Archive for: September, 2010

Syphilis, malaria, and other oddities

Sep 14 2010 Published by under Medicine

When I was younger, I used to lead canoe trips in Ontario.  These trips were often out of touch for days at a time, and the only way to get emergency help was to take a canoe and paddle toward an outpost of civilization as quickly as possible.   Because of this uncomfortable fact, we got quite a bit of first aid training, including how to clear an airway using the Heimlich Maneuver, which the Canadian medics insisted on calling an "abdominal thrust".

Thankfully, I never needed to use an abdominal thrust on a canoe trip (although I used plenty of other lifeguarding and first aid skills), but everyone seems to know the Heimlich maneuver, or at least what it is.  So I was shocked when I got an email from a Peter Heimlich, the son of the Dr. Heimlich.  In addition to reminding me that Dr. Heimlich did not, in fact, invent his eponymous maneuver, he told me that Heimlich had become involved in some pretty sketchy pseudoscience.  In fact, Heimlich was purposely giving malaria to people with HIV disease, something that is both ineffective and dangerous.

The use of fevers to treat diseases is certainly not new.  One of the most interesting cases was that of Dr. William Coley, a surgeon who treated sarcomas in the late 19th and early 20th centuries.  He noted that patients who acquired erysipelas, a severe infection marked by high fevers, would sometimes have improvement in their tumors.  He moved from observation to intervention, placing sarcoma patients in soiled beds recently vacated by erysipelas patients.  Eventually, he created a potion of "toxins" isolated from erysipelas bacteria, injecting it directly into patients.   While we no longer give patients crushed up bacteria to treat cancer, interleukin 2, a biologic agent used as chemotherapy for some cancers, has an outwardly similar effect, often giving patients fevers and dropping their blood pressure inducing a state similar to septic shock.

So I wasn't entirely surprised when, in digging through some old journals, I found an article on treating advanced syphilis by giving patients malaria.

Syphilis is still a common sexually transmitted disease, but the late stages of the disease are not so common anymore.  The standard treatment for syphilis is penicillin, and many people receive penicillin for infections unrelated to syphilis, perhaps being inadvertently treated. But in the days before penicillin, syphilis relentlessly progressed, often leading to a condition known as "general paralysis of the insane".  A modern case report in the Southern Journal of Medicine is typical.  A 48 year old woman came to her doctor with vague complaints of fatigue and memory problems.  Her family was a bit less vague, telling the doctors of the patient's conversations with non-existent visitors, and her belief that her husband was the devil.  The patient also had significant neurologic problems including weakness of her facial muscles and frequent falls.   She rapidly declined, and became, essentially, comatose.

Neurosyphilis can be permanently disabling and deadly.  Before penicillin, doctors would try almost anything to save patients from this easy to catch but hard to cure illness.  Most treatments available in the pre-penicillin era were of questionable efficacy and undeniable toxicity, mostly involving heavy metals like arsenic and mercury (an old saw went, "One night with Venus, a lifetime with Mercury").  Doctors and patients were stuck with a horrible disease, and a poisonous cure.

But many of the doctors treating syphilis were ferociously smart, and made excellent observations.  In the inaugural issue of the British Journal of Venereal Diseases, one expert noted:

It has been noted for over a hundred years that an intercurrent infection or an artificially produced fever may effect a remission in the course of general paralysis.

Using this observation, and other hypotheses regarding the effect of fever on disease, some doctors  tried using a more-or-less controllable source of fever: malaria parasites. But even in the 1920's Britain, you couldn't just give people malaria (at least, not the un-incarcerated).

The consent of the patient and his relatives having been obtained, the patient is admitted to hospital. The tolerance to quinine is enquired into or tested.

The reference to "consent" is encouraging, although the meaning of the term was much different than the "informed consent" that is now the standard. The quinine tolerance was also important. Quinine was the only treatment available for malaria, so if you're going to give someone a potentially fatal disease, you'd better make sure you can cure it.

But what I really like about the paper is the caution with which the author approached his results:

In interpreting the results of any method of treatment of general paralysis it is necessary to bear in mind the well-known tendency of this disease to show natural remissions.

One of the keys to medical charlatanism, a problem then as now, is taking advantage of the natural course of a disease to take credit for nature's work.   The author would have been aware of this, and of the many "cures" for syphilis that had come and gone.  He framed his conclusions recognizing the seriousness of the disease and the risk of the cure:

Conclusions. (i) The optimism of the Continental writers cannot be confirmed, but the treatment has justified-itself until a better method can be found.(2) Success of treatment depends on the choosing of earlycases free from arterial disease and bronchial infection.(3) The treatment should be withheld from all debilitatedparetics and from all cases over fifty years of age.(4) The method of inoculation giving most satisfactory results seems to be natural infection from mosquitoes.

The forty-eight year old woman left in a coma had a diagnosis of syphilis confirmed by spinal tap.  She was treated with penicillin and was able to walk out of the hospital.  She did not, however, return to normal.  With well over a century of experience treating syphilis, we still do better with prevention than with treatment.

Selected References

British Journal of Venereal Diseases, 1 (1), 58-63 DOI: 10.1136/sti.1.1.58

Schiff E, & Lindberg M (2002). Neurosyphilis. Southern medical journal, 95 (9), 1083-7 PMID: 12356119

Lewis Gates (1925). Neurosyphilis Southern Medical Journal, 18 (10), 723-726

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A final (?) word on book burning

Sep 13 2010 Published by under Politics

I was pleased to see PZ Myers respond to my open letter about book burning.  (Digression: For all of you who are cheesed off about my grammar or my failure to respond to your one particular comment: There's a lot of comments, and yours was either not worthy of pursuing, or more likely, just lost in the shuffle.  And if you are terribly worried about grammar on the internet, STFU.)

This post is going to run on a bit, so I'll be dividing into two parts.

I: General thoughts on freedom of expression

PZ and I agree about many things, probably about most things when it comes to science and religion.  Religion, in and of itself, is irrational, and people who are religious should not be permitted to limit those of us who fail to believe in their gods.

But people, like religions, are irrational.  For whatever reasons, they believe.  I live in a world with six billion other people, most of whom hold some irrational beliefs, religious or otherwise.  In some parts of the world, the religious attempt to impose these views on others.  In Saudi Arabia, failing to believe in a particular form of Islam can get you killed.  In the U.S., failing to believe in particular forms of Christianity can get you killed. (Some would argue that it's different because in Saudi, the state kills you, but here in the U.S., if you get a botched abortion because of religion-inspired laws, you're just as dead.)

Given that most of my fellow human beings believe in things that I do not (supernatural or otherwise), I have to figure out how to get along in this world, and in doing so I have to look to history.  The founders of the U.S. did us some terrific favors by explicitly separating religion and the State.  This hasn't always worked well, because in a democracy, the religious majority can still win some battles (cf abortion, gay marriage, etc.).  But we've still remained much more secular than a good piece of the world.

If we take as a given that religion, as it intersects with secular interests, is a negative force (something which I will grant for the sake of argument only), then it must be dealt with.  One way to deal with it is to extend the French model, and outlaw public displays of religious (and often ethnocultural) identity.  If religion is confined to the home, its influence may be better contained.

But suppression of religion has its problems as well.  In addition to being oppressive, limiting religious expression can cause the religious to rise up and use the mechanisms of democracy or violence to release themselves from legal constraints.  But we shouldn't be "tolerant" simply because we fear violence. We should be tolerant because it is good and proper.

The way the founders chose to deal with the threat of religious diversity (and that's what it was: a threat---the threat posed by different belief systems vying to control secular life) was to recognize that religion exists, is valuable to most, and to say, "that's fine, but leave the State out of it."  They realized that people will continuously act in ways that would insult each other's beliefs, and understood that allowing this was the way to go.

I favor the U.S. system.  Although we continue to have problems with the religious majority attempting to impose its will on us all, we have been able to do better than most of the world.  This is a democracy, and to deny either the nonbelievers or believers of their right to believe or not believe is wrong.

But this American compromise  did not deal with a particular question: what if religion---all religion---is inherently detrimental to human well-being?  Those who believe this would, I imagine, work to end religion in all its forms.  When this is done through speech, this is perfectly congruent with American values and laws as regards to freedom of expression.  When done through action that constrains the rights of others, this is in direct opposition to American values and laws (depending on the action of course).

Burning of books is, and must always be, legal in the United States as a protected form of expression, rather than as an action that constrains the rights of others.

Now lets add a layer of historical context.  The Founders, in addition to ensuring our freedom of religion and expression, were concerned about tyranny, and not just the tyranny of a  monarchy.  They were concerned about the tyranny of a majority, whose combined political power could be used to oppress a minority, often through legal means.  The enumerated rights we enjoy were specifically designed to apply to all, regardless of minority or majority status.  This allows, for example, those of us who want to protest against a popular war to do so.  It allows those of us in the atheist minority to speak out against the beliefs of the majority, and prevents them from from passing laws forbidding this.

As Americans, we defend the most heinous forms of expression, knowing that doing so protects us all. We allow KKK rallies, Nazi marches, book burnings.  Given our inherent disgust, we often have to rely on others to keep us honest.  The ACLU is one such organization, bravely standing in the way of our own anti-democratic instincts.

But the tyranny of the majority can work extra-legally as well, and history has its lessons for us here.  Minorities, even despised minorities, have the right to exist and to disseminate their beliefs.  Atheists have the right to insult religion, Christians have the right to decry gay marriage, Muslims have the right to ask us to respect their religious texts---and we have the right to say "no".

And sometimes, we should say no.  If you truly believe that the greatest threat to the world is religion and those who believe, anything else I write is irrelevant.  But our own desire to express ourselves can be used to intimidate, oppress, and destroy.  Our own actions, even our own legal actions, can be wrong.

Throughout history, oppressors have used believer's attachment to sacred objects as a weapon, and they have often enrolled the majority perpetuating this oppression.  Burning Korans in Saudi Arabia is an act of rebellion.  Burning Korans in America (or France, the UK, etc) is not an act of rebellion against religious oppression, but a statement to an ethnic minority that they are despised.  It is legal, and should always remain so, but it has consequences.  Some of us have perspective on this.  In Europe, Jews were attacked by religious and secular institutions for centuries, and one of the ways the terror was maintained was through destruction of religious objects.  That an attachment to a religious object is "irrational" does not change the fact that preying on this belief to harm someone is wrong.  The ownership of the object is also irrelevant in this sense. This is not about property rights.

I think I made it quite clear in my original piece that I book burning are and should always be legally protected expression.  The reason people try to outlaw expression is that it is powerful---it has consequences.  If we act to burn books, to defend the burning of books, to prevent the burning of books, we are acknowledging the power of the act.  As responsible human beings we should, when exercising our rights, try to understand the consequences of our actions.

It may be a sad statement that I feel the need to voluntarily limit my own expression in order to prevent a greater harm.  But that's part of being a mature adult.  Yes, many Muslims would ask me to restrain myself from burning a Qur'an in order to please their god.  But refusing to burn it does not mean I am acknowledging their god, or acknowledging any legal abridgment of my rights.  It acknowledges that in the U.S., Muslims are currently a minority under threat, and an act like protesting a cultural center or burning a pile of  Qur'ans is cruel, intimidating, and selfish.

II: Specific thoughts on PZ's response

I agree with PZ entirely when he reminds us that "we have a right to destroy our own property."  As far as I'm aware, few rational people are arguing otherwise, rendering this statement a non sequitur.  The real question is what are the consequences of burning a pile of Qur'ans and how should good people react to it.  And this is where PZ loses me:

Informing me that the Muslims are genuinely and sincerely and deeply offended is not informative — contrary to the suggestion that I must have an empathy deficit to be unaware of that, I know that and appreciate the fact that their feelings are hurt and they are angry and outraged. My point is that I don't care, and neither should anyone else.

If PZ thinks that burning Qur'ans makes a statement, and this statement is worth the consequences, what is the statement and what are the consequences?  He admits that one of the consequences is to make Muslims hurt and angered.  He agrees with Glenn Beck et al. that we are in danger of having Muslims enforce their practices on us.  If the real issue were the imposition of Qur'anic beliefs on the rest of us, I would also be enraged.  Just as when the New Right tries to impose its belief onto our laws, we should fight any religion's similar impositions. I would agree with the sentiment that how this plays abroad is, in the long run, irrelevant.  True religious zealots will hate us or not, independent of how we behave.  But I also do care if my actions make people feel hurt and angry because I'm not a total douche.

PZ argues (or so it I read it) that the correct frame for this is that failing to burn a Qur'an is surrender to the whims of kooky religious zealots.

No one is saying you can't irrationally revere some religious object — we're just saying you can't tell others that they must irrationally revere your religious object, and you especially can't tell others that their cheap, mass-produced copy of your religious object must be treated in some special way.

I see it differently, from a different historical perspective.  While he looks at 2000 years or so of theocratic imposition, I see a century or so of majority attacks on minorities.  I'll admit it is an imposition to have to tolerate irrational beliefs, but as he says, "It is not a crime to offend others, and in fact, it's pretty much a natural consequence of having diverse cultures."  When I tolerate an irrational belief, I am also tolerating other human beings and their desire to be treated with respect, regardless of the irrationality of their beliefs.  I refuse to dehumanize them simply because they believe in fairies.

There is an intersection of beliefs and actions that is difficult to reconcile.  Most Christians profess to believe many of the things I believe.  For example, they have an injunction against murder.  They often ask all of us to follow that belief.  Some Christians also insist that I should ignore the humanity and rights of homosexuals.  I refuse to adhere to the latter, but I will the former, even though it will as an unintended consequence adhere to Christian beliefs.

The latter part of PZ's response is frankly patronizing and dehumanizing.

The West is still barging in militarily and causing devastation. Muslims in those countries should be righteously pissed off, but not about something as trivial as copies of their favorite book being destroyed.

That's empathy, too — the awareness that Muslims are human beings who deserve better, and that watching them get distracted by such pointless noise is doing them harm.


Religion infantilizes people. It makes them humorless and blind to others' ideas. We're doing no favor to them by indulging their unrealistic and impossible dreams of controlling everyone else's life.

I'm not sure why PZ, a spokesperson for atheists, also feels he can appoint himself spokesperson for all the poor, deluded Muslims.  This over-generalization, this dehumanization, is the sort of thinking that blinds someone to the harm caused by, say, burning the books held sacred by an at-risk minority.  PZ simply redefines the battle: those Muslims shouldn't be offended, because it's our right to burn the Qur'an, and they shouldn't believe this nonsense in the first place, and I'm really helping to free them.  They should thank me.

If you lack empathy, if you come from a position of privilege, if you are not the member of a minority with a history of significant persecution, it may seem that simple.  It is not.  It is and always should be legal to burn a pile of paper with words, or a shmate on a stick.   But for many people in this world, the burning of their books is followed closely by the burning of their houses of worships, their homes, and their person.  What PZ and his followers are arguing is that their acknowledged right to engage in this particular form of expression is always more important that the desire of others to feel safe.

46 responses so far

Open letter to PZ Myers

Sep 11 2010 Published by under Politics

Dear Paul,

I've read your writing for years, and have generally admired it.  While I haven't always agreed with you, we've generally seen eye-to-eye on the big issues.  It is out of my respect for you that I'd ask you to re-examine some of your thoughts about the recent non-burning of the Koran.

Of course it's legal to burn anything (well, usually not cannabis). But speech has consequences. These consequences are not always apparent to people, who may be blinded by their own beliefs, by their own position of privilege, etc. Your careless response to the aborted Koran burning fails on many levels, but especially on the level of empathy.

I've already argued that burning books is a form of expression that carries a lot of baggage.  You may feel like a despised minority due to your atheism, but I gotta tell you, from my perspective as an atheist and an ethnic minority, you're full of shit on this one.  Despite your atheism, you comes from a position of privilege that you are  perhaps too incredulous to see.   The first clue to this blindness comes early in your post:

People just aren't getting it; they're so blinded by an inappropriate attachment to magic relics that they're missing the real issues.

Yeah, but no.  The primary problem from the perspective of a white, male, employed atheist sitting in a house munching on lutefisk and aqvavit (don't you love stereotypes)  is that of people's inappropriate attachment to objects.  From the perspective of the poor, deluded people, it's the threat implied by the action of destroying something sacred to them.

Perhaps you didn't mean to erect such an enormous straw man to fight, but review this statement.  Humor me.

The problem isn't a few books being burned; that's not a crime, and it doesn't diminish anyone else's personal freedoms. The problem is a whole fleet of deranged wackaloons, including the president of the USA in addition to raving fundamentalist fanatics, who think open, public criticism and disagreement ought to be forbidden, somehow.

And seriously, this whole silly contretemps would have evaporated if a few people learned to shrug their shoulders and react rationally instead of feeding the fury with Serious Pronouncements and Reprovals.

Paul, the problem isn't the legality.  It does diminish people's personal freedoms.  It diminishes their sense of safety and security.  If I become afraid to practice my religion because of violent bigotry, I'm less free.  To tell me to get over it is some seriously fucked up victim-blaming.

I'm tempted to ask you the following question, but also afraid to.  If I could legally obtain a Torah for you, would you burn it? (I wouldn't but it's a thought experiment.)

If the answer is "no", then you're a hypocrite.  If the answer is "yes", then you have no understanding of history, of oppression, of fear.

Whether or not you think it appropriate, people imbue objects with meaning.  Why else try to save your house from burning down?  You have insurance, don't you?  But most people don't want to lose a house and the objects it contains because they have meaning.  Religious objects are no more or less irrationally revered than family photos.  People give them meaning.

It's appropriate to call out people on harmful beliefs, to criticize Catholic beliefs about homosexuality, Torah passages about rape, Koran suras about violence.  But collecting and burning religious texts is not simple criticism, it is an attack on the people who hold these texts dear, no matter how irrational they are.

To ignore this is to betray a sense of bigotry, one to which you may be blind.  Think of this as a gentle reminder.

In friendship and collegiality,


193 responses so far

Reporting on stroke prevention

Sep 10 2010 Published by under Medicine

Stroke is one of the three most common causes of death in the United States.  A stroke is, in effect, a "brain attack".  The most common type of strokes occur when the blood supply to part of the brain is suddenly interrupted.  These "thromboembolic" strokes have many causes. Many common risk factors are the same as those for heart disease: age, diabetes, high blood pressure, high cholesterol, smoking, unfortunate genetics.  Symptoms of stroke depend on the area of the brain affected.  If the blood supply to the area that controls the left limbs is interrupted, the limbs will be come weak.  Aside from the usual cardiovascular risk factors, strokes have a couple of other discrete causes which are pretty interesting.

Thromboembolic strokes can originate in the blood vessels of the brain itself;  if the blood vessels are affected by atherosclerosis, they can become acutely blocked causing a stroke.  But strokes can also be caused when blood clots break off of the walls of other parts of the circulation and travel to the brain.

Clots formed in the left atrium are a common cause of stroke

The carotid arteries supply the middle and front of the brain

One common cause of stroke is atrial fibrillation.  In this condition, the left atrium of the heart fails to contract normally and instead twitches irregularly.   The relatively still blood in the atrium can clot, and these clots are shot into the left ventricle and from there through the aorta and then to the vessels that supply the brain.

Another common cause of stroke is plaque in the carotid arteries. Plaques build up in the carotid arteries much as the do in coronary arteries. These plaques can become unstable and send clots shooting up the carotid artery into the brain.

Strokes from atrial fibrillation can be prevented by the use of anticoagulants which prevent the formation of blood clots in the fibrillating atrium.  The prevention of strokes from carotid artery disease is a bit more complicated.  Many studies have evaluated the use of medication, surgery, and stenting for the prevention of strokes due to carotid artery disease.  People with severe carotid artery disease often have warning signs of a stroke, such as brief, stroke-like symptoms called "transient ischemic attacks" (TIAs).  In patients with such symptoms and with severe blockages of a carotid artery, evidence supports surgical repair of the carotid artery.  This basically involves cutting it open and scooping out the nasty bit.

A newer procedure which is still under active investigation is "stenting".  Similar to , stenting of coronary arteries, stenting of a carotid artery involves threading a catheter from a let artery into the artery and opening it with a metal scaffold.

A study being released soon in The Lancet explored some of the risks and benefits of carotid artery stents.  The study was widely reported this week, and some of the reporting was pretty lousy.  Part of the problem may be that news outlets are relying on a press release or abstract, since this early release article is widely available.  Many of the articles failed to cite the source. One report in particular failed completely to understand the medical facts behind the study.

It starts by announcing the main findings:

Stroke patients over 70 who get stents to keep their arteries open may be doubling their risk of having another stroke or dying compared to patients who get surgery instead, a new study says.

But it isn't until halfway down the page that they (sort of) explain what kind of "stents" they are writing about:

In February, an American study found stents were as safe as surgery for treating narrow neck arteries. It also found the stents were more dangerous in patients older than 70.

As a medical professional, I suspected the article was about carotid artery stents, but I at first wondered if they could be talking about stroke risk related to coronary artery stents which would be a pretty dramatic new finding.

This sort of presentation adds further weight to the argument that reporters covering health topics must work to gain at least a minimal understanding of a topic before misreporting it.


Carotid Stenting Trialists’ Collaboration (2010). Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data The Lancet : 10.1016/S0140-6736(10)61009-4

Chaturvedi, S. (2005). Carotid endarterectomy--An evidence-based review: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology, 65 (6), 794-801 DOI: 10.1212/01.wnl.0000176036.07558.82

One response so far

Your disease, your fault

Sep 09 2010 Published by under Medicine

This post was originally published at Science-Based Medicine. --PalMD

Earlier this week, my colleague Dr. Gorski explored a common theme in alternative medicine: the idea that all disease is preventable.  This implies that all disease has a discrete cause and that individual behavior can mitigate this cause.

If biology worked this way, my job as an internist would be very different.   Many people would love to believe that life is this predictable, and that they have that much control over their health, but they don’t.  Most disease represents the interaction of environment and genetics, and you can’t change your genes (with a few exceptions, of course).

It’s natural to want to be able to exert an impossible level of control over your health, but when unscrupulous charlatans (redundant redundancy alert!) play on these beliefs and fears, they can cause, rather than prevent problems.

Continue Reading »

35 responses so far

Book Burnings

Sep 08 2010 Published by under Politics

Not long ago, I wrote a long piece about the resurgence of fascism as a mainstream political movement in the U.S.   The battle over an Islamic center in New York could perhaps be seen as an isolated incident by those who are completely blind, but as mosques and Muslims are attacked across the U.S., a trend has emerged: it’s open season on anyone demonized by the New Right.  As Sarah Palin yells, “don’t retreat, reload,” a line that brings cheers from her 2nd Amendment-loving but 14th Amendment-hating followers, real people are reloading.

Fascism incites its followers to demonize the Other, to physically attack him and all he stands for.  Once it becomes the new normal to attack Muslims, burn their books, and forbid their houses of worship, all it takes to spread the hate further is to accuse enemies of the cause of being Muslims or Muslim-sympathizers.  The spread of lies about President Obama's origins, religious beliefs, etc. aren't just the rantings of a few nut jobs. They are part of an organized effort to create hate, division, and to delegitimize a lawfully elected and constituted government.

It's often been said that all that is required for evil to flourish is for good people to do nothing.  But that ignores two facts: bad people are doing plenty, and other bad people, who wish to be seen as "mainstream" are keeping mum.    Where are the "sane" Republicans and others on the right condemning the planned burning of Qur'ans by a Florida pastor?  Some religious leaders and Democrats have spoken out, but where is Sarah Palin, Glenn Beck, and the other leaders of the Right?  John Boehner made a tepid, general statement about it, similar to one being used about the so-called Ground Zero mosque:

“Just because you have a right to do something in America does not mean it is the right thing to do. We are a nation of religious freedom, we’re also a nation of tolerance,” Boehner said. “I think in the name of tolerance people ought to really think about the kind of actions they’re taking.”

No, John, this is what you need to say:

" Book burning has no place in a civilized society.  If we do not speak out loudly against this act, we are all equally culpable of this hateful act."

Friends of mine of a more conservative bent love to rationalize away the most disturbing trends on the right with such phrases as, "no one listens to those crazies," and, "that's not what real Republicans are about."


Until American conservatives explicitly condemn the Sarah Palins and Glenn Becks, the New Right will continue to rise to the top of the GOP, will be The Right in America.  These folks aren't just going away.  As long as the GOP and other conservatives tolerate these new fascists, they are guilty: guilty of hate crimes, of bigotry, of destroying American ideals.

I accuse you, all of you on the right today, and call on you today to publicly renounce the New Right and their hate-filled rhetoric.  If you can't do this, you are not an enabler of fascism---you are a fascist.

47 responses so far

Piss whiskey and bad medicine

Sep 07 2010 Published by under Medicine

Chasing around wild internet stories is a full time job, and I already have one of those, but thanks to a friend (h/t Dr. Isis), a wild story came across my desk today. Like many internet stories, this one may turn out to be difficult to verify, and the website that originated it is dead, but the story is worth some exploring independent of its veracity.  The story, reported in Wired UK and on boingboing describes a (presumably) quirky fellow who made whiskey from urine.  Many readers may find the whole idea revolting or redundant, but the idea isn’t (biochemically) insane.

Making booze relies on two basic chemical processes: fermentation and distillation.  Fermentation uses various microorganisms (usually yeasts) to convert the sugar present in foods into ethyl alcohol.  For whiskey, a mash is typically made by boiling various grains and adding yeast (unless it is naturally occurring).  The mixtures stands while the yeast feed on the sugars, excreting ethyl alcohol as a waste product.  The reaction stops either when substrate (sugar) is depleted, or when the environment becomes too toxic for the yeast.  Depending on the yeast species, fermentation can produce around 5-20% alcohol before the yeast gives up.

But if you want something more intoxicating, such as whiskey, you have to take it another step.  The alcohol mixture can be distilled, yielding up to 100% alcohol.  In vodka production, this highly concentrated alcohol is diluted with water, bottled, and consumed with great rapidity.  Whiskey goes through a much more complex process involving cask aging which gives it its rich color and some of its complex flavors. The key, though, is that just about any source of carbohydrates can be used to make booze: potatoes, barley malt, cane sugar, and perhaps even urine.

If you’re wondering how piss whiskey would taste, don’t worry---the source of the sugar is less important that what’s done with it.  Real whiskey has the complex flavors of the mash included with the sugars, so I don’t think that piss whiskey should really be called “whiskey”---it’s more of a moonshine. It appears that the producer extracts sugar from urine, ferments it, and adds real whiskey to make it palatable.  On second thought, "moonshine" might be too kind a name for this stuff.

As a physician, one thing struck me as especially troublesome (besides the idea of drinking piss whiskey): the idea that it is “normal” for diabetics to excrete glucose in their urine.  When blood enters the kidney, it heads to the nephrons, the basic operating unit of the kidneys.  It enters the nephron through the glomerulus (the kidney’s “filter”) where glucose freely enters the soon-to-be urine.  After it is filtered, glucose-rich filtrate passes through a part of the nephron where the glucose is removed and put back into the circulation, so that by the time the urine is excreted, it has no glucose in it.

Unless, that is, so much glucose is filtered that it exceeds the kidney’s ability to reabsorb it.  In diabetes, the body cannot handle glucose properly, and glucose concentrations in the blood increase, often beyond the ability of the kidney to reabsorb it.  This causes many of the classic symptoms of diabetes, such as excess thirst and frequent urination.  It also indicates diabetes that is very poorly controlled.

While in the past approximate urine glucose concentrations were used to monitor diabetes, the measurement of capillary blood glucose is now trivial.  In the early days of insulin therapy, patients had to learn some basic biochemistry lab techniques to find out how much glucose was spilling into their urine.  Now a simple finger stick can measure a reasonably accurate blood sugar in seconds, at concentrations well below those where glucose appears in the urine.

If urine is sweet enough to be used to make alcohol, then something is going wrong.  We have the ability to regulate blood glucose in diabetics very tightly.  Most diabetics following proper diet and using medications properly should not have glucose in their urine, eliminating the need to find something horrid to do with the damned stuff.

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Saturday Morning Reflections

Sep 04 2010 Published by under Uncategorized

It only took about twelve hours for summer to turn to autumn. The air had been stifling---hot, still, humid---until quite suddenly the wind shifted to the north, changing the sound of the leaves to one that says, "You live farther north than you had remembered."

Outside my office are a couple of apple trees. No one maintains them, but the few edible apples aren't bad. Most fall to the ground, and the yellow jackets fall right after, buzzing around them greedily. They don't like to be disturbed---at all.

When the orchards open up for picking, they'll be there, too, but the apples are so good that it's worth the risk. There is no way to compare a traveling apple, days to weeks from the tree, to one snapped off the stem by my daughter. It doesn't hurt to have the fresh cider and doughnuts to go with it. The nearby cider mill opens Monday, and the smell of those doughnuts will precipitate lines of people seemingly out of nowhere.

I'm thrilled to say hello to fall, ragweed pollen and all. Bring it on.

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The death and rebirth of vitalism (repost)

Sep 02 2010 Published by under [Medicine&Pharma], Medicine

While we get our servers ramped up to handle our increasing traffic we have cut back on commenting. This should be fixed soon. Meanwhile, here's a piece from last year for you. --PalMD

One of the common themes in biology and medicine is the feeling that somehow there must be more. Creationists simply know that life must be more than matter, and mind-body dualists (which includes most alternative medicine advocates) are certain that humans are more than just "ugly bags of mostly water" (sorry for the geek reference). If you can stick with me here, I'll explain to you a bit of the history surrounding this fallacy.

Most of us intuitively feel that we are both a body and a person. In every day life, it makes a certain operational sense to think of our "mind" as being something distinct. From a biological standpoint, however, this doesn't work as well.

Biology was one of the last of the "natural philosophies" to become a science. It was clear to those who studied chemistry and physics that certain principles seemed to explain the natural world, but those who studied living things were mostly involved in description. Still, biology has become a science in its own right.  According to Ernst Mayr, one of the greatest biologists of the last century, a number of events preceded biology being recognized as a legitimate science. One vital event (sorry) was the recognition that all biological processes were constrained by the laws of physics and chemistry. Another important step was the rejection of two erroneous principles: vitalism, and teleology.

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Hang on folks, server woes

Sep 01 2010 Published by under Medicine

Sorry folks, but as you may have noticed, we're having some server problems and working with our host to resolve them.  That's a long story which I hope to tell you at some point.

Meanwhile, to decrease the load on the servers, I have to TEMPORARILY DISABLE COMMENTING.

This will hopefully be solved shortly, and for now, feel free to rant and rave at the WCU facebook site if you must.

In some ways, this is a good thing: we are growing quickly.  Woo-hoo!

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