Science Ain't So Bad

Cold

NASA TO “CHILL” ASTRONAUTS

NASA needs a refresher course in being human. Its latest idea is just too “cold”.

One of NASA’s contractors, Spaceworks Engineering, has proposed turning Astronauts into popsicles. The plan would keep Astronauts on a Mars mission “on ice” – hypothermia – to conserve supplies and to shrink the size of the spaceship. The unconscious astronauts would be fed intravenously and maintained by medical equipment.  Like in sci fi movies, they would be in “hibernation”. Doctors have been doing similar stuff for heart attacks and head injuries. Believe it or not, it works well.

If it works for heart attacks, why not for astronauts?

SEND-A-HUMAN-TO-MARS ?

First some background.

Up till now, “manned” space trips have consisted of stiff legging it around the moon or orbiting in space hardware like the space station. The planets were considered out of reach to humans.

MISTER ScienceAintSoBad never had a problem with the way things were. We’ve sent all kinds of “probes” to the planets. And we’ve explored the heck out of Mars while humans stayed mostly in earth orbit. There have been some deaths and injuries in our space program but we’ve done a lot of science without many casualties. Now there’s a big push to get humans out to Mars to “fulfill our destiny”.

This isn’t because people are a better deal then robots .

They’re not.

It’s much more expensive and much riskier to send people. Radiation is intense out there -really intense. A space ship big enough to carry people and supplies and provide some radiation shielding for such a long trip would be hard to create. Sending humans on a long journey makes everything more complicated.

For a while, I wasn’t worried. Let them lobby Congress about getting humans to Mars, I thought. Let’s face it, Congress will never bite. What’s bad about the “frozen astronaut” idea is that, with the lower costs, Congress might actually fall for the idea.

DELUSIONS ABOUT HUMANS

Look, it is is true that doctors have been succesfully cooling people who might die otherwise. It’s risky but it’s worth it. It takes a while to recover from a heart attack, or a busted head. Slowing things down by cooling the patient gives the body a chance to catch up with the healing process.

Astronauts aren’t dying though. The only thing wrong with their heads is that they take crazy risks. They’re in great shape. Keeping them chilled, asleep, and on intravenous lines for that long is dangerous. All kinds of bad things can happen to their hearts, their lungs, their circulatory systems, etc.  Induced hypothermia is okay in a medical crisis.  But it is not okay in the name of smaller, cheaper space ships.

We’ve been getting good science done on Mars with our rovers. And Robots will only get better – if we don’t use up too much robot money tossing men and women at the problem.

An analysis of the space shuttle indicated that 99 out a hundred flights would succeed. The one in a hundred that would fail? Believe me. You don’t want to know!

The shuttle was  just a space taxi. It was a complicated mess but making a shuttle is nothing compared to making a Mars mission. It’s too early to say what the “risk analysis” would be for a Mars mission but there’s nothing about traveling a zillion miles through intense radiation, relying on fragile systems to protect you for months and maybe years, that sounds safe. Nobody has explained how we would safely reduce levels of radiation to anything near acceptable. And do you know a bookie who would like the odds for surviving the trip and landing safely?

If they do get there, they will have absorbed way too many “rads”. They would still look like astronauts but inside that space gear would be people who were actually nasty medical experiments plunging into the abyss.

Irresponsible? You said it!

I’m not picking on NASA.  Well –  maybe I am – but, mainly,  I’m just pointing out that we should resist the irrational urge to “head for the stars”. It would be cool to see people in space suits up there (if they weren’t wretching and dying, of course) but robots are safer, cheaper, and better.

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The drawing is mine.

                                             No oxygen?

 THE ANTIOXIDANT CONUNDRUM

You’ve got some vitamin C  on the kitchen counter next to the bananas.

Why?

Probably because vitamin C is an antioxident. Everybody knows antioxidants are good for you because they keep “free radicals” (which can promote cancer) in check.

Oxygen is an aggressive chemical. It can turn an iron bar into a hunk of rust. Most living things take advantage of oxygen’s “reactivity” by sucking energy out of the air. It’s why we have lungs. How living organisms learned to “handle” air without being eaten alive by it is one of the great back stories of evolution. Our cells have built in antioxidant “fire extinguishers” designed to protect us from toxic chemical reactions with oxygen.

But why don’t studies support the use of antioxidants?. In FACT, why do antioxidants often seem to make things worse?

Dr. David Tuveson ( Director of Research for the Lustgarten Foundation), and Dr. Navdeep S. Chandel (Feinberg School of Medicine at Northwestern University) did a study published in The New England Journal of Medicine. Here’s what they found.

Small amounts of oxidants are needed in the cells. The cell actually creates them.  If the level of oxidants gets too high though, they become a cancer threat and have to be countered. Evolution came up with its own way to handle this problem. In the mitochondria (energy center) of the cells, where the danger lies, natural antioxidants keep things under control.

The problem with supplements such as Vitamins C, E, and A is that they don’t appear to get the antioxidants to the mitochondria. Instead, they show up all over the place, doing no particular good and maybe even causing undesirable effects.

Tuveson and Chandel think we could figure out better ways to control the levels of “reactive oxygen species” in our cells. With more research, we might come up with a pill that actually does something useful instead of confusing people.

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The drawing is mine.

RESEARCH LIKE THIS ISN’T FREE

HEARING

In 2006, the ever amazing Dr. Stefan Heller  – amazing because of his remarkable pioneering role in research into a cure for deafness –  predicted that we would reverse hearing loss in an animal. He said it would take about five years. Five years later, hearing loss was reversed in a mouse model. Eerily accurate but MISTER ScienceAintSoBad wasn’t surprised. Heller knows his stuff. He’s been at the forefront of this field since it began. (He is at Stanford University’s School of Medicine). 

Where do things stand now? It’s been two and a half years since the first mouse was “cured” of deafness and already we have human trials. In about two months, a human trial will actually begin for adults. Dr. Hinrich Straeker  (University of Kansas Medical Center) will be in charge. His team will insert a gene (the Atoh1 gene) into the ears of the volunteers. The Athoh1 gene is involved in supporting the “microphone of the inner ear” (hair cells). It worked for mice. They had, on average, about a 20 db improvement in hearing. It would be nice if it worked that well for people. Novertis (the pharma company) is partnering on the research. 

There’s also a study  gearing up at Childrens Memorial Hermann Hospital in Texas which is aimed at kids. Dr. Samer Fakhri, is the lead. Stem cells taken from cord blood will be used. This is a  phase 1 (make sure nothing bad happens) study –  an important step.

Just about everything I read about this stuff contains a don’t-get-your-hopes-up warning reminding us that it could take  years – decades probably – before you see anything like a cure for deafness.

You know what? That’s fine. But I love the fact that we have finally reached the point where human studies have begun. If we can somehow increase the meager trickle of funds that supports this research, maybe we can speed things up even more. Spending on hearing loss research is very efficient. You get a lot for your dollar. Graduate student researchers are cheap.

Dr. Heller tells me his “naive dream” is to develop a way to get  funding direct from individuals – grass roots funding, as he calls it –  where “every person suffering from hearing loss would gives $5 – $10.  That would be huge,” he says, “because, right now, almost everything comes from  just two institutions, the Stanford Initiative To Cure Hearing Loss  and The Hearing Restoration Project. And the available funds are very limited. Ten dollars to either of these instutions would make a big difference.”

MISTER ScienceAintSoBad would sincerely appreciate it if you would ask your friends to give. It’s a great cause.

RESEARCH CENTER FOR HEARING LOSS

Even better .  let’s establish – this is Stefan’s idea too – a major research center. The laboratories where much of this work takes place are scattered. Why not relocate them  into a a single hearing research center,  intensifying and focusing the effort of several individual labs? A donation from a private benefactor (or more) could make this happen. With interest rates this low, what are you going to do with all your unproductive investment dollars anyway? Can you think of anything that could change more lives?

A large segment of the population – especially the elderly – live with the world “turned off” because they can’t hear anymore. With your generous help, that can change.

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The drawing is mine (He look better in real life).

HAWKING HAS ALS

LOU GHERIG’S DISEASE

Remember Lou Gherig, the baseball player?

He got very sick.

He couldn’t talk, couldn’t walk, couldn’t stand up. Eventually, he couldn’t even swallow. Gherig never got over it. And he died from the disease which is now called amyotrophic lateral sclerosis or ALS. In the US it’s also called Lou Gherig’s disease in honor of a great guy who got a tough break.

Amyotrophic lateral sclerosis attacks the motor neurons in the body. The most common form of it shows up in the extremeties – the arms and legs – first. Most people succumb to the disease in less than five years.

Physicist Stephen Hawking has had ALS for about forty years. In spite of being  paralyzed, he has managed to leave  his able bodied colleagues in the dust, physicswise. His story is an amazing one. However, no one doubts that Hawking would give up a bunch of his honors and awards to be able to scratch his ear.

A FLICKER OF HOPE

Eva Feldman, University of Michigan neurologist (also President of the American Neurological Association) conducted a small human trial using stem cells to treat ALS. The results were fantastic. The stem cells, which were implanted in one of several locations along the spine, slowed the progress of the disease for some of the patients. Slowed, in this case, meant “no significant disease progression” for the entire two year study. That’s like halted, right? One of the participants put away his cane and took part in a two and a half mile walkathon.

Nine other patients with more advanced disease didn’t do so good. No significant benefit. Since the phase 1 human trial kept a strict lid on the allowed doseage, the real surprise is that so many patients did so well. The phase 2 trial (starting soon) allows a much bigger dose.

MISTER ScienceAintSoBad is excited about this.  Stephen Hawking could use a little good news. I think , maybe, that will happen soon.

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My drawing.

THE MISERABLE MALE MEMORY

THE BRAIN YOU’RE BORN WITH

Guys have a problem.

It’s their brains.

You knew that, of course. I’m talking about their memories here. We will defer the many other peculiarities of male thinking for another blog post if you don’t mind. A big honking study of 48,000 people in Norway was carefully done by a team from the Norwegian University of Science and Technology.

Here’s what was discovered.

Guys can’t remember worth a damn. (I sure can’t.) They’re really bad at names. (I really am too.) The Norwegian study, called Hunt3, was led by Dr. Jostein Holmen. It was published in  BMC Psychology.

The participants were asked about names and dates, details of past conversations. All the stuff you would expect, right?

The surprise? Guys were awful! They did much worse than women. Nobody knows why. They were bad when they were young, they were bad when they were middle aged and they were bad (just a little worse, actually) when they were old.

The age thing was a surprise though. The expectation was that younger guys would do a lot better on names and dates and such than they did in real life. More education was a good thing as far as good memory goes. And chronic depression was a bad thing. Neither factor was a surprise as the roles of education and depression have been known for some time.

The researchers were stimied. They couldn’t figure it out.

MISTER ScienceAintSoBad has a theory however. Back in the days before we were too enlightened to stick women with all the child rearing and family duties, the guys went out and threw spears at oxen while the women busied themselves with keeping track of several generations of kids and adults. Maybe there was a selective advantage to being good at knowing the names and ages and personal details of all those people in your charge. This theory, courtesy of ScienceAintSoBad, isn’t without its flaws but the price is right.

Anyway, that’s it for today folks. You’ll forgive me if I forget your birthday.

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Sure. That cartoon is mine.

THIS IS SCIENTIFIC?

DOES YOUR CHIROPRACTOR ACTUALLY DO ANY GOOD?

You’ve been to a chiropractor, right? Everyone has.

They’re doctors. More or less. They take the sting out of a backache and they do other stuff too like headaches and such.

Nothing wrong with it.

Here’s the thing though.

They’re not really doctors. They don’t even like doctors. In fact, mostly they’re  not big fans of the scientific method that underlies medicine.

Still. They do something, right?

Paul Ingraham, Assistant Editor of Science Based Medicine, at saveyourself.ca, looks at this. He examines the history and the literature of chiropractic; he also looks at what users have to say about their experiences including a Gallup poll.

His conclusion?

Chiropractic techniques may make some people feel better for a little while but the evidence for long term benefits is pretty sketchy. The studies that appear to support chiropractic aren’t scientifically sound.Even the members of the profession seem to be locked into some kind of ideological dispute about what chiropractors are good for.

Ingraham is perfect for this role. He’s not a hater. He sometimes uses chiropractors himself and refers others for treatment. He modestly insists that he isn’t qualified to sit in judgment. He’s sharing what he has dug up from his own careful research of the literature. Which is why its harder to dismiss what he has to say.

Ingrham lays out the five “big” questions about spinal manipulation: 1) Do chiropractors oversell their services with distateful and overly agressive tactics? 2) Is the historical idea behind “spinal subluxations” as the cure all for countless disorders and diseases faintly ridiculous in a modern scientific era? 3) Are the possible risks of injury or death from spinal manipulations justified by the insufficient evidence for its efficacy? 4) Now that a major scientific review (2014) has failed to demonstrate a good case for chiropractic treatment of low back pain, does this weaken its most basic appeal? and 5) Should chiropractors be allowed to continue treating children and babies where, say some, the chances for harm to the patient are greatest?

Ingraham says the profession, itself, is divided by its response to these basic questions.

The idea  of “subluxations”, so basic to chiropractic treatments since its very beginnings,  is rejected, Ingraham says, by many chiropractors as unsupported by science. (If MISTER ScienceAintSoBad gets to chime in here – It sure is!!) In fact, chiropractors fall into categories. The “straight” chiropractors still cling to the original theory of subluxations. If I understand this right, they wouldn’t be shy about fixing gout and liver disease with spinal manipulation therapy.

The “progressives” are called “mixers”. They focus mainly on the spine where even some medical doctors concede that it might at least make sense to find a beneficial effect from SMT.

Ingraham says there’s very little high quality research that supports the idea that chiropractic spinal manipulation therapy works better than other treatments. But, he says, for some people the “joint popping” effect is pleasurable and may even temporarily relieve pain. For others – not so much. He calls attention to a 7 year old Gallup poll that rates chiropractors at the very bottom of the medical profession for honesty and ethics. Considering how unrealistic people are about their expectations for their doctors – how tough they are on them- patients must really think chiropractors are dirt bags! However, I should caution that medicine isn’t all about popular opinion. A single poll shouldn’t be taken out of context.

Paul Ingraham makes a strong case. He’s probably right. Yet chiropractors continue to have their defenders. Many of them.

Who knows?

Maybe a better study will come along. That’s what makes science fun, right?

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The drawing is mine.

THOSE TEETH !

CATS

Cats are stunning things – amazing beings. If you have one in your house, you know. Please don’t mistake them for pets as they are visitors from another star system that just happen to favor fur coats.

THEY decide if they’re in the mood.

Or not.

Often they rub against arms and purr. However. Wind up toys, they are not. They’re willful, intelligent co-inhabitants of your life space and, if they get pissed off at you, they won’t hold it all in and give themselves ulcers.

Cats bite and scratch. If you haven’t had the pleasure, believe me, they can make their point.

Here’s the thing.

If a cat bites your hand, take it seriously, okay? One in three bites to the hand put the attached person into the hospital with a nasty infection that all too often needs surgery to debride the wound. Dr, Brian Carlsen (lead study author on the paper which was published in the  Journal of Hand Surgery) says this is because the needle-ish teeth of cats do a great job of injecting bacteria deep into structures that aren’t exposed to air. Once the tooth gunk is sealed off in there, the infectious organisms have enough privacy to engage in intimate behavior leading to many bacterial babies and a glorious explosion of infection.

No need to make them crazy in the emergency room. Don’t show up every time your cat brushes you lightly with a paw. But if you do get a puncture wound – especially if it looks red or inflamed – please don’t ignore it. Let a medical type have a quick look. If it’s nothing, you can go home and change the litter box. But – seriously – if that bugger is getting infected, the best time to act is now.

Do it for me. Okay?

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The drawing of the unsmiling kitty is mine.

SOME CELLS LEFT?

THE PROBLEM WITH CANCER SURGERY

Cancer.

You’ve been “scheduled” even though you’re not sure you heard everything they said and aren’t sure you made the right choices.

How did this happen? Will everything be okay? Will your kids be orphaned?  Nobody answers these questions for you. It’s all about practical next steps.

You’re on a gurney talking to a nice doctor.

Isn’t she a little too young? Shouldn’t she be more reassuring?  Less “We’ll know a lot more after we get in there”?

You think she said  “We’ll take away the bad stuff and leave the good stuff.” 

That must be what she said. That’s what they do right?

THE BIOPSY

The surgeon’s job is to get rid of the diseased tissue. How is that determined?

Biopsies.

To see if all of the cancer has been successfully removed, a sample is put into a container with preservative. The sample is sent to the pathologist. After a gross exam ,  the sample is quickly frozen, stained, and sliced.  Other samples go into a cassette for a more complete analysis later. Those samples go into hot paraffin which, after a few hours of cooling, get sliced on a “microtome” for the eventual “thumbs up/thumbs down”.

This process is a cumbersome one. If the pathology lab says the quick frozen sample still has cancer, the surgeon has to take out more tissue, send a new sample, wait for the lab, and maybe even repeat again. When it’s all done, and the patient is supposedly recovering,  the lab gets a second vote based on the samples that were saved for further study.

The doctor wants to walk out to the waiting family and say things went great.  Good margins. All gone. Its embarrassing for the doctor and dispiriting for the patient and the family to find out that those margins might not have been so great after all.

A BETTER GRIP ON THINGS IN THE OPERATING ROOM

Two tools are trying to make their way to the operating room that could add more certainty and reduce the “standing around” time for the surgeon.

One of them, I mentioned last July. It’s a “hot knife” that does an instant analysis of the vaporized tissue. In early testing, the results were in perfect agreement but there is more testing to be done before the instrument is submitted for regulatory approval.

Another way to get at the problem is a pair of special glasses that make cancer cells visible to the surgeon.  Dr.  Samuel Achilefu, PhD, professor of radiology and biomedical engineering at Washington University is the project head. The system uses a “heads up” display to see cancer cells as small as one millimeter. The cells look like they are glowing when you look at them with the goggles. The trick is a contrast agent that is injected beforehand into the tissue.

Like the iKnife the googles aren’t ready for approvals. More testing has to be done with humans.

For now, we’re still stuck with the painstaking path lab process but this would seem to be the future of cancer surgery.

The sooner the better, I think.

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The drawing is mine.

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Conked By Caffeine

CAFFEINE ADDICTION?

Caffeine is one of those counterintuitive things. You think it’s going to turn out bad for you  and it turns out good.

I recently wrote an article about coffee . I called coffee a “guilty pleasure”. I talked about how surprisingly good it seems to be  for you with good effects on blood flow, liver function, and diabetes.

I didn’t let myself get too carried away. Some inner birdie chirped in my ear to watch it. Don’t forget to tell them to use common sense, said the birdie.

So I did.

I ended with “Don’t get too carried away. I don’t want to hear you’re drinking back-to-back coffees all day.”

Good thing.

Now comes a new study  about “caffeine use disorder”.  This comes from Dr. Laura Juliano (American University) and was published in the Journal of Caffeine Research. Dr. Juliano did a literature review pulling in information about the habits of many drinkers of coffee and other caffeinated beverages.

What did she find?

Pretty much what the birdie  – the one who said I better stick that declaimer in my last article? – figured. If you douse yourself in the stuff,  you’re looking for trouble.

Okay. This doesn’t seem to apply to everyone. But, for some people, there’s a real chance you can get hooked on caffeine like you can get hooked on a drug. Withdrawal symptoms. Can’t cut down even when you know you have to.

A cup or two of coffee should be okay but three or more cups can, for some people, lead to trouble.  Any source of caffeine  that dumps 400 mg of caffeine into your system each day could make you a caffeine junkie. Pregnant women should keep it to about 200 mg a day. About a cup of coffee.

SUMMARY

How right was the birdie? Does coffee fall from its pedestal? Not the healthy drink I triumphantly proclaimed in November? Or is this last study just making seeming science out of the obvious fact that if you’re one of those who gets too buzzed out on caffeine, you should use a cup of common sense?

MISTER ScienceAintSoBad thinks it’s a good study. It reminds us to keep some sense of proportion even when numerous studies seem to “give permission” for something we love. I guess we’ll tack this onto our Controversy Board for now and track developments  while sipping (in moderation) a cup of  java.

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The drawing is mine

URGE TO PURGE

Pee less. Sleep more.

It looks like an ordinary bathroom door.

At night, however, when you are comfortably snoozing,  it whispers “Come to me, come to me.” Once, twice, sometime four or five times it calls out to you. In the morning, you feel like you haven’t slept because – actually – you barely have.

Guys with enlarged prostates know what I’m talking about. They’re on the prowl all night long. Their oversized prostates press against their urethras, keeping them from  emptying their bladders completely  so they “have to go”.

And go.

And go.

The “right” name for an enlarged prostate is benign hypertrophy of the prostate. Benign means not cancerous  (bad as it is, it could be worse.) Some drugs help but, for lots of guys, drugs only delay the day when they  will have to sit down with the doctor and try to find a real answer.  Hearing about the risk of erectile dysfunction and urinary incontinence  (with most surgical stuff) will make them think twice.

Here’s the thing.

There are new alternatives to relieving the symptoms of BPH without (hopefully) permanent side effects.

Artery Embolization

Dr. Francisco Carnevale, associate professor at the University of San Paolo just did a study of 120 guys. He treated their enlarged prostates  with “artery embolization”. Embolization means putting an “embolus” (an obstruction) into the artery to reduce the flow of blood. If you do that to a guy’s prostrate, guess what? It has less blood in it and less volume.  

It shrinks.

For enlarged prostates, shrinking is good. It takes pressure off of the urethra and peeing gets back to the way it was in the old days.

That’s the concept.

How did it go with Francisco Carnevale’s 120 men?

Actually, it went amazingly well. (The study, by the way, was reported at the International Symposium on Endovascular Therapy.) Almost all (97%) of the participants in the study did better. However, within the 15 month study period, 14% of the patients started to have symptoms again. They had to be retreated or had to find another solution for their BPH other than artery embolization.

Embolization has a lot going for it. The innovative treatment is simpler (local anesthetic) and has virtually no side effects.  If it all hangs together over a longer time period and with more people receiving the treatment, it has great potential.

UroLift

Another interesting approach  is an implantable device called a “UroLift” (made by NeoTract). The devices are inserted into the urethra in a minimally invasive (easy for me to say) procedure and they are anchored so as to pull the prostate tissue back and away from the urethra, relieving the pressure. Several UroLift devices may be required, depending on the size of the prostate. This device was approved by the FDA based on two studies with a little less than 300 men; they were followed for two years.  As with the embolization effort, we want to see what things look like after more people get treated.

May you sleep soundly.

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The drawing is mine.