Secondary Care, Social Beliefs, and Scientific Inquiry
Joeseph Manring
Southern Utah University
Capstone: Biology of Disease
October 28, 2016
Introduction
Scientists and healthcare professionals often live, work, and socialize within primarily academic circles. As a result of this, the discovery that serves as a driver for our professions does not efficiently permeate into the vast majority of our communities, and there is often a time delay between the acquisition and application of new ideas. In this literature review, I intend to bridge some of the gap between these two instances. While this manuscript may be of some interest to those in the health and science fields, its primary intent is to provide insight for those who do not directly play a role in these fields. Specifically, persons who are involved in secondary care (special needs, geriatrics, disabled care, weight loss) will find a summary of some of the relevant information that is directed towards their fields. Finally, we will survey some of the literature that has been directed towards societally accepted beliefs and tradition, as we inquire into their roots, costs, or benefits.
Health Considerations for Secondary Care Providers
Perseveration is commonly described as being the most disruptive symptom of autism and is known to make it more difficult for affected individuals to socially interact. It is most simply defined as any repetitive action and can include repetitive language, the inability to change topics, repeating body language, and many other behaviors (Arora, 2012). Perseveration is very common amongst individuals who are considered to be within the autism spectrum and just as severity of autism varies greatly, so too does the severity of behavioral perseverance. This is not to say that this behavior is unique to those on the autism spectrum; it is seen in many other cognitive disorders as well. Beyond their personal difficulty in interacting with others, it can often cause other parties to stigmatize the autistic individual as well. This logic can easily be followed when children with autism are observed in a classroom. Their perseverance is often seen as disruptive and even if it is understood that they have a developmental disorder, their inclusion in the learning environment can diminish greatly as a result. In addition, perseveration is often erroneously interpreted as an expression of diminished cognitive function. This is not the case, and the available research seems to indicate that the perseverative behavior is a symptom caused by some problem with their ability to process sensory information. Despite this fact, it is worth noting that the root cause of perseveration in individuals with autism is not entirely understood. Pharmaceutical approaches to treatment are being successfully applied to minimize the problems associated with perseverative behaviors, but a better understanding of the root cause is clearly necessary in order to cultivate the best possible outcome for individuals on the autism spectrum. Importantly, teachers and care providers should ensure that they are adequately addressing the unique needs of these people, and they should also be wary of the widely accepted notions surrounding autism.
Alzheimer’s is a neurodegenerative disease that has no known cure. There are many mechanisms within the body that are suspect, but there is a volume of research that suggests that Alzheimer’s may be related to type-2 diabetes mellitus. Both of these diseases have been linked to old age and until relatively recently, it was generally (and erroneously) assumed that this was simply a coincidental relationship. Some of the available literature shows that diabetes can be a causative agent in generating plaques in the blood vessels (atherosclerosis), and this has been proposed to be one of the links between neurodegenerative disorders (such as dementia) and diabetes. This alone however, does not account for the particular issues that manifest within the brain of an individual afflicted with Alzheimer’s disease (Akter, 2011). There is an incredible amount of research into how diabetes may play a role in generating Alzheimer’s pathology but no definitive cause has been agreed upon within the scientific community. In acknowledging that there is such a strong association it has been argued that Alzheimer’s should be considered to be an extension of diabetes. Often, younger people with diabetes have a very relaxed attitude regarding their care and do not fully understand the severity of their illness. Those who are involved in providing any sort of care to the elderly should be familiar with these ideas and in general it should be widely understood that proper diabetes treatment is of utmost importance.
Under normal physiological conditions a protein called myelin coats the outside of long nerve fibres. Myelin is a very nonpolar, waxy protein that provides additional functionality to nerves by preventing charges from escaping or entering the axon (the long “wire” portion of the nerve that sends information). This means that signals produced by the axon hillock are preserved for longer conduction while false signals, that would typically result from salts on the outside of a nerve, are minimized. In multiple sclerosis, the myelin decays and this functionality is lost. The result is that individuals with multiple sclerosis experience a deterioration of motor functions, and eventually life preserving functions such as respiration. The precise biological mechanisms that cause multiple sclerosis are still not known, but it is a vibrant and very active area of research. There are several proposed mechanisms that this effect may be resulting from, including malfunction in myelin production, and autoimmune destruction of the myelin. In any case, the result is very clear and unfortunate for those afflicted. Recent studies have also shown that the disease extends into the unmyelinated regions of the central nervous system, which suggests to me that there may be an autoimmune component to the disease (Damasceno, 2014). It has been shown that even in patients with multiple sclerosis in remission, the neural decay is substantial enough to cause a significant depreciation in cognitive functions. If researcher can find ways to approach one of the pathological elements of multiple sclerosis, the outlook for patients would be much better. Preventing grey matter atrophy would allow for individuals to be cognizant for the rest of their lives, while a preservation of the myelin would extend their life. Either of these, and many other areas, deserve time and attention from researchers.
In modern civilization we have access to incredibly high energy food sources, and we really don’t have to physically work very hard to get it. This is a large contributor to the obesity epidemic in our country, but there may be other factors at play. Researchers across the globe have been looking at the normal bacteria of a human gut so that we can understand certain relationships that the internal microbiome has when compared to weight gain. In addition, we needed to determine whether the microbiota influence weight gain, or if weight alterations influence the composition of the bacteria living in our gut. The answer, as we always expect from a biological system, is a little of both. Throughout a one year weight loss program, the fecal microbiota of the participants was monitored to see if the ratios of bacterial species to one another, could be associated with weight loss of the host. As the participants lost weight, the ratio of two specific species of bacteria(Bacteroidetes to Firmicutes) in the participants changed drastically. In contrast to this result, changing the ratio of Bacteroidetes to Firmicutes via fecal transplant in mice was able to cause weight change in the mice. After moving bacteria cultivated from obese mice into normal mice, the normal mice gained weight. Some studies have shown that specific probiotics can also induce a change in the bacteria ratios in a human gut, but to date there is no precise way of knowing how a given probiotic will affect an individual's gut microbiota. If we can devise a reliable method of gut ecology management in the future, it may provide a novel method of treating or stemming the insurgence of obesity in our society. In the meantime, it is important to understand that there are often additional barriers to weight loss that some people will have to overcome and that the road to healthy living is longer for some individuals as a result.
Scientific Inquiry and Tradition
Given the widespread consumption of probiotic products across the country, as well as the lax definition that is attributed to them, they are a subject that deserves some exploration. The efficacy of probiotics in maintaining digestive system health is widely accepted in society, but is hotly debated within the scientific community. In older adults gastrointestinal issues are very common, but very little is known about the biological mechanisms that are behind this depreciation of gut function. In a study of elderly adults with gastrointestinal inconsistency, subjects were given a supplement that contained the bacteria Lactobacillus reuteri, and patients were provided a questionnaire periodically for 12 weeks. This questionnaire asked questions about stool consistency, general feelings of health, anxiety, depression, and other factors that researchers could analyze to generate a view of the gastrointestinal health of the patients. In the end, this particular study could not find any statistical differences between the patients who were given L. reuteri and those who were given a placebo. Indeed, this would seem to indicate that, at least in this particular case, probiotics just don’t work. This is not the end of the argument though, as other bacterial strains have been tested and confirmed to generate some degree of health benefit. It can therefore be concluded that we actually do not understand what the ideal balance of bacteria in the human gut is, and that probiotics have mixed effects because we simply do not understand how they work. More research is needed but I feel confident ascertaining from this, that a refined definition of “probiotic” is necessary before it should be used a marketable term, as you often just have no idea what you’re buying.
For a very long time, physicians believed that stomach ulcers were the result of stress, poor diet, or lifestyle choices. It wasn’t until 2005 that was accepted that there is a bacterium that directly causes stomach and intestinal ulcers. The number of diseases that Helicobacter pylori has been implicated in is impressive; chronic superficial gastritis, chronic active gastritis, peptic ulcers, and gastric adenocarcinoma (Ahmed, 2005). It has been shown that H. pylori is the cause of ~90% of stomach ulcers and ~80% of gastric ulcers. The discovery that Helicobacter pylori causes gastric issues was made by Barry Marshall and Robin Warren, but it was not readily accepted by the scientific community. In order to overcome the immense resistance that they received, Marshall actually subjected himself to a gastric biopsy in 1985 so that he could provide evidence that he was not infected with the bacteria. He then purposely infected himself with H. pylori and histologically showed that he was contracting a gastric illness. This study showed without any doubt that Helicobacter pylori is the direct cause of some gastric issues. After their publication was released, debates continued about the function of H. pylori with some even arguing that the bacterium is, in some cases, a symbiont to humans. Subsequent studies showed that it does indeed help to maintain a physiologically beneficial pH in the stomach, and that it reduces incidences of diarrhea in children. Of course, it should be recognized that this pathogen does directly contribute to the production of cancer and any beneficial effect that we gain from H. pylori almost certainly does not outweigh this fact. There are many people that still believe they can self treat their suspected ulcers and digestive maladies, and it should become more widely known that the only treatment for ~90% of ulcers is antibiotics. Reducing stress, changing your diet, or consuming probiotics will not kill an infection that is living in your gut and not only is it painful, but it could be giving you cancer.
Historically, Ayurveda is a holistic healing practice that originated in India. It encompasses surgical procedures, mental health, possession, the production of tonics, and any other (even remotely) health related field. Some practices originally designed by Ayurvedic healers have been adopted by modern medicine practitioners, and there are still Ayurvedic healers to this day. Despite the adoption of some traditional medicine practices, it should be acknowledged that not all traditional healing would be considered to be beneficial by modern western medicine. Since Ayurveda is still practiced by some people, it is of medical interest to investigate methods and compounds used for healthcare and medicine. Like many other cultures, Ayurvedic healers use traditional herbal drugs in their patient treatment. Even though herbal treatments are typically well established due to their observed positive effects, modern diagnostic procedures allow us to also evaluate the toxicity of these medicines. Specifically, heavy metals are known to be incredibly toxic when they reach high concentrations in the body and if medicinal herbs contain them, long term use would be invariably unhealthy. It is for this reason that trace metal analysis was performed on eight of the most commonly used medicinal plants in Ayurvedic medicine (Nema, 2014). The results of this analysis actually showed that the plants were supplementing patients with some essential elements that are not common in their natural diets, and that any toxic elements would be consumed at a satisfactorily low level under normal use. Thus we can conclude that in the specific example of Ayurvedic medicine, traditional medicines do not appreciably contribute to toxicity in their patients. This is not true across all forms of holistic and traditional medicine, of course, but it may be an indication that some Ayurvedic medicines should now be investigated for their efficacy and method of action in the constant search for novel disease treatments.
Prion diseases are interesting, in that the infectious agent is a not a living organism at all: it is a single protein. These diseases often remain symptomless in their host for many years before their effects are noticeable, and the damage to the brain is already severe. A prion is in essence, a misfolded protein that becomes less accessible to the normal protein digestion processes of the body, such that it is unlikely to be naturally removed. When it contacts other correctly folded proteins of the same type, a favorable interaction between the two can occur to generate the misfolded version. This cascading type of interaction eventually builds plaques in the small blood vessels of the brain that prevent proper nutrient exchange. The brain deteriorates as a result of limited waste removal and nutrient delivery to the tissue, and the signature spongiform encephalopathy (“holes” in the brain where there used to be living tissue) of prion disease begins to develop. Prion disease is invariably fatal, though the time that it requires to kill an individual can fluctuate. There is a small group of closely related prion diseases that affect humans by acting on the same glycoprotein (PrP) in the brain, and these are of great concern because we have observed epidemics that resulted from at least two of them. One well known and studied example of this occurred amongst a group of cannibals in Papua, New Guinea. These people stopped using cannibalism in their funeral practices in the late 1950’s, but individuals with Kuru were found as recently as June, 2004. It was shown as a result, that the dormant period of prion disease can be upwards of 50 years. This is particularly concerning because we have learned that prion diseases can often traverse between species’ with ease. One example of this is bovine spongiform encephalopathy; commonly known as Mad Cow disease.
Across Europe we have observed the spread of a specific variant of Creutzfeldt-Jakob disease. Analysis of the disease has shown that it is actually the same strain of prion that caused the outbreak of Mad Cow disease (Collinge, 2006). Mad Cow disease infected approximately 2 million animals, and the results of consuming the infected cattle are still being seen in the form of a rise in variant Creutzfeldt-Jakob disease. Exposure was not limited to Europe, and the spread of the disease is being observed worldwide. In addition to this, we do not have a firm understanding of exactly how long this particular prion disease can remain dormant, so the scale of the effect on humans is still unclear. Typically, the symptoms of variant Creutzfeldt-Jakob are much more quickly expressed than those of the typical version of the illness, but our knowledge of the disease is still incomplete. This point is greatly illuminated by the fact that we are still studying Kuru over 50 years after the initial epidemic exposure. As a result of these studies, we know that the rate at which any individual shows symptoms of prion disease is greatly affected by both genetic and environmental factors. The cumulative effects of human consumption of bovine spongiform encephalopathy are yet to be tabulated, and one should expect that due to the nature of the disease, this will remain the case for some time.
Conclusions
Socially accepted beliefs are very difficult to change once they have been integrated into a culture. Our culture is a very unique one, in that there is such a sharp division between social groups and it is sad and shameful that there is such separation between academia and the general populous. That rift has the potential to shrink as we become increasingly bound to each other via technology, but we have not seen if the spread of misinformation outpaces knowledge by any wide margin. This article (and the forum on which it is hosted), while broad and generalized, is one such attempt at breaching the social divide, but it will do little without the interest of other subcultures. A public forum in theory is a marvelous platform for the spread of ideas, but in practice means little until interest is garnered. Until that goal is reached, socially constructed stigmas about weight, disability, superstition and the like, will regrettably continue to be the foremost intellectual currency as we move forward.
Works Cited
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