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Restoring locomotion in primates with spinal cord injuries

dr. dolittle — Thu, 10 Nov 2016 08:59:42 +0000

Restoring locomotion in primates with spinal cord injuries

Pioneering research being conducted by Dr. Gregoire Courtine (Swiss Federal Institute of Technology - Lausanne) may enable paralyzed humans to walk again someday. Through his collaborative research with a lab in Beijing China, he has developed a wireless brain implant that detects signals in the brain and then sends these signals to electrodes implanted in the lower spine (below the injured region) of the animals. This technology allows the brain signals to bypass the spinal cord injury.

Dr. Courtine is beginning trials in paralyzed humans using a simpler model of his new system that only includes electrodes in the lower spine. Many challenges lie ahead for the research, but it is a great advance in technology and medicine. One of the challenges will be to determine the 'appropriate' brain signals to send to the electrodes that encode locomotion. With the primates, this was easier as they were able to record brain electrical activity that stimulated locomotion prior to the injury and in essence, play that same signal back to restore motion.

Source:
Nature doi:10.1038/nature.2016.20967

dr. dolittle Thu, 11/10/2016 - 03:59

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No, cancer is not the "best death," and curing cancer would be anything but a waste of resources

oracknows — Tue, 08 Mar 2016 05:00:53 +0000

No, cancer is not the "best death," and curing cancer would be anything but a waste of resources

Medical research is a scientific enterprise, but, like most areas of science, nonscientific considerations have a great deal of influence over what sorts of research are funded. This is true regardless of who is funding the research. When it's the government, obviously it's impossible to avoid some degree of politics. (Indeed, politics is largely responsible for why the National Center for Complementary and Integrative Health, or NCCIH, even exists and has been studying quackademic medicine for over 20 years.) The same, however, is true when it comes to foundation funding. Some foundations are better than others at raising money, of course, but it goes beyond that. Foundations can basically disperse grant money based on any criteria they like to whomever they like, and they don't have to explain their criteria if they don't want to. Then there's the issue of some diseases drawing a lot more money than others. Breast cancer advocates, of course, are very successful at garnering funding, while, for example, pancreatic cancer advocates are a lot less so, even though pancreatic cancer is considerably more deadly than breast cancer.

Of course, people deciding to donate money to various medical research charities are free to decide where they will donate their hard-earned money based on whatever criteria they wish. Most of the time, I have little to say one way or the other about how people decide to donate to medical research. This time, however, I make an exception. The reason is that I've seldom come across an article so simultaneously misguided and vile as I saw popping up on Facebook in the form of an op-ed published in The Independent yesterday. It's by Richard Smith and entitled I'll never give money to cancer research charities - cancer is the best death and curing it would be a waste of time. Rarely have I seen a justification so depressingly callous and stupid at the same time.

The ugliness starts right in the first couple of paragraphs. No, wait. It starts in the title that says that "cancer is the best death and curing it would be a waste of time." At first, I was willing to give Smith the benefit of the doubt, knowing that rarely do writers come up with headlines for their articles. It's usually the editor who does that. But then I saw these paragraphs and saw that the first couple of paragraphs in the article weren't the most vile after all:

“In Glasgow, where I was born, death seemed imminent; in Canada, where I trained it was inevitable; but in California, where I live now, it’s optional,” says Ian Morrison, once president of the Institute for the Future. Death is not yet optional in Britain, and of the four main ways to die—sudden death, dementia, organ failure, and cancer—cancer has been the best. (I know you chose sudden death, but think of those around you—no time to say goodbye.)

I write “has been” because death from cancer is beginning to look like death from dementia or frailty, taking years and years with quality of life slowly draining away. Life expectancy in Britain has increased by 10 years since 1960, but the length of time in ill health has increased more—and can now be over 20 years for women. Is this progress?

What? I mean, seriously? WTF? Cancer has been the "best death." Has Smith ever actually seen a loved one die of cancer? I have. What happens to people who die of cancer before the end? Let me educate Mr. Smith a moment. I've written of this before, but that was seven years ago; so I don't think it's too soon to repeat and paraphrase it.

Dying from cancer can mean unrelenting pain that leaves you the choice of being drugged up with narcotics or being in agony.

Dying from cancer can mean unrelenting vomiting from an uncorrectable bowel obstruction. It can mean having a nasogastric tube to drain your digestive juices and prevent you from throwing up. Alternatively, it can mean having to have a tube sticking out of your stomach to drain its fluids.

Dying from cancer can mean bleeding because you don’t have enough platelets to clot. The bleeding can come in many forms. It can be bleeding into the brain, in essence a hemorrhagic stroke. It can mean bleeding from the rectum or vomiting blood incessantly. And, because so many transfusions are all too often necessary, immune reactions can chew up new platelets as fast as they’re infused. Yes, paradoxically, even when a cancer patient’s immune system is suppressed in late stage cancer, frequently it does work against the one thing you don’t want it to: Transfusions of blood products.

Dying from cancer can mean horrific cachexia. Think Nazi concentration camp survivor. think starving Africans. Think famine. Think having cheeks so sunken that your face looks like the skull underlying it. Just Google Steve Jobs or Patrick Swayze before their deaths.

Dying from cancer can mean your lungs progressively filling with fluid from tumor infiltration. Think choking on your own secretions. Think a progressive shortness of breath. Think an unrelenting feeling of suffocation but with no possibility of relief.

Dying from cancer can mean having your belly fill with ascites fluid due to a liver chock full of tumor.

Dying from cancer can mean so many other horrific things happening to you that they are way to numerous to include a comprehensive list in a blog post, even by me.

Given these various unpleasant ways to die, I would actually argue that what Smith dismisses as a failure is actually a great success. Many cancers are, more and more, becoming chronic diseases to be managed. We might not be able to cure them, but we can manage them, like diabetes. Let's take the example of metastatic breast cancer. It's becoming increasingly common for these women to live years with their disease—and with decent quality of life, as well. Smith seems to think that such resources are wasted. In fact, he makes an argument so ludicrous and offensive that I can't believe he seriously thought it was a good idea to put this idea down to paper:

I never give to people who approach me in the street asking for money to cure cancer. The reasons I don’t give are numerous: we’ll never cure cancer; too much is spent on cancer research and treatment; cancer is a better way die than most others; and the whole enterprise carries a terrifying utopian odour of trying to achieve human perfection.

“Cancer, we have discovered, is stitched into our genome,” writes oncologist Siddartha Mukherjee in his Pulitzer prize-winning history of cancer, The Emperor of all Maladies. “Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves….We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth—aging, regeneration, healing, reproduction.” In other words, cancer is us. Cure of us of cancer and you cure us of being human.

To which I answer: Nonsense. Curing cancers and eliminating cancers are two entirely different things, which Smith seems to be disingenuously conflating. I mean, seriously. Does Smith realize how bad this argument is, how risible? Curing cancer means eliminating it after it has developed. That means the "human" developed cancer, which means that all the flaw in our growth was still there and the processes that depend on growth—growth—aging, regeneration, healing, reproduction—are all still there. In other words, there is nothing about curing cancer that makes us less human. Smith's argument is a truckload of fetid dingos' kidneys.

But, hey, doesn't all of medicine carry a "terrifying utopian odour of trying to achieve human perfection"? What about those vaccines that build that "artificial" immunity that has prevented untold millions of babies and children from dying of vaccine-preventable diseases? Or what about those antibiotics that have allowed so many people survive diseases that killed their ancestors in droves? Or what about insulin, which allows diabetic children who wouldn't have made it to adulthood 90 years ago to live long and productive lives? What about surgery for congenital heart defects, like Tetralogy of Fallot, which guaranteed death in childhood? What about every medical advance that ever prolonged life and alleviated suffering going all the way back to the time of Hippocrates? What is medical science but a utopian pursuit of human perfection?

What's wrong with trying to achieve human perfection, anyway? It's a goal we all know we can never reach, but reaching for it drives improvements in medicine that relieve suffering and prolong life.

Unfortunately, Smith plumbs new depths of bad arguments:

The commonest skin cancers can be removed without any threat to life, and deaths from childhood leukaemia have been dramatically reduced in my lifetime. But is cancer ever “cured”? Death may be averted at considerable cost, perhaps at the possibility of being able to reproduce - but cancer is always there, lurking.

Once again, Smith is disingenuously conflating two things. In this case, he's conflating single cancers treated for cure with all cancer. Take his example of a child with leukemia who is treated successfully. That child can indeed be said to be cured of his leukemia. It's gone. It's not coming back. This child, of course, will grow up. Perhaps in his elder years he will get a cancer more typical of old age, such as colon cancer. So, from that perspective, yes, "cancer is always there, lurking," but it isn't the same cancer that was actually cured. That a person successfully treated for cancer remains at risk for developing another cancer is trivially true but meaningless as an argument. One might just as well argue that we shouldn't treat a person for pneumonia because,that person might one day develop pneumonia or another infection again, thanks to the ever-lurking bacteria—which, by the way, are every bit a part of being "human" as aging and death, given how important our microbiome is, as we are now understanding more and more.

The vileness doesn't end here, either:

In 2014 the UK spent £370m on cancer research, far more than on any other disease category. Compare that expenditure with £109m on mental health or £9m on injuries and accidents, the major killer of young people.

Look, I understand the problem we frequently face with cancer. Treating it is expensive. Many of the new treatments and drugs that we come up with to combat various cancers only prolong life by months, an observation that brings up legitimate questions about the value of some very expensive drugs. However, just because some areas might be underfunded is not a good argument not to donate any money to cancer research or to declare cancer research to be not worth spending more money on, as Smith does. There's also a not-so-subtle ageism in his argument, which argues in essence that we shouldn't bother wasting resources on old people dying of cancer? No, that's not a straw man, either:

What is the ultimate aim of cancer researchers? Most won’t think about this: they are immersed in their particular projects, hoping to achieve further funding—sometimes by hyping their achievements. But somebody ought to think about the long term aim. Could it be immortality?

Why the latest cancer treatment breakthrough could change everything
I hope not in an overcrowded world--because without death, every birth would be a tragedy. Could the aim be the avoidance of aging? That might seem attractive to our profoundly ageist society, where the old are shoved into corners and looked after by underpaid staff, while women in their 50s are expected to look like women in their 20s.

We forget—or may never have fully accepted—that cancer is predominantly a disease of the elderly. Your chances of developing cancer increase exponentially as you age.

Yes, but so your chances of developing atherosclerotic coronary artery disease (a.k.a. heart disease for short), and heart disease kills more people than cancer, at least for now. One wonders if Mr. Smith thinks we shouldn't waste money researching heart disease. Granted, heart disease is a bit of an easier problem, involving as it does only one organ system, but it is primarily a disease of old people.

As for whether the aim is the avoidance of aging, come on. The aim is avoiding particularly unpleasant ways of dying. It's not as though scientists don't know that we all have to die of something and that if one cause of death is eliminated or drastically reduced, people will die of something else. As I like to say, life is a sexually transmitted fatal disease. None of us gets out of here alive. Sure, it's possible that the results of cancer research might also be applicable to improving longevity, but so what? Humans have been using science to push back against the inevitability of death since time immemorial. If that weren't the case, many, if not most, of us wouldn't make it to adulthood because we'd be felled by various nasty infectious diseases. Indeed, a mere few hundred years ago in London, roughly 65% of those born did not make it to adulthood because they died of childhood infectious diseases, for an average life expectancy of 27. Of those who did make it to age 25, only half lived beyond around 53 years of age, and only about one third made it to age 60.

When I first read this abomination of an article, it didn't click who Richard Smith is. Then I saw his identity pointed out. This Richard Smith is a former editor of the BMJ, and he wrote something similar for the BMJ blog on New Years Eve 2014 in which he proclaimed that "dying of cancer is the best death" that's "achievable with love, morphine, and whisky." In it, he said basically the same thing as in this article. Apparently he's learned nothing from the backlash against his original article.

It's not unreasonable to discuss or question prioritization of research funding, nor is it unreasonable to express an opinion that cancer research doesn't provide as much bang for the buck as we would like. I disagree now, given that after several decades we've finally developed the tools to make a real impact on cancer. Indeed, death rates from several cancers are falling; the age-adjusted death rate from breast cancer, for instance, has been steadily decreasing, down over 25% since 1990. Unfortunately, Smith clings to a romantic view of dying from cancer that is not rooted in reality or actual experience and remains utterly tone deaf in how expresses his view. I just hope he never has the opportunity to put his romantic view of death from cancer to the test.

oracknows Tue, 03/08/2016 - 00:00

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aaah the smell of trolling in the morning!

Nonsense. The best death is to fall in battle against the enemies of the Klingon Empire. Qapla'!

...

Is this guy serious? His rethoric is just a few steps behind summary execution of terminally ill people to give them the "best death".

Yow.

The father of a dear friend died in his sleep a while back at a very advanced age, having kept his marbles and been in good touch with his family until the end. No cancer that I know of. I'll take that over my own father's suffering from cancer any day.

Oh no, did you have to say life was sexually transmitted? LOL sorry I know it's not funny we should have the related content box replaced or killed off this week.

This guy ignores the reality that the elderly are not the only ones to get cancer, but if we draw an arbitrary age line on research and treatment, then we won't have the knowledge to treat the young ones either. My 26 year old sister just got diagnosed with breast cancer, and it being a "good death" or not, who wants her to die at 26, leaving 2 small children behind? What a blinking idiot. I have no kind words in my heart for such selfishness right now. If he wants to refuse treatment for himself when he gets cancer, fine, but I want the knowledge for how to treat available when I get it, thankyouverymuch.

I recently had a brush with the 'Lungs filling up with fluid' one due to kidney failure, I can attest that it's less pleasant than Orac paints it.

And my sister in law is currently dying from breast cancer, having kids aged 10 and 8. Curing her would not be 'a waste of time', pretty sure about that one.

Some would argue that the best death belonged to that of Benkei, who according to legend, stood guard at the bridge to the main gate of his master's castle during his final battle, and slew 300 soldiers before succumbing to his arrow wounds, still standing.

I think I'd prefer dying of old age, myself. Preferably at 300 or so.

He... he must be a Poe, right? I mean... nobody would could honestly argue that because cancer is a relatively benign way to go (in his mind at least, as Orac points out, not so much in reality) so we shouldn't bother looking for a cure...?

From the Babbage report -- life expectancy in rural Yorkshire during the mid-Victorian era.

The findings of Babbage’s report are shocking. Haworth was a small industrial mill town, and the view onto the moors was broken by tall smoking chimneys. Excrement ran down the street; for want of sewers, fenced in areas held human waste, offal from the slaughterhouse and pigsty waste for up to months at a time. Housing was poorly ventilated and overcrowded, with several dwellings in cellars. The average life expectancy was 25.8 years; 41.6% died before the age of six. Perhaps most appallingly, Babbage’s investigation confirmed that the graveyard, situated on the hill at the top of the town and in front of the Brontës’ home, was so overcrowded and poorly oxygenated that decomposing, putrid matter filtered into the water supply.

Haworth was hardly unusual, either. Depressing.

http://www.bl.uk/collection-items/sanitary-report-on-haworth-home-to-th…

Please don't tell my cousin, JB:
she spent a great deal of time and effort trying to help her brother who had lung cancer ( they live/ lived far away so I only know of the details through phone calls).

At first, t seemed as though he was doing well with chemo-radiation ( no discernible disease) and he even worked
BUT then it came roaring back and he experienced many complications of both the illness and treatments for it.

She tried to help him through visits and acquiring whatever he needed ( she got someone to build a ramp to his house and put up assistance bars on walls) as well as finding foods he might like / be able to eat and buying films for him to watch. She stopped working to be there for him in the end.

The first 14-15 months were not so terrible but the last 4 were horrendous because of multiple emergencies and medical interventions.

She found this very traumatic - especially because she understood very well what was happening to him. I expect her to become emotionally worse because he deteriorated during the spring and it will now be two years.

Seeing a celebrity with cancer like David Bowie set her off in January: she commented that the final photos looked like how her brother did. To make matters worse, she is in the middle of a financial dispute between his widow ( the step mother) and 2 adult children.

"None of us gets out of here alive."

"I'll Never Get Out of This World Alive" - Hank Williams

I by no means wish anyone cancer. But one still has to wonder if mr Smith were to discover he has a cancer, if he'd still held this opinion. And if he'd refuse therapy on the grounds of cancer being the best death and the fact that any therapy he'd be offered would be result of all that unnecessary research.

he must be a Poe, right?

Some people really are that sociopathic. I'll grant that in some cases a loved one's chronic illness gives a person a chance to come to terms with said loved one's death. But I know from family experience that this does not always happen (the death in question wasn't from cancer, but a different unpleasant way to die). And this is balanced against the anguish of watching your loved one die slowly and in great pain, and knowing that little or nothing can be done about it. With a quick death, perhaps the family didn't get to say a personal goodbye, but they also don't have to watch the protracted agony either. They get to remember the deceased as (s)he was, memories uncolored by the months (or longer) of terminal illness.

If it is printed, it must be true.

@ Eric Lund

Some people really are that sociopathic. I’ll grant that in some cases a loved one’s chronic illness gives a person a chance to come to terms with said loved one’s death.

Yes and yes. But to emphasize your first point: Richard Smith's very approach is still wrong.
He is measuring the "goodness" of a death on some supposed opportunity for the survivors to say goodbye to the dying person.
He is completely under-estimating, or even denying the level of discomfort of the one busy doing the dying.

In short, "cancer is the best death" because it is convenient for bystanders like Richard Smith.

Apologies for the harsh tones. Two of my grandparents died in their sleep; I didn't have a chance to tell them goodbye, true, but I would feel like a selfish pillock to have wished they would have a longer, protracted agony, so I could drop by.
On the other hand, one of my friends lost her dad to a throat cancer. The last days were not pretty; she was obviously very shocked. It didn't help that she was not on good terms with her other siblings. A deathbed is not the ideal family reunion to mend disputes.
How is this sort of death supposed to help the survivors?

Cancer is the best death? Oh good lord.

Honestly, I'd rather go quickly, and I'd rather my loved ones go quickly, so they did not have to suffer. And for "best death" -- he forgets (or more likely doesn't care to know) that pneumonia is often described as the blessing for a cancer patient, because as horrible as pneumonia is, it can kill you quicker. I remember my grandfather was upset when my aunt's pneumonia was treated; she was dying of metastatic breast cancer, and since they decided to treat her pneumonia, she ended up lingering a very long time.

I've had relatives who died suddenly, and relatives who lingered. Neither was easy, and he's fooling himself if being able to say goodbye actually makes it any better. You mourn either way, and you never get to find out what the alternative would have felt with that particular relative.

Now, if we got to choose our exit, I personally would like to die of being hit by a small but solid palladium meteorite at the age of 106, while backpacking through the wilderness, with relatives on hand to collect the meteorite, which would be sold to become an awesome estate for all my descendents. That would be perfect. But I don't think it's going to happen. ;-)

...not to mention that tissues can start to turn gangrenous...most people who come here won't need have spelt out the consequences of that..

Wow. Just ... wow. I have no words.

To use a good British insult, what a plonker!

I've had a parent die a relatively quick death, a stroke, although if it hadn't happened she'd have died of cancer and as shocking as it was I know that for her it was the better deat. I've also had a parent gradually cease to function through Parkinsons, it took years and the grief of seeing his mental decline in the last few of those years was awul, to the extent that it was a relief when his body finally died. Give me quick every time, kinder for the person dying and for the relatives.

As for young people being injured and dying from accidents, there are things that could be done, but there is a limit as most young people do not really believe they will die and sadly many suffer the inevitable consequences of the risks they take as a result of that belief.

Another important matter we need to consider is that successful treatment of cancer interferes with bonding by concerned relatives and friends of the patient.

In the olden days, people gathered by the bedside of the cancer patient and got to enjoy this bonding experience. Nowadays, what with prolonged remission and cures, patients stay alive considerably longer and deprive their loved ones of the intimacy that terminal illness provides.

(note that a mom quoted on the Internet made this exact point about vaccine-preventable infectious diseases. She regretted missing out on the opportunity to comfort her measles and mumps-ridden children. Why, I remember my parents taking care of me during the weeks I was ill with just these two diseases. It was an important facet of my childhood and I wouldn't have missed it for the world.

@ Dangerous Bacon

Another important matter we need to consider is that successful treatment of cancer interferes with bonding by concerned relatives and friends of the patient.

I think you are being facetious, but you are approaching PEH (Poe's event horizon).

note that a mom quoted on the Internet made this exact point about vaccine-preventable infectious diseases.

That is actually the first anti-vax argument I came across a long time ago, while idly browsing the "health" section of a bookshop.
I just thought then, and I'm still thinking now, if the only/main occasions someone has to bond with his/her relatives is when they are sick and unable to run away, it doesn't say nice things about the type of human being he/she is.

Dr. Smith responded to the uproar his BMJ article provoked: http://blogs.bmj.com/bmj/2015/01/05/death-a-response-from-richard-smith/

This is the opening sentence from his response:

I’m sorry that I’ve upset many people who have cancer or who have had a bad experience of somebody dying of cancer. That wasn’t my intention. I was writing for The BMJ and so primarily for doctors.

So then he goes and submits essentially the same article to a newspaper read by the general public.

The guy's a troll.

I sure hope somebody cures cancer soon, so I can keep smoking. I mean, I should quit at some point anyway, I'm only 28, but I won't be 28 forever.

@ JP:

That's entirely true.

I smoked for a few years ( in grad school and when working and writing a lot ) and decided that I really wanted/ needed to quit: I had bronchitis once and didn't want it again. I used everything I knew about habit and physiology to no avail- gradually increasing times between smokes, using exercises etc.. I couldn't quit for more than a few days or a week
.
I then proceeded to frighten myself about lung cancer, imagining the slow, grim terminal process happening in me- a doctor telling me the diagnosis and prognosis- then not being able to breathe, struggling. No way out .

I made various attempts to use stress reduction, meditation and supplements like tryptophan- even a few rx meds like valium.
.
I imagine that I ( briefly) quit about a dozen times until FINALLY one day I did for ( probably- never say never) good. It took a few years of repeated, concerted attempts
.
What did it? I think I knew I had to quit before a certain age that I had in my head. So I did.
It might have been a magic number or something else symbolic that motivated me in some arcane manner and it worked. Well, so far so good. Knock on wood/ touch wood.

I imagine that I ( briefly) quit about a dozen times until FINALLY one day I did for ( probably- never say never) good. It took a few years of repeated, concerted attempts

My grandma always said, "It's easy to quite smoking, I've done it a hundred times!" She did eventually quit for good, but at a fairly advanced age. Better late than never, I suppose.

I mean, hey, Mr. Obama smokes, as do a lot of my grad school colleagues, so I don't feel like a total pariah. Yet.

As many here know, my wife died of metastatic BC. Her liver was involved and it was exactly as Orac described. Although she went quickly, 28 days from diagnosis, to be exact, it was not the best death. Her last hour was horrific. I would not wish that end on my worst enemy.

Smith is demented.

I’m only 28, but I won’t be 28 forever.

While experience would certainly seem to side with that belief, you'll never know until you try.

I imagine that I ( briefly) quit about a dozen times until FINALLY one day I did for ( probably- never say never) good.

I've heard similar stories from several ex-smokers. As the saying goes, it's easy to quit smoking--many people have done it several times. Apparently nicotine is even more addictive than cocaine.

To bring this back on topic: for many people, what leads them to finally quit smoking is a desire to spare themselves and their loved ones from the slow and painful death that results from several diseases associated with smoking: lung cancer in particular, but emphysema is also an unpleasant way to go.

I never smoked, but for a few years I'd put a pinch between my cheek and gum. Boy, howdy, that was a rush. The nicotine would run straight into my bloodstream and slam into my brain. It took a year or so of continuous effort to get my usage down to a coupla times a day, once I decided to stop, and then the only way was to just not buy it.

Even after about 30 years, if I see it for sale, and I have dollars in my pocket, it's an effort to just say no. There is no doubt in my mind I could be addicted again before the weekend.

Dad did smoke, and, yes, cancer killed him, and also his mother. I was able to be with him at the end, and held his hand as he stopped breathing. I was also heard his last words a coupla days before. They were to ask me to help him die.

Anyone who would call that a 'good death' is a f***ing idiot.

(Dad always said that he wanted to live to be 100, and be shot by a jealous husband. I guess that would be as good a way as any to go.)

My mom's brain cancer took away her ability to speak so quickly that she never had a chance to say goodbye. We had to sit around and watch her slip away - unable to talk, barely able to look at us as it progressed, trying to find meaning in twitches and slow blinks from a fantastically intelligent PhD cancer researcher with a love of languages and music. Best death, my ass.

Smith's comments aren't necessarily informed by sociopathy as such -- they may reflect religious indoctrination -- e.g., the exaltation of pain and suffering that's common in conservative Christianity. Mother Teresa would likely agree with him on the "good death", for others at least.

@ Johnny:

After I had stopped a few weeks, I wasn't tempted in the least by smoking. I didn't care if others smoked and I even smoked MJ a few times, 10 years later, to be social. The smell doesn't affect me negatively or positively.
-btw- a few perfumes/ colognes use a tobacco scent which some people love.

I must say though that smoking is helpful if you're writing and need to really focus etc. HOWEVER there is caffeine.

W ell could it be that I share a home city of birth with the villain of Orac's latest denigration piece that I understand EXACTLY what he was saying. And by happy coincidence I share his dislike of the cancer charity industry that grabs as many dollars as it poissibly can by using the emotional cards of millions of deaths.. He mentions Glasgow as death being 'imminent' . Perhaps something was lost in the cultural relevance of this statement where this small Scottish city which is rich in Art and culture (thanks ironically to the tobacco lords of the 19th century ) that has 4 universities within a couple of square miles,also has a unique claim to fame of having areas of Glasgow which have mortality norms for men of an average of 20 years less than even the other socially deprived areas of the U.K. Where men have a lower lifespan that they're counterparts in Iraq, Palestine, and India, about as low ams Australian aboriginals which causes the United Nations human rights folks no end of consternation. It even has a name - the Glsgow factor,but of course no money available to find out why this hasn't abated in the 60 odd years that I've been alive. His point? Why spend vast quantities of money on extending a life an average of four years when a significantly smaller amount could be spent on giving whole communities of folks an extra 20 years... Course not a crookit bawbee would go to Pharmaceuticals,but on education opportunity, and nutrition. You want vile? Smug gits who discuss their self inflicted cancer risks -in the the hope that some mug will donate so they don't have to take any responsibility. Oh, I maybe should mention my mum died of lung cancer, so no it wasn't a good death. but there is something very dignified and reality driven about someone who has had a hard struggle to live. She accepted at 75 that quality of life was more important than quantity. No cancer industry guinea pig - dragged along by false hope ...She saw how often others had died,from 'complications' of medical treatment and opted for the non intervention route, the palliative care route. The best part of the whole year of her dying was that my brother was so sickened by her illness - he quit smoking. Reckon he increased his odds of not being a Glasgow statistic of the dead kind for a few years... Extending social justice - is where my money would go ...

TBruce @22 -- Smith's statement is a classic "nopology" -- "i'm sorry some people got upset".

To which the reply is "Yeah. But you're not sorry for what you said."

It's a tactic for shifting the blame onto the people who criticize you.

He seems to have forgotten that doctors are human, and thus include people who have had cancer, and whose siblings, spouses, parents, children, and best friends have had cancer.

If he, personally, wants morphine, whiskey, and love as his way out, he can have the first two out of three whether he has cancer or not--and cancer won't improve his chances of being loved.

Ugh, why bother even breathing? I mean, you're just going to have to breath again in a few seconds.

My father died of liver cancer. It was NOT the best death, and I did not have time to say good bye the way I would have wanted to. By the time he was actually diagnosed, the cancer had spread incredibly rapidly. I was not able to get to the bedside in time.

I never wish ill on other people. But I am feeling very tempted at the moment.

I spent half my career as a PA tending to patients with cancer, AIDS, and sometimes both. I can attest to all the horrors of cancer deaths Orac details above, and a few more.
We've all seen movies where the villain promises the hero a lingering death, a death for which the hero will beg long before it comes. It's no cliche. That's exactly the horror so many cancer and AIDS deaths are like.
I almost wish that Richard Smith could experience it in the first person, but in the end not even I can be so cruel and vindictive, and believe me, you don't want to see how vindictive I can be.
As to his immortality gabble, in the Middle Ages they used to say, "We all owe God a death." That's going to remain true as long as I live, and it will be true for my children, my grandchildren, and for many more generations to come.

@ Andrea
In France there are many people like Smith and you, especially among journalists and teachers, for whom equality is more important than prosperity. If cancer could kill capitalists and not the poor they would support it actively. But killing both is a trend toward equality. Come in France and enjoy.

I havent been this angry in quite some time. The logic employed in that article, and I use the term logic generously, is just shocking.

Regarding "best death" I have to wonder if he has ever spent any time with patients who are dying of cancer.

A friends mother developed an obstructed bowel from ovarian cancer and spent the last few weeks of her life vomiting up her own feces. There are no pills to ease that discomfort, nor the psychic pain that must have accompanied it.

Another thing he seems to neglect to discuss is the mental aspect. Either through brain mets, or a combination of malnutrition/cachexia or hormonal and metabolic changes due to the tumor load, many cancer patients experience terrible delirium. I remember my mother screaming at the top of her lungs because she was cognizant enough to recognize she was in a hospital and likely wasnt getting out, except it had transformed in to a nazi medical experiment facility and she could hear my father screaming as they tortured him in the next room. This even though he was right beside her trying to comfort her.

The worst part was that between sedation she would wake and do everything she could to try to save us. Can you imagine seeing your mother who is so weak she cant even support her own weight, screaming at us to run, still trying desperately to get out of bed so she can take care of her family and save us from Nazi torture. And the anguish of thinking she had failed when she couldnt do it and continued to hear our screams of agony day in and day out. Her identity was so heavily rooted in caring for us that it was the worst kind of torture to take that away from her during every waking moment.

I watched cancer rob my mother of every concept of health that exists. She was in physical pain and mental anguish for weeks. There is nothing about that which makes it a good death. I would not wish that on anyone, not even the misguided author of the article. I do wish he would spend a few weeks vomiting up his own feces though.

I do wish he would spend a few weeks vomiting up his own feces though.

How do you think he wrote the article?

Yeah, cheap shot, but I couldn't pass it up.

I've had relatives die slowly (my paternal grandmother died of kidney failure) and quickly (my maternal grandmother died from a ruptured aneurysm). I think the latter is the better death, if only because I didn't have to watch her fall apart over the course of several months. As such, Richard Smith, may you be eaten by carcinogenic rats.

My mother died of a brainhemorage. No, I didn't have time to talk things out and we didn't know what her final wishes were, but I defenitly take this over the dead of the wife of a nephew from cancer, leaving him with 2 children in puberty.

Screw Mr. Smith, preferably with a railroad spike. He's obviously never known or interacted with any cancer patients ever, and he should get his license pulled for his exhibition of sociopathy. I've lost two out of three grandparents to cancer, and Grandpa was barely keeping it at bay. While they all went peacefully enough, compared to the commentariat's horror stories, I'd still prefer to cure cancer. Not to mention that it's one of my personal nightmares.
Mr. Smith's comments are almost as bizarre as the guy I saw on another site claiming that childhood cancers were punishment for the parent's sexual immorality and that cancer didn't exist until the 20th century.

That said, a lot of the charities need to do some work. For example, in the Susan Komen scam, maybe a dime out of every dollar actually goes to research? I've never contributed to them and never will, unless I see some sign that the money is actually going to labratories and not just being spent on TV ads.

JP: Hey, my grandma was 28 for 80 years, and I'm celebrating the third anniversary of my 28th in a couple of months, so you never know until you try. (I just plain can't smoke, myself. Even secondhand smoke makes me wheeze.)

My maternal grandmother died of cancer back in the 1970s. She was first diagnosed with breast cancer, then even after a double mastectomy (they only did double radical mastectomy back then) and radiation and chemo, she got cancer again, in the lungs this time. Watching someone you love die of lung cancer in the 1970s was fairly horrific. So no, I'm sorry, I don't agree with Mr Smith. I also do not agree that public health has to be a zero-sum game. There is enough money to go around, if we but bothered to allocate it.

So I was just playing "Dying Light: The Following" the other day and in it there is a character dying of cancer who pretty much fits the "dignified death" mentioned by Mr. Smith: becoming reclusive and a drunkard, sitting in his dimly lit house with a glass of whiskey just awaiting the inevitable end - with no other symptoms you see in real life when it comes to cancer.

That made me realise that it is a pretty common trope in all kinds of media, such as video games, movies and television. If Mr. Smith is indeed serious on his position on the topic, I am pretty sure his opinion has been tainted by such fictional portrayals of cancer sufferers.

@Amethyst
Smith was a medical journal editor. He probably did not read the papers he was accepting or accepted to read only those where cancer patients died peacefully. In any case, he knows how to boost an impact factor.

@ Amethyst

That made me realise that it is a pretty common trope in all kinds of media,

It's a quite ancient trope, indeed. See TVTropes: Victorian Novel Disease

I hope a late comment to this post will be considered acceptable, because there are things I want to say in relation to this story.

One of my grandmothers was afflicted with cancer. Multiple times. She underwent surgery twice. I don't want to minimize the trauma of undergoing surgery, but honestly, as far as cancer stories go, she seemed to have it fairly easy. Her chemotherapy made her slightly nauseous. Not the horror stories that everyone seems to always tell about chemo. Her life was extended considerably by the treatments, and it was a genuine quality of life, not the extended chronic illness that Mr Smith seems to think we're turning cancer into. When she finally did pass on, my dad was there and had a chance to talk to her first. She was weak, but she didn't seem to be in any significant pain. He told me about how he really appreciated having the time to talk with her that last time. That couldn't have happened without modern cancer treatment. It would have been a far different experience if Mr Smith had his way.

I have a friend who was afflicted with a particularly nasty case of cancer. When last we spoke he'd already been in for surgery and he'd had part or all of multiple organs removed. But it came back, and was big enough that his doctors wouldn't operate unless it could be shrunk enough with chemo first. He got put on some sort of study chemo drug after conventional treatments failed. It hurt him badly, it put him into kidney failure. But it shrunk the cancer enough that he was scheduled for surgery the last time I talked with him.

Forget it being a disease of the elderly. I don't think he's over 30. He wasn't ready to die yet, he hadn't had his full chance to live yet. If Mr Smith had his way that study drug wouldn't have existed. Forget utopian. Forget death being made optional. His choice was between dying hard and young, or else getting a fair shot at experiencing the rest of his life. Needless to say he doesn't believe dying young of cancer was his best option.

My boyfriend told me a story too. About his stepfather, lying dying in a hospital. He almost cried, telling me how hard it was to see the strongest person he'd ever known brought down to the point of crying from the pain he was in. That's his last memories of the man. He didn't get the experience of the one last positive memory. He got suffering and pain. Even taking the cynical view of being more concerned about the convenience of those around you, there was nothing ideal about that death.

He told me that he wanted to get ahold of Mr Smith and choke him, to within an inch of his life, and when he was about to die he'd let him have just enough air to keep him alive, and then start choking him all over again. I'm not sure, but I think he was unintentionally mimicking something from the movie Deadpool as the worst thing he could do to him.

I can't really defend his torture fantasy. except to say that he wouldn't really torture him. That's just how upset he was, he has to be really aggravated to get to that point. He was trying to come up with a scenario in which he could share what extended suffering was really like.

The smell of trolling, good god, this whole science blog thing is one big troll, who pays this ridiculous place to be so damn pro pharma?

New treatments for cancer from elephants?

dr. dolittle — Sat, 17 Oct 2015 14:59:39 +0000

New treatments for cancer from elephants?

Check out this new YouTube video describing a new study aimed at discovering how elephants resist developing cancer:

dr. dolittle Sat, 10/17/2015 - 10:59

Tags

I am not quite sure that this study can result in any kind of treatment, but this as been proposed before:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1693304/

I believe the study will change people's life. Elephants can be helpful in cancer treatment. Impressed! Maybe cancer deaths can be improved effectively in future.

http://www.creative-peptides.com/blog/index.php/cancer-deaths-could-be-…

Soon, an elephant in the chemo room?
I am disappointed that the media pay so much attention to silly proposals at the end of an experimental study or to university press releases aimed at promoting a basic research lab. There are much more realistic approaches taking into account the physiology of the cancer cells, which may lead to treatment, and do not receive such publicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799276/

There is a difference between manipulated
mice and animals naturally selected like
elephants. Animal expermentation for
cancer research is important but studies
of natural cancers in animals is also
important. There was also ( may be still there
is to day ) research on sharks which have no
cancers. There are many anti-oncogenes
but it might be that TP53 remains therefore
one of the most attractive for gene therapy
In the future, vectors for gene therapy will I
suppose and I hope.
improve. Would it be then silly to treat people
with a high risk of cancer occurence ( for
instance people having being exposed to
high doses of carcinogenic agents) with
a TP 53 gene therapy ?

Malvy Claude Paul
"Would it be then silly to treat people
with a high risk of cancer occurence ( for
instance people having being exposed to
high doses of carcinogenic agents) with
a TP 53 gene therapy ?"
My answer would be: yes it would be silly. Because it is not sure that it would be efficient, because there is a risk of insertional mutagenesis and because gene therapy efficiency is not 100%. This means that cells no efficiently transfected could be led to proliferate as a side effect of gene therapy, and it will counteract the beneficial effect.

When I mean vectors will improve, I
mean that their rate of transfection cell efficiency
will be very high and that they will
have a very high rate of targeted ( non random) insertion
in DNA. Of course the animal models will
be required to test the benefit/risk ratio
before any clinical trial. There is no treatment
without side effects. With actual chemotherapy
it is known that secondary cancers can be
induced by chemotherapy. This does not
prevent of course to use chemotherapy to
treat patients.

Here's an Elephant getting The Treatment:
https://www.youtube.com/watch?v=OX9xCo183VA

New discovery about dog eyes

dr. dolittle — Sat, 08 Mar 2014 22:45:44 +0000

New discovery about dog eyes

Image from U Penn.

I came across this really interesting press release from the University of Pennsylvania that I just had to share.

Despite having a close relationship with dogs for thousands of years, we are still making new discoveries about our canine friends. Drs. William Beltran (School of Veterinary Medicine), Artur Cideciyan (Perelman School of Medicine), and colleagues teamed up to study canine eyes in an effort to improve treatments for humans with retinal diseases.

Dr. Beltran was quoted as saying “It’s incredible that in 2014 we can still make an anatomical discovery in a species that we’ve been looking at for the past 20,000 years, and that, in addition, this has high clinical relevance to humans.”

Prior to their research it was assumed that, unlike primates, dogs do not have a fovea (the pit in the middle of the retina that contains numerous cone photoreceptor cells). The new research published in PLoS ONE, used advanced imaging to show that dog eyes do have a tiny region packed with greater than 120,000 cone photoreceptor cells per square millimeter in the center of their retina. This density is much higher than previously reported for dogs and is similar to the fovea of primates.

Sketch of an eyeball from www.dba.med.sc.edu

The researchers also explored genetic mutations that are associated with macular degeneration in humans. Macular degeneration is a leading cause of blindness over age 65y and results in a loss of central vision (see image below). They found that dogs with similar mutations in these genes also had similar anomalies in the fovea-like region of the retina.

Depiction of how a person with macular degeneration might see this image. Image from www.johnsoneye.com

Dr. Cideciyan was quoted as saying, “Our findings, which show the canine equivalent of a human genetic disease affecting an area of the retina that is of extreme importance to human vision, are very promising from the human point-of-view. They could allow for translational research by allowing us to test treatments for human foveal and macular degenerative diseases in dogs.”

Source:
Penn Current

dr. dolittle Sat, 03/08/2014 - 17:45

Tags

New discover about dog eyes made an addition in my knowledge

Now we know. There appears to be some similarity between our dogs and us in the way we see things. So… why be surprised we love them ? We’ve got things in common

I find it fascinating that, like Dr Beltron quoted about how in the year 2014, things are still being discovered and scientifically worked on. Dogs are a mans best friend which has been proven over thousands of years. The fact that it has been proven that dogs also suffer from the macular degeneration in their eye site is unbelievable due to years ago scientists believed that dogs do not have a fovea. This is a huge discovery due to the fact that treatments can now be tested on dogs which can lead to the improvement in their eye sight as well as humans eye sight. This discovery can lead to a cure and can even prevent macular degeneration.

It is amazing that technology is still improving to the point where we can make new discoveries in fields where so much research has already been done. Science continues to make a difference in the world. With this new discovery the scientific community will be able to improve thousands of people's lives by curing retinal diseases like macular degeneration. But I do believe that this study might spark some controversy with animal rights societies due to the fact that testing must be done on the dogs first, before it can be used on humans.

Whipworm parasite reduces symptoms of autism

dr. dolittle — Thu, 12 Dec 2013 17:06:52 +0000

Whipworm parasite reduces symptoms of autism

Image from www.Nematode.net.
Credit: http://www.latech.edu/ans/faculty-staff/liberatos-james-d/parasite-pict…

Believe it or not, scientists at Albert Einstein College of Medicine in collaboration with Coronado Biosciences are intentionally infecting people who have autism with whipworms from pigs (Trichuris suis), although generally considered non-pathogenic to humans.

For some individuals, an elevated inflammatory state contributes to repetitive and irritable behaviors associated with autism. Researchers have observed that allergic responses (measured by skin prick tests) are higher in people who had received anti-parasitic therapies. Therefore, parasites may actually reduce inflammation and activate pathways that regulate immune responses. In fact, neurobiologist Dr. Paul Patterson (California Institute of Technology) noted that epidemiological evidence suggests there is an increased prevalence of autoimmune diseases in families that have autistic members.

I was surprised to learn that the idea of trying this radical therapy came, not from a scientist, but from the father of an autistic boy. This idea was featured in The Scientist. The father administered whipworm eggs to his son (under the supervision of Dr. Eric Hollander now at Albert Einstein) and noted reduced autistic behaviors.

Following the success of this case study, Dr. Hollander will now conduct a double-blind trial of 10 young adults with autism. Half of the group will receive a placebo and the other half will receive the parasite eggs (Trichuris suis ova) for 12 weeks. The groups will then go through a 2 week wash-out period to allow the parasite to clear from the digestive tract at which point the groups will receive the alternative treatment (a crossover design).

The suggestion above that 2 weeks will allow the parasite to clear is intriguing as that suggests that this particular parasite may need to be administered chronically in order to have sustained effects.

Source:
The Scientist

dr. dolittle Thu, 12/12/2013 - 12:06

Tags

It is interesting to see how the animals we deem 'parasites' are now being researched as cure to diseases our own bodies produce.

It leaves me wondering what other possible applications this could have, such as whether or not such therapies could benefit asthma and other auto immune disease?

Compound from bear bile helps slow diabetes in mice

dr. dolittle — Sun, 17 Nov 2013 13:51:36 +0000

Compound from bear bile helps slow diabetes in mice

A new study from Science Translational Medicine (DOI:10.1126/scitranslmed.3006534) presents data showing that tauroursodeoxycholic acid (TUDCA), a compound isolated from the bile of bears, may actually slow the development of type 1 diabetes (in mice at least). It is thought to work by reducing stress responses from the endoplasmic reticulum in the insulin-producing beta cells of the pancreas which become defective in type 1 diabetes. Use of bear bile is common in traditional Chinese medicine, and at one time led to near-extinction of black bears in China. Fortunately, synthetic versions of the compound are available and have also been shown to be effective in treating ocular diseases (DOI:10.1007/s12177-009-9030-x).

Chinese medicines made from bear bile. Image from Bornean Sun Bear Conservation Centre.

dr. dolittle Sun, 11/17/2013 - 08:51

Tags

Could Camels Cure Cancer?

dr. dolittle — Mon, 04 Feb 2013 11:07:18 +0000

Could Camels Cure Cancer?

Image of camel from ukmedix news.

Researchers from King Abdulaziz University (Jeddah) have tested the effectiveness of micro and nanoshells for delivering a substance from camel urine, PMF701, thought to be a cure for cancer. These findings will be presented at the 2nd Biotechnology World Congress (Feb 18-21).

PMF701, not yet approved by the Saudi Food and Drug Authority, is currently in clinical trials. In a quote published by SciDev.net, the head of the university's tissue culture unit and the principal investigator of the project Faten Abdel-Rahman Khorshid stated, "We made a natural product medicine, proved its safety and efficiency in vitro [in test tubes] and in vivo on animal models, and finished phase I clinical trials on healthy volunteers with no side effects".

More research is needed to test the ability of this controversial therapy at treating cancer. In another quote from SciDev.Net, Dr. Edzard Ernst, Emeritus Professor in Complementary Medicine from the University of Exeter (UK) stated, "There is no evidence here that this new treatment does anything to the natural history of human cancers. Even if there were positive results, it would be wise to wait for independent replications."

It will be interesting to watch the progress of this research.

Sources:

2nd Biotechnology World Congress

SciDev.Net

F. Khorshid, H. Alshazly, A. Al Jefery and Abdel-Moneim M. Osman, 2010. Dose Escalation Phase I Study in Healthy Volunteers to Evaluate the Safety of a Natural Product PM701. Journal of Pharmacology and Toxicology, 5: 91-97.

dr. dolittle Mon, 02/04/2013 - 06:07

Tags

why just camel urine? Maybe we should all be stockpiling urine or drinking our own like the former prime minister of India?

This is very great step for science, the curing of cancer from the urine of a camel. Although the sources listed on this blog, like 2nd Biotechnology World Congress said that the results revealed that PMF in Camel urine contains different types of macro and nanoshells with different types of metals that attack A549 cells and causes apoptosis (cell death) and also claims that healthy volunteers have no side effects. I ask this question, what if the side effects are genotypic side effects rather than phenotypic? It would be very advantageous to cure cancer but I simply do not agree with the fact that ingestion of urea in the urine cannot cause adverse effects afterwards especially if it continues to be an undergoing urine therapy for a long time.

Very cool post Dr. Dolittle! It's amazing how scientists were able to discover a natural substance that could potentially cure cancer. I can see why it is controversial though. Nowadays we do hear about new potential cures, but then they hardly ever progress. Here is an example, however, of a cure that actually has significant potential: http://gtresearchnews.gatech.edu/brain-cancer-treatment/ This cure, rather than using a natural substance, utilizes a man made chemical called imipramine blue compound, which is an organic triphenylmethane dye. It has been tested so far in vitro, and has produced great results. Between the natural cures and engineered cures, hopefully one day we can find one that will succeed!

This is a very interesting post! I truly believe that we need to look into different natural substances in order to someday find a cure for cancer. If the findings here are accurate, we need to further our investigation, because it seems too often we find "potential" cures, but with little progression in investigating. However, if through research we find camel urine may have the "potential" cure, maybe we should look into other animal's urine as well closely related to the camel. First step, we need approval of PMF701 by the Food and Drug Authority. Hopefully, this substance will be one of many that will be able to cure cancer for good!

This is an interesting blog. I myself am a cancer survivor. I'm always interested in what is going on the the cancer world and any advancements we have made towards curing it. However, I see this being quite controversial. I typically hear a lot about new potential cures that never really fall through. The main source of this blog, 2nd Biotechnology World Congress, states that this camel urine has different types of nanoshells that attack cells and cause cell death. This may be good for cancer cells because they grow too rapidly. Will this only attack cancer cells, though? What if it happens to attack normal healthy cells as well? Are we sure there are no side effects from this. I find it hard to believe that humans can just ingest this with having at least some minor side effects. I think that this is definitely a step in the right direction. I just believe that we may need to see more work and study done on this before it's ready.

I agree. What is it about camel urine that specifically aids in the cessation of multiplying neoplasms in humans. Cancerous cells are potentially caused by reactive oxygen species "free radicals" within the body and I could see that maybe the nitrogen rich urea forms a product which acts as an antioxidant like uric acid ,the highest concentration antioxidant in the human body, to prevent the radical formation leading to neoplasms and cellular mutation. However what about cells that are already malignant? Where is the cessation of division occurring, if it it even is. Many people rarely catch cancer in the early stages, and this is the only logic I can come to think as to where this theory could be applied. It is definitely a step in the right direction towards oncology if so, but how and why?

I find it very interesting that something as simple and random as camel urine has even been thought of to be used as a cure for cancer. I find it hard to believe that anything will come out of this, considering the majority of blogs that I read that consist of a cure for cancer never really come out to anything. I just found this article interesting because our society today revolves around "man-made" substances that we ingest without thinking twice about. With this, we are atleasting exploring an all-natural method that could potentially save many lives. Here's hoping that this camel urine can get us over the cancer "hump" (haha).

PMF701, not yet approved by the Saudi Food and Drug Authority, is currently in clinical trials. In a quote published by SciDev.net, the head of the university’s tissue culture unit and the principal investigator of the project Faten Abdel-Rahman Khorshid stated, “We made a natural product medicine, proved its safety and efficiency in vitro [in test tubes] and in vivo on animal models, and finished phase I clinical trials on healthy volunteers with no side effects”.

actually 1400 years ago Islam Prophet Mohammed (peace be upon him) said that camel urine and milk is very useful, i think this is the motive behind this study

I want to make relation and want to have information from Prof.Faten Abdulrahman Khorishid who innovates new medicine for cancer.

Epilepsy medication reverses symptoms of Alzheimer's

dr. dolittle — Tue, 07 Aug 2012 18:03:11 +0000

Epilepsy medication reverses symptoms of Alzheimer's

Image from: Alzheimer's Association

Researchers Sanchez et al. from the Gladstone Institute, University of California San Franciso and Washington University School of Medicine discovered that an FDA-approved anti-convulsant medication used to treat epilepsy (levetiracetam) can also reverse memory loss in addition to reducing other Alzheimer's related symptoms in a mouse model of the disease.

Alzheimer's is currently the most common form of dementia (memory loss) representing 50-80% of cases. It is a disease that worsens over time. Although there are available medications to help slow the progression of the disease or lessen the symptoms, there is currently no cure. Presently, an estimated 5.4 million people have Alzheimer's disease in the United States and this number is expected to rise.

When administered to mice with Alzheimer's, levetiracetam was found to decrease abnormal signaling in the brain by 50% in just one day. By 2 weeks, neurons within the brain exhibited signs of improved communication. Using a maze test, the researchers were able to demonstrate improved learning and memory with the anti-convulsant medication. Moreover, proteins necessary for normal brain function were restored to normal levels in the treated animals.

More research is needed however, to determine whether this new use of levetiracetam in the treatment of Alzheimer's disease is effective and safe for humans. Although a recent trial showed that it could improve memory and brain function in patients with mild cognitive impairments:

Sources:

Sanchez PE, Zhua L, Verreta L, Vossela KA, Orra AG, Cirritoc JR, Devidzea N, Ho K, Yua G-Q, Palopa JJ, and Mucke L. Levetiracetam suppresses neuronal network dysfunction and reverses synaptic and cognitive deficits in an Alzheimer's disease model. Proceedings of the National Academy of Sciences. Epub ahead of print. doi: 10.1073/pnas.1121081109

Alzheimer's Association

dr. dolittle Tue, 08/07/2012 - 14:03

Tags

do you know that you can get infected to taeniasolium engesting the intamidiat host caring the worm. and the worm can even reach the brain and distub the brains work.

Well how do you extrapolate mouse memory to humans, this is creationism of a scientific kind Dr Donothing, LOL

That is precisely where more research is needed especially since these findings were made in mouse models of Alzheimer's disease. The way that they measure mouse memory is to determine how well a mouse remembers their way around a maze...like a recall test. It was also shown to improve levels of proteins required for normal brain function. So the big assumption would be that if the treatment improved levels of these proteins, then perhaps brain function overall is improved.

In a more recent study at Johns Hopkins, Levetiracetam was shown to improve memory and brain function in humans with cognitive impairments that lead to Alzheimer's. The hope is to be able to use this drug as a way to slow down the progression of the debilitating disease. A video report from this study has been added to the blog entry.

The anti-convulsant medication reverses which symptoms of Alzheimer's? How much memory loss is reversed and how was this studied?

Emeryville Pharmaceuticals

How have treatments for other diseases fared in the leap from mouse to man? What is the comparative data?Seems a bit underwhelming that I have not seen more comment on levetiracetam result in the press, given the lack of any other promising treatments and the potential disasterous scale of the issue.

Since I was injured in a major car accident in 1991, I have had memory gaps of my youth, college, classical music (3 degrees), work etc. My recent memories are easily accessible but I have difficulty recalling details prior to the accident. Could this promising epilepsy drug be effective in helping me with my brain injury? Is there a clinical trial I could join ?

I would suggest that you discuss this with your doctor. I don't think they have looked at whether or not it would be useful at helping to reverse memory loss resulting from a traumatic brain injury.

My husband has epilepsy from a brain tumor, brain infections and 4 brain surgeries AND has been on Levetiracetam / Keppra for 4 years. It really does work! He should have memory loss due to the area where the tumor damaged his brain , he still has seizures -- yet his memory is strong. I am hopeful!

Personally, I have some experience with the use of levetiracetam in patients with Alzheimer's disease and epilepsy on a case level. These are of course NOT study results and are only personal impressions in patients with rather advanced forms of the disease. In my personal experience, I have never seen any beneficial effect in patients. On the contrary, patients with probable, moderate to severe Alzheimer's disease (NOT MCI) on levetiracetam seem to display significantly more behavioral and psychiatric symptoms in dementia (BPSD) which improve after changing the treatment for epilepsy. FRIN!

Doctor I have been experiencing temporary memory loss for about 10 to 15 seconds when I am very stressed out since the past 05 yearsI have consulted a nuber of doctors but no one has diagnosed yet. currently am using tegrol but these days am experiencing a lot of atttacks. can you please diagnose what i am suffering from and how it can be treated?

I find it a little confusing as to how it is possible that this medication can improve brain and memory function but at the same time cause cognitive impairment? Is that not contradictory that the meds are suppose o help the brain but the side effects are related to the brain? Did the research account the facts that humans do not share all the same proteins as mice. For example the apoE4 gene in humans is not found in mice. It is this gene that is responsible for the degeneration in Alzheimer's patients. Was this gene taken into account when conducting the experiment?

PTSD, Mental Health, and the Military: Problematic Reporting at Scientific American and ScienceBlogs

tqa — Tue, 24 Mar 2009 07:30:22 +0000

PTSD, Mental Health, and the Military: Problematic Reporting at Scientific American and ScienceBlogs

Author (and fellow ScienceBlogger) David Dobbs has an article on PTSD in the latest Scientific American, and has several related posts on his blog here at Sb. Dobbs' primary argument seems to be that PTSD is being widely overdiagnosed, in part because the condition itself is poorly defined, and in part as the result of various social and economic factors. At least a couple of other bloggers enjoyed his writing on the topic. Personally, I'm not so sure.

As many of you know, I've got some fairly significant ties to the US military. My wife has deployed twice, and has had close and personal experiences with combat. Our family has dealt with her deployments well, all things considered, but that does not mean that it's been an easy process. The first-hand experiences have encouraged me to take a much closer look at both the military healthcare system in general and at mental health issues in the military in particular than I probably would have otherwise. I'm bringing this up not because I'm hoping that you'll think I'm some sort of authority on the topic (I'm not), but because I'd like to make sure that my potential biases are out in the open from the start.

Dobbs' Scientific American article is certainly thought-provoking, and it raises a number of valuable and important issues. Unfortunately, the important and valid points are found mixed in with far too much poor reporting. Although Dobbs admits that the issue of PTSD diagnosis is complex and the subject of scientific debate, his report is almost entirely one sided. It also contains some apples-and-oranges comparisons, and conflates several different problems. His blog articles continue that trend.

For the sake of simplicity, fairness, and a cliche, I'm not going to go through the article point by point. Instead, I'm going to look at the good stuff first, then the bad, then (naturally) the ugly.

The Good:

Although Dobbs is skeptical of the current process for diagnosing PTSD in veterans, neither he nor anyone he interviewed for his story doubt the existence of the condition - they simply doubt that the prevalence is as high as some have claimed. As starting points for discussion go, there are far worse.

Dobbs' analysis of the problems with the current PTSD diagnosis is good. The relationship between PTSD diagnosis and malleable human memory is not well understood, and does need quite a bit of additional attention. The overlap between symptoms of PTSD and other conditions is definitely problematic, particularly since (as Dobbs points out) a misdiagnosis of PTSD can get in the way of the correct diagnosis and treatment of other mental conditions.

Dobbs is also dead on the money with his analysis of the interference between the dysfunctional VA benefits process and the treatment of PTSD. The disability system does not provide any incentive for veterans to report recovery or improvement of PTSD symptoms, which makes both treatment and epidemiological study of the condition more difficult. His suggestion that we look at the Australian system is interesting, if unlikely to happen.

The Bad:

I'm not usually a massive fan of the journalistic impulse toward "balance." There are far too many examples of articles where the reporter is covering a topic where there is no real scientific debate, but still covers "both sides" out of some sort of urge to ensure that every point of view -no matter how insane- receives equal time. But that does not mean that it's always safe to ignore a point of view, either.

In the case of PTSD, there certainly does seem to be considerable scientific debate over a number of points. Surprisingly, though, Dobbs focuses almost entirely on the position advocated by Harvard psychologist Richard McNally - someone Dobbs himself identifies early in the article as "perhaps the most forceful of the [PTSD] critics." Dobbs quotes McNally extensively during the course of the article, and seems to uncritically adopt a number of McNally's positions. He names one critic of McNally - Dean Kilpatrick - and says that Kilpatrick "once essentially called McNally a liar", but he does not provide any explanation of what, exactly, Kilpatrick objects to, or even why he called McNally a liar.

One particularly egregious example of Dobbs' uncritical acceptance of McNally's perspective can be found on page 2 of the web version of the Scientific American article:

McNally shares the general admiration for Dohrenwend's careful work. Soon after it was published, however, McNally asserted that Dohrenwend's numbers were still too high because he counted as PTSD cases those veterans with only mild, subdiagnostic symptoms, people rated as "generally functioning pretty well." If you included only those suffering "clinically significant impairment" the level generally required for diagnosis and insurance compensation in most mental illness the rates fell yet further, to 5.4 percent at the time of the survey and 11 percent lifetime. It was not one in three veterans who eventually developed PTSD, but one in nine and only one in 18 had it at any given time. The NVVRS, in other words, appears to have overstated PTSD rates in Vietnam vets by almost 300 percent.

The original source for McNally's perspective seems to be a letter to the editor that was published in Science in early 2007:

Moreover, contrary to what Kilpatrick states, Dohrenwend et al. did not use "extremely conservative criteria to determine PTSD status." Instead, they accepted a case as PTSD-positive if the veteran received a score from one through seven on the nine-point Global Assessment of Functioning (GAF) scale. Nine is the highest possible level of functioning, whereas one is the lowest. The typical (apparent) PTSD case received a GAF score of seven, defined as "[s]ome difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships OR some mild symptoms (e.g., depressed mood and mild insomnia, occasional truancy, or theft within the household)" [(2), p. 2]. Clearly, a seven does not indicate clinically significant impairment, as noted by Buckley. Had they been slightly more stringent (i.e., GAF rating from one through six), the prevalence would have dropped by 65%, not 40%. Thus, the estimate for current (late 1980s) prevalence would have been 5.4%--substantially lower than either Dohrenwend et al.'s estimate of 9.1% or the original NVVRS estimate of 15.2%.

McNally is objecting to diagnosing someone with PTSD is they are only experiencing "some difficulty", but not "moderate difficulty", as the result of their symptoms. If we agree with McNally and Dobbs, what does that mean? If someone experiencing "some difficulty" functioning as the result of PTSD-like symptoms is not diagnosed as actually having PTSD, are we saying that "some difficulty" functioning is an acceptable mental health outcome in the combat veteran? That it's not really "significant"? Do they receive a different diagnosis, or do we think that "some difficulty" isn't something that warrants receiving mental health assistance?

More importantly, this glosses over the fact that the current level of impairment doesn't always equal the maximum level experienced by the veteran. From Dohrenwend et al.'s own analysis:

The clinicians made ratings of the severity of PTSD at its worst in addition to the severity at the time of the examination. These severity ratings, which are strongly related to the GAF impairment ratings, suggest that the results in Table 1 underestimate impairment when the disorder was at its worst. For example, 36.1% of veterans in the current group were rated mild, 43.1% moderate, and 20.8% severe at the time of diagnosis. When PTSD was at its worst, 3.7% of veterans were rated mild, 31.8% moderate, and 66.5% severe. The results also suggest that at least 85% of veterans in the past group had more than slight impairment when their PTSD was at its most severe.

McNally makes no mention of that finding, which would indicate that while the "current" prevalence of PTSD would substantially drop if his definition of significant is accepted, the lifetime rate would not change much. It's also worth noting that the accuracy of McNally's assertion that the "typical (apparent) PTSD case received a GAF score of seven" depends largely on how one defines "typical." PTSD-diagnosed veterans with a GAF score of seven were the largest group, but not a majority. It can as easily be said that the "typical" PTSD case presents with moderate to severe difficulty functioning (GAF range of 4-6).

Of course, you'd learn this only if you reviewed Dobbs' sources. Although he cites them, he makes no mention of anything that would cast any level of doubt on McNally's position.

The Ugly:

Dobbs' uncritical acceptance of McNally's position and failure to adequately present any other view are what I'd call bad reporting. Unfortunately, that's not the only problem with Dobbs' piece. The next two issues, at least in my opinion, cross the line that separates the merely bad from the inexplicably horrible.

One of these issues is actually something that Dobbs did not mention. He paid a great deal of attention to the financial incentives that can result in the inflation of PTSD diagnosis rates in the VA system, but he did not discuss factors that can lead to the underreporting of PTSD in troops who are still in the military. Writing an article about the diagnosis of PTSD in the military without mentioning the effect stigmatization can have on diagnosis and treatment is like writing the history of the New York Yankees without mentioning Babe Ruth.

Dobbs' failure to mention barriers to diagnosis and treatment in soldiers is particularly noteworthy because of two recent studies that he brings up late in the article. Both of these studies report on the prevalence of PTSD in troops who have come back from combat deployments in the last few years. As Dobbs notes, both of these studies reported a much lower prevalence of PTSD than studies that have involved Vietnam or Gulf War I vets. I suspect that the differences are too large to be explained as being only the result of an unwillingness to report symptoms in troops still in the military, but that doesn't mean that stigmatization played no role in the difference. I'm baffled by Dobbs' failure to at least mention the issue.

Dobbs also manages to either inexplicably misinterpret or misrepresent one of the recent studies. Here's some of what he wrote:

The biggest longitudinal study of soldiers returning from Iraq, led by VA researcher Charles Milliken and published in 2007, seemed to confirm that we should expect a high incidence of PTSD. It surveyed combat troops immediately on return from deployment and again about six months later and found around 20 percent symptomatically "at risk" of PTSD....

A few months later another study the first to track large numbers of soldiers through the wars in Iraq and Afghanistan provided a clearer and more consistent picture. Led by U.S. Navy researcher Tyler Smith and published in the British Medical Journal, the study monitored mental health and combat exposure in 50,000 U.S. soldiers from 2001 to 2006. The researchers took particular care to tie symptoms to types of combat exposure. Among some 12,000 troops who went to Iraq or Afghanistan, 4.3 percent developed diagnosis-level symptoms of PTSD. The rate ran about 8 percent in those with combat exposure and 2 percent in those not exposed.

These numbers are about a quarter of the rates Milliken found. ...

Dobbs also brings this up in one of the blog posts:

Finally, the conflicting studies of PTSD in US veterans of the Iraq and Afghanistan wars cited in the piece are Milliken et alia, "Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War," JAMA 14 Nov 2007, which found rates of around 20%, and Smith et al, "New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study," BMJ 16 Feb 2008, which found rates of under 5%

If you actually take the time to read the two articles, it's immediately apparent that Dobbs is comparing apples and oranges. Smith et al. reported the rate of patients meeting the criteria for a formal diagnosis of PTSD. Milliken et al. did not. They looked at a different assessment tool, and reported not only the prevalence of soldiers who met enough criteria to be diagnosed with PTSD, but also the prevalence of soldiers reporting any symptoms.

The Milliken study based their assessment of PTSD risk on the answers that the soldiers gave on a four-item assessment that's widely used in the primary care community to determine if a patient should be referred to a mental health professional for follow-up. Patients who give positive answers to three or four of the questions are considered to test positive, and should receive referrals for follow-up with a specialist. In Table 1 of their paper, they note that they considered anyone who answered any of the four questions positively to be at risk for PTSD.

I'm not entirely clear where Dobbs got his 20% figure from. Looking at Table 1, it appears that about 22% were shown to be at risk at initial assessment, and 29% at follow up. However, they also reported that 20.3% of all the respondents were identified as having a "clinician-identified mental health problem". That figure is not restricted to PTSD diagnoses - it also includes depression, anger, suicide, and family conflict. He seems to either be understating what Milliken actually reported, or reporting the wrong result. (I should note that all of those figures are based on the active duty results, and that the reserve/national guard results are all much higher.)

At initial assessment, 6.2% of the respondents in the Milliken study met the criteria for referral for PTSD follow-up. That figure increased to 9.1% at the time of the follow-up study. That's still higher than the Smith study, but it's nowhere near 20%.

Dobbs seems to be implying that it's strange that the Milliken study reported a higher PTSD percentage than the Smith study. Given that the two studies looked at different populations, used different diagnostic criteria, and - most importantly - weren't actually reporting on the same thing, I do not share that feeling.

There were things that I enjoyed about Dobbs SciAm article, and there were definitely items in there that should spark more discussion. Unfortunately, the article as a whole suffered from a number of serious problems. A controversial topic was discussed without attempting to cover (or fully acknowledge) more than one viewpoint. Alternative explanations for findings were ignored, even though they had been presented in the original research, and one research article that did not fit the chosen perspective was thoroughly misrepresented. There is no doubt that the diagnosis of PTSD is complex and difficult topic that would benefit from a thorough, careful, and unbiased examination. The Scientific American article in question fit exactly none of those criteria.

References:

Dohrenwend et al. 2006. The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods. Science Vol. 313. no. 5789, pp. 979 - 982

DOI: 10.1126/science.1128944

McNally. 2007. Letter to the Editor. Science Vol. 315. no. 5809, pp. 184 - 187

DOI: 10.1126/science.315.5809.184b

Milliken et al. 2007. Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War. JAMA Vol 298(18):2141-2148

Smith et al. 2008. New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ Vol 336(7640): 366-371

DOI: 10.1136/bmj.39430.638241.AE

tqa Tue, 03/24/2009 - 03:30

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medicine

treatment

How do you mistake windshield wiper fluid for Kool-Aid? -or- What do we do in cases of methanol poisoning?

purepedantry — Fri, 13 Mar 2009 12:12:41 +0000

How do you mistake windshield wiper fluid for Kool-Aid? -or- What do we do in cases of methanol poisoning?

This is just unbelievable. At a day care center in Arkansas, 10 kids were accidentally given windshield wiper fluid instead of Kool-Aid:

Child welfare investigators plan to talk to the owner of an Arkansas daycare center where 10 children were sickened after they were given windshield wiper fluid to drink.

"They'll go out, they'll get an explanation and they'll try to sort (it) out preliminarily," said Julie Munsell, spokeswoman for the state Department of Human Services.

Hospital officials say a staffer mistakenly put the blue liquid in the refrigerator after shopping and later served it thinking it was Kool-Aid. Doctors estimate the children, ages 2 to 7, drank about an ounce of the fluid.

Only one child remained hospitalized Friday morning after blood samples showed "measurable levels" of methanol, a highly toxic alcohol that can induce comas and cause blindness, officials said.

Arkansas' Department of Human Services said depending on the results of the investigation, the daycare operator Carolyn Bynum could have her license revoked or suspended.

How could you possibly not know the difference? I mean, I know they are both colored fluids, but windshield wiper fluid has a very distinctive smell because it contains methanol.

Setting aside how the hell this happened, I thought this would be a nice time to explain what we do in the case of methanol poisoning.

Methanol poisoning happens primarily because of three reasons. First, lots of stuff around the house has methanol in it: windshield wiper fluid, antifreeze, some paint thinners, copy machine fluid, etc. Kids can get into them and drink them. Also, if you are trying to brew alcohol and you don't know what you are doing, sometimes the resultant moonshine can have methanol in it. Finally, there are people who try and kill themselves this way, but that is pretty rare.

Methanol is a problem because it exploits the pathway that is involved in degrading ethanol in your body and produces toxic byproducts. During ethanol metabolism, ethanol is first converted by your liver to acetaldehyde by an enzyme called alcohol dehydrogenase (ADH). Acetaldehyde is then converted to acetic acid by aldehyde dehydrogenase. Acetic acid can be used in cellular metabolism to make energy (which is why alcohol has calories). This is how it normally works. Acetaldehyde as a compound is not great for you. We think that accumulation of it may be why people get hangovers, and prolonged exposure to it damages your liver and kidneys. But people can metabolize ethanol without too much of a problem.

Methanol is also metabolized by these enzymes. ADH changes methanol to formaldehyde and aldehyde dehydrogenase changes it to formic acid. But formic acid is bad news. It is eventually oxidized down to carbon dioxide, but this is a slow process. While it accumulates it can be toxic to a variety of body systems.

For one, it is an acid. Accumulation of an acid in your blood causes metabolic acidosis -- where you blood pH is too low. This is a medical emergency because it causes respiratory distress and also cardiac arrhythmias that can result in death. Also, formic acid is directly toxic to your eyes and brain. We are not exactly certain why but methanol poisoning can cause blindness by killing cells in the retina and brain damage by killing neurons in a movement initiating part of the brain called the putamen. Symptoms also include nausea, coma, seizures, headaches, and pain.

So clearly this is a serious business. Particularly in children where it takes very little methanol to be toxic, this is a medical emergency.

That being said, patients with methanol poisoning can be hard to diagnose. Obviously in this case someone realized they had given them the wrong thing and called poison control. But say someone walks in who looks intoxicated with ethanol -- which they do -- and you don't know it is methanol poisoning. Further, it can take 12-24 hours to present with methanol poisoning symptoms because it takes the body a while to convert the methanol into formic acid. So it can be tough.

How do we treat it? Well, first of all, you want to provide respiratory support if necessary. If the patient is running a metabolic acidosis, we give them bicarbonate -- a base -- to correct the pH in their blood. Then the issue is getting the methanol out of their system. If they have a lot of it, you can do this with dialysis. Another option is to wait until they urinate it out.

This gets to one of the more interesting treatments I have read about in medicine: one option is to give them ethanol. Ethanol has a much higher affinity for the enzymes that degrade it than methanol, so you can use it as a competitive inhibitor to prevent methanol from being degraded into formic acid. Now, I once saw an episode of House where the case was one of methanol poisoning. House treats it by doing shots of whiskey with the guy. To the best of my knowledge that is not how we administer the ethanol. You administer it through the IV. (Also, there is another competitive inhibitor of ADH called fomepizole, but it is pricey and ethanol works just as well.)

Anyway, I hope upon hope that someone had the sense to treat these kids for methanol poisoning as soon as possible -- clearly the day care people are clueless. If you want more information on diagnosis and treatment, read this.

purepedantry Fri, 03/13/2009 - 08:12

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Nice explanation of methanol intoxication, dude! If I recall correctly, there was a dude working in Antarctica who died that way.

I could easily see this happening. The original writer hasn't ever smelled Blue Wiper Fluid or tasted it? I have had it splashed as I was pouring, it is slightly sweet tasting. I wouldn't know the smell of methanol from anything. Cold fluid in a fridg won't have a huge smell anyway.

It might not have much smell but it would be in a bottle clearly labeled "Wind Shield Wiper Fluid". This is a stretch, I know I am assuming that daycare workers in Arkansas can read.

I'm pretty sure wiper fluid is sold with a child-proof cap. I just don't see how this can go unnoticed.

Jake, in the House episode you referenced, the guy was on death row and had tried to kill himself. He was refusing medical treatment, so House tricked him into the "treatment"...

Smell aside, bottles of washer fluid are usually labeled something like WASHER FLUID.

There really isn't any excuse for this.

If it was labelled. Winshield washer fluid is available in bulk for oil change places to dispense... maybe the daycare worker's husband filled a random bottle at the garage he worked in and put it in his wife's trunk. Something like that happened around here once, although it was his own kids that drank it.
Just sayin... there are labeling regs for a reason... unfortunately the one that doesn't follow them isn't always the one that pays the price.

I'm looking at an MSDS for methanol. It says

Ingestion:
If victim is conscious and alert, give 2-4 cupfuls of milk or water. Never give anything by mouth to an unconscious person. Get medical aid immediately. Induce vomiting by giving one teaspoon of Syrup of Ipecac.

The second MSDS I review reads "Ingestion: induce vomiting immediately â¦" in the first aid section.

Is there some reason not to induce vomiting if one suspects methanol ingestion?

What I want to know is what the washer fluid was doing in the fridge? Not storing poisons in with your food is kindof basic.

I'm not excusing this, but the insinuation was that it was intentional. At least to me. When someone says something is "unbelieveable" to me that means things must be deliberately done. Now I don't know about this situation but a gallon bottle of blue stuff in a fridge, without looking, what would think that was? Would you even put "Windshield Washer Solution" on your list?

The fact that they are saying that the same person served it makes me suspicious that it maybe was intentional. I could see someone else not really looking at the bottle, but not the person who put it there.

One of the problems on my graduate biochem final had to do with calculating the amount of ethanol needed to prevent significant methanol poisoning (with all the fun affinity/kinetic and concentration info given). Pretty interesting... I'm pretty sure the answer would've left a person with a hefty hangover, but it'd be better than methanol poisoning.

The good news this morning is that the children will (apparently) not have any permanent problems from this, AND the owner of the daycare has agreed to give up her license.

I just have to say, when I read the first line of your post I thought you wrote, "This is just inevitable" instead of "This is just unbelievable." I thought you were pretty insane for a minute. But nice post anyway.

Nice Post Jake....It is important to acknowledge that BallanJ's remarks are correct about certain Oil Change franchises dispensing methanol mixtures into unlabeled bottles as a customer gesture. Far more serious is the poorly glued paper label scenario whereby here in Wintry New York State the barely adhered paper labels on these manufacturer's 1-gal plastic jugs frequently fall COMPLETELY OFF! This happens with tremendous frequency when the bottles are display exposed to the elements. It is not uncommon to be carrying the label separate of the toxic bottle to the register for checkout. Consideration should also be given for the length of time these poorly labeled bottles would languish in a Southern home. IN CANADA, METHANOL WASHER FLUID IS SOLD IN PLASTIC JUGS SIMILAR TO THE RECTANGULAR JUG CONTAINER WE WOULD FIND PAINT THINNER IN AT HOME DEPOT. THE JUGS ARE LABELED WITH A TOUGH REMOVAL-RESISTANT PLASTIC FILM THAT IS SHRUNK ON LIKE A GIRDLE DURING MANUFACTURING. THE METHANOL CONTENT IS POTENT, DYED DARK PURPLE, AND HAS A DISTINCT UNPLEASANT CHEMICAL ODOR BEYOND THE ALCHOHOL ODOR OF THE METHANOL. LAST, THE LABELS ARE PRINTED WITH A POP-CULTURE-UNIQUE, UGLY-LARGE SKULL & CROSSBONES LOGO ON EACH OF FOUR SIDES OF THE RECTANGULAR JUG. THIS WARNING LOGO CORRESPONDS DIRECTLY TO A NATIONAL EDUCATIONAL CAMPAIGN WHICH WARNS CHILDREN AS YOUNG AS PRESCHOOL AGAINST THE DANGERS OF POISONING.

THE COST OF THIS LEVEL OF PEDIATRIC DEVOTION TRANSLATES TO ABOUT $7 FOR A 1.5 GAL. (litres) Here in the States we would balk at $3.50 for a bottle of washer fluid.

How I see it is, WHO PUTS WINDSHIELD WASHER FLUID IN THE FRIDGE!?? Are you for real, seriously...
It is a scary thing to think that, people like that are watching our children?