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DJP Update 7-2-2007: a salute to Public Health;
National Geographic cover story on malaria July 2007 issue
As we all know, our new AMA president, Dr. Ron Davis, is a public health
physician at Henry Ford Medical Center. I therefore will dedicate this DJP
Update to Dr. Davis all of those physicians, nurses, researchers, other
professionals, and philanthropists who labor daily and donate time and money
to fighting deadly scourges that affect the Inhabitants of our planet.
As a student at Tulane Medical School, my classmates and I were fortunate in
getting a strong background in public health and tropical medicine. In 1834
Tulane Medical School began as the Medical College of Louisiana and in 1912
the Tulane School of Hygiene and Tropical Medicine was established; the
first such institution in the U.S. The website is:
http://www.sph.tulane.edu/
I now have the privilege to see the dedicated folks in the School of Public
Health and Tropical Medicine in my role on the Tulane Board of Health
Sciences Center and see the Dean of the School of Public Health & Tropical
Medicine, Pierre Buekens, MD, PhD, at each meeting. Also, as Adjuvant
Professor in Health Systems Management in the same school, I get to work
with the chair of that department, Dr. Claudia Campbell. It was fun to be
able to connect Dr. Campbell up with Dr. Jim James and Dr. Mike Maves at AMA
and the result of the discussion lead to a joint venture for the article
"Characteristics of Physician Relocation Following Hurricane Katrina" in the
first issue of AMA's new journal, Disaster Medicine and Public Health
Preparedness.
http://www.dmphp.org/cgi/content/short/1/1/21
One more item about research. Check out the Tulane National
Primate Research Center under the leadership of Andrew A. Lackner, DVM,
PhD at:
http://www.tnprc.tulane.edu/index.shtml As the website points out, the
Tulane University Regional Biosafety Laboratory being built at The Tulane
National Primate Research Center is a biosafety level three (BSL-3)
facility. Research conducted in the facility will focus on the development
of treatments, vaccines and diagnostics for emerging infectious diseases
that occur naturally, such as Severe Acute Respiratory Syndrome (SARS)
and against biological agents that have the potential for misuse
for terrorism. The overall goal of research associated with this facility is
to protect the health and safety of our community and the nation.
Finally, for this update, I wish to bring to your attention an outstanding
article in the July issue of National Geographic. The
cover story is Malaria. It is a dramatic article with powerful photographs.
Selected excerpts from the article are below. I recommend you get the July
issue and read this article. Alternative is to go online to the National
Geographic website and look for the July issue. Note the depth of field in
the electron microscopy image of the mosquito. A deadly invader!
http://www7.nationalgeographic.com/ngm/0707/feature1/ National
Georgraphic July 2007 Cover Story Malaria
Malaria
It begins with a bite, a painless bite. The mosquito comes in the night,
alights on an exposed patch of flesh, and assumes the hunched, head-lowered
posture of a sprinter in the starting blocks. Then she plunges her stiletto
mouthparts into the skin.
The mosquito has long, filament-thin legs and dappled wings; she's of the
genus Anopheles, the only insect capable of harboring the human malaria
parasite. And she's definitely a she: Male mosquitoes have no interest in
blood, while females depend on protein-rich hemoglobin to nourish their
eggs. A mosquito's proboscis appears spike-solid, but it's actually a sheath
of separate tools—cutting blades and a feeding tube powered by two tiny
pumps. She drills through the epidermis, then through a thin layer of fat,
then into the network of blood-filled micro-capillaries. She starts to
drink.
To inhibit the blood from coagulating, the mosquito oils the bite area with
a spray of saliva. This is when it happens. Carried in the mosquito's
salivary glands—and entering the body with the lubricating squirt—are
minute, wormlike creatures. These are the one-celled malaria parasites,
known as plasmodia. Fifty thousand of them could swim in a pool the size of
the period at the end of this sentence. Typically, a couple of dozen slip
into the bloodstream. But it takes just one. A single plasmodium is enough
to kill a person.
The parasites remain in the bloodstream for only a few minutes. They ride
the flume of the circulatory system to the liver. There they stop. Each
plasmodium burrows into a different liver cell. Almost certainly, the person
who has been bitten hardly stirs from sleep. And for the next week or two,
there's no overt sign that something in the body has just gone horribly
wrong.
....
....malaria now affects more people than ever before. It's endemic to 106
nations, threatening half the world's population. In recent years, the
parasite has grown so entrenched and has developed resistance to so many
drugs that the most potent strains can scarcely be controlled. This year
malaria will strike up to a half billion people. At least a million will
die, most of them under age five, the vast majority living in Africa. That's
more than twice the annual toll a generation ago.
-------
Only in the past few years has malaria captured the full attention of aid
agencies and donors. The World Health Organization has made malaria
reduction a chief priority. Bill Gates, who has called malaria "the worst
thing on the planet," has donated hundreds of millions of dollars to the
effort through the Bill and Melinda Gates Foundation. The Bush
Administration has pledged 1.2 billion dollars. Funds devoted to malaria
have doubled since 2003. The idea is to disable the disease by combining
virtually every known malaria-fighting technique, from the ancient (Chinese
herbal medicines) to the old (bed nets) to the ultramodern (multidrug
cocktails). At the same time, malaria researchers are pursuing a
long-sought, elusive goal: a vaccine that would curb the disease for good.
Malaria is a confounding disease—often, it seems, contradictory to logic.
Curing almost all malaria cases can be worse than curing none. Destroying
fragile wetlands, in the world of malaria, is a noble act. Rachel Carson,
the environmental icon, is a villain; her three-letter devil, DDT, is a
savior. Carrying a gene for an excruciating and often fatal blood disorder,
sickle-cell anemia, is a blessing, for it confers partial resistance to
falciparum. Leading researchers at a hundred medical centers are working on
antimalarial medicines, but a medicinal plant described 1,700 years ago may
be the best remedy available. "In its ability to adapt and survive," says
Robert Gwadz, who has studied malaria at the National Institutes of Health,
near Washington, D.C., for almost 35 years, "the malaria parasite is
a genius. It's smarter than we are."
........
It's easy to list every vaccine that can prevent a parasitic disease in
humans. There is none. Vaccines exist for bacteria and viruses, but these
are comparatively simple organisms. The polio virus, for example, consists
of exactly 11 genes. Plasmodium falciparum has more than 5,000. It's this
complexity, combined with the malaria parasite's constant motion—dodging
like a fugitive from the mosquito to the human bloodstream to the liver to
the red blood cells—that makes a vaccine fiendishly difficult to design.
-----
Stephen Hoffman is the founder and CEO of the only company in the world
dedicated solely to finding a malaria vaccine. The company's name is Sanaria—that
is, "healthy air," the opposite of malaria. Hoffman is 58, lean and
green-eyed, with a demeanor of single-minded intensity. "He's impassioned
and impatient and intolerant of negativity," is how one colleague describes
him.
Hoffman is intimately familiar with the pitfalls of the vaccine hunt.
During his 14-year tenure as director of the malaria program at the Naval
Medical Research Center, he was part of the team working on the vaccine
promised in the 1984 New York Times article. He was so confident in the
vaccine that he tested it on himself. He exposed himself to infected
mosquitoes, then flew to a medical conference in California to deliver what
he thought would be a triumphant presentation. The morning after he landed,
he was already shaking and feverish—and, soon enough, suffering from
full-blown malaria.
Now, more than two decades later, Hoffman is ready to return to prominence.
He couldn't have found a more uninspiring launchpad: Sanaria is
headquartered in a dismal mini-mall in suburban Maryland, near a
picture-framing shop and a discount office-supply store. From outside,
there's no mention of the company's mission. A window badly in need of
washing bears the company name in tiny adhesive letters. Hoffman realizes
it's probably best if the office-supply customers aren't fully aware of
what's going on a few doors away.
Inside, generating a hubbub of activity, are some 30 scientists from across
the globe. The lab's centerpiece is a room where Hoffman raises mosquitoes
infected with the falciparum parasite—yes, in a quiet mini-mall. Hoffman
claims it's the world's most secure insectary. To enter, a visitor must pass
through multiple antechambers that are sealed between sets of doors, like a
lock system in a canal. Everyone has to wear white cotton overlayers, masks,
shoe covers, and gloves. White makes it easier to see a stray mosquito. The
air is recirculated, and the insectary is checked daily for leaks. Signs
abound: "WARNING! WARNING! INFECTIOUS AGENT IN USE." And hanging on a wall
is a time-honored last line of defense: a flyswatter.
---------
When it comes to malaria, only one thing is guaranteed: Every evening in the
rainy season across much of the world, Anopheles mosquitoes will take wing,
alert to the odors and warmth of living bodies. A female Anopheles needs to
drink blood every three days. In a single feeding, which lasts as long as
ten minutes, she can ingest about two and a half times her pre-meal
weight—in human terms, the equivalent of downing a bathtub-size milk shake.
If she happens to feed on a person infected with malaria, parasites will
accompany the blood. Two weeks later, when the mosquito flies through the
open window of a mud hut, seeking her next meal, she'll be loaded.
Inside the hut, a child is sleeping with her sister and parents on a blanket
spread over the floor. The family is aware of the malaria threat; they know
of the rainy season's dangers. They've hung a bed net from the ceiling. But
it's a steamy night, and the child has tossed and turned a few times before
dropping back to sleep. Her foot is sticking out of the net. The mosquito
senses it, and dips down for a silent landing.
------
End of excerpts.
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Stay well,
Donald
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Donald J. Palmisano, MD, JD
Intrepid Resources / The Medical Risk Manager Company
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