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  • Melamine – And Cyanuric Acid, A deadly pair?

    Like melamine, cyanuric acid is also used to artificially increase the nitrogen content of the food (detected as protein in protein tests).

    ScienceDaily: Pet Food Recall: How Melamine Impairs Kidney Function

    Perry Martos and colleagues in the Agriculture and Food Laboratory at Guelph’s Laboratory Services have found that melamine and cyanuric acid can react with one another to form crystals that may impair kidney function. Tests conducted at the University’s Animal Health Laboratory (AHL) and elsewhere have identified these crystal-like substances in the kidneys and urine of affected animals. The experiments conducted at the Agriculture and Food Laboratory showed that the chemical composition of the crystals that are formed when these two compounds interact matches the composition of urinary crystals removed from affected animals. Tests conducted at the University’s Laboratory and in the United States have identified the compounds as contaminants in gluten used to make a variety of pet food and treat products.

    Interestingly enough, the analytical test for cyanuric acid is to precipitate it with Melamine, so it is not as if these guys “discovered” this reaction, as the press release seems to intimate. There is also speculation that the  cyanuric acid was a metabolic byproduct of melamine from bacterial action, which is possible if the gluten was not stored correctly. It seems to me that Chinese manufacturers were using melamine or cyanuric acid to boost protein content for a while now. But it may have been only recently that they started adding both to the same food. The other possibility (and have you ever read the ingredients list in pet food, it takes a while!), is that one ingredient contained melamine, the other, cyanuric acid and when mixed…

    Either way, neither of these compounds belong in pet food.

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    FDA cannot find anything in China

    FDA Finds Chinese Food Producers Shut Down – washingtonpost.com

    American inspectors who arrived in China last week to investigate the two companies that exported tainted pet food ingredients found that the suspect facilities had been hastily closed down and cleaned up, federal officials said yesterday.

    “There is nothing to be found. They are essentially shut down and not operating,” said Walter Batts, deputy director of the Food and Drug Administration’s office of international programs.

    Well, we gave them plenty of warning, did we not!

  • Smoking bans

    If you followed the failed attempt in North Carolina this year to ban smoking in indoor public spaces, one of the so called arguments was the famous slippery slope one, that this was only a prelude to banning smoking “in the comfort of your own home”, and other attendant property rights arguments. Well, it turns out that there is an impromptu smoking ban in place in most homes already!

    Study: Smoking forbidden in most U.S. households – CNN.com

    Smoking is forbidden in nearly three out of four U.S. households, a dramatic increase from the 43 percent of homes that prohibited smoking a decade ago, the federal government reported Thursday.

    Before anyone makes the property rights argument that this “ban” is by choice, and not by government fiat, let me make it, and break it. Smoking falls into the category of occupational and reccreational exposure to pollution that harms and kills. It’s no different from lead in the water or smog as far as the non-smoker is concerned. So, property rights are not polluter rights, sorry.

    It’s only a matter of time before smoking indoors is considered completely and utterly unacceptable, kinda like smoking in airplanes!

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    Glass baby bottles making comeback

    More Bisphenol A blowback, apparently, SF parents are switching to glass.

    Glass baby bottles making comeback / Stores selling out after health alarms raised about plastics

    Glass baby bottles, replaced decades ago by unbreakable plastic, are making such a comeback that parents can’t get their hands on them.

    Online and brick-and-mortar retailers report a run on glass baby bottles in recent weeks that they say was spurred by reports that the most common type of plastic in baby bottles may leach a toxic chemical.

    San Francisco resident Sean Mullins said he decided to switch his 6-month-old son, Mickey, from plastic to glass bottles last month despite manufacturers’ insistence that plastic bottles are safe.

    Independent tests done for The Chronicle and reported in November found bisphenol A, a chemical that mimics estrogen, in a baby bottle and several toys. Bisphenol A is also found in the lining of food cans, some anti-cavity sealants for teeth, and electronics.

    Watch for plastics manufacturers to fight back, this study ought to provide some ammo.

    Comparison of six samples of each of three brands of water available in both glass and polyethyelene terephthalate (PET(E)) showed that the waters bottled in glass contained approximately 57, 30, and 26 times more Pb due to leaching from the containers. Our study includes 25 brands of bottled water from Canada, and the median Pb concentration in these samples was 15.9 ng/L (n = 25), with a range from 2.1 to 268 ng/L. For comparison with the bottled waters, pristine groundwater from six artesian flows in southern Ontario, Canada, where some of the bottled waters originate, yielded a median concentration of 5.1 ng/L Pb (n = 18). In fact, all of the waters tested were well below the maximum allowable concentration established by the EU, Health Canada, and the WHO for Pb in drinking water (10000 ng/L).

    It all depends on which bolded sentence you chose to emphasize! So, glass bottles do leach some lead out, but nowhere near the amount needed to cause any effects whatsoever. I guess this is all the American Chemistry Council can come up with as a problem with glass.

    It’s irrefutable that glass can shatter, Hentges said. But there is “no scientific basis to conclude that BPA is something to be concerned about … at the extremely low levels that people might be exposed to from use of consumer products.”

    There is plenty of scientific basis to conclude that Bisphenol A has some very subtle effects at ambient doses. But science has never stopped the American Chemistry Council!

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    Sugar Pills, now more effective!

    Well, all sugar is not bad for you. Apparently, when given to you in pill form by someone wearing a white coat with a pleasant demeanour, it can cure all kinds of ills.

    It’s not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.

    Via Wired

    An interesting article that takes the reader through a recent history of placebos, why they seem to work better now than they used to, and tangentially, why the competitive research paradigm of the pharmaceutical industry delayed recognition, and continues to delay possible fixes and therapies.

    A few things about the placebo effect:

    1. There appears to be a physiological and neurological basis to the effect, something that can actually be turned off by deactivating the body’s natural production of opioids.
    2. This effect is triggered by various patient stimuli, including exposure to advertising, faith in the medicine, doctor bedside manner, etc. It appears that for minor ailments, these effects could be as strong as the medication prescribed.
    3. It is not short lived, the effects can linger well after consumption of sugar pills.
    4. Despite all this, the article states that we are no closer to finding the most appropriate way to administer placebos (Hmm, or are we? Read on!).

    Pharmaceutical companies conduct hundreds of clinical trials every year. They are not required to publish them in most countries, so negative results, failures, etc. which reflect badly on the company’s stock price are routinely hushed up. This means that the mounds of data that show tested drugs as no better than placebo are not accessible for research. This is one of the greatest drawbacks of competitive research paradigms, the lack of cooperation, the inefficiency that comes from duplication of negative results, and the lack of statistical power that comes from inability to use all the data available. In a milieu where knowledge = stock price, this is the logical approach, but something to note next time an Ayn Rand acolyte comes bleating to you about the beauty and perfection of the market. You might ask “What are some options to the current patent exclusivity driven regime”? My favourite economist Dean Baker of the Center for Economics and Policy Research has written extensively about the drug development process and alternatives in his excellent (and free to download) book The Conservative Nanny State, I suggest reading at least the chapter on drug development and patents!

    Anyway, back to placebos, what to do? How to administer sugar pills in a quasi-official setting for minor ailments. It’s almost like you need a parallel paradigm of medicine that dispenses sugar pills that did not have to go through double blind randomised clinical trials. it would help if this paradigm uses vaguely scientific terminology while doing very little harm. It would work in conjunction with the conventional approach, not in competition so there is little danger of people taking sugar pills for malaria!

    I give you, Homeopathy!!! This blog(ger) is no stranger to this wonderful form of medicine, involving concepts such as the memory of water, similars, dilution, etc. When I wrote about homeopathy last year, it was more in relation to the psychological aspects of my experience with it. I (and I assume you did not click through to read!) wrote about my parents’ great and enduring relationship with their homeopath, and the benefits it brought them. Back in India this time around, it was suggested that I take some homeopathy for a cold I was developing, which I did (yum, sugar!). The cold went away in a few days 🙂 There was some swine flu medicine being passed around as well (I did not partake), which worked too, nobody at home got swine flu 🙂

    So, how to make it work? It already works in India because belief in the efficacy of homeopathy is well established. As long as the homeopath is well qualified in basic diagnosis, and crucially, knows when to punt the patient into conventional therapy, the system works to a certain extent. But what about a society with no such foundation? Do you go to a clinic with both an allopath and a homeopath, and if your ailment is one where placebo works about as well, let the homeopath make some well diluted similars for you to consume? How to settle turf wars? Would it be better for the allopath to feign develop an expertise in homeopathy and make that work for her in treating the patient? Would they apply the most important lessons in homeopathic treatment, Listen, Empathise, Soothe?

    I don’t know. It is not my nature to believe in sugar pills, faith, or advertising. So it is hard for me to say what would work. But given that sugar pills work well, it is vital for society to find a way.

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    Circumspection on Circumcision – Lessons for India

    Circumcision May Help Protect Against HIV – washingtonpost.com

    Getting circumcised may reduce men’s risk of acquiring HIV, according to a study conducted in Africa. “Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men,” lead study author Robert Bailey, professor of epidemiology at the University of Illinois at Chicago (UIC), said in a prepared statement.

    This study, published in The Lancet (registration and kidney donation required!) adds to the growing body of research suggesting that circumcision significantly reduces the incidence of HIV infection. The doubts on circumcision as a protective factor against HIV are falling away.

    But, is this a viable public health strategy? In context, the US health and human services reports an 85% reduction in HIV risk through condom usage. This is probably a conservative estimate. There’s no indication yet that the gains from circumcision and condom use together are multiplicative.

    Let’s look at India, for instance. Circumcision is not practiced among Hindus. There is no history of circumcision, and when I was growing up, it was clear that circumcision was for Muslims and Muslims only. It was often laughed about and there was a sense of superiority about not having to mutilate. It was a clear distinction setting difference between “us” and “them”. This article by Jaishanker and Haldar provides some perspective on Hindu-Muslim identities.

    Apart from that, the other important identity of Muslim males is circumcision. It is found in many riots that Muslims were victimized based on their religious identity. In the riots if the perpetrators or the police are not able to identify victims with their religion they forcefully remove the pants of the victims to check whether they are circumcised or not. Once they find that the victim is circumcised he is targeted without further analysing which community he belongs to.

    For example in Bombay riot (1992) there is a case of man who was frisked by the police for assessing whether he was a Muslim. However, out of fear he gave his name as Raju (a Hindu name) the officer made him take out his trousers and, noticed that he was a circumcised Muslim, and fired at him.

    No Hindu parent in their right mind would circumcise their male child. It’s that simple. It’s part of the ingrained Hindu psyche that having an uncut member sets us apart from our Muslim brethren.

    Nothing has changed about AIDS prevention strategies. But it’s boring to study the same variables all the time, let’s recap them one more time, shall we!

    Education and awareness: Look at this picture from India (from the NFHS Survey):
    Now tell me that increasing awareness among women and empowering them is not the most important thing you can do!

    Condom use = 85% risk reduction

    Nothing more to say. Continuing to improve access to condoms is important. Avert indicates that condom use is very state dependent, especially among sex workers, with Tamil Nadu having an 80-90% use rate and Mysore in neighboring Karnataka having a 9% use rate.

    Access to antiviral therapy

    India is in a lucky position here with a very well established pharmaceutical industry. So, drugs are likely to be available (patent issues notwithstanding). The issue however is with infrastructure, getting the drugs to the right people at the right time. This 2004 paper from the Indian Journal of Medical Ethics indicates that coverage is spotty at best. India’s National AIDs Control Organization (NACO) recognizes this, but in my opinion does not go far enough to provide free/affordable drugs to infected people, especially to prevent mother-child transmission.

    So, to cut a long story short, circumcision in India is not likely to be a factor in the pantheon of choices available. We have a long way to go with our other major AIDS prevention challenges, and I hope this circumcision issue does not become an increasing distraction.