Monday, December 15, 2008

Cocaine and other Drug Products of the Past

Cocaine toothache drops (c. 1885) were popular for children.
Not only would the medicine numb the pain, but it could also put the user in a “better” mood.
Bayer heroin bottle. From 1898 to 1910 heroin was marketed as a non-addictive morphine substitute and cough medicine for children!
Metcalf’s Coca Wine was one of a large number of cocaine-containing wines available on the market.
All claimed medicinal effects, although they were undoubtedly consumed for their “recreational” value as well.
Vin Mariani (c. 1865) was the leading Coca Wine of its time.
Pope Leo XIII purportedly carried a hipflask of Vin Mariani with him, and awarded a Vatican gold medal to its creator, Angelo Mariani.
Coca wine was made by the Maltine Manufacturing Company (New York). The dosage indicated on the back of the bottle reads: “A wine glass full with, or immediately after, meals. Children in proportion.”
Cocaine-containing throat lozenges (c. 1900) were “indispensable for singers, teachers, and orators.” In addition to quieting a sore throat, these lozenges undoubtedly provided the “pick-me-up” to keep these professionals performing at their peak.
Paperweight advertisement for C.F. Boehringer & Soehne (Mannheim, Germany), “largest makers in the world of quinine and cocaine.” This chemical manufacturer was proud of its leading position in the world’s cocaine market.
This bottle of Stickney and Poor’s paregoric (mixture of opium and alcohol) was distributed much like the spices for which the company is better known. Doses for infants, children, and adults are given on the bottle. At 46% alcohol, this product is 92 proof which is pretty potent in itself.
This ad is for Glyco-Heroin manufactured by Martin H. Smith Company (New York). Heroin was widely used not only as an analgesic but also as a remedy for asthma, coughs, and pneumonia. Mixing heroin with glycerin (and often adding sugar or spices) made the bitter-tasting opiate more palatable for oral consumption.
This National Vaporizer Vapor-OL (opium) Treatment no. 6 for asthma may have provided a unique method of essentially “smoking” opium. The volatile liquid was placed in a pan that was heated by a small kerosene lamp (see below). Other substances were also used in these early (c. 1890) vaporizers, but this mixture probably ensured plenty of visitors for the spasmodically affected.

Wednesday, November 19, 2008

US teen lives 118 days without heart

By Jim Loney

MIAMI, Nov 19 (Reuters) - An American teen-ager survived for nearly four months without a heart, kept alive by a custom-built artificial blood-pumping device, until she was able to have a heart transplant, doctors in Miami said on Wednesday.

The doctors said they knew of another case in which an adult had been kept alive in Germany for nine months without a heart but said they believed this was the first time a child had survived in this manner for so long.

The patient, D'Zhana Simmons of South Carolina, said the experience of living for so long with a machine pumping her blood was "scary."

"You never knew when it would malfunction," she said, her voice barely above a whisper, at a news conference at the University of Miami/Jackson Memorial Medical Center.

"It was like I was a fake person, like I didn't really exist. I was just here," she said of living without a heart.

Simmons, 14, suffered from dilated cardiomyopathy, a condition in which the patient's heart becomes weakened and enlarged and does not pump blood efficiently.

She had a heart transplant on July 2 at Miami's Holtz Children's Hospital but the new heart failed to function properly and was quickly removed.

Two heart pumps made by Thoratec Corp (THOR.O: Quote, Profile, Research, Stock Buzz) of Pleasanton, California, were implanted to keep her blood flowing while she fought a host of ailments and recovered her strength. Doctors implanted another heart on Oct. 29.

"She essentially lived for 118 days without a heart, with her circulation supported only by the two blood pumps," said Dr. Marco Ricci, the hospital's director of pediatric cardiac surgery. During that time, Simmons was mobile but remained hospitalized.

When an artificial heart is used to sustain a patient, the patient's own heart is usually left in the body, doctors said.

In some cases, adult patients have been kept alive that way for more than a year, they said.

"This, we believe, is the first pediatric patient who has received such a device in this configuration without the heart, and possibly one of the youngest that has ... been bridged to transplantation without her native heart," Ricci said.

Simmons also suffered renal failure and had a kidney transplant the day after the second heart transplant.

Ricci said her prognosis was good. But doctors said there is a 50 percent chance that a heart transplant patient will need a new heart 12 or 13 years after the first surgery. (Editing by Cynthia Osterman)

Claudia Castillo gets windpipe tailor-made from her own stem cells

A woman has been given a new section of windpipe created from her own stem cells in an operation that could revolutionise surgery.

Claudia Castillo, 30, who lives in Barcelona, has become the first person to be given a whole organ tailor-made for her in laboratories across Europe.

A graft from a donor was used, but because it has been imbued with Ms Castillo’s own cells, there is no sign that her body will reject the organ. Researchers and surgeons from Britain, Italy and Spain collaborated to grow tissue from Ms Castillo’s own bone marrow stem cells, using them to fashion the new bronchus – a branch of the windpipe. They believe that one day the approach will be used to create engineered replacements for other damaged organs, such as the bowel or bladder. In five years they hope to begin clinical trials in which laboratory-made voice boxes are implanted into patients with cancer of the larynx.

Martin Birchall, of the University of Bristol, a British member of the team, said: “This is the first time a tissue-engineered whole organ has been transplanted into a patient. I reckon in 20 years’ time it will be the commonest operation – it will transform the way we think about surgery.”

Ms Castillo, who was born in Colombia, had suffered a tuberculosis infection that ravaged her airways, leaving her unable to do simple domestic tasks. Disease had caused her windpipe, or trachea, to collapse just at the point where it entered her lung. Without the pioneering operation in June, the lung would have been removed. Today she again has a normal life and is able to look after her two children. She can walk up stairs without getting breathless and has even been dancing.

The prospect of the patient needing powerful drugs to avoid rejection had been thought to outweigh any potential benefits of trachea transplants. Four months on, Ms Castillo’s doctors have seen no sign of her immune system rejecting the transplant, even though she has had no immunosuppres-sive drugs.

Details of the transplant, performed by Paolo Macchiarini, at the Hospital Clinic of Barcelona, are published online today by The Lancet.

First a section of trachea was taken from a donor and stripped of cells that could cause an immune reaction, leaving a grey trunk of connective tissue. Stem cells were then taken from Ms Castillo’s bone marrow and grown in Professor Birchall’s laboratory. Stem cells can develop into different kinds of tissue, given the right chemical instructions, enabling researchers to cultivate cartilage and epithelial cells to cover the 7cm graft. It was then “seeded” with the new cells using a process developed in Milan. Finally the trachea, covered in cartilage and lined with epithelial cells, was cut to shape and fitted.

Professor Macchiarini said: “The probability that this lady will have rejection is almost zero. She is enjoying a normal life, which for us clinicians is the most beautiful gift.”

The researchers said that the surgery could help some patients in Britain but admitted that the procedure was too expensive to be widely available. They are seeking EU funding and commercial sponsors for trials to create and transplant a larynx, an operation that could be more cost-effective.

Ms Castillo said: “I was scared at the beginning because I was the first patient – but trusted the doctors. I am now enjoying life and am very happy that my illness has been cured.”

Friday, October 3, 2008

In Some Cultures, Cancer Stirs Shame

In Some Cultures, Cancer Stirs Shame

When Mildred Wong received a diagnosis of breast cancer last year, she faced two tough decisions: what treatment to pursue and whom, if anyone, to tell about it.
Secret Treatment

Brooklyn's Maimonides Cancer Center takes pains to break through barriers to care among ethnic and minority groups.

In Mrs. Wong's native China, people often keep illnesses like cancer a secret. That tradition continues even here in America, where her family settled in the 1950s. Years ago, Mrs. Wong's infant daughter developed a brain tumor and her own mother insisted she tell no one. When the baby died, the grandmother tried to dissuade Mrs. Wong from attending the funeral, so great was the stigma.

Now, as she stares down her own health crisis, memories of her family's long-buried wounds are rushing in. "I came from a cultural background of stoic acceptance, saving face, keeping quiet," she explains.

Mrs. Wong, 60 years old, sought treatment at Maimonides Cancer Center, located on the edge of Brooklyn's booming Chinatown. Its patients are an ethnic tapestry of Chinese-Americans, Hasidic Jews from nearby Borough Park, Russians from Coney Island, Pakistani Muslims, as well as some Caribbean and African-Americans. Though starkly diverse, these groups often share strong beliefs about keeping a cancer diagnosis -- and possible treatments -- under wraps. The subject is such a cultural taboo that families have been known to shield loved ones from the seriousness of their condition. Some patients are reluctant to seek or heed medical advice; others even refuse to utter the word "cancer."

With ethnic minorities and immigrants fast becoming the collective U.S. majority, there is a push in medical circles to be more sensitive to cultural nuances. In 2001, the National Cancer Institute established the Center to Reduce Cancer Health Disparities to study why mortality rates for cancer can be so much higher for some groups than others. Only 71% of African-American women, for instance, survive for five years after a cancer diagnosis, compared to 86% of white women. Issues such as poverty, lack of access to care and inadequate care, are among probable reasons for the gap. But cultural factors, says the NCI center's director, Dr. Tanya Springfield, are now being recognized as a "significant" part of the problem.

Maimonides is among several hospitals nationwide attempting to hit these issues head on. In addition to dispensing medical advice to individuals, doctors routinely confer with family members, rabbis and other religious leaders as part of some patients' care. The facility has several Asian oncologists on staff who speak Chinese dialects fluently. As a nod to discretion, the center is located about a mile from the main hospital and lacks any overt signage referring to its true mission of cancer treatment. A back entrance and a special waiting room with frosted glass help visitors go undetected.
Balancing Act

Staff at the four-year-old facility balance a complicated set of cultural mores and medical responsibilities. The range of attitudes "makes our job very difficult," says Dr. Yiqing Xu, a Chinese-born oncologist.

U.S. law dictates that patients be informed about their conditions and consent to all medical treatments. Those who submit to chemotherapy or other therapies are required to sign forms that spell out the drugs they are receiving, as well as possible side effects. However, consent forms tend to be in English, as Dr. Xu points out. And many families -- especially Chinese, Russians and Muslims -- often want their loved ones to know as little as possible about their cancer.

Sze Cheng's 72-year-old grandmother, born in China, was recently found to have advanced colon cancer. But Ms. Cheng and her husband have been determined to play down the true nature of her situation -- despite advice from a Maimonides doctor.

"We try to do what is best for her," explains Ms. Cheng, who says she loves her grandmother very much. "We talked about telling her," adds her husband, Sheng Lam. "But if we tell her, she will be upset -- she will go into a depression."

Oncologist Yiwu Huang says he worked with the family to explain the consent form to his patient. He says he told the woman, who does not speak English, that she had a growth in her colon, and that the chemotherapy was a "medication to try to prevent the disease from coming back." Still, "I avoided the word 'cancer,'" he says. He beseeched the family to be more direct, he says, but to no avail. "They said, 'please don't tell her,'" the doctor recalls.

"It is not uncommon in Chinese families to hide the news," notes Dr. Xu. But while she and other doctors may defer to families, some bristle at doing so. "It is not good for the patient," says Dr. Xu. "They don't have a chance to have a say in their treatment. It should be what they want, not what their families want." She pauses, then adds: "I may be too Americanized in my views."

Alan Astrow, Maimonides's director of Hematology-Medical Oncology, says that good medical practice calls for full disclosures. "But in many traditional cultures, crucial decisions are made by the patients' family -- we treat people from all over the world. Is there a conflict? Yeah there is a conflict." While it is necessary for doctors to follow the law, he says, it is also important that clinicians be mindful of the feelings and values of both patient and family.

The center's doctors have learned to modulate their vocabulary. For example, "we don't use the term chemotherapy," says Dr. Xu. Instead, she will merely say "treatment." To get around the "C" word, she might use substitutes such as "lesion" or "mass."

Many patients welcome the edited approach. Malka Friedman, a devout Orthodox Jew, prefers to avoid all direct reference to the disease. "The word is like a sword -- this is the way we were brought up," says Mrs. Friedman. Merely to say "cancer," she believes, could somehow give malignant cells more power to spread.

Upon learning that she needed a mastectomy, Mrs. Friedman added an unofficial member to her medical team. During an appointment with her breast surgeon, she placed a call to her rabbi and had him speak to the doctor.

"It was one of my first experiences with a rabbi calling and saying 'We have been praying over this and we have gotten guidance and we don't want major surgery to be done,'" Dr. Patrick Borgen, her surgeon at Maimonides, recalls. (He agreed to perform a less-radical procedure.) Now, he says he has learned to expect that rabbis will weigh in on medical decisions.

A gentle yet strong-willed woman, Mrs. Friedman's faith dictated she cover her head with a wig even before chemotherapy. She refers to Dr. Borgen, chief of breast surgery, as "a messenger of God." Still, the 61-year-old doesn't always do what he asks.

Dr. Borgen encouraged his patient to take a test to determine if she is a carrier of a particular genetic mutation -- one way to predict if a woman might be at a high risk for developing other cancers. He further advised that her female relatives have the same test.

She refused. Instead, Mrs. Friedman says she told her daughters and other kin to go for regular medical check-ups.

Cancer is considered to be something of a social blemish in the tightly-knit Orthodox community. Merely being seen entering or leaving a cancer center might spark rumors that could have profound repercussions for a family. A young person who has suffered from the disease, for instance, is generally considered an undesirable marriage partner. Cancer in a parent or sibling also could affect one's marital prospects.

Across backgrounds, the forces of denial don't discriminate. Over the years, several hospitals have worked to try to persuade African-American women to get early screening for breast cancer -- only to find that some won't come back even when told they have a tumor.

In Atlanta, for example, the Georgia Cancer Center for Excellence reaches out to black women at churches and health fairs. Such targeted efforts have yielded results: Patients coming in with advanced, Stage Four cancers declined from 16.8% to 9% between 2001 and 2005. Even so, anywhere from 7% to 10% of women found to have cancer either fail to return or don't stay through the entire course of treatment, according to Dr. Mitchell Berger, Chief of Hematology and Oncology at the center, a division of Grady Health System.

"There are so many myths that can influence a person's tendency to seek care or refuse care -- there are many examples from Harlem to Appalachia to Native America," says Dr. Harold Freeman, founder of the Harlem-based Ralph Lauren Center for Cancer Care and Prevention. The center is a joint venture of Memorial Sloan-Kettering Cancer Center and North General, a local Harlem hospital.

"We need to be careful. It is very tough to separate race from poverty from culture, yet you need to do that," he says.
Culture Cues

Since arriving in Harlem in the 1960s, where he recalls seeing women with cancers so advanced as to be inoperable, Dr. Freeman has seen the need to address cultural points of difference.

One approach is to be mindful of patients' own myths and taboos -- then figure out ways to get them into treatment. At the Lauren center, for example, patients are assigned a "navigator" -- an employee charged with walking them through the different phases of their diagnosis and care. That can mean phoning people who don't show up for an appointment, or even knocking on their door at home if they go missing at any point during treatment.

Monica Williams, 70 years old, arrived at the Harlem center three years ago. Born in Grenada, Ms. Williams is a devout Catholic who says she had a premonition that she was ill. Years before her diagnosis, she recalls having a nightmare: "A voice said to me, 'You have cancer,' and I said, 'Get away from me, you devil.'" She remembered the dream when she learned she had colon cancer. She believed that God, not doctors, had the power to heal her.

Maud Colas, the patient navigator assigned to Ms. Williams, recalls painstaking sessions to get her to agree to treatment -- even while respecting her religious convictions. The feisty septuagenarian, herself a home health-care aide, at first wouldn't budge. Ms. Colas, who is also of Caribbean descent, appealed to Mrs. Williams to reconsider.

"I had barriers too, and I said, 'I also love God, but give our doctors a try,'" Ms. Colas recalls. She helped work out a solution: Mrs. Williams agreed to let the doctors perform surgery to remove her tumor -- while praying to God to guide them.

Ms. Williams, a proud woman who shows up to the center impeccably dressed -- she sported a pink gauze ensemble one recent afternoon -- has since endured numerous rounds of chemotherapy. All the while, she has continued her work. Yet still she harbors her secret, having told no one, not even immediate family, about her condition. When her hair started falling out as the result of chemo, she waved it off as a bad experience at the hairdresser. Asked if perhaps her husband and other relatives may have guessed the truth, she replies only: "Maybe."

Ms. Williams's cancer was fairly advanced when she was diagnosed. Then a lesion was found in her liver and she needed more surgery. As of now, says Dr. Freeman, there is no evidence of the disease. Ms. Williams says she has made her peace with human medical interventions. "I ask God to lift me up," she says.

As for Mrs. Wong, she came to a major decision this year: She would be more American than Chinese in dealing with her breast cancer. She couldn't forget how desperately alone she had felt when her baby was ill. "I didn't tell anyone, and no one came to visit," she says. In the months when the infant lay in a hospital, friends and relatives heard only that she suffered from a cold.
Difficult News

When she was first diagnosed with breast cancer, she sought a second opinion at Maimonides. The news was hard to bear. Given that the cancer had spread to a lymph node, Dr. Borgen, her surgeon, suggested treatment that would include a single mastectomy as well as chemotherapy.

Instead of keeping her fears about breast cancer bottled inside, she reached out to friends, both Chinese and American. She also leaned on members of her Baptist church where she and her husband are active. She has even attended a few meetings of a Chinese cancer support group. Without the burden of her mother's insistence on secrecy, Mrs. Wong says she was strangely liberated. "I felt totally different this time because of the love and support of my friends," she recalls. "They came over and cooked and shopped."

After surgery came a grueling round of chemotherapy. She still recalls the horror of seeing her hair fall out. She took an American step she had heard was "empowering." She shaved her head.

"You do feel better," afterwards, she says, adding that she went and bought a couple of wigs. She still wears one of them, even though her treatment is finished. "My prognosis is very good, and I am very grateful."

Firms Struggle With Varied Rules on Melamine

Firms Struggle With Varied Rules on Melamine
HONG KONG -- Differing and shifting government regulations have complicated food companies' efforts to grapple with the widening Chinese tainted-milk scandal, leading to outright bans in some places for products that pass official muster in others.

U.S. regulators Friday said food products wouldn't raise health concerns if they contained levels below 2.5 parts per million of melamine, an industrial chemical at the center of the tainted-milk scandal. But they said they won't tolerate the use of melamine as a food additive, saying they couldn't determine a safe level for use in infant formula, citing gaps in scientific knowledge about its effect on babies. The agency said tainted formula hasn't been found in the U.S. (Statement)
[testing limits chart]

Meanwhile, other regulators around the world are scrambling to establish melamine limits where none previously existed. Taiwan had no standard until last week, when it set a tough limit of 0.05 parts per million. That led to a recall this week of Nestlé SA products after regulators said they found traces of melamine in Nestlé products made in China. Nestlé said that its products are safe and that the small traces found by Taiwan "exist in the natural food cycle."

Last week, Indonesian authorities announced that they had found melamine in a dozen Chinese-made products, including Nabisco Oreo wafers and Mars M&M's and Snickers, in quantities ranging from 8.5 to 945 parts per million. Mars Inc. and Kraft Foods Inc., which owns Nabisco, questioned the results, pointing to other jurisdictions where test results for the same Chinese-made products came up clean.

An Indonesia Food and Drug Control Agency spokeswoman, reached late Friday, said, "It is no surprise if the industry has complained, but that does not lessen its result." She said Indonesia follows World Health Organization guidelines for melamine levels, which are based on U.S. standards involving weight and diet. In a report issued last week, however, the WHO said that the U.S. approach "has a large uncertainty" due to the lack of data about the effects of various types of melamine and its interaction with other substances.

Multinational firms have warned that adopting tougher standards than those of the U.S. and Europe could lead to higher food costs and product unavailability. "If governments start adopting low tolerance reporting levels, that will have huge implications for many countries where most foods produced in those countries won't pass the test," said Khaled Rabbani, director of corporate and regulatory affairs for Asia Pacific for Mars.

Daniel Chan, a professor of nephrology at the University of Hong Kong, sees the justification for the tougher standards in Hong Kong and Taiwan. "Ideally, we would want none of it," he said. "But if that would have implications with the availability of choices or prices of materials involved, then we have to decide how far we're willing to be exposed to it."

Hong Kong adopted rules Sept. 23 that set a limit of one part per million for children under the age of three and women who are pregnant or breastfeeding. For others, the territory adopted the European Union's standard of 2.5 parts per million. By comparison, one brand of milk powder implicated in the scandal, made by China's Shijiazhuang Sanlu Group Co., had levels exceeding 2,500 parts per million in powdered form, according to Chinese authorities.

In Asia, parts of which import far more food from China than in the West, there's a heightened sense of vulnerability to tainted products. Thousands of products have been tested so far in a number of countries.

Melamine's presence in Chinese-made baby formula has been blamed for the deaths of as many as four infants and sickening more than 50,000 others. China is still working on national standards, and Friday it posted a notice on the Web site of the Ministry of Science and Technology inviting the public to submit methods for detecting melamine in quantities of less than two parts per million within 30 minutes.

The chemical is generally considered safe for adults in minute amounts by other agencies that follow U.S. and EU standards. But little is known about the long-term health effects of the chemical that first rose to prominence as a contaminant a year ago during a tainted pet food scandal in the U.S.

In the U.S., the FDA has limited recall power, and it relies on manufacturers to pull questionable products off shelves. Since it warned against selling or eating one brand of Chinese-made candy called White Rabbit Creamy Candy, state officials in California, Connecticut and others have found it on shelves and warned consumers.

After promising to take a "zero tolerance" approach to melamine, on Sept. 24 Taiwan's health authorities said they would adopt the EU standard.

Sunday, September 7, 2008

Hearing Aids Go Hi-Tech

PURE from Siemens is the latest in hearing aid technology that not only boasts a discreet design, but it is also unparalleled in sound amplification and signal-processing technology. This new device enables wearers to access Bluetooth-enabled devices wirelessly, including phones and MP3 players.

Wednesday, September 3, 2008

Patients 'free from cancer' after immune-boost treatment

Cancer patients have been left free of the disease after being treated with a new drug which harnesses the power of their own immune cells.
# Cancer and immunotherapy Q and A
# Immunotherapy: could it be the cure for cancer?
# Cancer patient recovers after injection of immune cells

Four of 38 patients with non-Hodgkin's lymphoma have seen "complete regressions" following treatment, while five others saw reductions of 50 per cent in their tumours.

Immunotherapy for cancer
While the trials were only carried out on patients with blood cancer, it is hoped the methods can be adapted to tackle other cancers

The drug, which could prove cheaper than other therapies that try to achieve the same effect with cells, works by activating the body's own defences to attack the cancer.

The results have been described as an "exciting" and "significant" development in the use of immunotherapy, the process of using the body's own immune system to fight disease.

While the trials were only carried out on patients with the blood cancer, it is hoped the methods can be adapated to tackle other cancers.

The disease claims the lives of more than 150,000 people in the UK every year and more than one million people are suffering from cancer at any one time.

Earlier this year doctors announced that a patient with advanced skin cancer was free of the disease two years after they injected him with billions of his own immune cells using a different method. However, experts warned at the time that the process could prove extremely expensive.

The development of the drug could prove a much cheaper alternative way of providing immunotherapy treatments.

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "These exciting preliminary results come from using them to harness the body's own immune response in a new way. Although the side effects need to be monitored carefully, we hope that this type of treatment will prove to be active in larger trials in the future"

"This a significant study," said Dr Cassian Yee, Fred Hutchinson Cancer Research Center, Seattle, who has had significant results using the alternative method of treating patients with white blood cells grown in the lab.

"It remains to be seen if most of the responses are longlasting. Certainly the results are very promising."

The drug, which has been developed by Micromet, in Bethesda, Maryland, was trialled by a team led by Dr Ralf Bargou at University of Würzburg in Würzburg, German.

The results, published in the journal Science, are encouraging because they suggest that the bigger the dose, the bigger the effect.

Coauthor of the study Dr Patrick Baeuerle, of Micromet, said all seven who received the highest dose responded to the drug.

"Two of the seven had a complete response, and five a partial regression (greater than 50 per cent reduction of tumour).".

The longest duration of a response was so far seen in a patient who received one quarter of their dose. After 13 months, he remains free of the blood cancer.

There are adverse side effects involved, however, such as fevers and chills, occasionally with confusion and tremor, though all stopped after treatment ceased.

Now a further trial is investigating how the drugs works in patients with another form of blood cancer, called acute lymphoblastic leukaemia.

Trials with a similar drug are also under way on patients with another type of cancer, which affects glandular tissue and can appear in the lungs, prostate, breast, colon and elsewhere in the body.

Micromet targets the body's own white blood cells on the cancer, using a fraction of a millionth of a gram of a specialised protein called a "bispecific antibody".

The company has created antibodies, called BiTE antibodies, which are able to stick to sites with exquisite precision, in this case to activate specialised white blood cells ( T cells) to attack cancer.

The antibodies overcome a key problem with immunotherapy that as tumours become more advanced they become more "invisible" to the T cells because the cancer cells lack molecules for white blood cells to hang on to and stage their attack.

Normal antibodies are designed to latch on to one molecular target but the bispecific antibody developed by Micromet, given the name blinatumomab, binds to two, the cancer cell and the T cell, and bring the two together to target the immune system on the cancer.

The team tried varying doses of blinatumomab in patients, and found that among 38 patients, at doses from 0.0005 to 0.06 milligrams (millionths of a gram) per square metre of body surface per day, 11 of them exhibited major responses and tumour shrinking. The disease was cleared from bone marrow, spleen and liver too.

Monday, August 25, 2008

Killer Carbs: Scientist Finds Key To Overeating As We Age

ScienceDaily (Aug. 22, 2008) — A Monash University scientist has discovered key appetite control cells in the human brain degenerate over time, causing increased hunger and potentially weight-gain as we grow older. The research by Dr Zane Andrews, a neuroendocrinologist with Monash University's Department of Physiology, has been published in Nature.

Dr Andrews found that appetite-suppressing cells are attacked by free radicals after eating and said the degeneration is more significant following meals rich in carbohydrates and sugars.

"The more carbs and sugars you eat, the more your appetite-control cells are damaged, and potentially you consume more," Dr Andrews said.

Dr Andrews said the attack on appetite suppressing cells creates a cellular imbalance between our need to eat and the message to the brain to stop eating.

"People in the age group of 25 to 50 are most at risk. The neurons that tell people in the crucial age range not to over-eat are being killed-off.

"When the stomach is empty, it triggers the ghrelin hormone that notifies the brain that we are hungry. When we are full, a set of neurons known as POMC's kick in.

"However, free radicals created naturally in the body attack the POMC neurons. This process causes the neurons to degenerate overtime, affecting our judgement as to when our hunger is satisfied," Dr Andrews said.

The free radicals also try to attack the hunger neurons, but these are protected by the uncoupling protein 2 (UCP2).

Dr Andrews said the reduction in the appetite-suppressing cells could be one explanation for the complex condition of adult-onset obesity.

"A diet rich in carbohydrate and sugar that has become more and more prevalent in modern societies over the last 20-30 years has placed so much strain on our bodies that it's leading to premature cell deterioration," Dr Andrews said.

Dr Andrews' next research project will focus on finding if a diet rich in carbohydrates and sugars has other impacts on the brain, such as the increased incidences of neurological conditions like Parkinson's disease.

Saturday, August 23, 2008

Japanese create stem cells from wisdom teeth

Japanese scientists said Friday they had derived stem cells from wisdom teeth, opening another way to study deadly diseases without the ethical controversy of using embryos.

Researchers at the government-backed National Institute of Advanced Industrial Science and Technology said they created stem cells of the type found in human embryos using the removed wisdom teeth of a 10-year-old girl.

"This is significant in two ways," team leader Hajime Ogushi told AFP. "One is that we can avoid the ethical issues of stem cells because wisdom teeth are destined to be thrown away anyway.

"Also, we used teeth that had been extracted three years ago and had been preserved in a freezer. That means that it's easy for us to stock this source of stem cells."

The announcement follows the groundbreaking discovery by US and Japanese scientists last year that they could produce stem cells from skin, a finding that was hailed by the Vatican and US President George W. Bush.

Research involving embryonic stem cells -- which can develop into various organs or nerves -- is seen as having the potential to save lives by helping find cures for diseases such as cancer and diabetes.

But studies on embryos are strongly opposed by religious conservatives, who argue that such research destroys human life, albeit at its earliest stage of development.

In the new research, cells were extracted from the wisdom teeth and developed for about 35 days.

The researchers then tested them and found that they were stem cells, which can develop into various other kinds of human cells, Ogushi said.

As with last year's skin cell discovery, the Japanese researchers said it would take time to put the use of wisdom teeth into practical use.

Ogushi estimated it would take at least five years to put the method into clinical use such as trial treatments of congenital bone disease.

"Because extractions of wisdom teeth are commonly operated in dental clinics, we can expect a lot of donors of stem cells," he said.

"That enable us to create stem cells of various genetic codes, eliminating the risk that a body of a patient would reject transplanted tissues or organs," he added.

He was hopeful that the method would produce stem cells of various genetic codes -- reducing the risk that patients' bodies would reject transplanted tissues or organs.

Theoretically, people who give up their wisdom teeth in their youth could use the stem cells later in life if they need treatment.

The research takes points from last year's skin cell breakthrough, which was a collaborative effort by researchers at Kyoto University and the University of Wisconsin at Madison.

The Kyoto University team, led by Shinya Yamanaka, generated human stem cells by introducing four genes into a sample of human skin.

Ogushi introduced three of of the four genes identified by Yamanaka into the wisdom teeth.

Japan, the largest spender on scientific research after the United States, in December announced a 10 billion-yen (92 million-dollar) plan to advance stem cell research over five years.

Friday, August 8, 2008

Sleep on It: How Snoozing Makes You Smarter

During slumber, our brain engages in data analysis, from strengthening memories to solving problems

By Robert Stickgold and Jeffrey M. Ellenbogen

In 1865 Friedrich August Kekulé woke up from a strange dream: he imagined a snake forming a circle and biting its own tail. Like many organic chemists of the time, Kekulé had been working feverishly to describe the true chemical structure of benzene, a problem that continually eluded understanding. But Kekulé’s dream of a snake swallowing its tail, so the story goes, helped him to accurately realize that benzene’s structure formed a ring. This insight paved the way for a new understanding of organic chemistry and earned Kekulé a title of nobility in Germany.

Although most of us have not been ennobled, there is something undeniably familiar about Kekulé’s problem-solving method. Whether deciding to go to a particular college, accept a challenging job offer or propose to a future spouse, “sleeping on it” seems to provide the clarity we need to piece together life’s puzzles. But how does slumber present us with answers?

The latest research suggests that while we are peacefully asleep our brain is busily processing the day’s information. It combs through recently formed memories, stabilizing, copying and filing them, so that they will be more useful the next day. A night of sleep can make memories resistant to interference from other information and allow us to recall them for use more effectively the next morning. And sleep not only strengthens memories, it also lets the brain sift through newly formed memories, possibly even identifying what is worth keeping and selectively maintaining or enhancing these aspects of a memory. When a picture contains both emotional and unemotional elements, sleep can save the important emotional parts and let the less relevant background drift away. It can analyze collections of memories to discover relations among them or identify the gist of a memory while the unnecessary details fade—perhaps even helping us find the meaning in what we have learned.

Not Merely Resting
If you find this news surprising, you are not alone. Until the mid-1950s, scientists generally assumed that the brain was shut down while we snoozed. Although German psychologist Hermann Ebbinghaus had evidence in 1885 that sleep protects simple memories from decay, for decades researchers attributed the effect to a passive protection against interference. We forget things, they argued, because all the new information coming in pushes out the existing memories. But because there is nothing coming in while we get shut-eye, we simply do not forget as much.

Then, in 1953, the late physiologists Eugene Aserinsky and Nathaniel Kleitman of the University of Chicago discovered the rich variations in brain activity during sleep, and scientists realized they had been missing something important. Aserinsky and Kleitman found that our sleep follows a 90-minute cycle, in and out of rapid-eye-movement (REM) sleep. During REM sleep, our brain waves—the oscillating electromagnetic signals that result from large-scale brain activity—look similar to those produced while we are awake. And in subsequent decades, the late Mircea Steriade of Laval University in Quebec and other neuroscientists discovered that individual collections of neurons were independently firing in between these REM phases, during periods known as slow-wave sleep, when large populations of brain cells fire synchronously in a steady rhythm of one to four beats each second. So it became clear that the sleeping brain was not merely “resting,” either in REM sleep or in slow-wave sleep. Sleep was doing something different. Something active.

Sleep to Remember
The turning point in our understanding of sleep and memory came in 1994 in a groundbreaking study. Neurobiologists Avi Karni, Dov Sagi and their colleagues at the Weizmann Institute of Science in Israel showed that when volunteers got a night of sleep, they improved at a task that involved rapidly discriminating between objects they saw—but only when they had had normal amounts of REM sleep. When the subjects were deprived of REM sleep, the improvement disappeared. The fact that performance actually rose overnight negated the idea of passive protection. Something had to be happening within the sleeping brain that altered the memories formed the day before. But Karni and Sagi described REM sleep as a permissive state—one that could allow changes to happen—rather than a necessary one. They proposed that such unconscious improvements could happen across the day or the night. What was important, they argued, was that improvements could only occur during part of the night, during REM.

It was not until one of us (Stickgold) revisited this question in 2000 that it became clear that sleep could, in fact, be necessary for this improvement to occur. Using the same rapid visual discrimination task, we found that only with more than six hours of sleep did people’s performance improve over the 24 hours following the learning session. And REM sleep was not the only important component: slow-wave sleep was equally crucial. In other words, sleep—in all its phases—does something to improve memory that being awake does not do.

To understand how that could be so, it helps to review a few memory basics. When we “encode” information in our brain, the newly minted memory is actually just beginning a long journey during which it will be stabilized, enhanced and qualitatively altered, until it bears only faint resemblance to its original form. Over the first few hours, a memory can become more stable, resistant to interference from competing memories. But over longer periods, the brain seems to decide what is important to remember and what is not—and a detailed memory evolves into something more like a story.

In 2006 we demonstrated the powerful ability of sleep to stabilize memories and provided further evidence against the myth that sleep only passively (and, therefore, transiently) protects memories from interference. We reasoned that if sleep merely provides a transient benefit for memory, then memories after sleep should be, once again, susceptible to interference. We first trained people to memorize pairs of words in an A-B pattern (for example, “blanket-window”) and then allowed some of the volunteers to sleep. Later they all learned pairs in an A-C pattern (“blanket-sneaker”), which were meant to interfere with their memories of the A-B pairs. As expected, the people who slept could remember more of the A-B pairs than people who had stayed awake could. And when we introduced interfering A-C pairs, it was even more apparent that those who slept had a stronger, more stable memory for the A-B sets. Sleep changed the memory, making it robust and more resistant to interference in the coming day.

But sleep’s effects on memory are not limited to stabilization. Over just the past few years, a number of studies have demonstrated the sophistication of the memory processing that happens during slumber. In fact, it appears that as we sleep, the brain might even be dissecting our memories and retaining only the most salient details. In one study we created a series of pictures that included either unpleasant or neutral objects on a neutral background and then had people view the pictures one after another. Twelve hours later we tested their memories for the objects and the backgrounds. The results were quite surprising. Whether the subjects had stayed awake or slept, the accuracy of their memories dropped by 10 percent for everything. Everything, that is, except for the memory of the emotionally evocative objects after night of sleep. Instead of deteriorating, memories for the emotional objects actually seemed to improve by a few percent overnight, showing about a 15 percent improvement relative to the deteriorating backgrounds. After a few more nights, one could imagine that little but the emotional objects would be left. We know this culling happens over time with real-life events, but now it appears that sleep may play a crucial role in this evolution of emotional memories.

Precisely how the brain strengthens and enhances memories remains largely a mystery, although we can make some educated guesses at the basic mechanism. We know that memories are created by altering the strengths of connections among hundreds, thousands or perhaps even millions of neurons, making certain patterns of activity more likely to recur. These patterns of activity, when reactivated, lead to the recall of a memory—whether that memory is where we left the car keys or a pair of words such as “blanket-window.” These changes in synaptic strength are thought to arise from a molecular process known as long-term potentiation, which strengthens the connections between pairs of neurons that fire at the same time. Thus, cells that fire together wire together, locking the pattern in place for future recall.

During sleep, the brain reactivates patterns of neural activity that it performed during the day, thus strengthening the memories by long-term potentiation. In 1994 neuroscientists Matthew Wilson and Bruce McNaughton, both then at the University of Arizona, showed this effect for the first time using rats fitted with implants that monitored their brain activity. They taught these rats to circle a track to find food, recording neuronal firing patterns from the rodents’ brains all the while. Cells in the hippocampus—a brain structure critical for spatial memory—created a map of the track, with different “place cells” firing as the rats traversed each region of the track [see “The Matrix in Your Head,” by James J. Knierim; Scientific American Mind, June/July 2007]. Place cells correspond so closely to exact physical locations that the researchers could monitor the rats’ progress around the track simply by watching which place cells were firing at any given time. And here is where it gets even more interesting: when Wilson and McNaughton continued to record from these place cells as the rats slept, they saw the cells continuing to fire in the same order—as if the rats were “practicing” running around the track in their sleep.

As this unconscious rehearsing strengthens memory, something more complex is happening as well—the brain may be selectively rehearsing the more difficult aspects of a task. For instance, Matthew P. Walker’s work at Harvard Medical School in 2005 demonstrated that when subjects learned to type complicated sequences such as 4-1-3-2-4 on a keyboard (much like learning a new piano score), sleeping between practice sessions led to faster and more coordinated finger movements. But on more careful examination, he found that people were not simply getting faster overall on this typing task. Instead each subject was getting faster on those particular keystroke sequences at which he or she was worst.

The brain accomplishes this improvement, at least in part, by moving the memory for these sequences overnight. Using functional magnetic resonance imaging, Walker showed that his subjects used different brain regions to control their typing after they had slept. The next day typing elicited more activity in the right primary motor cortex, medial prefrontal lobe, hippocampus and left cerebellum—places that would support faster and more precise key-press movements—and less activity in the parietal cortices, left insula, temporal pole and frontopolar region, areas whose suppression indicates reduced conscious and emotional effort. The entire memory got strengthened, but especially the parts that needed it most, and sleep was doing this work by using different parts of the brain than were used while learning the task.

Solutions in the Dark
These effects of sleep on memory are impressive. Adding to the excitement, recent discoveries show that sleep also facilitates the active analysis of new memories, enabling the brain to solve problems and infer new information. In 2007 one of us (Ellenbogen) showed that the brain learns while we are asleep. The study used a transitive inference task; for example, if Bill is older than Carol and Carol is older than Pierre, the laws of transitivity make it clear that Bill is older than Pierre. Making this inference requires stitching those two fragments of information together. People and animals tend to make these transitive inferences without much conscious thought, and the ability to do so serves as an enormously helpful cognitive skill: we discover new information (Bill is older than Pierre) without ever learning it directly.

The inference seems obvious in Bill and Pierre’s case, but in the experiment, we used abstract colored shapes that have no intuitive relation to one another, making the task more challenging. We taught people so-called premise pairs—they learned to choose, for example, the orange oval over the turquoise one, turquoise over green, green over paisley, and so on. The premise pairs imply a hierarchy—if orange is a better choice than turquoise and turquoise is preferred to green, then orange should win over green. But when we tested the subjects on these novel pairings 20 minutes after they learned the premise pairs, they had not yet discovered these hidden relations. They chose green just as often as they chose orange, performing no better than chance.

When we tested subjects 12 hours later on the same day, however, they made the correct choice 70 percent of the time. Simply allowing time to pass enabled the brain to calculate and learn these transitive inferences. And people who slept during the 12 hours performed significantly better, linking the most distant pairs (such as orange versus paisley) with 90 percent accuracy. So it seems the brain needs time after we learn information to process it, connecting the dots, so to speak—and sleep provides the maximum benefit.

In a 2004 study Ullrich Wagner and others in Jan Born’s laboratory at the University of Lübeck in Germany elegantly demonstrated just how powerful sleep’s processing of memories can be. They taught subjects how to solve a particular type of mathematical problem by using a long and tedious procedure and had them practice it about 100 times. The subjects were then sent away and told to come back 12 hours later, when they were instructed to try it another 200 times.

What the researchers had not told their subjects was that there is a much simpler way to solve these problems. The researchers could tell if and when subjects gained insight into this shortcut, because their speed would suddenly increase. Many of the subjects did, in fact, discover the trick during the second session. But when they got a night’s worth of sleep between the two sessions, they were more than two and a half times more likely to figure it out—59 percent of the subjects who slept found the trick, compared with only 23 percent of those who stayed awake between the sessions. Somehow the sleeping brain was solving this problem, without even knowing that there was a problem to solve.

The Need to Sleep
As exciting findings such as these come in more and more rapidly, we are becoming sure of one thing: while we sleep, our brain is anything but inactive. It is now clear that sleep can consolidate memories by enhancing and stabilizing them and by finding patterns within studied material even when we do not know that patterns might be there. It is also obvious that skimping on sleep stymies these crucial cognitive processes: some aspects of memory consolidation only happen with more than six hours of sleep. Miss a night, and the day’s memories might be compromised—an unsettling thought in our fast-paced, sleep-deprived society.

But the question remains: Why did we evolve in such a way that certain cognitive functions happen only while we are asleep? Would it not seem to make more sense to have these operations going on in the daytime? Part of the answer might be that the evolutionary pressures for sleep existed long before higher cognition—functions such as immune system regulation and efficient energy usage (for instance, hunt in the day and rest at night) are only two of the many reasons it makes sense to sleep on a planet that alternates between light and darkness. And because we already had evolutionary pressure to sleep, the theory goes, the brain evolved to use that time wisely by processing information from the previous day: acquire by day; process by night.

Or it might have been the other way around. Memory processing seems to be the only function of sleep that actually requires an organism to truly sleep—that is, to become unaware of its surroundings and stop processing incoming sensory signals. This unconscious cognition appears to demand the same brain resources used for processing incoming signals when awake. The brain, therefore, might have to shut off external inputs to get this job done. In contrast, although other functions such as immune system regulation might be more readily performed when an organism is inactive, there does not seem to be any reason why the organism would need to lose awareness. Thus, it may be these other functions that have been added to take advantage of the sleep that had already evolved for memory.

Many other questions remain about our nighttime cognition, however it might have evolved. Exactly how does the brain accomplish this memory processing? What are the chemical or molecular activities that account for these effects? These questions raise a larger issue about memory in general: What makes the brain remember certain pieces of information and forget others? We think the lesson here is that understanding sleep will ultimately help us to better understand memory.

The task might seem daunting, but these puzzles are the kind on which scientists thrive—and they can be answered. First, we will have to design and carry out more and more experiments, slowly teasing out answers. But equally important, we are going to have to sleep on it.

Thursday, August 7, 2008

Doctors Find Promise To Help Cure Leukemia

New York - German doctors seeking a cure for leukemia see promise in an unexpected source - methadone.

The drug, used to treat people addicted to heroin and other opioids, kills leukemia cells without harming healthy blood cells, University of Ulm researchers report in the journal Cancer Research.

And methadone may attack other cancers, too.

“[It] also can kill solid tumors,” said study chief Dr. Claudia Friesen.

Friday, August 1, 2008

The Exercise Pill

A pill that can replace exercise? Sounds too good to be true, right? For the time being, it is — unless you’re a lab mouse. (Stupid mice, they get all the cool drugs before we do.) But according to Scientific American, promising test results mean it might not be long before an “exercise pill” is in the works for humans.
So how does it work? “It tricks the muscle into ‘believing’ it’s been exercised daily,” says Ronald Evans, a developmental biologist at the Salk Institute for Biological Studies, in La Jolla, Calif., and co-author of a study published in Cell. “It proves you can have a pharmacologic equivalent to exercise.” (That’s pretty definitive language; usually scientists mumble about the results “suggesting” that something “might” work in humans … but this study proves it? We’re impressed … and maybe a little skeptical, too.) What it does it “reprogram” muscle cells, switching them from being sugar-burning, fast-twitching machines that are built for power and sudden bursts of speed but tire quickly — not so necessary if you’re a desk jockey/couch potato — to fat-burning, slow-twitching muscles that enjoy increased endurance and stamina.

You read right: not only would the pill help you lose weight, it also increases your endurance, meaning that if you do decide to work out (even while taking the pill), like lab mice, you may find you can rock the Stairmaster 40-50% longer without becoming exhausted. (I have a feeling this is going to be a hit with middle-aged men; kill that gut and cancel your Viagra presecription as well.)

The key to this transformation is a protein called PPARdelta, which the team previously showed could create so-called high-endurance “marathon mice” when the animals were genetically engineered to make a lot of it. But, a drug that targeted only PPARdelta—although having metabolic benefits like lowering fatty acids and blood sugar—had no effect on endurance unless the mice were running regularly.

Enter AICAR, which targets a protein called adenosine monophosphate-activated protein kinase (AMPK). AMPK is produced when cells need more energy, as they do when we’re exercising. It also interacts with PPARdelta, effectively turbo-boosting that protein’s activity. So, by using AICAR, the scientists thought they might be able to trick the body into thinking it was exercising.

After four weeks of treatment with AICAR alone, the mice that took it could run on treadmills nearly 1.5 times as long as untreated animals—and without any training.

That does sound too good to be true, doesn’t it? Naturally, some contrarian scientists agree, maintaining that there’s no way a pill can replace the multitude of benefits that actual sweat-through-your-shirt exercise provides your body (not to mention your mental health). Here’s hoping the naysayers are wrong!

Monday, July 28, 2008

Drugs may offer some hope in autism cases

By Blythe Bernhard

ST. LOUIS — New treatments for a rare genetic disorder may hold clues for treating autism, researchers said Thursday at the International Fragile X Conference held at Union Station.

Fragile X syndrome is a common inherited cause of cognitive impairments, including about 5 percent of autism cases. Symptoms can include hyperactivity, seizures, learning disabilities and speech delays.

About one in 4,000 boys and one in 6,000 to 8,000 girls are born with the Fragile X, according to the Centers for Disease Control and Prevention.
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Because the disorder can be linked to a defect in a singular gene, it's a promising field of study for researchers. At the weeklong conference sponsored by the National Fragile X Foundation, St. Louis hosts several hundred parents, physicians and researchers looking for the latest developments in treatments and patient support.

Typically, treatment for Fragile X includes medications that treat behavioral symptoms. Researchers are now working on the underlying disorder that over-stimulates the nerve pathways in the brains of people with the syndrome and those with autism.

Drug therapies that block those pathways are still experimental. To date, there have been no large clinical trials in Fragile X patients. The small studies have shown some promise, however.

"It's been the first conference where the promise of powerful new treatments is literally around the corner," said Robert Miller, the foundation's executive director. "There's just a lot of hope and excitement because everybody's picked up on the buzz."

One drug, the mood stabilizer lithium, corrected hyperactivity and reduced seizures in mice. In a two-month trial in 15 children, behavioral symptoms improved in 13 patients after two months, but IQ levels did not change.

Other drugs mentioned at the conference included oxytocin, a mood-enhancing hormone, and minocycline, an antibiotic that shows promise in reducing symptoms of mice treated in infancy.

Another drug, fenobam, has also shown reductions in seizures in mice affected with Fragile X. In a human trial of 12 adult patients at Rush University Medical Center in Chicago and the University of California, Davis, half of the patients showed improved eye contact and one-third experienced calmer behavior, researchers said.

With that anecdotal data, researchers feel future trials are worthwhile in adults and kids, and are awaiting approval from the Food and Drug Administration for a larger study to start as soon as January. Researchers theorize that the drugs could work even better in children because their brains are still developing and more adaptable.

There's a "strong possibility that non-Fragile X autism patients may also improve" on Fenobam, said Dr. Randi Hagerman of the MIND Institute at the University of California, Davis.

The future for treatment of Fragile X and autism will probably include combinations of these drugs, Hagerman said.

Still, the researchers cautioned parents and researchers that the drugs are not overnight cures. Patients with Fragile X and autism will still need behavioral therapy and help from a team of family members, teachers, psychologists and doctors.

Saturday, July 12, 2008

Tilapia May Be Risky

Winston-Salem, NC - Researchers from Wake Forest University Medical Center say you’re better of with a big juicy burger than with this mild, low-fat fish, which turns out to be high in an unhealthful form of fat called long-chain omega-6 fatty acids, especially when it’s produced by fish farms.
Long chain omega-6 fats promote inflammation associated with heart disease, asthma, some cancers, Alzheimer’s disease, stroke and other conditions, said Floyd Chilton, professor of physiology at Wake Forest and head of the study.
Is there anything left that the experts say we should eat? Not much, said Chilton, thanks to a large-scale corruption of the American food chain with cheap corn feed. That has altered the composition of fats found in beef, chicken, eggs and farmed fish, such as catfish and tilapia.
In tests, the researchers found that grain-fed tilapia concentrated even more of the worst fats than did grain-fed beef.
One animal-based food that Chilton recommends is wild-caught fish, such as salmon and sardines, since they contain inflammation-fighting omega-3 fatty acids.
Unfortunately, he said, public health officials have been wrongly telling people to get more of this important nutrient by eating more fish without specifying what kind.

Saturday, July 5, 2008

The Fattest States

Calorie Lab’s Fattest States rankings for 2008 are out, and Mississippi is number one for the third year in a row. Colorado has the smallest percentage of obese people.

West Virginia passed Alabama to become the second fattest state in 2008. The four states of Mississippi, West Virginia, Alabama, and Louisiana have obese populations that exceed 30 percent over a three-year average and two-thirds of the citizens of Mississippi and West Virginia were either overweight or obese by CDC standards in 2007.

7 Tips for quality sleep

Sleeping can be made efficient too? That’s right — getting 10 hours of sleep is useless if it isn’t good sleep! I’m sure you’ve spent entire nights tossing and turning without actually falling asleep and waking up feeling just as exhausted as the night before. This happens to everyone but there are several methods to try to prevent this and to make sure you really are getting the best sleep you can get.

1. Sleep - Quality over QuantityGet a Comfortable Bed
The definition of comfort is different for everyone, but I would suggest trying different beds. It’s been proven that really soft mattresses aren’t good for the spine but neither are hard ones so it’s up to the individual to find something that suits them.
2. Avoid sugar and caffeine right before bed
Both of these things are stimulants and won’t let your body relax properly. If you’re thirsty right before bed, water is the best bet (in fact water is the best bet for almost all situations).
3. Don’t exercise right before bed
If you’re going to do 50 sit-ups before you sleep, make sure you do it a few hours in advance. Exercise, like sugar, stimulates the body and hinders it from properly relaxing.
4. Don’t drink too much water
On that last note, drinking too much water isn’t good. Depending on your bladder size you may have to get up to urinate in the middle of the night!
5. Keep a good constant temperature
If it’s cold outside, stay warm; if it’s hot, stay cool. Try to keep a constant temperature so you aren’t constantly kicking your blanket off and pulling it back on. Also, you may want to avoid sleeping naked since it is harder to maintain a constant temperature without the benefit of a layer of clothing.
6. Ambient noises
This is another personal preference. Some people prefer music, some prefer the quiet hum of their computer fan, others prefer dead silence. Figure out what works for you and stick with it.
7. Maintain a regular sleep pattern
By keeping a stable biological clock, your body will know when it is time for sleep so it can prepare itself adequately. Unless you really need to pull that all-nighter, try your best to sleep at the same time every night. Waking up at the same time every day regardless of when your day actually starts is great too — my best tip is to keep your window blinds open to let in the morning sun.

With most of these points, consistency is the key. Once you’ve figured out a combination that works for you then try to replicate the exact situations every day. That way your body gets conditioned to sleep under those environmental conditions.

How do you know if you’ve gotten quality sleep?

* If you wake up on your own before your alarm goes off.
* If your joints aren’t aching when you get up.
* If you feel relaxed and ready to start your day.
* If you wake up smiling :)

And guess what, getting a good night’s rest can increase metabolism and help you stay in shape and lower heart disease.

20 Well Known Cooking Ingredients that Act Like Medicines

The use of herbal treatments for everything from sore throats to cancer has become more and more common with every passing year. We all know about the herbal supplements like St. John’s Wort that can help you with chronic health problems, but did you know that many common edible herbs can provide impressive health benefits?

While you probably already use these herbs in your home, you may not realize that they can do much more than just making your meals tasty and interesting. Here are five common herbs that do double duty as effective herbal treatments.


1. Turmeric
As anyone who has ever treated a head cold with a nice hot Indian meal already knows, turmeric is one of the best healing herbs available to us today. It contains the anti-inflammatory curcumin, which may function in the same way as some pharmaceutical arthritis drugs.

The next time your joints are aching, just have a healthy serving of curry and see if your symptoms respond to the exotic spice. Researchers recommend a daily serving of 400 mg each day.

2. Ginger
Ginger has been well-known as a calmer of upset tummies for many generations. This “old wives’ tale” has actually been proven to be true following several research studies on the effects of ginger ingestion of cruise ship passengers.

Many people around the world also use ginger as a mild pain reliever. For everyday aches or for arthritis pain, fresh or powdered ginger added to food can actually help to reduce your symptoms.

Ginger may also be an effective means of controlling ovarian cancer cells, according to a 2006 study by the University of Michigan Comprehensive Cancer Center. More research is needed, but the preliminary findings are very promising.

3. Cinnamon
Cinnamon was recently studied by German scientists for its effects on people with type 2 diabetes. Amazingly, they found that diabetics could decrease their blood sugar by up to 10% just by taking a cinnamon extract daily. Another study found that cinnamon may help to lower cholesterol as well.

Since cinnamon can be toxic when taken in very large quantities (much more than you would probably be able to eat at once), experts recommend that you use a cinnamon extract rather than actual cinnamon.

4. Garlic
Garlic is truly a super food. Not only does it taste wonderful, but it may even reduce your cancer risk. A 2006 study published in the American Journal of Clinical Nutrition showed that people who consumed high doses of garlic had low instances of several types of cancers.

Garlic is known to be extremely useful against bacteria, even those that are resistant to antibiotics. It has antifungal and antiviral properties and may even help to lower cholesterol and prevent strokes.

5. Rosemary
If you have to choose just one herb to help you avoid several different types of cancer, rosemary may be it. Rosemary can actually help to prevent carcinogens that you ingest from binding with your DNA. This can help to prevent the formation of tumors and the eventual development of cancer.

Although human studies have not yet been conducted, preliminary animal studies have shown amazing potential for this common herb. You don’t need to buy any special form of rosemary to get these benefits; simply use rosemary liberally in your cooking along with other beneficial herbs like parsley, oregano, onion, garlic, or thyme.

6. Honey
Honey is commonly used as a digestion aid and to soothe sore tummies and throats. The hydrating qualities of honey are well-known all around the world, and desert travelers have been known to carry honey and water to quench their thirst on long treks.

Honey is used externally as well as internally. Its ability to hydrate skin works even when it is applied topically. Because of this, honey is a common ingredient in many skin treatments, lotions, soaps, and anti-aging skin creams.

Perhaps the most impressive of honey’s abilities is its effectiveness as a burn treatment. Honey helps to soothe the pain of a burn while limiting inflammation and retarding infection.

7. Chili Peppers
Hot peppers are an amazing food that can help you treat any number of common conditions. At home, you can eat them to to clear up a congested head and as a natural pain reliever.

An exciting and often-publicized use for chili peppers is as a metabolism boost. Adding chili peppers to your meals can help you burn more calories, and it is believed that chili peppers can even help you feel fuller after a meal.

8. Olive Oil
This delicious and exotic-tasting oil may help to save your life some day. With regular modest consumption, olive oil can help stop plaque from forming in arteries, thus reducing your risk of heart attacks.

9. Rice
Rice is one of the best-tolerated foods available. It can help to soothe a stomach that is suffering from constipation or diarrhea, and even people suffering from the flu are likely to be able to take some rice. Eating rice regularly can prevent the formation of kidney stones and block some types of intestinal cancers.

10. Parsley
Because it is rich in antioxidants, parsley can help to block certain types of cancers and keep your body’s cells young and healthy. Antioxidants are particularly useful for detoxifying carcinogens, such as the types found in cigarette smoke.

11. Onions (and related plants such as chives, shallots, and leeks)
Plants in the onion family have been used as medicines since ancient times. Their properties have been known and enjoyed by cultures all around the world. Their exceptionally high concentration of antioxidants makes onions and related plants ideal for preventing cancer.

Onions and related plants are also a hugely effective treatment for lung disorders such as pneumonia and chronic bronchitis. They have outstanding anti-inflammatory properties and can be used as antibiotics and antivirals.

12. Lemon
Lemon has a multitude of medicinal uses and has been a prized part of the medicinal kitchen for many generations. It is a general clarifier and purifier, and can be taken to cleanse the body of impurities. It has also been used to treat headaches, arthritis, and pneumonia.

Although it seems counterintuitive (or just plain painful), applying lemon juice to cuts and scrapes is great for preventing infections. The natural antiseptic properties of lemon juice will keep infections at bay and can even reduce the appearance of bruises.

13. Mustard
This humble little plant is commonly used as an expectorant and decongestant. It is antibacterial and can also help to clear nasal passages when one is suffering from a cold or other sinus malady.

Surprisingly, mustard is also used to increase the metabolism. Using plain yellow mustard liberally on foods adds a negligible amount of calories and helps to increase the amount of calories that the body burns.

14. Cloves
Clove oil is used by many cultures as a natural painkiller and anti-inflammatory. It is used in many modern toothache remedies to dull the pain and swelling.

15. Apples
An apple a day keeps the cancer away. Regular consumption of apples can block many types of cancer and act as a general health-booster. Apples can reduce appetite and even lower your cholesterol.

16. Kale. Kale has enjoyed a resurgence in popularity lately, and with good reason. It has more lutein than any other vegetable and more beta carotene than spinach. It can help prevent cancer and regulate estrogen in the body.

17. Licorice
Not the licorice candy sold in the United States - this often contains no licorice at all! Real licorice contains a substance that is strongly anti-cancer. Licorice is also antibacterial and can reduce stomach ulcers and diarrhea.

18. Peppermint
Most mints, in fact. The leaves of mint plants are commonly used in teas and medicines to calm upset stomachs, promote sleep, and reduce stress and tension.

19. Horseradish
Like its relative mustard, horseradish is a fantastic tool for fighting digestive disorders. It can be used to treat constipation. It is also a great immune system booster, giving the liver increased power to filter out harmful substances from foods.

20. Avocado
The main ingredient in guacamole isn’t just tasty; it’s the source of lots of “good” fat and can prevent the buildup of “bad” cholesterol. It keeps your heart and circulatory system healthy by preventing the clogging of arteries.

Now that you know the incredible health benefits that some common herbs, spices, and plants can provide, try to incorporate some of them into your everyday eating. You may just find yourself in better health today and in the future.

Friday, July 4, 2008

Scientists: Watermelon yields Viagra-like effects

LUBBOCK, Texas (AP) - A slice of cool, fresh watermelon is a juicy way to top off a Fourth of July cookout and one that researchers say has effects similar to Viagra—but don't necessarily expect it to keep the fireworks all night long.

Watermelons contain an ingredient called citrulline that can trigger production of a compound that helps relax the body's blood vessels, similar to what happens when a man takes Viagra, said scientists in Texas, one of the nation's top producers of the seedless variety.

Found in the flesh and rind of watermelons, citrulline reacts with the body's enzymes when consumed in large quantities and is changed into arginine, an amino acid that benefits the heart and the circulatory and immune systems.

"Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it," said Bhimu Patil, a researcher and director of Texas A&M's Fruit and Vegetable Improvement Center. "Watermelon may not be as organ-specific as Viagra, but it's a great way to relax blood vessels without any drug side effects."

Todd Wehner, who studies watermelon breeding at North Carolina State University, said anyone taking Viagra shouldn't expect the same result from watermelon.

"It sounds like it would be an effect that would be interesting but not a substitute for any medical treatment," Wehner said.

The nitric oxide can also help with angina, high blood pressure and other cardiovascular problems, according to the study, which was paid for by the U.S. Department of Agriculture.

More citrulline—about 60 percent—is found in watermelon rind than in the flesh, Patil said, but that can vary. But scientists may be able to find ways to boost the concentrations in the flesh, he said.

Citrulline is found in all colors of watermelon and is highest in the yellow-fleshed types, said Penelope Perkins-Veazie, a USDA researcher in Lane, Okla.

She said Patil's research is valid, but with a caveat: One would need to eat about six cups of watermelon to get enough citrulline to boost the body's arginine level.

"The problem you have when you eat a lot of watermelon is you tend to run to the bathroom more," Perkins-Veazie said.

Watermelon is a diuretic and was a homeopathic treatment for kidney patients before dialysis became widespread.

Another issue is the amount of sugar that much watermelon would spill into the bloodstream—a jolt that could cause cramping, Perkins-Veazie said.

Patil said he would like to do future studies on how to reduce the sugar content in watermelon.

The relationship between citrulline and arginine might also prove helpful to those who are obese or suffer from type-2 diabetes. The beneficial effects—among them the ability to relax blood vessels, much like Viagra does—are beginning to be revealed in research.

Citrulline is present in other curcubits, like cucumbers and cantaloupe, at very low levels, and in the milk protein casein. The highest concentrations of citrulline are found in walnut seedlings, Perkins-Veazie said.

"But they're bitter and most people don't want to eat them," she said.

Wednesday, July 2, 2008

Cancer Cured? Granulocytes Treatment Worked 100 Percent In Mice Work But Will It Work In Humans?

Scientists at Wake Forest University Baptist Medical Center are about to embark on a human trial to test whether a new cancer treatment will be as effective at eradicating cancer in humans as it has proven to be in mice.

The treatment will involve transfusing specific white blood cells, called granulocytes, from select donors, into patients with advanced forms of cancer. A similar treatment using white blood cells from cancer-resistant mice has previously been highly successful, curing 100 percent of lab mice afflicted with advanced malignancies.

Zheng Cui, Ph.D., lead researcher and associate professor of pathology, will be announcing the study June 28 at the Understanding Aging conference in Los Angeles.

The study, given the go-ahead by the U.S. Food and Drug Administration, will involve treating human cancer patients with white blood cells from healthy young people whose immune systems produce cells with high levels of cancer-fighting activity.

The basis of the study is the scientists' discovery, published five years ago, of a cancer-resistant mouse and their subsequent finding that white blood cells from that mouse and its offspring cured advanced cancers in ordinary laboratory mice. They have since identified similar cancer-killing activity in the white blood cells of some healthy humans.

"In mice, we've been able to eradicate even highly aggressive forms of malignancy with extremely large tumors," Cui said. "Hopefully, we will see the same results in humans. Our laboratory studies indicate that this cancer-fighting ability is even stronger in healthy humans."

The team has tested human cancer-fighting cells from healthy donors against human cervical, prostate and breast cancer cells in the laboratory – with surprisingly good results. The scientists say the anti-tumor response primarily involves granulocytes of the innate immune system, a system known for fighting off infections.

Granulocytes are the most abundant type of white blood cells and can account for as much as 60 percent of total circulating white blood cells in healthy humans. Donors can give granulocytes specifically without losing other components of blood through a process called apheresis that separates granulocytes and returns other blood components back to donors.

In a small study of human volunteers, the scientists found that cancer-killing activity in the granulocytes was highest in people under age 50. They also found that this activity can be lowered by factors such as winter or emotional stress. They said the key to the success for the new therapy is to transfuse sufficient granulocytes from healthy donors while their cancer-killing activities are at their peak level.

For the upcoming study, the researchers are currently recruiting 500 local potential donors who are 50 years old or younger and in good health to have their blood tested. Of those, 100 volunteers with high cancer-killing activity will be asked to donate white blood cells for the study. Cell recipients will include 22 cancer patients who have solid tumors that either didn't respond originally, or no longer respond, to conventional therapies. The study will cost $100,000 per patient receiving therapy, and for many patients (those living in 22 states, including North Carolina) the costs may be covered by their insurance company. There is no cost to donate blood. For general information about insurance coverage of clinical trials, go to the American Cancer Society's web site at

For more information about qualifications for donors and participants, go to (Web site will be available the evening of 6/27.) Cancer-killing ability in these cells is highest during the summer, so researchers are hoping to find volunteers who can afford the therapy quickly.

"If the study is effective, it would be another arrow in the quiver of treatments aimed at cancer," said Mark Willingham, M.D., a co-researcher and professor of pathology. "It is based on 10 years of work since the cancer-resistant mouse was first discovered."

Volunteers who are selected as donors – based on the observed potential cancer-fighting activity of their white cells – will complete the apheresis, a two- to three-hour process similar to platelet donation, to collect their granulocytes. The cancer patients will then receive the granulocytes through a transfusion – a safe process that has been used for more than 30 years. Normally, the treatment is used for patients who have antibiotic-resistant infectious diseases. The treatment will be given for three to four consecutive days on an outpatient basis. Up to three donors may be necessary to collect enough blood product for one study participant.

"The difference between our study and the traditional white cell therapy is that we're selecting the healthy donors based on the cancer-killing ability of their white blood cells," said Cui. The scientists are calling the therapy Leukocyte InFusion Therapy (LIFT).

The goal of the phase II study is to determine whether patients can tolerate a sufficient amount of transfused granulocytes for the treatment. Participants will be monitored on a regular basis, and after three months scientists will evaluate whether the treatment results in clear clinical benefits for the patients. If this phase of the study is successful, scientists will expand the study to determine if the treatment is best suited to certain types of cancer.

Yikong Keung, M.D., a medical oncologist, is the chief clinical investigator of the study. Gregory Pomper, M.D., assistant professor of pathology and the director of the Wake Forest Baptist blood bank, will oversee the blood banking portion of the study.

Saturday, June 28, 2008

The Itch

Its mysterious power may be a clue to a new theory about brains and bodies.
by Atul Gawande

It was still shocking to M. how much a few wrong turns could change your life. She had graduated from Boston College with a degree in psychology, married at twenty-five, and had two children, a son and a daughter. She and her family settled in a town on Massachusetts’ southern shore. She worked for thirteen years in health care, becoming the director of a residence program for men who’d suffered severe head injuries. But she and her husband began fighting. There were betrayals. By the time she was thirty-two, her marriage had disintegrated. In the divorce, she lost possession of their home, and, amid her financial and psychological struggles, she saw that she was losing her children, too. Within a few years, she was drinking. She began dating someone, and they drank together. After a while, he brought some drugs home, and she tried them. The drugs got harder. Eventually, they were doing heroin, which turned out to be readily available from a street dealer a block away from her apartment.

One day, she went to see a doctor because she wasn’t feeling well, and learned that she had contracted H.I.V. from a contaminated needle. She had to leave her job. She lost visiting rights with her children. And she developed complications from the H.I.V., including shingles, which caused painful, blistering sores across her scalp and forehead. With treatment, though, her H.I.V. was brought under control. At thirty-six, she entered rehab, dropped the boyfriend, and kicked the drugs. She had two good, quiet years in which she began rebuilding her life. Then she got the itch.

It was right after a shingles episode. The blisters and the pain responded, as they usually did, to acyclovir, an antiviral medication. But this time the area of the scalp that was involved became numb, and the pain was replaced by a constant, relentless itch. She felt it mainly on the right side of her head. It crawled along her scalp, and no matter how much she scratched it would not go away. “I felt like my inner self, like my brain itself, was itching,” she says. And it took over her life just as she was starting to get it back.

Her internist didn’t know what to make of the problem. Itching is an extraordinarily common symptom. All kinds of dermatological conditions can cause it: allergic reactions, bacterial or fungal infections, skin cancer, psoriasis, dandruff, scabies, lice, poison ivy, sun damage, or just dry skin. Creams and makeup can cause itch, too. But M. used ordinary shampoo and soap, no creams. And when the doctor examined M.’s scalp she discovered nothing abnormal—no rash, no redness, no scaling, no thickening, no fungus, no parasites. All she saw was scratch marks.

The internist prescribed a medicated cream, but it didn’t help. The urge to scratch was unceasing and irresistible. “I would try to control it during the day, when I was aware of the itch, but it was really hard,” M. said. “At night, it was the worst. I guess I would scratch when I was asleep, because in the morning there would be blood on my pillowcase.” She began to lose her hair over the itchy area. She returned to her internist again and again. “I just kept haunting her and calling her,” M. said. But nothing the internist tried worked, and she began to suspect that the itch had nothing to do with M.’s skin.

Plenty of non-skin conditions can cause itching. Dr. Jeffrey Bernhard, a dermatologist with the University of Massachusetts Medical School, is among the few doctors to study itching systematically (he published the definitive textbook on the subject), and he told me of cases caused by hyperthyroidism, iron deficiency, liver disease, and cancers like Hodgkin’s lymphoma. Sometimes the syndrome is very specific. Persistent outer-arm itching that worsens in sunlight is known as brachioradial pruritus, and it’s caused by a crimped nerve in the neck. Aquagenic pruritus is recurrent, intense, diffuse itching upon getting out of a bath or shower, and although no one knows the mechanism, it’s a symptom of polycythemia vera, a rare condition in which the body produces too many red blood cells.

But M.’s itch was confined to the right side of her scalp. Her viral count showed that the H.I.V. was quiescent. Additional blood tests and X-rays were normal. So the internist concluded that M.’s problem was probably psychiatric. All sorts of psychiatric conditions can cause itching. Patients with psychosis can have cutaneous delusions—a belief that their skin is infested with, say, parasites, or crawling ants, or laced with tiny bits of fibreglass. Severe stress and other emotional experiences can also give rise to a physical symptom like itching—whether from the body’s release of endorphins (natural opioids, which, like morphine, can cause itching), increased skin temperature, nervous scratching, or increased sweating. In M.’s case, the internist suspected tricho-tillomania, an obsessive-compulsive disorder in which patients have an irresistible urge to pull out their hair.

M. was willing to consider such possibilities. Her life had been a mess, after all. But the antidepressant medications often prescribed for O.C.D. made no difference. And she didn’t actually feel a compulsion to pull out her hair. She simply felt itchy, on the area of her scalp that was left numb from the shingles. Although she could sometimes distract herself from it—by watching television or talking with a friend—the itch did not fluctuate with her mood or level of stress. The only thing that came close to offering relief was to scratch.

“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.” For M., certainly, it did: the itching was so torturous, and the area so numb, that her scratching began to go through the skin. At a later office visit, her doctor found a silver-dollar-size patch of scalp where skin had been replaced by scab. M. tried bandaging her head, wearing caps to bed. But her fingernails would always find a way to her flesh, especially while she slept.

One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night—and all the way into her brain.

Itching is a most peculiar and diabolical sensation. The definition offered by the German physician Samuel Hafenreffer in 1660 has yet to be improved upon: An unpleasant sensation that provokes the desire to scratch. Itch has been ranked, by scientific and artistic observers alike, among the most distressing physical sensations one can experience. In Dante’s Inferno, falsifiers were punished by “the burning rage / of fierce itching that nothing could relieve”:

The way their nails scraped down upon the
Was like a knife scraping off scales from
carp. . . .
“O you there tearing at your mail of
And even turning your fingers into
My guide began addressing one of them,

“Tell us are there Italians among the
Down in this hole and I’ll pray that your
Will last you in this task eternally.”

Though scratching can provide momentary relief, it often makes the itching worse. Dermatologists call this the itch-scratch cycle. Scientists believe that itch, and the accompanying scratch reflex, evolved in order to protect us from insects and clinging plant toxins—from such dangers as malaria, yellow fever, and dengue, transmitted by mosquitoes; from tularemia, river blindness, and sleeping sickness, transmitted by flies; from typhus-bearing lice, plague-bearing fleas, and poisonous spiders. The theory goes a long way toward explaining why itch is so exquisitely tuned. You can spend all day without noticing the feel of your shirt collar on your neck, and yet a single stray thread poking out, or a louse’s fine legs brushing by, can set you scratching furiously.

But how, exactly, itch works has been a puzzle. For most of medical history, scientists thought that itching was merely a weak form of pain. Then, in 1987, the German researcher H. O. Handwerker and his colleagues used mild electric pulses to drive histamine, an itch-producing substance that the body releases during allergic reactions, into the skin of volunteers. As the researchers increased the dose of histamine, they found that they were able to increase the intensity of itch the volunteers reported, from the barely appreciable to the “maximum imaginable.” Yet the volunteers never felt an increase in pain. The scientists concluded that itch and pain are entirely separate sensations, transmitted along different pathways.

Despite centuries spent mapping the body’s nervous circuitry, scientists had never noticed a nerve specific for itch. But now the hunt was on, and a group of Swedish and German researchers embarked upon a series of tricky experiments. They inserted ultra-thin metal electrodes into the skin of paid volunteers, and wiggled them around until they picked up electrical signals from a single nerve fibre. Computers subtracted the noise from other nerve fibres crossing through the region. The researchers would then spend hours—as long as the volunteer could tolerate it—testing different stimuli on the skin in the area (a heated probe, for example, or a fine paintbrush) to see what would get the nerve to fire, and what the person experienced when it did.

They worked their way through fifty-three volunteers. Mostly, they encountered well-known types of nerve fibres that respond to temperature or light touch or mechanical pressure. “That feels warm,” a volunteer might say, or “That feels soft,” or “Ouch! Hey!” Several times, the scientists came across a nerve fibre that didn’t respond to any of these stimuli. When they introduced a tiny dose of histamine into the skin, however, they observed a sharp electrical response in some of these nerve fibres, and the volunteer would experience an itch. They announced their discovery in a 1997 paper: they’d found a type of nerve that was specific for itch.

Unlike, say, the nerve fibres for pain, each of which covers a millimetre-size territory, a single itch fibre can pick up an itchy sensation more than three inches away. The fibres also turned out to have extraordinarily low conduction speeds, which explained why itchiness is so slow to build and so slow to subside.

Other researchers traced these fibres to the spinal cord and all the way to the brain. Examining functional PET-scan studies in healthy human subjects who had been given mosquito-bite-like histamine injections, they found a distinct signature of itch activity. Several specific areas of the brain light up: the part of the cortex that tells you where on your body the sensation occurs; the region that governs your emotional responses, reflecting the disagreeable nature of itch; and the limbic and motor areas that process irresistible urges (such as the urge to use drugs, among the addicted, or to overeat, among the obese), reflecting the ferocious impulse to scratch.

Now various phenomena became clear. Itch, it turns out, is indeed inseparable from the desire to scratch. It can be triggered chemically (by the saliva injected when a mosquito bites, say) or mechanically (from the mosquito’s legs, even before it bites). The itch-scratch reflex activates higher levels of your brain than the spinal-cord-level reflex that makes you pull your hand away from a flame. Brain scans also show that scratching diminishes activity in brain areas associated with unpleasant sensations.

But some basic features of itch remained unexplained—features that make itch a uniquely revealing case study. On the one hand, our bodies are studded with receptors for itch, as they are with receptors for touch, pain, and other sensations; this provides an alarm system for harm and allows us to safely navigate the world. But why does a feather brushed across the skin sometimes itch and at other times tickle? (Tickling has a social component: you can make yourself itch, but only another person can tickle you.) And, even more puzzling, how is it that you can make yourself itchy just by thinking about it?

Contemplating what it’s like to hold your finger in a flame won’t make your finger hurt. But simply writing about a tick crawling up the nape of one’s neck is enough to start my neck itching. Then my scalp. And then this one little spot along my flank where I’m beginning to wonder whether I should check to see if there might be something there. In one study, a German professor of psychosomatics gave a lecture that included, in the first half, a series of what might be called itchy slides, showing fleas, lice, people scratching, and the like, and, in the second half, more benign slides, with pictures of soft down, baby skin, bathers. Video cameras recorded the audience. Sure enough, the frequency of scratching among people in the audience increased markedly during the first half and decreased during the second. Thoughts made them itch.

We now have the nerve map for itching, as we do for other sensations. But a deeper puzzle remains: how much of our sensations and experiences do nerves really explain?

In the operating room, a neurosurgeon washed out and debrided M.’s wound, which had become infected. Later, a plastic surgeon covered it with a graft of skin from her thigh. Though her head was wrapped in layers of gauze and she did all she could to resist the still furious itchiness, she awoke one morning to find that she had rubbed the graft away. The doctors returned her to the operating room for a second skin graft, and this time they wrapped her hands as well. She rubbed it away again anyway.

“They kept telling me I had O.C.D.,” M. said. A psychiatric team was sent in to see her each day, and the resident would ask her, “As a child, when you walked down the street did you count the lines? Did you do anything repetitive? Did you have to count everything you saw?” She kept telling him no, but he seemed skeptical. He tracked down her family and asked them, but they said no, too. Psychology tests likewise ruled out obsessive-compulsive disorder. They showed depression, though, and, of course, there was the history of addiction. So the doctors still thought her scratching was from a psychiatric disorder. They gave her drugs that made her feel logy and sleep a lot. But the itching was as bad as ever, and she still woke up scratching at that terrible wound.

One morning, she found, as she put it, “this very bright and happy-looking woman standing by my bed. She said, ‘I’m Dr. Oaklander,’ ” M. recalled. “I thought, Oh great. Here we go again. But she explained that she was a neurologist, and she said, ‘The first thing I want to say to you is that I don’t think you’re crazy. I don’t think you have O.C.D.’ At that moment, I really saw her grow wings and a halo,” M. told me. “I said, ‘Are you sure?’ And she said, ‘Yes. I have heard of this before.’ ”

Anne Louise Oaklander was about the same age as M. Her mother is a prominent neurologist at Albert Einstein College of Medicine, in New York, and she’d followed her into the field. Oaklander had specialized in disorders of peripheral nerve sensation—disorders like shingles. Although pain is the most common symptom of shingles, Oaklander had noticed during her training that some patients also had itching, occasionally severe, and seeing M. reminded her of one of her shingles patients. “I remember standing in a hallway talking to her, and what she complained about—her major concern—was that she was tormented by this terrible itch over the eye where she had had shingles,” she told me. When Oaklander looked at her, she thought that something wasn’t right. It took a moment to realize why. “The itch was so severe, she had scratched off her eyebrow.”

Oaklander tested the skin near M.’s wound. It was numb to temperature, touch, and pinprick. Nonetheless, it was itchy, and when it was scratched or rubbed M. felt the itchiness temporarily subside. Oaklander injected a few drops of local anesthetic into the skin. To M.’s surprise, the itching stopped—instantly and almost entirely. This was the first real relief she’d had in more than a year.

It was an imperfect treatment, though. The itch came back when the anesthetic wore off, and, although Oaklander tried having M. wear an anesthetic patch over the wound, the effect diminished over time. Oaklander did not have an explanation for any of this. When she took a biopsy of the itchy skin, it showed that ninety-six per cent of the nerve fibres were gone. So why was the itch so intense?

Oaklander came up with two theories. The first was that those few remaining nerve fibres were itch fibres and, with no other fibres around to offer competing signals, they had become constantly active. The second theory was the opposite. The nerves were dead, but perhaps the itch system in M.’s brain had gone haywire, running on a loop all its own.

The second theory seemed less likely. If the nerves to her scalp were dead, how would you explain the relief she got from scratching, or from the local anesthetic? Indeed, how could you explain the itch in the first place? An itch without nerve endings didn’t make sense. The neurosurgeons stuck with the first theory; they offered to cut the main sensory nerve to the front of M.’s scalp and abolish the itching permanently. Oaklander, however, thought that the second theory was the right one—that this was a brain problem, not a nerve problem—and that cutting the nerve would do more harm than good. She argued with the neurosurgeons, and she advised M. not to let them do any cutting.

“But I was desperate,” M. told me. She let them operate on her, slicing the supraorbital nerve above the right eye. When she woke up, a whole section of her forehead was numb—and the itching was gone. A few weeks later, however, it came back, in an even wider expanse than before. The doctors tried pain medications, more psychiatric medications, more local anesthetic. But the only thing that kept M. from tearing her skin and skull open again, the doctors found, was to put a foam football helmet on her head and bind her wrists to the bedrails at night.

She spent the next two years committed to a locked medical ward in a rehabilitation hospital—because, although she was not mentally ill, she was considered a danger to herself. Eventually, the staff worked out a solution that did not require binding her to the bedrails. Along with the football helmet, she had to wear white mitts that were secured around her wrists by surgical tape. “Every bedtime, it looked like they were dressing me up for Halloween—me and the guy next to me,” she told me.

“The guy next to you?” I asked. He had had shingles on his neck, she explained, and also developed a persistent itch. “Every night, they would wrap up his hands and wrap up mine.” She spoke more softly now. “But I heard he ended up dying from it, because he scratched into his carotid artery.”

I met M. seven years after she’d been discharged from the rehabilitation hospital. She is forty-eight now. She lives in a three-room apartment, with a crucifix and a bust of Jesus on the wall and the low yellow light of table lamps strung with beads over their shades. Stacked in a wicker basket next to her coffee table were Rick Warren’s “The Purpose Driven Life,” People, and the latest issue of Neurology Now, a magazine for patients. Together, they summed up her struggles, for she is still fighting the meaninglessness, the isolation, and the physiology of her predicament.

She met me at the door in a wheelchair; the injury to her brain had left her partially paralyzed on the left side of her body. She remains estranged from her children. She has not, however, relapsed into drinking or drugs. Her H.I.V. remains under control. Although the itch on her scalp and forehead persists, she has gradually learned to protect herself. She trims her nails short. She finds ways to distract herself. If she must scratch, she tries to rub gently instead. And, if that isn’t enough, she uses a soft toothbrush or a rolled-up terry cloth. “I don’t use anything sharp,” she said. The two years that she spent bound up in the hospital seemed to have broken the nighttime scratching. At home, she found that she didn’t need to wear the helmet and gloves anymore.

Still, the itching remains a daily torment. “I don’t normally tell people this,” she said, “but I have a fantasy of shaving off my eyebrow and taking a metal-wire grill brush and scratching away.”

Some of her doctors have not been willing to let go of the idea that this has been a nerve problem all along. A local neurosurgeon told her that the original operation to cut the sensory nerve to her scalp must not have gone deep enough. “He wants to go in again,” she told me.

A new scientific understanding of perception has emerged in the past few decades, and it has overturned classical, centuries-long beliefs about how our brains work—though it has apparently not penetrated the medical world yet. The old understanding of perception is what neuroscientists call “the naïve view,” and it is the view that most people, in or out of medicine, still have. We’re inclined to think that people normally perceive things in the world directly. We believe that the hardness of a rock, the coldness of an ice cube, the itchiness of a sweater are picked up by our nerve endings, transmitted through the spinal cord like a message through a wire, and decoded by the brain.

In a 1710 “Treatise Concerning the Principles of Human Knowledge,” the Irish philosopher George Berkeley objected to this view. We do not know the world of objects, he argued; we know only our mental ideas of objects. “Light and colours, heat and cold, extension and figures—in a word, the things we see and feel—what are they but so many sensations, notions, ideas?” Indeed, he concluded, the objects of the world are likely just inventions of the mind, put in there by God. To which Samuel Johnson famously responded by kicking a large stone and declaring, “I refute it thus!”

Still, Berkeley had recognized some serious flaws in the direct-perception theory—in the notion that when we see, hear, or feel we are just taking in the sights, sounds, and textures of the world. For one thing, it cannot explain how we experience things that seem physically real but aren’t: sensations of itching that arise from nothing more than itchy thoughts; dreams that can seem indistinguishable from reality; phantom sensations that amputees have in their missing limbs. And, the more we examine the actual nerve transmissions we receive from the world outside, the more inadequate they seem.

Our assumption had been that the sensory data we receive from our eyes, ears, nose, fingers, and so on contain all the information that we need for perception, and that perception must work something like a radio. It’s hard to conceive that a Boston Symphony Orchestra concert is in a radio wave. But it is. So you might think that it’s the same with the signals we receive—that if you hooked up someone’s nerves to a monitor you could watch what the person is experiencing as if it were a television show.

Yet, as scientists set about analyzing the signals, they found them to be radically impoverished. Suppose someone is viewing a tree in a clearing. Given simply the transmissions along the optic nerve from the light entering the eye, one would not be able to reconstruct the three-dimensionality, or the distance, or the detail of the bark—attributes that we perceive instantly.

Or consider what neuroscientists call “the binding problem.” Tracking a dog as it runs behind a picket fence, all that your eyes receive is separated vertical images of the dog, with large slices missing. Yet somehow you perceive the mutt to be whole, an intact entity travelling through space. Put two dogs together behind the fence and you don’t think they’ve morphed into one. Your mind now configures the slices as two independent creatures.

The images in our mind are extraordinarily rich. We can tell if something is liquid or solid, heavy or light, dead or alive. But the information we work from is poor—a distorted, two-dimensional transmission with entire spots missing. So the mind fills in most of the picture. You can get a sense of this from brain-anatomy studies. If visual sensations were primarily received rather than constructed by the brain, you’d expect that most of the fibres going to the brain’s primary visual cortex would come from the retina. Instead, scientists have found that only twenty per cent do; eighty per cent come downward from regions of the brain governing functions like memory. Richard Gregory, a prominent British neuropsychologist, estimates that visual perception is more than ninety per cent memory and less than ten per cent sensory nerve signals. When Oaklander theorized that M.’s itch was endogenous, rather than generated by peripheral nerve signals, she was onto something important.

The fallacy of reducing perception to reception is especially clear when it comes to phantom limbs. Doctors have often explained such sensations as a matter of inflamed or frayed nerve endings in the stump sending aberrant signals to the brain. But this explanation should long ago have been suspect. Efforts by surgeons to cut back on the nerve typically produce the same results that M. had when they cut the sensory nerve to her forehead: a brief period of relief followed by a return of the sensation.

Moreover, the feelings people experience in their phantom limbs are far too varied and rich to be explained by the random firings of a bruised nerve. People report not just pain but also sensations of sweatiness, heat, texture, and movement in a missing limb. There is no experience people have with real limbs that they do not experience with phantom limbs. They feel their phantom leg swinging, water trickling down a phantom arm, a phantom ring becoming too tight for a phantom digit. Children have used phantom fingers to count and solve arithmetic problems. V. S. Ramachandran, an eminent neuroscientist at the University of California, San Diego, has written up the case of a woman who was born with only stumps at her shoulders, and yet, as far back as she could remember, felt herself to have arms and hands; she even feels herself gesticulating when she speaks. And phantoms do not occur just in limbs. Around half of women who have undergone a mastectomy experience a phantom breast, with the nipple being the most vivid part. You’ve likely had an experience of phantom sensation yourself. When the dentist gives you a local anesthetic, and your lip goes numb, the nerves go dead. Yet you don’t feel your lip disappear. Quite the opposite: it feels larger and plumper than normal, even though you can see in a mirror that the size hasn’t changed.

The account of perception that’s starting to emerge is what we might call the “brain’s best guess” theory of perception: perception is the brain’s best guess about what is happening in the outside world. The mind integrates scattered, weak, rudimentary signals from a variety of sensory channels, information from past experiences, and hard-wired processes, and produces a sensory experience full of brain-provided color, sound, texture, and meaning. We see a friendly yellow Labrador bounding behind a picket fence not because that is the transmission we receive but because this is the perception our weaver-brain assembles as its best hypothesis of what is out there from the slivers of information we get. Perception is inference.

The theory—and a theory is all it is right now—has begun to make sense of some bewildering phenomena. Among them is an experiment that Ramachandran performed with volunteers who had phantom pain in an amputated arm. They put their surviving arm through a hole in the side of a box with a mirror inside, so that, peering through the open top, they would see their arm and its mirror image, as if they had two arms. Ramachandran then asked them to move both their intact arm and, in their mind, their phantom arm—to pretend that they were conducting an orchestra, say. The patients had the sense that they had two arms again. Even though they knew it was an illusion, it provided immediate relief. People who for years had been unable to unclench their phantom fist suddenly felt their hand open; phantom arms in painfully contorted positions could relax. With daily use of the mirror box over weeks, patients sensed their phantom limbs actually shrink into their stumps and, in several instances, completely vanish. Researchers at Walter Reed Army Medical Center recently published the results of a randomized trial of mirror therapy for soldiers with phantom-limb pain, showing dramatic success.

A lot about this phenomenon remains murky, but here’s what the new theory suggests is going on: when your arm is amputated, nerve transmissions are shut off, and the brain’s best guess often seems to be that the arm is still there, but paralyzed, or clenched, or beginning to cramp up. Things can stay like this for years. The mirror box, however, provides the brain with new visual input—however illusory—suggesting motion in the absent arm. The brain has to incorporate the new information into its sensory map of what’s happening. Therefore, it guesses again, and the pain goes away.

The new theory may also explain what was going on with M.’s itch. The shingles destroyed most of the nerves in her scalp. And, for whatever reason, her brain surmised from what little input it had that something horribly itchy was going on—that perhaps a whole army of ants were crawling back and forth over just that patch of skin. There wasn’t any such thing, of course. But M.’s brain has received no contrary signals that would shift its assumptions. So she itches.

Not long ago, I met a man who made me wonder whether such phantom sensations are more common than we realize. H. was forty-eight, in good health, an officer at a Boston financial-services company living with his wife in a western suburb, when he made passing mention of an odd pain to his internist. For at least twenty years, he said, he’d had a mild tingling running along his left arm and down the left side of his body, and, if he tilted his neck forward at a particular angle, it became a pronounced, electrical jolt. The internist recognized this as Lhermitte’s sign, a classic symptom that can indicate multiple sclerosis, Vitamin B12 deficiency, or spinal-cord compression from a tumor or a herniated disk. An MRI revealed a cavernous hemangioma, a pea-size mass of dilated blood vessels, pressing into the spinal cord in his neck. A week later, while the doctors were still contemplating what to do, it ruptured.

“I was raking leaves out in the yard and, all of a sudden, there was an explosion of pain and my left arm wasn’t responding to my brain,” H. said when I visited him at home. Once the swelling subsided, a neurosurgeon performed a tricky operation to remove the tumor from the spinal cord. The operation was successful, but afterward H. began experiencing a constellation of strange sensations. His left hand felt cartoonishly large—at least twice its actual size. He developed a constant burning pain along an inch-wide ribbon extending from the left side of his neck all the way down his arm. And an itch crept up and down along the same band, which no amount of scratching would relieve.

H. has not accepted that these sensations are here to stay—the prospect is too depressing—but they’ve persisted for eleven years now. Although the burning is often tolerable during the day, the slightest thing can trigger an excruciating flareup—a cool breeze across the skin, the brush of a shirtsleeve or a bedsheet. “Sometimes I feel that my skin has been flayed and my flesh is exposed, and any touch is just very painful,” he told me. “Sometimes I feel that there’s an ice pick or a wasp sting. Sometimes I feel that I’ve been splattered with hot cooking oil.”

For all that, the itch has been harder to endure. H. has developed calluses from the incessant scratching. “I find I am choosing itch relief over the pain that I am provoking by satisfying the itch,” he said.

He has tried all sorts of treatments—medications, acupuncture, herbal remedies, lidocaine injections, electrical-stimulation therapy. But nothing really worked, and the condition forced him to retire in 2001. He now avoids leaving the house. He gives himself projects. Last year, he built a three-foot stone wall around his yard, slowly placing the stones by hand. But he spends much of his day, after his wife has left for work, alone in the house with their three cats, his shirt off and the heat turned up, trying to prevent a flareup.

His neurologist introduced him to me, with his permission, as an example of someone with severe itching from a central rather than a peripheral cause. So one morning we sat in his living room trying to puzzle out what was going on. The sun streamed in through a big bay window. One of his cats, a scraggly brown tabby, curled up beside me on the couch. H. sat in an armchair in a baggy purple T-shirt he’d put on for my visit. He told me that he thought his problem was basically a “bad switch” in his neck where the tumor had been, a kind of loose wire sending false signals to his brain. But I told him about the increasing evidence that our sensory experiences are not sent to the brain but originate in it. When I got to the example of phantom-limb sensations, he perked up. The experiences of phantom-limb patients sounded familiar to him. When I mentioned that he might want to try the mirror-box treatment, he agreed. “I have a mirror upstairs,” he said.

He brought a cheval glass down to the living room, and I had him stand with his chest against the side of it, so that his troublesome left arm was behind it and his normal right arm was in front. He tipped his head so that when he looked into the mirror the image of his right arm seemed to occupy the same position as his left arm. Then I had him wave his arms, his actual arms, as if he were conducting an orchestra.

The first thing he expressed was disappointment. “It isn’t quite like looking at my left hand,” he said. But then suddenly it was.

“Wow!” he said. “Now, this is odd.”

After a moment or two, I noticed that he had stopped moving his left arm. Yet he reported that he still felt as if it were moving. What’s more, the sensations in it had changed dramatically. For the first time in eleven years, he felt his left hand “snap” back to normal size. He felt the burning pain in his arm diminish. And the itch, too, was dulled.

“This is positively bizarre,” he said.

He still felt the pain and the itch in his neck and shoulder, where the image in the mirror cut off. And, when he came away from the mirror, the aberrant sensations in his left arm returned. He began using the mirror a few times a day, for fifteen minutes or so at a stretch, and I checked in with him periodically.

“What’s most dramatic is the change in the size of my hand,” he says. After a couple of weeks, his hand returned to feeling normal in size all day long.

The mirror also provided the first effective treatment he has had for the flares of itch and pain that sporadically seize him. Where once he could do nothing but sit and wait for the torment to subside—it sometimes took an hour or more—he now just pulls out the mirror. “I’ve never had anything like this before,” he said. “It’s my magic mirror.”

There have been other, isolated successes with mirror treatment. In Bath, England, several patients suffering from what is called complex regional pain syndrome—severe, disabling limb sensations of unknown cause—were reported to have experienced complete resolution after six weeks of mirror therapy. In California, mirror therapy helped stroke patients recover from a condition known as hemineglect, which produces something like the opposite of a phantom limb—these patients have a part of the body they no longer realize is theirs.

Such findings open up a fascinating prospect: perhaps many patients whom doctors treat as having a nerve injury or a disease have, instead, what might be called sensor syndromes. When your car’s dashboard warning light keeps telling you that there is an engine failure, but the mechanics can’t find anything wrong, the sensor itself may be the problem. This is no less true for human beings. Our sensations of pain, itch, nausea, and fatigue are normally protective. Unmoored from physical reality, however, they can become a nightmare: M., with her intractable itching, and H., with his constellation of strange symptoms—but perhaps also the hundreds of thousands of people in the United States alone who suffer from conditions like chronic back pain, fibromyalgia, chronic pelvic pain, tinnitus, temporomandibular joint disorder, or repetitive strain injury, where, typically, no amount of imaging, nerve testing, or surgery manages to uncover an anatomical explanation. Doctors have persisted in treating these conditions as nerve or tissue problems—engine failures, as it were. We get under the hood and remove this, replace that, snip some wires. Yet still the sensor keeps going off.

So we get frustrated. “There’s nothing wrong,” we’ll insist. And, the next thing you know, we’re treating the driver instead of the problem. We prescribe tranquillizers, antidepressants, escalating doses of narcotics. And the drugs often do make it easier for people to ignore the sensors, even if they are wired right into the brain. The mirror treatment, by contrast, targets the deranged sensor system itself. It essentially takes a misfiring sensor—a warning system functioning under an illusion that something is terribly wrong out in the world it monitors—and feeds it an alternate set of signals that calm it down. The new signals may even reset the sensor.

This may help explain, for example, the success of the advice that back specialists now commonly give. Work through the pain, they tell many of their patients, and, surprisingly often, the pain goes away. It had been a mystifying phenomenon. But the picture now seems clearer. Most chronic back pain starts as an acute back pain—say, after a fall. Usually, the pain subsides as the injury heals. But in some cases the pain sensors continue to light up long after the tissue damage is gone. In such instances, working through the pain may offer the brain contradictory feedback—a signal that ordinary activity does not, in fact, cause physical harm. And so the sensor resets.

This understanding of sensation points to an entire new array of potential treatments—based not on drugs or surgery but, instead, on the careful manipulation of our perceptions. Researchers at the University of Manchester, in England, have gone a step beyond mirrors and fashioned an immersive virtual-reality system for treating patients with phantom-limb pain. Detectors transpose movement of real limbs into a virtual world where patients feel they are actually moving, stretching, even playing a ballgame. So far, five patients have tried the system, and they have all experienced a reduction in pain. Whether those results will last has yet to be established. But the approach raises the possibility of designing similar systems to help patients with other sensor syndromes. How, one wonders, would someone with chronic back pain fare in a virtual world? The Manchester study suggests that there may be many ways to fight our phantoms.

I called Ramachandran to ask him about M.’s terrible itch. The sensation may be a phantom, but it’s on her scalp, not in a limb, so it seemed unlikely that his mirror approach could do anything for her. He told me about an experiment in which he put ice-cold water in people’s ears. This confuses the brain’s position sensors, tricking subjects into thinking that their heads are moving, and in certain phantom-limb and stroke patients the illusion corrected their misperceptions, at least temporarily. Maybe this would help M., he said. He had another idea. If you take two mirrors and put them at right angles to each other, you will get a non-reversed mirror image. Looking in, the right half of your face appears on the left and the left half appears on the right. But unless you move, he said, your brain may not realize that the image is flipped.

“Now, suppose she looks in this mirror and scratches the left side of her head. No, wait—I’m thinking out loud here—suppose she looks and you have someone else touch the left side of her head. It’ll look—maybe it’ll feel—like you’re touching the right side of her head.” He let out an impish giggle. “Maybe this would make her itchy right scalp feel more normal.” Maybe it would encourage her brain to make a different perceptual inference; maybe it would press reset. “Who knows?” he said.

It seemed worth a try. ♦