Viruses cause many serious diseases. Here are 4 dangerous and interesting ones explained.

Rabies

This disease is transmitted by rabid animals to humans typically by a bite.  After being bitten, the disease slowly progresses through the nervous system until it reaches the brain.  It is 100% fatal at that point.

Because of how slow the disease progresses, it is possible to be vaccinated for rabies after being infected.

A girl was infected with rabies at church in the early 2000s and was given an experimental treatment.  She was the first person known to ever have survived rabies.  The treatment used on her was an induced coma and heavy dosing of anti-viral medications and is now used in other cases as a last ditch method.

Measels

This was one of the worst killers until we developed a vaccine to it, taking millions of lives per year until then.

Measels is a disease that is exceptionally contagious.  As a professor of virology puts it, if he came to class with it and released it into the room, if you weren’t vaccinated, there is an almost 100% chance of infection.

Its high mortality rate and exceptional infectiousness made measles a somewhat rare disease until modern times.

A fascinating complication of measles is the development of disease 2-10 years after initial infection.  As an RNA virus, it is a puzzle how the virus is able to remain passively in the human host until then to cause disease.

Ebola

Ebola is a terrifying disease that kills through massive and excessive bleeding.  It has a mortality rate that is extremely high, in some cases killing most people who are infected.  Fortunately, it does not spread easily in humans – so far.

Primarily found in animals, ebola must mutate to become human infectious and has yet to achieve a foothold because it kills almost everyone who catches it.

Ebola is believed to be a strong contributor to the possible extinction of gorillas as it kills a great many per year.

Polio

Poliio is a disease that became a serious health concern with the introduction of improved sanitary conditions.  This is because previously, contaminated water supply meant kids were exposed to the disease at a young age, acquiring protection.

This lack of protection became an issue around the 20^th century as a rising number of cases occurred.  Most cases of polio are mild, but a significant percentage lead to paralysis.  One of the most famous people to suffer from polio is former US president, Franklin Roosevelt.

Viruses are devious.

They consist of small pieces of genetic code, whether in the DNA or RNA form, and little else.  They work by hijacking the life systems of living cells and forcing them to create more copies of the virus.

They are the cause of many of the worst diseases.  HIV, influenza, smallpox, polio, rabies, hepatitis, yellow fever – and many more are caused by viruses.

Are they alive?  Technically no as they can do nothing by themselves, but it is not a simple yes/no question with them.

Hyper efficent

What’s fascinating about them is how efficient they are.  Humans use almost none of their genetic code; something like 1%.  Depending how you look at it, some viruses could be argued to use more than 100% of their code.

They are, for instance, able to create proteins that have one function but can be easily switched into another form that does something else entirely.  Also, their genetic code can code for one set of proteins, but with a minor switch, code for another set entirely.

This hyperefficency allows viruses extremely complex and powerful abilities.

We have very few treatments that help someone who is infected with a virus.  We are often only able to give supportive care, while having limited ability to treat the actual disease.

Vaccines

Vaccines, however, can prevent the infection from happening.  They work by exposing someone to elements of a virus in a controlled and generally safe manner.  Their body develops an immune response to the virus, which allows it to respond rapidly and effectively when it attempts to attack them in real life.

Some disease are hard to develop vaccines for like HIV/AIDs.  This is due to the complexity of the virus, which actually acts to target immune cells.  A strong immune response might sadly strengthen the virus.

How viruses work

There are many ways that viruses work.  Many work by injecting themselves into a cell and then immediately hijacking internal factories to produce their products.  These include poliovirus.

Others infect the cell but first have to create the right coding sequences to use the cell’s genetic equipment.  These include influenza.

The more complex viruses don’t restrict their activity to the outer region of the cell known as the cytoplasm.  Some inject themselves into the more restricted nucleolus, where the host’s DNA is kept.

The retroviruses in particular come in as the RNA form, turn themselves into DNA, then add themselves into the host.

For Health and Life, I have written around 180 articles, and I’ve also written for other sites as well.  It adds up to easily more than 200 articles in the medical field.

What lessons have I learned?

1) You know too little if you think you know so much.

First, let me say that I do not feel as though I now know a great deal.  Actually, I feel like I know almost nothing.  In the realm of health and medicine, the only attitude one can have towards knowledge is humility.

Every week, studies are published that reveal new information.  Many things evolve and that were once popular fall into obscurity and vice versa.

2) Other people are passionate about their beliefs

I have, however, greatly changed in my perspective towards things.  At first, I was on the skeptical side, with my articles focused on addressing the concerns around medications.  In antidepressants in particular, I was concerned by what was and is at times questionable science.

This perspective is highly important, yet time has changed how I see things.  You can be right about the concerns in an area, but changing someone’s mind is not easy to do.  If you tell someone that antidepressants don’t work better than placebo in many studies, you will get this as a response:

“My cousin took them and they saved her life.  How dare you say they don’t work?!”

Some arguments are easier not to have.

3) You have to be skeptical

I remember being at a meeting with a head of testing at a hospital and his colleague, very reputable experts.  There, I was unclear about the validity of Vitamin D testing, which I mentioned, and the colleague said, “But the science here is valid.”

Despite that, it felt to me a fad, and with time, my perspective seems to be one that is more widely held.  Vitamin D deficiency is real, but it generally does not seem to be causing bad health.  You could be deficient, but just fine.

Some of my friend’s started getting concerned about being deficient, which may not have been necessary.

4) We are making new meds, slowly

The FDA has gotten fairly tough lately on new meds, but there are interesting and likely important innovations constantly being pumped out, like the new anticoagulants, of which I personally like apixaban.

In a year, something like 20-30 new meds are approved.  Most are not that new.  That said, progress is slowly being made.

Various thoughts

It’s sad when you analyze a medication and see that it could have health concerns that others miss.  I, for instance, picked up heart complications from Actos, a relative to Avandia, way back in the day.  Half a year later, as data started to show these problems occurring in patients, I was not surprised.

Cancer chemotherapies are fascinating and I’ve written a great deal on them.

Why?  Well, If you want to see the latest, most advanced techniques in drug research, they often appear first in chemotherapeutics.  Cancer is such a bad disease that new ideas are often tested there.

On pharmaceutical companies:  Neither good or bad, but they do a great deal for society.

It hurts me greatly to see the excesses and sadly common questionable ethical problems that have occurred at many companies, but now I try to put it in the overall picture.

As a whole, pharmaceutical companies have granted better health to many millions.  They do much good.  I’ve worked at one, and our drug (telaprevir) is going to hopefully reach market soon and really help patients with hepatitis c.

Ultimately

Pharmaceuticals are where I’ve written most of my articles and they remain fascinating.  Each pill represents great achievements of scientific research and testing – and ultimately better health.

Some people seem to be luckier than others.  Why is this the case?

Researchers did the following experiment to find out.  They gave volunteers newspapers to read.

Unknown to them, the newspapers had a coupon inside with the phrase:  “Get $50 For Free!” in bold black letters.  The coupons were fairly noticeable but not overly obvious.

Those who had said they were lucky tended to find this coupon.

Those who said, no, they’re not so lucky, tended to not.

The two groups both had the exact same situation and opportunity.  But those who thought of themselves as lucky tended to notice it more and get $50 for free.

Luck is something that happens when you have the mind frame for it, when you work in that direction.  A lot of luck happens because you are in the situation where it can occur.

So to get lucky, you have to put yourself in situations where it is likely to happen – then act on the opportunity when it arises.

Take Jerry Weintraub, who represented stars like Elvis Presley.  He was just starting and struggling to make it in Hollywood.  At one point, he stopped at a local restaurant that was a known hotspot for important people ‘in the biz.’ There, he overheard two executives talking about a job opportunity that fit him.

He then called there, demanded the job and got it.

Lucky.

A famous saying goes, “The harder I work, the luckier I get,” and it is very true.

To get lucky, have the mindset that you are lucky.  Switch yourself from the group that misses the coupon to the one that does.  Start thinking that you will come across fortunate twists and turns in life, and you will.

Now, the idea that just thinking something will make it come true is highly unrealistic, from my experience.  This is in general.  But when you have the mindset that you’ll notice things that can develop in your favor, it tends to result in that happening.

That said, in the end, most of us are quite lucky.  We live in a society which is wealthier than ever, where the average person lives in more comfort and longer than the mightiest ruler of 2,000 years ago.

7 ways to get luckier

1) Keep an open mind

Opportunities unfold when you have an open mind.  If you were given a newspaper to read in the study and had a closed mind (“I’m just reading this for the study”), you could easily miss the coupon.  By having a flexible, open mind, good things can happen unexpectedly.

2) Stay in touch with people

By staying in touch with people, you keep yourself open to new possibilities.  In talking with a friend, you may find that they are doing something which can somehow help you.

3) Look for opportunities

Have an active mindset that you are looking for opportunities.  Perhaps think things like, “I feel like I’m going to get lucky.”  Having this active mindset frames things in a positive way that naturally leads to better luck.

4) Put yourself in new situations

New experiences expose you to new possibilities.

5) Assume things are good

A lot of times, there is ambiguity to how things can be interpreted.  And often, the internal choice you make in interpreting things can influence how they develop.  If you make the choice to assume things are good, often they will end that way.

A positive attitude can create good luck.

6) Think, “This too is for the good”

A story goes of a quite happy person who always said, “This too is for the good.”  Sometimes something happens, like it rains and an event is canceled.  If you frame events as “this too is for the good,” then you are more likely to get lucky one way or another.

After the rain, you might, say, go to the grocery store and run into a friend who helps you get a job.

7) Think long term

Sometimes bad luck in the short term turns out to be good luck.   Once, I needed to rent an apartment as I couldn’t get a dorm.  I took the train out to campus to see three apartments, pick one, and sign a deal.

Two stood me up, and the one I saw was terrible.  But since I was in town, I decided to go beg the housing office for a dorm.  I got there, and they told me that they had just decided to give me a room.

Had I signed a deal, I would have lost the lease.

Many times what seems to be bad luck now turns out to be good luck in the future.

Contrave is a treatment for obesity that consists of bupropion combined with naltrexone. An FDA advisory panel voted 13-7 for its approval in December.  In the end of January, it is going for an official FDA decision.

Based on a variety of factors, we would hedge 60/65% in favor of its approval by the FDA.  Additional data may be requested, however, to better explore its heart safety.  Here’s why.

First, looking at the chemical ingredients.

Bupropion by itself is a commonly used antidepressant with eventual chemical similarity to stimulant type meds.  It has been known to cause temporary, minor weight loss.

Naltrexone is a less commonly used treatment for addictions.

The theory is that naltrexone will act to prevent the weight loss effect of bupropion from being temporary.

One document looked at indicated that there have been more than 50 million uses of bupropion and a million uses of naltrexone.  These are medications that have been very widely used for many years and have well known risk and side effect profiles.

The FDA in deciding on a treatment always balances two things.  Efficacy vs safety.  How effective a medication is for what condition must be weighed against how safe it is.

A treatment that is 99% cure for a type of advanced cancer, might be allowed to have the side effect of permanent infertility.  But the same treatment as a 99% cure for high blood pressure, would likely not.

Contrave has moderate efficacy.  It barely passes the standard of weight loss needed to meet the FDA’s official efficacy standards.  That said, it does, and this is modestly significant weight loss.

At the same time, it has modest side effects.  The main ones include a very minor increase in blood pressure/pulse rate and the potential for seizures.

The increase in blood pressure /pulse rate is exceptionally important as the FDA’s standard of heart safety has been very high for obesity medications.  That said, it is minor, about 1 beat per minute, and it did not occur in everyone.  Additionally, it tended to go away in those who lost weight.

This is a complex issue.  Bupropion alone has similar effects on blood rate and it has been used millions of times with no cardiac issues that this author has heard of.  Yet the FDA in the context of obesity meds is highly conservative and cautious.

That said, Contrave did not have two years of safety data as would ideally be looked for.  It has potentially a risk management structure that might mitigate this.

Contrave:

Pros – has modest efficacy, and is made of two medications that have a great deal of experience of use, and that seem to have minimal side effects.  The submission to the FDA at the advisory panel was high quality and indicates a company that knows what it is doing

Cons – modest efficacy.  Heart rate increase is unsettling.  Only 1 year of data.  A conservative FDA.

These pros and cons alone would lead to a slightly negative impression.  But there is a twist.  The FDA has shot down two other obesity medications.  Additionally, the FDA does not want the public to risk its health.  Lack of approved treatments may lead to unhealthy use of supplements or off label use of meds.

With obesity a tremendous health concern, and the high safety shown in individual med use, plus the negative politics of likely non-approving two other meds – our projection turns positive.

There is a stipulation.  This author has predicted perfectly FDA decisions, but predicts that this could be the one that ruins his record.

This is a competitive market analysis of the video laryngoscope field.

McGrath, Glidescope and Storz – these are the names of the three products that mainly control the video laryngoscope market.

There are many additional companies and products in video laryngoscopes, including Pentax-Airway Scope, Airtraq, Bullard and Bonfile.

Changing competitive landscape

The majority of the market is controlled by slightly outdated models which are highly expensive.  Costs are dropping rapidly, however, as new versions are being made that promise to offer lower prices and better features.

The latest McGrath model is a significant step forward in quality of design and use and promises to be significantly more affordable than previous models.  Despite requesting information and searching carefully, we were unable to obtain its price, but estimate about $3,000 with a projected range of $1,000-$5,0000.

Crucially, the majority of competitor development is in the straight-up video laryngoscope field.

Intubating LMA Devices

There are two main products in the ILMA area.

Fastrach – more laryngoscope based, no visualization component, rigid guide tube.  Exact cost, unclear, but fairly low, yet reported by some to be quite difficult to use due to lack of vision of throat

CTrach – ~2005, outdated, not so great modern design, image component large, not offer all features, not as good laryngoscope, fiberoptic

Costs ~$9,000 as of 2008

Limited view in some situations which may prevent proper treatment.

Limitations of Existing Video Laryngoscopes

Different products have different features, pros and cons.  Some Doctors do not like the McGrath’s lack of diversity in blade use, for instance, while others are generally dissatisfied with product life and overall performance.

Some do not like the angles of the existing monitors in general, say that it flickers, or that the blade structure does not work in all patients.  Quality of monitors and screen/battery life are important issues.

Storz DCI has been called somewhat bulky.

Additionally, most existing competing video laryngoscopes are highly priced.

Limitations of Existing ILMAs

The main limitation around ILMAs appears to be lack of visibility.  If the intubating LMA procedure is done without video support, then it is essentially blind, and this can present challenges.  It is hard to see what is going inside the mouth after insertion of the device.

In approaching this limitation by including video capabilities, it is essential to provide adequate view.  The CTrach’s view is not always as clear as it should be which has led to some failures in clinical use.

Body Language

Body language is the idea that the physical movements of our body are themselves a language.  By knowing it, you can understand what someone else is thinking or feeling but isn’t saying.

It’s important to know the basics of.  That said, often it can be overvalued.  Many times people’s body language is hard to read, and what means one thing for one person can mean something else for another.

I think body language is something that is very important to be aware of and know the very basics of.  Yet it is possible to become attached and place too much value on it.

Ultimately, body language is an important way of many to tell how someone is reacting to what you say, but shouldn’t be over thought.

Crossed arms

In general, the listener crossing their arms indicates defensiveness, self-protection, or disagreement.  If you say something and the listener crosses their arms afterwards, it is highly likely they didn’t particularly like it, and you need to try to get them to uncross their arms.

For instance, take this example exchange:  “I think the website should be bright green.”

Arms cross.  “What makes you say that?”

At this point, you should be thinking how to address the internal conflict or disagreement in your listener – (they’re probably thinking, ‘bright green?  Eww!) – so try something like:

“Well, bright green can be done well, as seen on financial sites and some specific brands.  It is a color that implies success and fits in with our brand…”

But beyond arm crossing, there are very few body language signs that can be generally said to mean one thing or another.

Eyes/face:  emotional reactions typically take place in the eyes and face.  An old saying is that the eyes are the windows to the soul.

Looking at someone’s face, which you usually do when talking to them, can help you read their emotional reactions.  That said, they are often very fleeting.  You can say something and get an emotional reaction that is shown for a fraction of a second.

As such, it might be a good idea to be aware of this, but not overthink it.

Legs: some people say that the legs are a very good indicator of what someone is thinking, particularly in the dating scene.  They argue that the legs are controlled mainly by older parts of the brain and that they automatically reflect your emotions as long as you don’t intentionally control them.

In that view, the direction of the legs/feet in terms of pointing and placement can be read to mean one thing or another.  I believe this is generally true, but hard to do consistently and not necessarily the most valuable thing to think about.

Mirroring

Mirroring is a simple idea.  When talking to someone, you should read their body language and copy it.  But not immediately, as that would be very weird.  If they put their hands together and lean forward, wait a little then do something similar.

It’s as though you are a slow reacting mirror to the other person.

The idea is that doing so subconsciously puts the other person at ease.  They get the sense that they are on the same emotional page as you.  And it all happens automatically.

This idea is valid in my experience yet absolutely must be done in moderation.  People who are too enthusiastic about it strike me as the always a little stressed, “high powered” sales type who may or may not be that successful.

Mirroring is something that is valuable but in moderation.

Then you need to know what it is you are saying.  This isn’t always entirely obvious. But usually there is something specific.

Mihály Csíkszentmihályi is well known for his theory of flow.

The idea is that we can enter a state of focus in which time flies by without us consciously being aware of it. Think in your own life; there likely have been situations where you were so focused or into doing something, that time just flew by.

This is what he calls a state of flow. This is opposed to when you’re doing something and you’re not so into it and time just kind of drags.

Flow is when you’re gardening and you spend 2 hours outside without being aware of it. Or when you’re painting, and you’re so focused on the brushstrokes that you forget everything else you have to do.

Flow is caused by you facing a challenge and being able to deal with it. It’s a state of heightened focus that is meaningful.

The question becomes, how do you get more of it in your life? To get into flow, you have to have a situation that is hard enough and that you have the right amount of skill for it.

It’s a balance between how hard something is, and your skill in doing that thing.

Take flipping burgers. The first time you do it, you don’t have so much skill. Even though it is arguably not such a hard task, you may be focused in on it and experience flow for a short while.

Yet if you are flipping burgers after a year of experience, your skill is now higher. There isn’t enough of a challenge, so you are not so likely to experience flow.

Mihály Csíkszentmihályi argues that we have to engineer our lives to create flow. This is because of how positive flow is to experience and how helpful it is in promoting productivity.

To do so, he suggests making even routine and boring things into a challenge. He talks about a factory worker who has had a fairly repetitive job for many years. The worker, however, is highly productive and seems to be happy. How can he remain positive after so long?

To do so, he makes his work into a challenge. He sets goals and challenges for how much work he can do, trying to beat himself or meet hard metrics. This makes the otherwise dull work engaging.

In our own lives, we all likely have things to do which are fun, and things that are not so fun. By thinking in terms of how we can create more flow, we can make life better.

When a company makes a medication or medical device, they face the challenge of marketing it.

In medications, the general approach is to either get Doctors to prescribe a medication themselves or to promote patients asking for the medication.

In devices, the general approach is to target distribution channels and important purchasers, such as hospital supply managers or influential Doctors.

The key is to establish a product as the normal choice in a field or for a condition.  An asthma med’s goal is to have a Doctor think of it as a normal treatment for asthma.  This ensures sales for many years.

Because of how lucrative medical products can be, however, and the great returns marketing can provide, many companies have indulged in unethical behavior.  This can consist of misleading or misrepresenting the benefits a product has.

For medications, for instance, marketing statements must be limited to the official information approved in the drug label.

Here are some marketing items for a new medical device, along with how it applies to new medications.  It is presented to provide a window into how new medical products are marketed and ultimately sold:

Medical Marketing Approaches

- Create literature and research about the product and then publish results in journals

This is very powerful.  A positive article in the New England Journal of Medicine can make a tremendous difference.

- Product donation and placement with leading Doctors, particularly key opinion leaders and those in charge of purchasing for hospitals.  Create awareness of the new product and its benefits.

In both meds and devices, there are key figures who are very influential.  Some Doctors are well respected by their peers and play a major role in the adoption – or not – of a new technology.

Understanding this and marketing to those Doctors is a large part of modern medical marketing.

- Aim to achieve placement of product in educational settings which are open to experimentation with new medical technologies and who are influential.  These institutes are willing to try something new, and play a key role in convincing other people to do so as well.

- Develop relationships with distributers and consider attaining distribution through their methods or advertising through their network

A medical device manufacturer can gain positive advertising through promotion by distributers.

-  Attend/speak at important medical conferences.  Presentations and events at medical conferences around an issue can be a powerful way to influence and help promote a product and is a key part in marketing medical innovation.

Presenting on a cancer therapy at a convention of oncologists, or cancer specialists, can help promote the therapy.

- Advertise in medical journals.

- Advertise on TV

- Continuing medical education – attain status as a provider of continuing medical education and develop such material that teaches about the benefits of a product

- Targeted websites and online advertising.  Create websites that either reflect patient experiences or are targeted to doctors, and use online advertising methods to promote.

There are three main therapies that are and were highlighted this year.  This article focuses on Contrave while also discussing briefly the other two, lorcaserin and Qnexa.

Contrave is a new treatment for obesity that consists of Wellbutrin sustained release combined with Naltrexone instant release.

It has shown modest efficacy to date, which was likely overstated, and concerns remain as to whether the addition of Naltrexone to Wellbutrin really causes that much weight loss.

Wellbutrin is a popular antidepressant that has a variety of effects, including some stimulatory ones that may help induce weight loss.  It is, for instance, eventually converted by the body to a form of amphetamine.  Naltrexone is an opioid antagonist that is used mainly for treating addiction.

The biochemical theory of action is as follows: Wellbutrin has been shown to have an effect on the pro-opiomelanocorin (POMC) pathway in the brain that works to suppress appetite.  Activation of this pathway leads to the release of alpha-MSH and beta-endorphin.  The alpha-MSH induces weight loss, while the beta induces tolerance to this effect via opioid receptors.

Some say that the reason Wellbutrin as a treatment by itself doesn’t cause such great weight loss is because of this tolerance.  That’s where naltrexone comes it.  It blocks the opioid activity of this pathway, which should, in theory, keep it working for a long time.

The efficacy data for Contrave does not clearly demonstrate efficacy superior to monotherapy with Wellbutrin alone in all studies.  Additionally, some of the data published on Contrave’s efficacy were overstated due to an ‘accidental’ clerical error.

Lorcaserin is a serotonergic receptor acting agent that promotes feelings of fullness.  It has shown modest albeit limited efficacy in most studies, with people on it losing slightly more weight than people on placebo.

The main concerns around it are: a) its limited efficacy b) its potential for side effects including possibly carcinogenicity and heart damage

Because of these concerns, it was not approved by the FDA.

Qnexa is a combination of phentermine and topiramate, a medication related to stimulants and a medication for the treatment of epilepsy and some other conditions.  It worked great, with a high percentage of those taking it losing a significant amount of weight.

The main concern was again of safety.  Phentermine was part of the fen-phen combination which was removed from the market.  As such, the safety concerns raised around it are unusually meaningful and led to its negative reception.