by Jim Caryl
The next time you’re down the pub, engaging your favourite Chimpanzee in an arm wrestle, I want you to reflect on a few things (besides the absurdity of wrestling an Ape).
As you take up the strain, know that the fine-tuned positioning and slow, steady building of muscle force you exert is due to the greater amount of grey matter that you posses in your spinal cord; motor neuron nerves cells that connect to muscle fibres and regulate muscle movement. The huge surplus of motor neurons you possess allows you to engage smaller portions of your muscles at any given time. A Chimpanzee, by comparison, has fewer motor neurons, thus each neuron triggers a greater number of muscle fibres, resulting in a greater proportion of muscle activation.
Reflect on how this finely tuned, incremental strength allows you to engage in tensing your muscle for a longer period. It is this fine motor control that allows you to do delicate tasks, like be victorious on the Nintendo Wii or replace the RAM in your laptop, and you know that if the RAM chip stubbornly refuses to slot back into place, you can gently exert greater and greater precise force until it does.
Finally, as the arm wrestle begins in earnest, reflect on two last things: one, your brain limits the degree of your muscle activation in an attempt to prevent damage to the fine motor control components of your muscles; and two, a Chimpanzee has no such limitation. So as the Chimpanzee tears off your arm easily and beats you over the head with it, think to yourself that rather than engaging in an arm wrestle with a Chimp, which has four times your strength, try sitting at home playing your Nintendo Wii instead, the precise motions for which it seems we are supremely evolved.
Inspired by Alan Walker’s (Professor of Anthropology at Penn State) research article ‘The strength of Great Apes and the speed of Humans’; free to read in the recent issue of the journal Current Anthropology.
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A little long, didn’t fly, but better luck next time.
[Guardian, Tuesday 31st April] Cherill Hicks article, ‘Not to be sneezed at’, gave a timely and largely useful revision of therapies available to hay fever sufferers, but tripped up by suggesting that research on homeopathic treatments was ‘encouraging’.
It is still the consensus in the scientific literature that homeopathy does not perform any better than placebo, an issue which has been addressed by a comprehensive study by Aijing Shang MD and colleagues at the University of Berne, Switzerland. The study, published in The Lancet (2005), compared 110 homeopathy trials with 110 conventional medicine trials, and found that conventional medicines work, with little evidence to say the same of homeopathic medicines.
The positive findings of a few placebo-controlled trials of homeopathic medicines are cherry picked from a mountain of contradictory results, and are generally found to result from combinations of methodological deficiencies and biased reporting. The ‘encouraging’ results for treatment of hay fever with Galphimia glauca arise from a series of studies by a single homeopathy research group, and have been given unwarranted kudos in homeopathy circles due to the publication of a meta-analysis, which is an analytical over-view of combined results from numerous methodologically similar studies.
However, the meta-analysis only consists of seven trials (included in the Lancet study by Dr Shang and colleagues), and all come from the same research group; indeed, the group leader was a co-author on the meta-analysis itself. There are insufficient data from independently reproduced studies to corroborate the positive findings for Galphimia glauca as a treatment for hay fever, thus its status as a recommendable therapy is dubious.
A technique to ensure/encourage patient compliance was recently described on the Freakonomics blog. In the example they described a device that could be used to detect the metabolites (breakdown products) of TB medication in urine. It was developed by Jose Gomez-Marquez and colleagues at MIT’s ‘Innovations in International Health’ programme; a more detailed discussion of the history behind its development can be found at MobileActive.org. Biosensors such as these are these are nothing new of course, but it is the potential application that is interesting. Essentially it is a device that encodes a pattern, or series of numbers or code, that can only be revealed by urine from a patient who has been taking their medication. This pattern of number could be their entry to a ‘lottery’ or some other economically-driven, and presumably ethical, contest.
It is certainly an interesting idea and can be derivatised for numerous treatments that require patient compliance. As the Freakonomics blog describes, it is an excellent fusion of economics and science, using the tangible prospect of economic gain to encourage patients to address the rather esoteric long-term treatment of slow-healing bacterial infections such as TB.
It is one of a number of tactics, along with new drugs that reduce treatment time, that could be brought to bear in the light of the rather sombre report ‘Global Tuberculosis Control 2009‘ commissioned by WHO, which is discussed in an editorial in The Lancet (4th April edition).
In today’s Daily Mail, the spurious ‘Good Health’ section features an article entitled, ‘How a shot of ozone can beat backache’. Ozone is something of a buzz word in the alternative therapy/naturopathy circles, where O2 (oxygen) is seen as an amazing cure all (rather than a potential damaging oxidiser), thus O3 (ozone) is king. Ben Goldacre, of the Bad Science blog, has written numerous times about pseudo-scientific ozone treatments.
The difference in this case is that the evidence comes from an 8,000 person meta-study led by Kieran Murphy, MD, at the University of Toronto, analysing results published in similar European treatments, and as such has some degree of validity. Dr Murphy, who performs oxygen/ozone treatments, recently pioneered a medical device for minimally invasion introduction of an oxygen/ozone delivery device to the lumbar discs (the fluid filled spongy spacers between the bones of your spine).
Importantly however, there was a lack of randomised, blinded trials, and there was no control (placebo) group, so it’s difficult to conclude whether any improvements were specifically due to the ozone injections. The placebo effect can be powerful, especially in treatments that involve injections or ‘medical theatre’ (the degree of organisation and preparation before a procedure); Ben Goldacre also writes about such effects.
In January, researchers at the same institution (the University of Toronto) published the results of an 8-week, 3-visit, triple-blinded, randomised controlled clinical trial involving 44 subjects, looking at treatment of hypersensitive teeth with ozone injections. They found that treatment resulted in reduced pain sensation, but that this was indistinguishable from the placebo, demonstrating the patient’s expectation of cure from an invasive practice, or ‘medical theatre’.
Without such controls, it is difficult to conclude whether such therapies are truly effective, though the power of placebo cannot be discounted as having some benefit if it is able to reduce pain.
Fortunately, in the Mail’s article they did offer one paragraph to a Professor of muskuloskeletal medicine at the University of Leeds who welcomed new innovation, but also suggested that the lack of appropriate randomised controlled trials needs to be addressed.
An article published this month reviews first aid treatments for burn injuries (Cuttle et al. 2009. Burns: EPub). Having just attended my first-aid re-qualifier I thought I’d take a look.
Review outcome: use cold water (2–15 °C cold water applied for 20 min, if you’re interested)
So no surprises there then.
Amusingly, the reviewers mention that treatment for an acute burn injury was first documented in the Ebers Papyrus (c. 1500 BC):
Treatment involved applying to a burn “on the first day” a mixture of milk from a woman who had just given birth to a son, gum, and ram’s hair, together with a spoken incantation: “Your son Horus has burned himself in the desert. Is water here? There is no water here. Water is in my mouth, a Nile is between my thighs, I have come to put out the fire. Flow out, burn!”. Since that time in history where plant and animal extracts were popular, many other topical treatments have been used, such as vinegar and wine in Roman times, oily mixtures in the 1800s, tannic and picric acids from the early 1900s and finally cold water.
So, assuming you have no lactating women around, no gum, no choice snippets of hair from a Ram, then you can always rely on the incanted threat of having your burn spat on, or pissed on. Invariably over the years, you would be oiled, wined or burned with wood acid or an explosive. I wonder whether there is some sense of irony given that every remedy seems poised to complete the cooking of meat that you’ve already started, complete with some basting?
Finally we get to cold water that, according to the review, has the documented benefits of: decreasing mortality, pain relief, decreasing cell damage, decreasing skin temperature to below dangerous level, decreasing cell metabolism in hypoxic tissue for greater cell survival, stabilising vasculature, reducing oedema, improving wound healing and scar formation and decreasing inflammatory response.
The above is a victory for common sense, and documented evidence-based medicine, rather than the hocus of old. However, the review points out that there continues to be some controversy still as many people prefer the old ‘natural’ and ‘folk’ remedies, despite the lack of documented evidence that they do anything, and in many cases act to delay healing.
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Cuttle, L., Pearn, J., McMillan, J., & Kimble, R. (2009). A review of first aid treatments for burn injuries Burns, 35 (6), 768-775 DOI: 10.1016/j.burns.2008.10.011
Alom Shaha, a science teacher at Camden School for Girls in North London, produced an excellent film that asks, and answers, the question ‘Why does science matter?‘ (via Guardian Science Blog).
If nothing else, it might help young scientists articulate an answer when faced with the question; it isn’t enough to have that warm, secure feeling of knowing that science is important in yourself, you need to be able to communicate this without getting bogged down in detail.
Also take a look at Alom’s other science short films.
On Friday I shall be off to a workshop in Manchester, run by Sense About Science:
Sense About Science is an independent charitable trust. We respond to the misrepresentation of science and scientific evidence on issues that matter to society, from scares about plastic bottles, fluoride and the MMR vaccine to controversies about genetic modification, stem cell research and radiation. We work with scientists and civic groups to promote evidence and scientific reasoning in public discussion.
Our recent and current priorities include alternative medicine, MRI, detox, radiation, health tests, the status of evidence in public health advice, an educational resource on peer review and the public language of science.
The workshop is run as part of the Voice of Young Science programme, aiming to discuss science-related controversies in media reporting and make a greater contribution to public debates.
I shall report back on this at the weekend.
Tomorrow I have a day workshop in nanomedicine. Working in bionanosciences, which is my current gig, I’d like to think I’ll get more out of it than just a free lunch, but we’ll have to see. Nanomedicine is the application of nanoscience to medicine; you’re probably wondering what on Earth nanoscience is? If you know, could you let me know before my boss finds out?
I jest. Actually, a good example of nanomedicine is described in an upcoming publication from Children’s Hospital Boston, where some enterprising chaps (Yung et al.) have developed a blood cleansing device for use in treating sepsis. Sepsis is a lethal systemic bacterial infection that spreads by the blood and rapidly overcomes the body’s defence system. Typical antibiotic therapies are not sufficient as they do not fully eliminate the infection, and the toxin load on the body, both as a result of live bacteria and dying bacteria, can cause systematic organ failure.
The researcher’s approach is to introduce what are called magnetic nanoparticles, spheres that are a few millionths of a millimetre in diameter, into the blood. These nanoparticles have two important properties, besides being extremely small: they can be attracted by a magnet; and the surfaces of each particle can be covered with an antibody (an immune system protein that binds to foreign molecules) that specifically binds a particular bug. In the case of this work, they used antibodies that bind the fungus Candida albicans, which can cause sepsis in people whose immune systems are not functioning.
[ratings]
IN geographic terms, the ‘great divide’ is used to define the point in the USA, roughly following the course of the Rocky Mountains, where on one side a drop of water will run down into the Pacific Ocean, and on the other, it will run down into the Atlantic.
There is however another great divide in the USA, which is between those that have a basic knowledge of the world around them, and those that don’t. The online newszine Science Daily described a recent poll commissioned by the California Academy of Sciences, in which a series of basic questions, designed to assess basic science literacy, were posed to 1,002 adults over a four day period last December. The poll has been ongoing (though in a less rigorous sense) online at the CAS website. The results were as follow:
Hands up who thinks this is unacceptable?
No, it’s not. So why is the USA finding it has a problem with scientific literacy? Well, please just indulge me. Let’s think about Pakistan, where many (though not all) Madrassas (Islamic schools) are engaging in the indoctrination of a new generation of children into fundamentalist rhetoric; this comes at the cost of education that can raise people out of poverty and morbidity; education that gives them some control over their lives. However, for many, Madrassas are the only source of ‘education’. Yet if you speak to a young professional on the street of moderate urban centres such as Karachi, they are not going to present you with the fundamentalist hard-line; they are the lucky few, to have been born into a better area, perhaps to a richer family whom are well educated.
It is not such a great step to see such a partisanship developing in the USA, with the richer, well educated ‘elite’ being outnumbered by those who are disenfranchised from modern successes, scientific discoveries and societal benefits. Those left behind in progress increasingly turn inward toward timeless stalwarts such as the fundamentalist hard-line, which not only serves to widen the gulf to be crossed by communicators of science, but ultimately results in senators, congressmen and governors becoming willing to bow down to public anti-science opinion, i.e. votes, at a government level, thus jeopardising the future scientific and medical progress.
Mental Indigestion 