replicate only inside a living cell. Viruses can infect any type of life form and can cause a wide range of infectious diseases.  

Though viruses have a broad range of characteristics that make them ever so changing, two things remain the same. They must contain a nucleic acid genome and a protein capsid that encases the genome. This was the case for a group of researchers that were studying the lung’s microbiome of people who had received lung transplants (Offord, 2019). 

While “stumbling” on the viral DNA sequence, the researchers noticed that it was comparable to a pig virus that was not studied very much (Offord, 2019). The sequence was assembled and guess what...two new circular viral genomes were found. These genomes have never been seen in humans before and suspecting that more may be lurking around the research team searched the metagenomic databases for other lung and mouth samples. And more surprises..they identified 17 more genomes that related to the initial two (A.A. Abbas et al.). 

These new researchers named this new viral family redondoviruses, Redondo gotten from the Spanish translation of round (at least it's not someone’s name). These redondoviruses were abundant in samples from individuals that had periodontal disease and also critically ill patients in intensive care (A.A. Abbas et al.). But due to its novel revelation, the correlation of this new viral family is unclear to these named diseases. 

Scientist are of course happy with this new revelation, but now comes the real scientific tassel. If the virus is not causing any known diseases, should time and effort be put into learning about it specifically or broadly characterizing it into the viral catalog and gaining more knowledge about other known viruses? The debate is still going on so I guess more to come.     

    

Papagrigorakis, MJ; Yapijakis, C; Synodinos, PN; Baziotopoulou-Valavani, E (May 2006). "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens". Int. J. Infect. Dis. 10(3): 206–14. 

Offord, C. (2019, September 1). Researchers Discover New Family of Viruses. Retrieved September 26, 2019, from https://www.the-scientist.com/the-literature/researchers-discover-new-family-of-viruses-66334. 

A.A. Abbas et al., “Redondoviridae, a family of small, circular DNA viruses of the human oro-respiratory tract associated with periodontitis and critical illness,” Cell Host & Microbe, 25:P719–29.E4, 2019.