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What would have killed your 19th-century doppelgänger?

Slate is doing a series of articles on life expectancy in the United States, both how it's changed and why. It kicks off with a piece that gives a broad overview of the medical and public health factors involved in our increased longevity — from clean water and the germ theory of disease, to generally increased wealth and nutrition, to vaccination. But author Laura Helmuth also offers up a morbidly fun challenge, asking you to think about how many times you might have already died had you been born before all these revolutionary changes happened.

It’s a fun conversation starter: Why are you not dead yet? It turns out almost everybody has a story, but we rarely hear them; life-saving treatments have become routine. I asked around, and here is a small sample of what would have killed my friends and acquaintances:

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Poor white women and a public health mystery

Over the past 18 years the life expectancy for white women who didn't finish high school has dropped precipitously. Today, those women can expect to die five years earlier than their counterparts a generation ago. It's one of the biggest magnitude losses in life expectancy ever recorded, and nobody knows what's causing it. At the American Prospect, Monica Potts reports on scientists efforts to untangle the knot of correlations at the heart of this public health mystery and tells the story of one woman, Crystal Wilson, whose life and death mirrors the statistics. Maggie 84

What the FDA doesn't want to tell you about livestock antibiotic use

Short version: There is LOTS the FDA doesn't want to tell you about livestock antibiotic use. And that matters. As I reminded you yesterday, the antibiotics we use to keep ourselves alive and healthy are rapidly losing their effectiveness against a whole host of diseases. Antibiotic resistance to disease is driven by overuse of antibiotics — both in humans and in animals. And there are lots of antibiotics being used on animals. The trouble is, public health researcher know very little about that use. Because the FDA refuses to release more than the bare minimum of data. For added fun, last year, they stopped even trying to regulate antibiotic use on livestock — opting instead for voluntary self-control systems. Maggie

How old is post-traumatic stress disorder?

It is very hard, and very weird to try to get a handle on how human health has changed between the 19th century and today. Obviously, the way we live has changed dramatically. But understanding how that impacts health (or doesn't) is complicated by the fact that healthcare, science, and public health research changed dramatically during those years, as well.

And all that science hasn't happened in a vacuum. The names we give various disorders change. Whether or not we consider something to be a disorder, at all, might change. And our cultural understanding changes, too—especially when it comes to mental illness.

At the Mind Hacks blog, Vaughn Bell has an excellent breakdown of two recent studies that try to put the modern diagnosis of post-traumatic stress disorder (PTSD) into a cultural and historical context. Many people assume that PTSD is just a new name for something that has always existed—look at shell shock, which made it onto Downton Abbey last season. But these new papers suggest that the distinction between what soldiers experienced in the past and what they experience today might go deeper than naming conventions.

The diagnosis of PTSD involves having a traumatic experience and then being affected by a month of symptoms of three main groups: intrusive memories, hyper-arousal, and avoidance of reminders or emotional numbing ... there has been a popular belief that PTSD has been experienced throughout history but simply wasn’t properly recognised. Previous labels, it is claimed, like ‘shell shock’ or ‘combat fatigue’, were just early descriptions of the same universal reaction.

But until now, few studies have systematically looked for PTSD or post-trauma reactions in the older historical record. Two recent studies have done exactly this, however, and found no evidence for a historical syndrome equivalent to PTSD.

A study just published in the Journal of Anxiety Disorders looked at the extensive medical records for soldiers in the American Civil War, whose mortality rate was about 50-80 greater than modern soldiers fighting in Iraq and Afghanistan. In other words, there would have been many more having terrifying experiences but despite the higher rates of trauma and mentions of other mental problems, there is virtually no mention of anything like the intrusive thoughts or flashbacks of PTSD.

Read the rest at Mind Hacks

David Dobbs adds some more context to Bell's post at the Neuron Culture blog.

The whooping cough vaccine your children get may not work as well as the one you got as a kid

About 20 years ago, the United States and a few other countries started using a different pertussis vaccine than had been used previously. The change was in response to public fear about some very rare neurological disorders that may or may not have had a relationship to that older vaccine (it couldn't ever be proven one way or the other).

The vaccine we use today was created to get around any possible mechanism for those disorders and, along the way, ended up having lower rates of the less-troubling (and far, far more common) sort of side effects, as well. Think short-term redness, swelling, or pain at the site of injection.

The downside, reports Maryn McKenna, is that this new vaccine might not be as effective as the old one. In fact, scientists at the Centers for Disease Control, Kaiser Permanente Medical Center in San Rafael, Calif., and Australia's University of Queensland’s Children’s Medical Research Unit, are raising the possibility that a less effective vaccine could be part of why we're now seeing a big increase in pertussis outbreaks.

In the most recent research, a letter published Tuesday night in JAMA, researchers in Queensland, Australia examined the incidence of whooping cough in children who were born in 1998, the year in which that province began phasing out whole-cell pertussis vaccine (known as there as DTwP) in favor of less-reactive acellular vaccine (known as DTaP). Children who were born in that year and received a complete series of infant pertussis shots (at 2, 4 and 6 months) might have received all-whole cell, all-acellular, or a mix — and because of the excellent record-keeping of the state-based healthcare system, researchers were able to confirm which children received which shots.

The researchers were prompted to investigate because, like the US, Australia is enduring a ferocious pertussis epidemic. When they examined the disease history for 40,694 children whose vaccine history could be verified, they found 267 pertussis cases between 1999 and 2011. They said:

"Children who received a 3-dose DTaP primary course had higher rates of pertussis than those who received a 3-dose DTwP primary course in the preepidemic and outbreak periods. Among those who received mixed courses, rates in the current epidemic were highest for children receiving DTaP as their first dose. This pattern remained when looking at subgroups with 1 or 2 DTwP doses in the first year of life, although it did not reach statistical significance. Children who received a mixed course with DTwP as the initial dose had incidence rates that were between rates for the pure course DTwP and DTaP cohorts."

You can read the rest of the story at Maryn's Superbug blog

A key thing to remember: This is a nuanced theory that may or may not turn out to be right. But, if it does turn out that this vaccine isn't as effective as we want it to be, that's not a dark mark against vaccines, in general. Sometimes, medicine doesn't work as well as intended. It's a risk of medicine. And the fact that it's major research institutions pointing this possibility out, should give people some comfort in the scientific process. If doctors and organizations who promote childhood vaccination are all in the pockets of an evil conspiracy then there would be no reason why they'd ever do research like this, or talk about it publicly.

Image: Day 59, Project 365 - 12.18.09, a Creative Commons Attribution (2.0) image from williambrawley's photostream

Uganda: Ebola's back

The president of Uganda has "banned all physical contact" as the deadly Ebola virus is reported in the city's capital, Kampala, for the first time. “The Ministry of Health are tracing all the people who have had contact with the victims,” president Yoweri Museveni said in a state broadcast. 14 have died of Ebola in Uganda in the past 3 weeks. (via @seanbonner) Xeni

Lies, damned lies, and flame-retardant furniture

All this week, The Chicago Tribune is posting a multi-part investigative report about the fire-retardant chemicals that turn up in everything from the foam in our couch cushions, to the plastic casings on our television sets. Turns out, research shows these chemicals don't actually prevent fire deaths and injuries. Worse, research does show that these chemicals are dangerous to human health—especially in the quantities to which we are exposed. Dose makes the poison, but we're not talking about small doses here. As the Tribune so succinctly puts it: This isn't something where we measure exposure in parts per million, it's measured in pounds.

The Tribune has also done a very good job of documenting both the existence and history of a pattern of corporate lies and manipulation that has made sure these chemicals remained a mandated part of our lives even as science shows they aren't helping us.

The lies are infuriating, but the history part is particularly fascinating. After all, it's easy to understand why chemical companies would lie and manipulate politics in order to maintain a lucrative market for their products. But why does that market exist, to begin with? Behind the scenes, our continued exposure to these chemicals comes down to two key issues: One poorly designed product safety test that encouraged heavy use of flame-retardants in foam instead of small doses of safer chemicals in fabric, and a 1970s-era attempt to deflect negative press away from cigarettes.

The problem facing cigarette manufacturers decades ago involved tragic deaths and bad publicity, but it had nothing to do with cancer. It had to do with house fires.

Smoldering cigarettes were sparking fires and killing people. And tobacco executives didn't care for one obvious solution: create a "fire-safe" cigarette, one less likely to start a blaze. The industry insisted it couldn't make a fire-safe cigarette that would still appeal to smokers and instead promoted flame retardant furniture — shifting attention to the couches and chairs that were going up in flames.

But executives realized they lacked credibility, especially when burn victims and firefighters were pushing for changes to cigarettes. So Big Tobacco launched an aggressive and cunning campaign to "neutralize" firefighting organizations and persuade these far more trusted groups to adopt tobacco's cause as their own. The industry poured millions of dollars into the effort, doling out grants to fire groups and hiring consultants to court them.

Playing With Fire: The entire four-part series updated all this week.

So far, parts 1 and 2 have been published.

Image:Image: ghost chair, a Creative Commons Attribution (2.0) image from wwworks's photostream

Scary science, national security, and open-source research

I’ve been following the story about the scientists who have been working to figure out how H5N1 bird flu might become transmissible from human to human, the controversial research they used to study that question, and the federal recommendations that are now threatening to keep that research under wraps.

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The world, as mapped by frequency of cholera cases

This really fascinating image comes from a Scientific American guest blog post about the appendix. What does the appendix have to do with cholera? Turns out, the more we study the appendix, the more it appears that this organ—once thought to be useless—is actually a storage system that allows your gut to repopulate itself with beneficial bacteria following a bout with a dramatic, gut-wrenching such as cholera.

This theory makes a lot of sense, but it hasn't been proven yet. The blog post, written by Rob Dunn, tells the story of a couple of studies that seem to add further support to the theory. In one, 11% of people with an appendix had a recurrence of Clostridium difficile infection, while 48% of those without an appendix had a recurrence.

Grendell’s results do not prove Parker is right. Science does not work that way. More tests, even true experiments, need to be done. Maybe there was something else that differed between individuals with and without their appendixes. Maybe the result only applies to the mostly white population Winthrop hospital serves. Maybe the immune system plays a more important or different role than Parker envisions. These “maybes” are part of what make science beautiful — the idea that each question, each test, and each day, lead to more questions. Every good question is a road that goes on forever, diverging and bounding forward, sometimes quickly, other times more slowly, as new paths emerge and some of the old ones run straight into brick walls.

Where does this leave us? In your body is an organ that appears to be/may be/could be helping out the bacteria in your life so they can, in turn, help keep you alive. If you do not have your appendix anymore, you may be at an increased risk of recurrence and even death when confronted with a pathogen like C. diff., cholera or any of a wild kingdom of other pathogens. This possibility raises the question of what to do if your appendix (or your child’s appendix) becomes inflamed. First things first, you should seek medical attention. As for what the treatment should be, while appendicitis can be deadly, recent studies suggest some, but not the majority, of cases of appendicitis can be resolved using antibiotics, though the topic is an active area of research and little is known about the prognosis for individuals treated with antibiotics for appendicitis later in life7. Might there, some day, be solutions other than surgery and antibiotics, solutions that aim at restoring the sanctuary of the appendix? Maybe. Until then, doctors keep cutting infected appendixes out. When they do, when they hold them up, they hold up a symbol — a somewhat gross, pinky-finger-sized symbol –both of our complex relationship with other species and of how little we know.

Honey, we have a problem

UPDATE: Hey guys, I screwed up on this one. NPR points out that the story I wrote about here is pretty heavily biased, produced by a website that's run by a law firm specializing in food poisoning cases. And the claims made here don't line up with evidence. Apologies. I normally manage to avoid being suckered in by stuff like this, but we all have bad days. Thanks to those in the comments who pointed out the flaws.

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How To: Use vinegar to diagnose cervical cancer

In developing countries, a new, inexpensive treatment allows nurses to spot pre-cancerous lesions on a woman's cervix and remove them—without needing a medical lab, and without surgery. It has huge implications for women's health, because cervical cancer kills 250,000 women every year.

In fact, before pap smears became commonplace, cervical cancer killed more American women than any other sort of cancer. But in places where the pap smear isn't practical, this new technique can help. From the New York Times:

Nurses using the new procedure, developed by experts at the Johns Hopkins medical school in the 1990s and endorsed last year by the World Health Organization, brush vinegar on a woman’s cervix. It makes precancerous spots turn white. They can then be immediately frozen off with a metal probe cooled by a tank of carbon dioxide, available from any Coca-Cola bottling plant.

... Dr. Bandit Chumworathayi, a gynecologist at Khon Kaen University who helped run the first Thai study of VIA/cryo, explains that vinegar highlights the tumors because they have more DNA, and thus more protein and less water, than other tissue.

It reveals pre-tumors with more accuracy than a typical Pap smear. But it also has more false positives — spots that turn pale but are not malignant. As a result, some women get unnecessary cryotherapy. But freezing is about 90 percent effective, and the main side effect is a burning sensation that fades in a day or two. By contrast, biopsies, the old method, can cause bleeding.

Via Robyn Lloyd

Bearded scientists: Will they kill us all?

This image comes from “Microbiological laboratory hazard of bearded men," a peer-reviewed research paper concerning the risk bearded scientists who work with bacteria and viruses might pose to their families. Published in 1967, the study tested whether bearded men were more likely to accidentally "carry" microbes home with them.

You can read the whole study online. And thank God for that. Because it's full of more great out-of-context quotes than I have time to cut and paste today.

Conclusion: Dirty hippie scientists shouldn't normally be a threat to family and friends. However, accidental beard-based contamination is possible, if the bearded scientist in question does a lot of repetitive, close-contact work with microbes. (Read: Grad students) In which case, those scientists should really wash their beards before they leave the lab.

Thanks, David Ng!

Weird laws (or lack thereof)

Technically, it's not illegal to distribute Salmonella-tainted food.

Want to live a long life? Ignore centenarians, watch Seventh Day Adventists

If a centenarian jumped off a bridge while eating a bag of jelly donuts and chain-smoking, would you do it, too?

That's basically the message in a new column by LiveScience's Christopher Wanjek, which looks at why the people who live the longest should not necessarily be health role models for the rest of us.

It seems that longevity goes hand-in-hand with some funny yesbuts. What you eat and how active you are doesn't seem to matter ... if you're one of the very, very lucky folks with a genetic predisposition toward surviving into extreme old age. For everybody else, there's pretty good evidence that healthy habits actually do extend your lifespan. Part of what fascinates me about the studies that show that is that they often compare Seventh Day Adventists to the general population. Why? Because Seventh Day Adventists generally don't eat meat (the first time I ever saw lentil loaf, it came from SDA cookbook), and are discouraged from booze, cigarettes, drugs, and caffeine. It also doesn't hurt that they run a massive, and well-respected, healthcare system, centered around Loma Linda University. Makes 'em easier to study like that.

For the general population, there is a preponderance of evidence that diet and exercise can postpone or ward off chronic disease and extend life. Many studies on Seventh Day Adventists — with their limited consumption of alcohol, tobacco and meat — attribute upward of 10 extra years of life as a result of lifestyle choices.

Image: Elderly People - sign on Warwick Road, Olton, a Creative Commons Attribution (2.0) image from ell-r-brown's photostream

Americans still being killed by racial segregation

How many Americans die because of routine racial segregation (the social kind, not Jim Crow)? According to calculations by the EpiAnalysis blog, it could be as high as 176,000 people per year. (Via Robin Lloyd)