# 9195
A quick note, today’s Ebola Symposium at Johns Hopkins – featuring a terrific Keynote address by CIDRAP’s Dr. Michael Osterholm – plus a lot of other not-to-be-missed content, has now been posted (in two parts) online.
The first video runs about 3 hours, and features the individual presentations. Dr. Osterholm’s remarks come at about the 2 hr 24 minute mark. The second video – running about 90 minutes – is the panel discussion.
The entire symposium is highly recommended.
Credit CDC PHIL
# 9048
There are tremendous challenges ahead as the international community attempts to help affected nations bring their Ebola epidemic under control. Tomorrow, a panel of experts from Johns Hopkins will discuss the ethical issues surrounding this response, which will be live streamed over the internet.
Ebola & Ethics Panel at Johns Hopkins -- live stream Monday, September 8, 12:15 PM
Ebola & Ethics Panel at Johns Hopkins – Live Stream Monday, September 8, 12:15 PM
A Johns Hopkins public health student with first-hand experience of the current Ebola outbreak will join a leading bioethicist and the health system's Senior Epidemiologist to discuss the ethical issues of the Ebola response thus far, and an ethical path forward as the crisis deepens.
WHEN: Monday, September 8, 2014 12:15 AM – 1:30 PM EDT
WHERE: Johns Hopkins Hospital, Baltimore, MD. Ustream:
WHO:
Nancy Kass, Deputy Director for Bioethics and Public Health at the Johns Hopkins Berman Institute of Bioethics and professor at the Bloomberg School of Public Health, who has defended the treatment of the first Americans infected with Ebola, and advised an ethical path forward, in an opinion in the Annals of Internal Medicine and an appearance on MSNBC.
Tim Roberton, fourth-year doctoral student at the Johns Hopkins Bloomberg School of Public Health, who travelled to Guinea in July as Red Cross consultant and observed the crisis response first-hand.
Trish Perl, Senior Epidemiologist, Johns Hopkins Health System, who has written in the Annals of Internal Medicine and spoken with media on protecting health care workers from Ebola and steps for managing the virus' spread.
Panelists will answer questions from the live audience. To add to the general discussion on Twitter, the event will utilize the #Ebola hashtag.
The panel discussion will kick off the 2014-2015 Bioethics Seminar Series, hosted by the Johns Hopkins Berman Institute of Bioethics.
Photo Credit-CDC
# 6394
While I often use this blog to promote better hand and respiratory hygiene, I must confess to a fascination with the hygiene hypothesis.
For those unfamiliar with it, this is multi-faceted and controversial theory that proposes that some diseases common to modern man may come about due to a lack of exposure to various biological agents (bacteria, viruses, and even parasites) . . . particularly in early childhood.
Research over the past decade has increasingly linked the use of household cleaners (bleach, disinfectants, carpet cleaners, etc) and other chemicals (turpentine, insecticides, etc) to childhood onset asthma and allergies (see MedNews Today Asthma in kids linked to household cleaning products and chemicals).
Essentially, the hygienic hypothesis says we may be trying to be `too clean’ for our own good.
Back in 2010, I wrote about a University of Michigan study that addressed growing concerns over two commonly used chemicals – Triclosan and Bisphenol A (BPA) - and their possible impacts on our immune systems.
Study: Bisphenol A, Triclosan and The Hygienic Hypothesis
While my article focused mostly on BPA, Maryn McKenna took a deeper look at the use of Triclosan, and at the `hygienic hypothesis’ in her Superbug Blog entry called: Triclosan, allergies and the “hygiene hypothesis”.
Very much worth reading.
All of which serves as prelude to a new study today, from the Johns Hopkins Children’s Center, that links antibacterial chemical exposure to a higher incidence of allergies in children.
First some excerpts from the press release, followed by a link to the study, and finally a few closing comments.
Antibacterials in Personal-Care Products Linked to Allergy Risk in Children
MEDIA CONTACT: Ekaterina Pesheva
EMAIL: epeshev1@jhmi.edu
PHONE: (410) 502-9433June 18, 2012
Exposure to common antibacterial chemicals and preservatives found in soap, toothpaste, mouthwash and other personal-care products may make children more prone to a wide range of food and environmental allergies, according to new research from Johns Hopkins Children’s Center.
Results of the NIH-funded study are published online ahead of print June 18 in the Journal of Allergy and Clinical Immunology.
Using existing data from a national health survey of 860 children ages 6 to 18, Johns Hopkins researchers examined the relationship between a child’s urinary levels of antibacterials and preservatives found in many personal-hygiene products and the presence of IgE antibodies in the child’s blood. IgE antibodies are immune chemicals that rise in response to an allergen and are markedly elevated in people with allergies.
“We saw a link between level of exposure, measured by the amount of antimicrobial agents in the urine, and allergy risk, indicated by circulating antibodies to specific allergens,” said lead investigator Jessica Savage, M.D., M.H.S., an allergy and immunology fellow at Hopkins.
The researchers caution that the findings do not demonstrate that antibacterials and preservatives themselves cause the allergies, but instead suggest that these agents play a role in immune system development.
<SNIP>
Children with the highest urine levels of triclosan had nearly twice the risk of environmental allergies as children with the lowest urinary concentrations. Those with highest levels of propyl paraben in the urine had twice the risk of an environmental allergy. Food allergy risk was more than twice as pronounced in children with the highest levels of urinary triclosan as in children with the lowest triclosan levels. High paraben levels in the urine were not linked to food allergy risk.
The study, which appears in the Journal of Allergy and Clinical Immunology, is called:
Urinary levels of triclosan and parabens are associated with aeroallergen and food sensitization
Jessica H. Savage, MD, MHS, Elizabeth C. Matsui, MD, MHS, Robert A. Wood, MD, Corinne A. Keet, MD, MS
For more on the Hygiene Hypothesis, a couple more resources to consider.
First, from a Scientific American podcast from April of 2011, an interview with Johns Hopkins School of Medicine researcher Kathleen Barnes, who studies this theory.
Can It Be Bad to Be Too Clean?: The Hygiene Hypothesis
Johns Hopkins School of Medicine researcher Kathleen Barnes talks about the hygiene hypothesis, which raises the possibility that our modern sterile environment may contribute to conditions such as asthma and eczema
Another, highly controversial aspect of this theory, is that intestinal parasites (ie. worms) – which have been largely eliminated in the western world - are actually beneficial, and can help prevent (or even cure) certain types of inflammatory bowel disease.
NPR (along with many other media outlets) covered this story at length back in 2010 (see Eat Your Worms: The Upside Of Parasites).
This past week, with the release of an avalanche of News From The Human Microbiome Project, we are learning just how much of our body consists of non-human microbes – which exist in or on just about every part of the human body.
Over hundreds of thousands of years man has evolved to co-exist with – and yes, even depend upon - many of these micro organism to protect our skin, digest our food, and even produce vitamins and anti-inflammatory compounds in our intestines.
Chemicals (and drugs - see The Other Reason Not To Abuse Antibiotics) that can upset the balance of these naturally occurring – often beneficial – organisms have the potential to affect our health in unexpected ways.
While intriguing, the Hygiene Hypothesis remains both controversial and unproven.
Good hand hygiene, avoidance of infection, and general cleanliness remain essential parts of staying healthy, and no one is seriously suggesting we indulge in geophagy (eating dirt), intentionally ingest worms, or move down into the sewers to enhance our immune system.
But there is increasing evidence to suggest that our modern mania for cleanliness - particularly with the use of chemicals like triclosan and parabens – may exact an unexpected cost on our overall health.
How much of a penalty is involved, and whether the tradeoff is worth it, are questions that are yet to be answered.
# 4717
Over the next couple of days I’ll be highlighting some of the interesting abstracts of slide presentations to the ICEID 2010 conference going on in Atlanta this week.
Academic conference presentations are not in the same league as peer-reviewed journal articles – but they do give us an important and early look at research being conducted around the world.
Many of these presentations will eventually end up in peer-reviewed journals, however. But that can take a year or longer.
Meanwhile, important information and avenues of research may languish. These presentations are therefore of keen interest, even if they haven’t been subjected to peer-review.
So as you read these abstracts, and follow news reports from this conference, I’d recommend a bit of caution.
But even peer-reviewed RCTs (Randomized Controlled Trials) (long considered the `gold standard’ for scientific research) published in prestigious journals - deserve a dash of skepticism on the part of the reader.
Today a cautionary note from Johns Hopkins Medicine on RCTs. From the press release below, here is the `money quote’, but follow the link to read the whole thing (emphasis mine).
Overall, 41 percent of the 146 trials in the review had improper or poorly described randomization techniques. Industry-funded trials were six times more likely to have high risk for biased randomization than government-funded trials or those funded by nonprofit organizations.
First, this press release from Johns Hopkins (hat tip @Lizsherer) on potentially flawed RCT pediatric studies, followed by a few words on my part.
Pediatric Clinical Studies Appear Prone to Bias
Released: 7/9/2010 8:00 AM EDT
Embargo expired: 7/12/2010 12:05 AM EDT
Source: Johns Hopkins Medicine-Better design, reporting urged to ensure accurate results
Newswise — A Johns Hopkins review of nearly 150 randomized controlled trials on children — all published in well-regarded medical journals — reveals that 40 to 60 percent of the studies either failed to take steps to minimize risk for bias or to at least properly describe those measures.
A report of the team’s findings in the August issue of Pediatrics shows that experimental trials sponsored by pharmaceutical or medical-device makers, along with studies that are not registered in a public-access database, had higher risk for bias. So were trials that evaluate the effects of behavioral therapies rather than medication, the report states.
“There are thousands of pediatric trials going on in the world right now and given the risk that comes from distorted findings, we must ensure vigilance in how these studies are designed, conducted and judged,” says lead investigator Michael Crocetti, M.D., M.P.H., a pediatrician at Johns Hopkins Children’s Center. “Our review is intended as a step in that direction.”
Considered the gold standard of medical research, the hallmark of double-blind randomized controlled trials (RTC) is a design that rules out or accounts for actual or potential bias. Results of such studies, when peer-reviewed and published in reputable medical journals, can influence the practice of medicine and patient care. A poorly designed or executed trial can therefore lead researchers to erroneous conclusions about the effectiveness of a drug or a procedure.
Citing the degree of bias risk in the studies they reviewed, the researchers caution pediatricians to be critical readers of studies, even in highly respected journals.
First and foremost, science is messy, and scientists are far from infallible.
Which is why I am always a little bit skeptical when I read the conclusions of the latest whiz-bang scientific study or a press release announcing an exciting new advance in medicine.
Not because I harbor conspiratorial beliefs, or a deep suspicion of the motives of scientists . . . but because I view scientific discovery as a journey. . . a learning process . . . not a destination.
Advances in science are anything but linear, and very often we find ourselves sidetracked or detoured down some flawed alley of investigation along the way.
What we know, or what we think we know, is constantly changing. This is particularly true in medicine.
When I was a young paramedic, 35 years ago (back when dinosaurs roamed the earth), every doctor knew that the very first thing you did for someone in cardiac arrest (after initiating CPR) was to give them a bolus of 1 or 2 amps of Sodium Bicarb to reverse the inevitable acidosis brought on by respiratory arrest.
You did this even before attempting to defibrillate, since conventional wisdom said that you couldn't cardiovert an acidotic heart.
And so 2 amps of bicarb went in as a matter of course. Because everyone knew that was the right thing to do.
Trouble is, even with our cardiac meds and defibrillators and advanced training, we were losing a lot of patients. By the mid-1980's it became apparent that the bolus of bicarb wasn't helping, and in fact, was probably hurting patients.
By 1986 several scientific studies had demonstrated that rapid provision of effective ventilation and artificial circulation were entirely adequate means of managing the small amount of respiratory- (or metabolic-) acidosis that accompanied common cardiac arrests.
Administration of even 1 amp of Bicarb was linked to poorer outcomes, and so the automatic administration of it was removed from the ACLS protocols in 1986.
How could we have gotten it so wrong?
(Note: Use of Bicarb (NaHCO3), while controversial, may still be considered in some cases of prolonged cardiac arrest, particularly in cases of asystole).
What seemed like a perfectly good idea in 1975 had become obsolete (indeed, regarded even as dangerous) by 1986. Studies were conducted, and while initial survival rates increased with bicarb administration, long-term survival rates were lower.
A result not unlike that which was found a few years ago with the use of high-dose steroid treatment for SARS. It increased short-term survival, but long-term it turned out to be detrimental.
No doubt, some of what we believe to be true or prudent today may be disproved or abandoned five or ten years from now.
Absolutes in science are hard to find. And the process of determining scientific `fact’ can be both arduous and prolonged.
While I try to highlight only reputable studies, I offer the admonition of Caveat Lector for anything you read here (or anyplace else for that matter).
