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Are you afraid of Lyme disease? The tick-borne illness has become a major health concern in the Northeastern part of America and in Western Europe. As many as 365,000 people are infected every year, and the number is growing (as is the habitat of the ticks which spread the disease).
There was a perfectly safe and effective vaccine against Lyme disease which was available in the 1990s. It was marketed as “LYMErix” by the pharmaceutical company which is now known as Glaxosmithkline, but which was then called something else (has anyone noticed how the names of pharma companies themselves mutate and get weirder and weirder? it must be a side effect of the industry, but it perplexes me as to what the exact mechanism is). Three $50.00 shots were needed, but they protected against Lyme disease to a high degree of efficacy (by allowing the immune system to immediately target the proteins on the cell coating of the Borrelia bacteria).
Unfortunately, just as the nineties contained the seeds of today’s political stalemate, it was also a time when the misbegotten anti-vaxxer hoaxes, lies, and misinformation were starting to go mainstream. The sad fate of LYMErix was an early harbinger of the bad things to come. The vaccine was properly tested, vetted, and approved through the FDA’s lengthy and comprehensive approval process, yet some immune specialists at the FDA voiced a concern that Lymerix could cause autoimmune problems. Extensive research found that it did indeed cause such problems…in a small percentage of hamsters.
This news (which was breathlessly reported by the media) came at the same time as the Lancet’s infamous & discredited false articles about important vaccines. Some LYMErix users came forward with claims of agonizing super arthritis which they believed was caused by the vaccine (although the FDA’s tests and surveys found the same rate of such symptoms in vaccinated and unvaccinated populations).
Nevertheless the damage was done. The pharma company pulled the product from the shelves over the bad publicity and it is has not been available since 2002…despite extensive evidence that it was safe and effective (albeit expensive). By now the vaccine could be made generically for a fraction of the price…but phara executives are disinterested since they would have to fight an expensive PR campaign for low profits. In the mean time high profits and free publicity are available to pseudoscientific quacks who gets rich preying on the fears of poorly educated or credulous people who do not know what to believe.
To say nothing of goddamn lawyers…
Like the story of the world’s best and most life-saving antivenin, I find this story infuriating. The market is touted as godlike and infallible by (highly paid) economists, but here is yet another abject market failure (although I am happy to share out the blame to scientific illiteracy of anti-vaxxers and to scary and not-very-good journalism). I do not necessarily have a solution, but it seems to me that if drug companies are not addressing actual problems like antibiotic resistant superbugs, deadly snakebites, and Lyme disease while at the same time they are actively promoting and profiting from the opioid crisis, perhaps their cozy relationship with government funded research, government regulators, and with lucrative patents needs to be rethought. We are seeing more and more market failures in every business sector (because of regulatory capture, monopolization, and, lately, good-old fashioned graft), but the biomedical ones are particularly chilling. It’s time to smash some of these companies up, nationalize others in the name of public health, and to pour a great deal more money into public research which has public benefits. As things stand now, the government, universities, and philanthropists pay for research and pharmaceutical companies come along and benefit from it with duopoly/cartel practices.
There is an upside to all of this though. You can get a safe effective and harmless Lyme disease vaccine for your dog. A lot of the people I talk to desperately wish that the health services available for their pets were available to them for the same prices. Here is another example where our furry friends have cheaper and better care…because of market successes! Why is everything so complicated?
Yesterday’s post concerned smallpox, one of the most dreadful scourges to ever afflict humankind. I shied away from writing about the physiological aspects of the disease–which is caused by two viruses, Variola major and Variola minor–because the symptoms are absolutely horrible (as I can fervently attest after some internet research involving photographs which were apparently taken in the cruelest depths of hell). Smallpox was badly named. It should have been called “deathrash” or “bloodskin” or “face-melt-fever”, but apparently Roman stoicism came to the fore and the Latin name merely means “spotted” or “pimple.” Not only did smallpox effectively kill off the native population of the new world (and later of Australia, which experienced a similar plague), but for thousands of years it regularly culled a sizable hunk of humanity from Africa, Asia, and Europe. Like influenza, the smallpox co-evolved in response to our immune reactions to it, so, even in parts of the world where people had inherited some resistance, the pestilence sometimes flared into a full scale pandemic.
Death and the Child (Sebald Beham, woodcut, early 16th century)
But smallpox is gone (almost)! Humankind joined together and beat one of the most horrible things we have ever faced. Today the last remaining live smallpox viruses are imprisoned in laboratories in Atlanta and Koltsovo, Novosibirsk Oblast.
In grade school, we were taught that this stunning victory came about when an English physician named Edward Jenner realized that milkmaids who contracted a mild rash called cowpox became immune to smallpox. By deliberately giving people cowpox, Jenner found a way of protecting them from the fatal smallpox. Jenner thus invented immunology, one of the most useful and inexpensive forms of medicine. His great work was taken up by subsequent generations of immunologists and physicians in allied fields who improved upon his findings. Together they used national and international resources to immunize the world. Smallpox was officially proclaimed to be eradicated in 1979.
Yet Jenner had antecedents who were not well appreciated because of the preconceptions and prejudices of the day, (also, by necessity, he worked with human subjects whose bravery went unheralded). Jenner’s greatness is not diminished by looking back at the others who were involved in an epic struggle against history’s greatest killer. There are descriptions of smallpox avoidance techniques in ancient Sanskrit texts from India dating back to 1000 BC, however scholars do not agree on whether these texts describe inoculation or not. What is certain is that a medical text from Ming dynasty China does indeed describe an effective inoculation process. The Douzhen xinfa published in 1549 was written by Wan Quan, a pediatrician who believed that sunlight and fresh air were good for children (and that overfeeding and overmedicating were bad). Wan Quan described a method of variolation—by which means a healthy person was purposely infected with Variola minor, the less dangerous o the two forms o smallpox. By the time of the Lonquing Emperor who reigned from 1567–1572 (and was the son of the addled Jiajing emperor) variolation was widespread–powdered smallpox scabs were blown up the noses of healthy children so that they would contract Variola minor. This was effective in preventing smallpox, but it had a fatality rate of .05% to 2%–a dreadful margin (though nothing like the 30%+ mortality rate of smallpox pandemic).
Variolation gradually spread through the Chinese empire and through the Turkish and Islamic world, but it did not reach the attention of western medicine until the early 18th century. Lady Mary Wortley Montagu was the wife of the British ambassador to the Ottoman Empire from 1716 to 1717 (as well as a sort of feminist pioneer, poet, and adventurer). After losing a brother to smallpox (and being disfigured by the disease) Lady Mary was eager for a means to protect her children from the scourge. In 1718, the embassy surgeon inoculated her son and, based on the success of this procedure, she arranged for her daughter to be inoculated in 1721 (when the family was back in England). The procedure attracted the attention of the medical establishment and the royal family. Although many doctors were aghast at an “Oriental” procedure (which was being popularized by a woman, no less) the royal family intervened directly in the controversy when a smallpox epidemic swept England in the 1720s. In order to fully test the safety of the inoculation, the King offered a full pardon to six (or seven?) condemned prisoners in exchange for undergoing variolation. Not surprisingly the condemned prisoners chose an unknown medical procedure instead of the hangman’s rope, and when they survived they were duly freed. Variolation was also tested on six orphan children–who also survived. After these human tests, the royal children were inoculated against smallpox.
Lady Mary Wortley Montagu with her son, Edward Wortley Montagu, and attendants (Jean Baptiste Vanmour, ca. 1717, oil on canvas)
Inoculation spread quickly among the rich and powerful of Europe, but it was staunchly opposed by reactionaries and by churchmen (who believed it was contrary to God’s will). Against such a background, came Jenner’s discovery of a cowpox based vaccine which was vastly safer than using live smallpox. But even with the much safer vaccine, it was a long time before the immunologists started to win over many ignorant and superstitious people to the life-saving virtues of the vaccine (and nearly two hundred more years before they stomped out the loathsome blight of smallpox).
The Groundhog, Marmota monax (photo by Bill Smith)
Happy Groundhog Day! Preliminary reports coming in seem to indicate that the nation’s most eminent groundhog oracles are not seeing their shadows today (what with the continent bestriding blizzard and all). Oddly, this is interpreted as a sign that spring will arrive early this year. However I tend to think those groundhogs on TV are media personalities who have forgotten their rural roots. When I lived on a farm, the concept behind the holiday was more straightforward: if you saw an actual groundhog on Groundhog Day, then winter might indeed end early, but if you didn’t (and I never did) winter would not be over for six more weeks. Today most non-celebrity groundhogs did not stir from their deep hibernation chambers. We probably still have plenty of winter left.
Groundhog Day is observed on or around Candelmas, which ostensibly celebrates the presentation of Baby Jesus to the temple: Mary and Joseph took Jesus to the Kohens & Levites to perform the redemption of the firstborn and ceremonially purchase their firstborn son’s life back from the priests (I’m not sure Jesus ever really escaped the priesthood or the temple of Solomon so maybe his parents should have gotten their money back–but that’s a different story). Candelmas was elided with pre-Christian holidays involving the prediction of the weather by animal augury. The holiday’s roots in America are from the Pennsylvania Germans. Apparently in pagan Germany, the original animal weather prophets were badgers or bears. Imagine how exciting this holiday would be if we stuffed our pompous civic officials together with a disgruntled bear who had just been prodded awake from hibernation so people could take flash photographs!
At any rate we have gotten rather far afield of the day’s celebrated weather oracle, the groundhog or woodchuck (Marmota monax) which is actually a rodent of the marmot family, Sciuridae. Marmots are large solitary ground squirrels which, like pikas, generally live in the mountains of Asia, Europe, and North America. The groundhog is an exception among the marmots since it prefers to live on open ground or at the edge of woodlands. The deforestation of North America for farms and subdivisions has caused groundhog population to rise. Although groundhogs are omnivores, the bulk of their diet is vegetation such as grasses, berries, and crops. They are gifted diggers who construct a deep burrow with multiple exits. This burrow serves as their chief living quarters and refuge from predators. Since groundhogs enter true hibernation, they usually also maintain a separate winter burrow (with a chamber beneath the frost line) for the sole purpose of their months-long suspended animation.
A Groundhog Enjoying a Garden
Groundhogs, however, have a deeper utility to modern humankind than as primitive weather gods. Devoted readers will know my fascination with liver research, and groundhogs are the principal research animal used in studies of Hepatitis B and liver cancer. Since groundhogs are prone to a similar virus in the wild, they always develop liver cancer when infected with hepatitis B. Laboratory groundhogs have thus been responsible for many advances in understanding liver disease and pathology–including the discovery of a vaccine for Hepatitis B and the realization that immunizing against hepatitis B virus can prevent liver cancer. Currently 350 million people around the world are suspected to have hepatitis B. Forty percent of those infected will develop chronic liver damage or cancer. According to the World Health Organization, an estimated 600,000 people die every year from complications related to the infection (which is more than the total number of United States citizens killed in World War I and World War II combined). Perhaps the Groundhog should be thought of as a profound benefactor to humankind thanks to its utility as a laboratory animal.
ferrebeekeeper 