Danny's Weblog

2005 Nov 20 [ Sun ]

Bird flu death rates (I got the flu last week)

As far as I can tell, I only got the common-or-garden variety flu, but it certainly made me think about bird flu.

First: apparently, this time of year is the season to get the flu in Cambodia. It seems a little strange that you would still get the flu in a cold season when it's hotter than the hot season in temperate areas, but oh well.

My symptoms started off with a sore throat, which I thought was something else entirely: then I felt very tired and had to more or less lie down for a day, and then the idea of flu seemed pretty clear. I felt relatively OK after about 36 hours and was able to putter around to check email and whatnot. (Actually, it might well have been a heavy cold, as I never felt feverish.)

However, I started to wonder what was going on when my girlfriend got something similar, but with different symptoms. She didn't get much tiredness, but complained of headaches and sore eyes. Also, her sore throat lasted much longer, and she had fever.

So I started checking into bird flu (there is a commercial chicken farm on my street). It turns out that initially there are no real differences from regular flu symptoms, up until people get close to death and need to be hospitalized. Regular flu does have a wide range of symptoms – the sore eyes thing, conjunctivitis, is apparently quite common although I don't remember it in my own experience – and they blend into the symptoms of bird flu.

So that makes me wonder a lot about the published death rates for bird flu – around 50% (gulp!). Why shouldn't there have been *many, many* cases of bird flu which were never identified as being anything out of the ordinary? Chinese spokesmen refuse to listen to questions about their reporting procedures, but there was a report I saw in the IHT which suggested that testing of blood samples revealed that millions of Chinese had antibodies to H5N1 in their bloodstream *years* ago. I wonder how many people with *regular* flu develop life-threatening symptoms and then die? We probably have a good estimate of the overall (lethal and non-lethal) incidence of regular flu, but do we actually have one for bird flu? I've seen no reports at all that the authorities are doing sampling on *all* flu victims in the affected areas.

So I think it's entirely possible that the death rate is actually *no higher than other flu varieties*.

2005 Sep 21 [ Wed ]

Acne: interesting blog page with suggestions on self-help

I've *always* had some acne. It was never really terrible, but it was often embarrassing. Doctors were useless and punitive: "Here, put on this cream three times a day although a single time makes your face raw, itchy, painful and swollen! Oh, you don't want to eh! Well get lost, loser!"

I never had acne rosacea so my comments relate basically to acne vulgaris.

If I had the chance to give my younger self some advice, I think I'd say this:

1. Benzol peroxide works. It does exfoliate the skin, but for me almost without irritation. It was wonderful when I discovered it.

2. Change sheets and pillows frequently.

3. Use small, cheap face towels so you can use them only once before washing them.

4. Never use soap on the skin, or shampoo. That sounds pretty off-the-wall, but I think now that soap is just too harsh and drying, and is the direct cause of excessive oil production. Shampoo contains many weird ingredients, including in most cases sugar; if you must use shampoo, avoid allowing the rinse water to flow across the face and back, and rinse *very throughly*. Water is sufficient to make the skin clean and fresh-smelling: my own skin smells much better (and less) when I use no soap.

If you think that sounds nuts, take a look at this mainstream guide to skin health and *think* about what it says: www.cnn.com [http://www.cnn.com/HEALTH/library/SN/00003.html] Clearly making the skin too dry harms the skin. But we are told acne is caused by excessive oil production. So people with acne must simultaneously avoid drying the skin *and* making it oily (I have found that moisturising soaps are absolutely disastrous for my skin!). So what *can* you do? The only thing is to remove *dirt* with water and let your *skin* deal with the oil balance.

It is conceivable that water in some areas may be bad for the skin, eg hard water. I think it's the other way around: soap makes the hardness in the water form particles which can irritate the skin.

5. Toothpaste also often contains sugar. (Hint: it's a "natural sweetener".) If you sleep face down your spit will cover the pillow... so rinse your mouth several times after brushing your teeth. That also helps remove fluoride, which has also been implicated in industrial acne.

Blog article with many interesting responses about people's attempts to find personal answers: www.freakonomics.com [http://www.freakonomics.com/2005/09/seth-roberts-on-acne-guest-blog-pt-iv.html]

Several posters make the point – which I have to agree with – that all such self-experimentation, including my own, is unscientific because it has a sample size of one and no double-blind. But what is one supposed to do when the medical profession is insultingly useless?

Incidentally, if my ideas are true, soap manufacturers are selling products which cause acne, as well as (much more expensive) products which purport to heal it. Would they want to pay dermatologists to test what their products do?

2005 May 23 [ Mon ]

Air conditioners and fans are not kept clean in Asia

I had been looking at the ceiling fan gloomily ever since I moved in, thinking I needed to clean it and wondering how (as I've never had a ceiling fan before and figured maybe you need a special solvent). I was too lazy to actually do it, though, largely because it gets pretty darned hot in there even with the fan running.

Yesterday there was a big storm. The landlord had "fixed" last season's leak problem a few weeks ago when the first rains started, but I wanted to observe carefully. The leak is over the fan, so if the fan is on the drops get splattered all over the room, so I turned off the fan to wait. (It seems the fix is working, although it didn't show up before till after at least 30 mins of heavy rain, so I'm not sure yet.)

As I was sweltering anyway, it occurred to me I finally had no excuses and should address the cleaning problem. I started off with the lower surfaces, as I couldn't see the upper surfaces to work on them. It turned out the scrunge was quite easy to remove with dampened Kleenex, although it was thick enough to need about a dozen sheets per blade. The blades have some rust on the edges, but it made no major difference to the scrunge accumulation.

Then I started wiping the *top* surface of a blade. Suffering cats! The grime was *thick* – something like 1/16-in thick, literally! Wiping the top surface was like cleaning up after you drop a plant pot! I couldn't *see* that surface, but it felt like it was thickest towards the outer edge. I began to realize that the scrunge was peeling off as I wiped and scattering over the furniture, so I moved the furniture well back.

As far as I can tell, and assuming the accumulation rate is the same for the top surface as for the bottom surface, the top surfaces had not been cleaned for five years, perhaps more.

My conclusion is that this is probably representative of all ceiling fans in Asia, and gives a good idea of how well AC systems are maintained too. There's not much you can do about this until you get your own place, but when you do, budget extra time for cleaning the stuff which provides the air you breathe.

2005 Mar 05 [ Sat ]

Gloomy bird flu prediction includes interesting epidemiology concept

In the course of an article in the LA Times by Wendy Orent about bird flu, she mentions the idea that by putting chickens – or people – together in close proximity, we are creating conditions in which a highly-lethal infection can survive. "Chicken flu is no big peril", 2005-02-28.

I have seen different versions of this idea before: in "Guns, Germs and Steel" for instance it suggests that a culture like China which encourages unhygienic, crowded living conditions dooms its citizens to recurring plagues, but renders them highly resistant to local casual infections, so that the culture is essentially immune to invaders (who will rapidly succumb to the local infection array).

Somehow though the Orent article struck home. Any infection, to survive, has to infect at least one more host before the current host dies, so by keeping thousands of chickens together – and then shipping them off to hundreds of places – we are ratcheting up the effective transmissiblity of the disease, and cutting the average period between infections, allowing an infection of higher lethality to survive. Looking at it another way, a new form of infection probably starts off with high lethality, and then "burns out" – it exhausts all the available hosts before spreading. (This is why Ebola has not spread: it wipes out the entire village before it can spread outside.) In order to survive, an infection has to mutate into a more benign form, just as syphilis has over the last 500 years.

A lot of discussion of diseases has centered on man's ability to form immunity to diseases, but I'm guessing that half the apparent effect is actually the infection's ability to adopt a more benign form.

On a more off-the-wall note, the Bible is not alone in suggesting that in prehistory men lived much longer than we do today: perhaps five hundred years. I have always wondered if today's effects of ageing, which are taken for granted, are actually the effects of a highly successful infection which spread to every human being thousands of years ago.

2004 Sep 16 [ Thu ]

Prozac's link to suicide

A new study suggests a link between Prozac, now routinely rescribed for depression in children, and suicide: www.propagandamatrix.com [http://www.propagandamatrix.com/articles/september2004/150904childsuicide.htm]

I've seen this association discussed before. I just want to point out that one could predict some sort of link to suicide even if the drug's basic action were entirely benign.

People who are severely depressed don't want to do *anything*. They don't want to change their clothes, or wash the dishes, or take out the trash. There must be a lot of people who are so depressed they *want* to commit suicide, but can't muster up the enthusiasm.

Now imagine they get a drug which increases their drive. Now, something like depression may well have a chemical basis, but it interacts with all sorts of conditions and behaviors. For instance, even if you were magically and intantaneously made perfectly sane, you would find yourself living a pretty horrible existence (remember the dirty clothes and the sink, not to mention the no job and the creditors and the crummy apartment). So it might well be that the "rational" course of action – the minute you can handle any action at all – seems like suicide.

This concept is supported by the fact that this suicide association seems to show up at the *beginning* of a course of Prozac, which otherwise seems strange.

2004 Apr 05 [ Mon ]

Sodium/potassium balance as a cause of cluster headaches

Cluster headaches are extremely painful. Although various treatments are available there is no fundamental understanding of why they occur at all. Some older texts still offer the vascular hypothesis but when it was actually tested it was found to be false.

I have always wondered if there was some relationship to the potassium/sodium balance, simply because in my case drinking a glass of water seemed to exacerbate the condition.

I have recently formed a habit of drinking electrolyte replacement solutions, because they work well for diarrhea and when I investigated their mode of action the texts talked about their usefulness to support heavy sweating in hot climates.

So when a bout of cluster headaches started I was intermittently taking electrolyte replacements, and to my great interest I found that they seemed to suppress the headaches. Of course, this is only anecdotal, but at this point in a cluster-headache bout my headaches have always been much worse.

A little googling suggests that low potassium levels are indeed associated with headaches. The following BBC link deals with the results of alcohol use; since it tends to deplete potassium levels the effects are relevant to my point:

It seriously disturbs the appropriate balance of minerals in the blood including potassium along with calcium, and sodium which are known as ions, is maintained by the kidneys.

The level of each ion must be maintained within narrow limits but dehydration caused by drinking, can affect the concentration of ions by draining potassium from the body, resulting in thirst, muscle cramps, dizziness and faintness.

The liver needs water to get rid of toxins from the body but as alcohol acts as a diuretic there will not be sufficient amounts in the body, so the liver is forced to divert water from other organs including the brain which causes the throbbing headaches.

news.bbc.co.uk [http://news.bbc.co.uk/1/hi/health/1721987.stm]

The effect of alcohol is probably more complicated than the above reference is suggesting. In my case the cluster headaches seem to correlate with periods of *lower or zero* alcohol use. It may well be however that when I curtail alcohol use my diet undergoes major oscillations in sodium/potassium balance until a new equilibrium is reached.

Incidentally, I was under the impression that the reason publicans provide free, heavily-salted peanuts is because drinks tend to boost potassium levels to an uncomfortable point, so that the drinker subconsciously stops drinking unless he can balance the potassium with the sodium in the peanuts. But I can find no reference for that in Google.

Perhaps they just make you thirsty.

2004 Apr 03 [ Sat ]

Bad diet: I get weak not fat

A very basic idea in dieting is that you should pick dishes which have a high proportion of "good" foods. The argument seems to be – although I don't have a link for it – that if your body perceives that it lacks something – vitamins, proteins, iron or whatever – it will turn up the gain on your appetite until the lack is filled – leaving the diet with an excess of calories, of course.

I want to make the point that my body doesn't seem to work that way.

For good or ill, my "appestat" seems to *only* work off the overall number of calories. Ie, even in periods when my diet has been just terrible by almost any standard (for instance, there was a period of several months in Germany when most of my calories were sweet white coffee, buns and beer) I have not gained weight. (Indeed, in that period in Germany, I lost several pounds. I should add that I felt no ill effects at that time.)

Looking at it logically, unless Western foods are so nutritious that almost any combination of them provides adequate nutrition, I must therefore have subjected my body to *lengthy* periods of inadequate nutrition.

Although I haven't suffered any obvious health problems related to nutrition, this is obviously a state of affairs which public health policy should not encourage. I just want to make the point therefore that even if an individual is neither overweight, underweight, nor visibly ill, his diet may well be inadequate and require medical intervention.

2004 Feb 04 [ Wed ]

What should our strategy be on the development of drug-resistant strains?

Reading this week's Economist magazine, I was struck by two very different statistics.

In an article on avian flu, it mentioned a study of SARS, which reported that the infectivity improved hugely during the outbreak:

...at the start of the epidemic only about 3% of those coming into contact with an infected individual caught SARS, while by the end the figure was about 70%.

There happened to be a very different story at the end of the magazine. Ernest Hendon died this January 16 aged 96; he was a survivor of the infamous Tuskegee Syphilis Study, in which people infected with syphilis were secretly left with no treatment whatsoever in order to study the progress of the disease – even after penicillin, etc became available.

What struck me was that – although of course Hendon was exceptional in his survival, many of his fellow experimental subjects having died well before the TSS was exposed decades ago – still he did survive, and was apparently in good health as recently as three years ago. I happen to be aware of the early reports of syphilis, apparently returning with Columbus from North America (this supposition is still controversial): because facilities of course did not exist to positively identify infections we cannot be sure, but it seems that syphilis at that time killed in months, after causing many horrible fast-moving lesions, disfigurements and crippling infections of multiple organs.

Is it simply luck that syphilis has mutated to far milder forms?

Consider the current lamentable situation among among sex workers in South-East Asia. They have only a vague and superstitious awareness of infection. Most of them do not know that infections, especially in women, may have no observable symptoms (for many years). Virtually none of them are aware of the importance of completing a course of antibiotics. (Are you?)

The outcome of course, is that they receive massive doses of antibiotics once or twice a year, with no followup, and sometimes it seems to work, or sometimes they breed a new more-resistant version of the bug, and the poor sap they pass it to has to tie it in a knot for the rest of his life.

On the other hand, what is the *long-term* result?

Look at SARS. We pursued it aggressively once the symptoms were observable. So all the selection pressure was on becoming more and more infectious. The *payload* – the deadly effect on the carrier – was insignificant, because SARS "knew" that its only survival option was to transmit itself rapidly before symptoms became obvious.

Compare that with the history of syphilis. For hundreds of years there was no effective treatment. On the other hand, people showing obvious lesions – or dying – make unattractive sexual partners, and thus don't spread the disease. So the pressure was on syphilis to find ways of surviving *without* frank symptoms. By the time the 20th century rolls around, while of course the long-term effects – sterility, blindness, etc – are hardly a picnic, syphilis must have been rubbing its hands with glee over the effectiveness of its strategy.

In other words, our culture's recent aggressive response to new infections, while it stands a chance of an ideal outcome, is continually training microbes to become infectious faster and faster, and to burn out hosts faster and faster.

2004 Jan 31 [ Sat ]

What happens when you eat an unbalanced diet?

I've seen a lot of stories about the importance of choosing a balanced diet which suggest that it helps you to maintain your weight, because your body is not fooled by all the "empty" calories you may eat and demands that you eat more until you have all the vitamins and whatnot you need – and by then of course you're eating too many calories.

I haven't seen anyone suggest that the *reverse* can also happen. Ie, in some people their feedback system that maintains their weight is *stronger* than the system that maintains their nutrients. The obvious result is that their weight may remain the same but they may suffer all sorts of deficiency illnesses.

Now in a way of course that just means "you need to get your vitamins". I just haven't seen it contrasted to the situation of weight gainers. It also suggests that maintaining one's weight is *not* a reliable sign of good nutrition or general health.

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