Scrabble and the UIC

January 23, 2007 at 1:28 pm (Sam's Posts)

I always wondered what the word “Qat” meant, because I had used it so many times in Scrabble games to get rid of the ‘Q’ when I didn’t have a ‘U’. As it turns out, there’s a fascinating story behind it.

Qat, or khat, is a plant with leaves that, when chewed, release cathinone, a ketone amphetamine that is classified as a Schedule I drug in the U.S (read: illegal), along with heroin, cannabis, and MDMA, among others. However, the plant loses its potency steadily after it is harvested, to the point where it becomes a Schedule IV drug (read: legal) in the U.S. after 48 hours.

Here’s where it gets interesting: There are no regulations on qat in the Horn of Africa and the Arabian Peninsula. The plant, which, I read, was originally cultivated in Ethiopia, was brought to Yemen seven centuries ago, and is now the primary contributor to Yemen’s GDP. In the past few decades, qat consumption has so pervaded society that at least one survey estimates consistent qat usage at 90% of the male population in Yemen. Again, there are no regulations on qat there, so qat farmers take advantage of recent infrastructural improvements to ship the leaves to urban Yemen, as well as to Somalia, Kenya, and Ethiopia, as fast as possible in order to maximize its potency (this means that most qat is picked in the morning, and used in the afternoon). Apparently every home in Yemen has a well-kept room devoted solely to qat sessions, which happen more or less every day after lunch. People seem to say that it gives clarity and promotes healthy dialogue, often leading to its use in business deals. But many others argue that qat is shortening the work day and drastically decreasing productivity. Many also suspect that qat is harmful to one’s health. Attempts to regulate qat in Yemen have met substantial resistance in the past; the people, and the economy, rely upon it.

Here’s what the Regional Office of the Eastern Mediterranean for WHO says, regarding Yemeni health:

“In recent years the lifestyle of Yemenis has radically changed with fast food, a sedentary lifestyle, the tension of modern city life, smoking, obesity, and  lack of physical activity. Ischaemic heart disease and hypertension have become another health problem in Yemen. Almost all male Yemenis chew khat, and khat chewing among women and school-age children has increased markedly. It is well known that khat raises blood pressure and heart rate. Cathinone, the active ingredient in khat leaves, produces severe coronary vasospasm in animal models. Khat also increases the desire to smoke, produces more nervous tension, increases sympathetic activity, and encourages a sedentary life.”

(Report on the WHO STEPwise surveillance system (for Egypt, Sudan, and the Republic of Yemen))

The qat-chewing phenomenon is fascinating in itself to me. But one more thing to consider – qat is also harvested and used in Somalia. At the very end of some news articles (Western media outlets, of course)covering Somali current events, hidden amidst AL-QAEDA! and REPRESSION!, is the fact that the Union of Islamic Courts (UIC) has, among its many stabilizing actions, banned qat from Somalia. Of course, I don’t mean to ignore whatever violations of individual rights that the UIC may have committed, and I think it’s very important to consider the qat farmers whose livelihoods were made illegal – but I am again reminded that something so vital to national, and international, stability as governmental health policy can be completely ignored in the media when it comes to the war on terror.


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More polychlorinated biphenyls, please

December 5, 2006 at 2:41 pm (Sam's Posts)

I just read this article about mercury consumption in my foster home state, Pennsylvania. Now, I should be wary of the fact that this came from an insert in UPenn’s daily newspaper, entitled ‘The Green Times’. Nonetheless, it was somewhat illuminating.

Pennsylvania is the 2nd highest mercury emitter in the nation, and 80% of mercury is produced from 36 coal plants within its borders.

Allegedly, once you ingest mercury, you’re done. It’s not leaving your body, ever. Also, it’s a neurotoxin, especially dangerous to pregnancies due to its ease of traversing the placenta and entering the fetal brain.

There are several things being done to protect the people. One is, state advisories against more than a half a pound of Pennsylvania-caught sport fish per week. Another is, national advisories against certain’danger’ fish like swordfish and king mackerel. These messages might help a little, if they were brought to the public’s attention. Up to now, though, I’ve never heard anything about these advisories. I’ll bet nobody has.

Then, of course, there is the whole emissions trading deal. Mercury is no longer classified as a toxic pollutant (a federal decision), which means companies that produce a lot of it can buy emissions credits from cleaner companies instead of forking over the capital to restructure and reduce their own emissions. So the hazard of mercury exposure is totally out of equilibrium. Areas with more coal plants, or more generally, older technology, get hosed, while new money reaps all the benefits of the emissions credit trade. I’ve read plenty of times about claims that emissions trading is only marginally effective, but this is the first time I’ve been told that its effect isn’t just marginal, but highly uneven.

Good for the governor, Ed Rendell, that he is pushing for more rigid restrictions and a quicker plan for emissions reduction. Among other things, he’s trying to block Pennsylvania plants from trading in other states. Apparently states have a good measure of power to build on (or move or away from) existing federal policy. And this is where the change is going to have to come.

So to sum this rambling up, two things: Food health advisories could use a better accessing strategy; and the state legislature has a significant role to play in environmental health.

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The science of resistance

November 10, 2006 at 5:07 pm (Links, Sam's Posts)

Here is another informative perspective from the New England Journal of Medicine:

Malaria – Time to Act

It was published just a couple days ago, and it covers the viability of a possible reentry into malaria treatment protocol for chloroquinone. With only a small amount of knowledge about drug resistance in infectious disease treatment, I was previously under the impression that once a drug lost its utility, it was gone for good, and would never be helpful again. Not so.

In particular, I find it amazing that ‘chloroquine resistance presumably confers a fitness disadvantage, and stable compensatory mutations sufficient to counter these disadvantage apparently have not occurred.’ I often look at infectious disease treatment as a bacterial seige on humans, patiently mutating, waiting outside the walls until we run out of drug innovations and become defenseless. The fact that some of these stronger, mutated agents are weak enough in other ways to want to revert back to their original form once their original scourge is gone – this confers some hope. We still need long-term, all-encompassing solutions, but in the meantime, you, drug, circle around back and hop in the end of the line – your turn will come again.


p.s. I see that the clinical trial asserting the rebound of chloroquine efficacy is also in the current issue of NEJM. In case you want to read that:

Return of Chloroquine Antimalarial Efficacy in Malawi

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Regarding Gender Mortality in India

October 27, 2006 at 2:24 pm (Links, Sam's Posts)

I realize I often resort to asking about/talking about interesting articles instead of posting solely based on physical experience or mental pondering.

Nonetheless. I decided today that I should take advantage of my automatic access to just about any journal I want.

Excess Female Mortality in India

Now, this article is from 2000, so the numbers have definitely changed. But the problem is still the same.

In particular I wonder whether or not the state of decline in female:male ratios that existed in 90s still exists. Do males still (allegedly) benefit more from nutritional and health advancement? I wish the author didn’t glaze over the reasons for uneven populations of men and women – “While the reasons for India’s anomalous sex ratio are fairly well established…” – but the examination of Himachal Pradesh seems like it might have a lot of potential. And it’s inspiring that something as concrete as literacy rates could explain an increase in female:male ratios; to me the improvement literacy rates seems a lot more doable, while also not being something that I would have thought of on my own.  I’ll have to look for publications involving further research into Himachal Pradesh.


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cheesesteaks and chili fries

October 11, 2006 at 4:47 pm (Links, Sam's Posts)

I don’t how my current city of residence, Philadelphia, would ever be able to mimic what might happen in New York City and Chicago, among other places.

New York City Plans Limits on Restaurants’ Use of Trans Fats

Seems pretty cool that the New York Board of Health can go ahead with legislation like this without much bureaucracy or red tape to bust through. I don’t want to speak too soon, of course.

 I’m pretty sure you can register on for free, so don’t complain that you need to log in to view this article. I feel like I’m breaking copyright laws when I copy and paste articles into word and post them on the web.

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Musing About Blood

October 4, 2006 at 4:58 pm (Sam's Posts)

Not too much to report here. I tried to give blood last week at the Hospital, and ended up waiting 45 minutes for a verdict on my eligibility. Denied. I have a genetic prothrombin mutation, and protein c deficiency. Both contribute to an increased likelihood of blood clotting. But neither has been explained to me as limiting in any other way other than a recommendation to stretch after long periods of inactivity. I had the head of the blood drive on the phone with the official Red Cross doctor in the vicinity for a half hour. Protein C is listed in the Red Cross database but is not an issue unless medication (e.g. coumadin) is being taken. The prothrombin thing is not in the database at all, even though 1-2% of the general population is heterozygous for the mutation. I got tested a few years ago for it only because my uncle had a blood clot and subsequently found out he had it. So there are probably a lot of people out there who have this mutation but don’t know it. I don’t think the condition is supposed to bar me from giving blood for life, so I am going to call my doctor. Either the authorities were wrong, or Red Cross should pay more attention to this condition. At least put it in the database.

Incidentally, I am reading Blood: An Epic History of Medicine and Commerce. I just finished a long section on blood and World War II. It was absolutely epic. Nothing like a war to encourage fast-paced advancement of medical technology. Predictably, there’s been a lot of talk about America, England, and France (as well as other developed countries) but not a lot about developing nations. I wonder what the blood donation systems of other countries are like, and in particular how countries interact with each other regarding blood. I think some of this is going to be clarified later in this book I’m reading though.

There’s not a shortage of blood within the U.S. anymore, is there? Is the surplus shipped out of the country? How much of a push is there to get blood/equipment to areas that don’t have access to these things, or haven’t prioritized them highly? I wonder. 

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September 26, 2006 at 4:59 pm (Sam's Posts)

The majority of the information gathering in my head the past couple weeks has been directly related to my research project. I am reading a cool book entitled Blood: An Epic History of Medicine and Commerce, but for now I am going to talk about what I am doing in the lab. I know that the theory behind the project is not front end global health, but as Sarah thankfully reminds me, there is lab research behind every product that goes out into the world to improve lives, and that makes me feel useful.

I have repeated the gist of my work multiple times to friends and family since I’ve started, and I’m getting better and better at it. I think my explanation can now be called ‘functional’, although there is still much room for improvement. The big picture is this: DNA tells the cell which proteins to build. The proteins do the cell’s (and thus the body’s) work. If your body’s not working correctly, there probably is something wrong with the DNA in addition to the proteins. So scientists think many diseases announce themselves through changes in DNA sequences. If we can fully identify the DNA content in a given sample, then we can compare DNA in diseased cells and normal cells and figure out which DNA sequences are responsible for the disease.

So the challenge lies in knowing the exact DNA content of a sample. We figure out what’s in a sample by mixing it with a probe that is complementary to only one specific DNA sequence. Only DNA that has a code complementary to the probe will bind to that probe. If we label the sample DNA beforehand, either with magnetic beads, or radioactive particles, or with molecules that can fluoresce, then we can measure magnetic field, radioactivity, or light emission, respectively, in order to know how much of a certain DNA sequence is in the sample.

I don’t do any of that.

What I do is figure out how we can raise the detection limit of the DNA analysis. The more fluorescent molecules you can bind to a piece of DNA, the brighter the light will be and the easier it will be to detect. This is where nanotubes come in; we think we can load a whole boatload of light-emitting molecules onto a nanotube and use it as a label. Then even if only a couple copies of a certain DNA sequence are present, we might still be able to detect it. And that gets us closer to knowing exactly what’s in the DNA and thus what’s causing the disease.

So it’s pretty far removed from widescale disease prevention. But it’s something. I’m thinking about the eventual arrival of a cheap and straightforward mechanism for rapid, full analysis of ones DNA. You know, one that can be done every year for every patient, just take a sample, toss it into a DNA purifier, throw it onto a chip with thousands of probes, and then slide it into a luminometer to measure the light and figure out what’s there and how much of it there is. I think some people are calling it a “lab-on-a-chip”. That would be pretty amazing.

I wonder what infectious disease research is like. Ideally I’d feel closer to the need, and to the actual advent of a technology. i guess I’ll take what I got right now though. It’s a good start.

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Teach me, o masterful ones

September 19, 2006 at 5:57 pm (A Mission Statement (or two), Sam's Posts)

I don’t know why I decided to co-found a blog about global health when I didn’t know the first thing about it. I know some science; does that help? Thank you, Ben Feigenberg, for suggesting I come along to that fateful gathering that co-founder Soule hosted in May of 2006.

I am a Brown University graduate with a degree in biomedical engineering. I like the tissue engineering research I did last year. I like the nanotechnology research I am doing this year. But I’m not convinced that this is how I really want to improve the world. I think there might be more pressing health issues than the ones I am exploring in the laboratory. Maybe I should join the Peace Corps; maybe I should go to medical school; these are things I think about a lot. To help me figure out if these things are the answers, or if there are other better answers, I am going to talk. Read, and talk.

What I’m realizing as I do this reading, and this talking, is that there are so many areas of health out there that beg for contribution – each time I read about another one, I think, maybe this is my cause. And maybe I’m a little overexcited; maybe I haven’t found my cause yet; but if I haven’t, and if you haven’t, then maybe we can all help each other find our causes.

Right. So maybe we should talk. About health. In the world. I think it would be good for me. And probably you.


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En Garde, Bez.

September 15, 2006 at 8:23 pm (Links, Sam's Posts)

AJHP Foray into Diabetes


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Bedtime Reading

September 12, 2006 at 8:50 pm (Sam's Posts)

A few weeks ago I met with the chair of a certain respected university’s public health department, and among other things, I asked him if he had any book suggestions for someone interested in reading about public health. He said he’d work on that. Fast forward to today. and I have received what he calls work-in-progress public health reading list. When he and his colleagues finish it, I’m sure it will quickly vault itself into the upper echelons of all reading lists. But for now, you’ll have to settle for what he sent me, which is attached to this post here:

Public Health Reading List

 I’ve only read half of just one book (Guns, Germs, and Steel) on the list, but the rest of them sound pretty cool for the most part. Interesting, Mountains Beyond Mountains, which I just finished two days ago, does not seem to have made the initial cut. Of course, I loved it because it appealed to my save-the-world complex, but Tracy Kidder (the author) implied a number of times that global health experts across the world aren’t exactly leaping for joy at the kind of example that Paul Farmer is setting. Regardless, the book rules and you should read it.


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