Category Archives: Commentary

Why can’t I take an antibiotic for my cold: A primer on viruses.

This is another article I put up on my Medium.com account.

As I’ve mentioned in a prior post, and is likely noted in other posts on my blog (and numerous medicine related sites), a virus is genetic material — either DNA or RNA — encapsulated in a protein coat. In some cases there is also a lipid envelope around the protein coat.

This gets to the crux of why antibiotics don’t work on viruses. Viruses need a living cell to reproduce, and does so by co opting the metabolic pathways of the host cell it invades. Normal cells use DNA to pass genetic information from one (cell) generation to the next. The DNA gets transcribed into RNA which is then taken to the cytoplasm of the cell (in eukaryotic cells) or other parts of the cell (in bacteria/non eukarotic cells), where proteins and ribosomes/ribosomal RNA read the RNA and ‘transcribe’ it into a protein.

In some cases, viruses do code for novel (relative to cells) enzymes and/or proteins. EG, reverse transcriptase in HIV viruses (HIV is a RNA based virus, but its genetic code is converted to DNA for replication). Other viruses replicate the RNA directly for future virus particles. However, as I note above, the vast majority of the replication is done by the cell’s own proteins.

This is why antibiotics don’t work on viruses. Bacteria have have different types of cell walls than human cells. They require chemicals that our cells just don’t use. Penicillins and cephalosporins interfere with the cell wall construction as an example. Other antibiotics target pathways our cells don’t have (eg, trimethaprim-sulfamathoxazole targets folate production in bacteria. Our cells don’t produce folate so it doesn’t affect us). There are other examples that could be used as well that utilize a chemical’s affinity for a bacterial protein/enzyme more than for the equivalent in human cells.

Having said this, there are some antiviral drugs for some (not all) viruses. These target the proteins viruses code for that are novel to the specific virus/virus family.

Now at this point, you might be thinking “well, my great aunt _namehere_ was told she had a viral pneumonia, but when she got admitted to the hospital she was given antibiotics”. In some cases, a viral infection goes through its course and the person can develop a secondary infection that’s bacterial in nature. In that case, antibiotics might be warranted. Or she was given them to prevent the superinfection/secondary infection. This is true of any viral illness, even corona viruses, rhinoviruses and covid 19.

Coronavirus biology 101

This is a post I put up in my Medium.com account.

Initially I was going to write specifically about covid19 and how to prevent getting (perhaps — or at least decreasing the chances of getting) it. I realized there are more than enough articles already about that subject and can be found on the CDC website.

Instead I decided to write more generically about Coronaviruses and doing so, hopefully address questions some people might have, and that might not be answered by posts that deal with coronovid19. First of all a virus, unlike bacteria, algae, fungi and animal cells, is just a bunch of genetic material encapsulated by protien (and in some cases, a lipid coat). They don’t have any mechanism to move, metabolize, ingest nutrients, replicate genetic material etc. Viruses are entirely dependent on infecting cells, and co-opting their metabolic pathways to reproduce. With some, there are some genes that code for things that cells — be they bacteria or eukariots — don’t have. An example would be Reverse Transcriptase in HIV viruses (Reverse Transcriptase reads RNA from the HIV genome and encodes it into DNA for use in viral replication. The virus is still dependent on the cell for the actual copying and reproduction of said genetic material and of making new viruses).

In the case of Coronaviruses, the genetic material is single stranded RNA. There are other families of RNA based viruses, such as Rhabdoviruses (EG the virus that causes rabies), Orthomyxoviruses (one such causes Measles), and others. The virus that causes HIV also uses RNA as genetic material, but by some classifications isn’t considered an RNA virus because the RNA has to be coded back into DNA for replication.

Because viruses don’t have the proteins/cell parts/etc to replicate themselves, as I note above, they’re dependent on a host cell for replication. This is why antibiotics don’t work for the common cold (or other viral illnesses. Though in some cases, such as HIV and some viruses closely related to the chicken pox virus, there are antivirals that work). As they don’t have a cell wall that’s different from our on cells’ walls, antibiotics that affect the building of the bacterial cell walls won’t work. For example, penicillin and cephalosporins interfere with an enzyme and chemical specific to what bacteria use to make cell walls. Other antibiotics interefere with enzymes and other proteins that are different enough from human cell proteins that the antibiotics don’t affect us. Others (eg, bactrim, aka trimethaprim-sulfamethoxazole) interefere with bacteria specific metabolic pathways.

Having said that, some viruses do need a particular enzyme or protein to reproduce that human (and mammalian cells in general) don’t have and do provide a target for medications. These are different than antibiotics.

As for coronaviruses, many are respiratory pathogens. In humans some coronoviruses cause the common cold. As one might expect or know, transmission can be through inhaling droplets that have active virus in them (and is why sneezing and coughing can spread the common cold, COVID-19, and so forth — the virus particles can become aerosolized). They can remain infectious on surfaces. Though the amount of time they can remain viable and therefore infectious is different for each virus and varies as well due to environmental conditions.

Anyhow, I hope this helps people understand why for viral illnesses, doctors don’t just hand out antibiotics. For COVID 19 information, use the link I have at the start of this post (it will take you to the appropriate page at the CDC).

Do Social Ties Affect Our Health? | NIH News in Health

Source:

Do social ties affect our health

This article caught my attention. In medical school we’re taught about physiology, anatomy, pathology of diseases and treatment of diseases. Yes, we do rotate through a psychiatry rotation in our third year of medical school, and in some specialties (pediatrics, for example) social aspects of health are kept in mind (some specifics probably vary from state to state, but physicians are mandated reporters for such things as child abuse and elder abue) as kids, for example, don’t raise themselves. Abuse of any kind can affect growth, development and health – especially if it involves physical abuse, starvation, etc (sexual abuse as horrific as it is, is a whole other post and not the topic of this blog post).

Some studies have indicated people who attend religious services are healthier than those who don’t. Though it has been a while since I’ve looked at the literature for this, and I think some studies make the effect to be murkier or not as solid as some might make it, these are my thoughts on it:

  1. It’s not some supernatural being, or belief in one, that makes one healthier, but the fact as someone who is involved in a community, and a purpose larger than onself.
    1. 1a) I’d add, however, that this probably includes athiests and agnostics who aren’t church/mosque/temple goers, but are involved promoting athiest ideals and in the community at large.
  2. Being part of a community might mean access to people who can help older (or otherwise impared) community members to doctors appointments, help with food, etc.
  3. Being part of a community can also help alleiviate stress levels.
  4. Married people live longer, presuming the marriage is a healthy one. Though it’s important to be part of a a community larger than 2 as well.

For more information, follow the link above.

 

The Wide-Ranging Role of the Microbiome

What goes in your stomach can influence countless disorders, from cancer to asthma. Dr David Johnson surveys the latest data underlining the ever-increasing importance of a low-fat, high-fiber diet.

Source: The Wide-Ranging Role of the Microbiome

 

Anyone who’s been reading my blog probably won’t be surprised by my linking to this article (you may have to subscribe to medscape to read the full article).

Basically, the gist is that diet effects the kinds of bacteria in one’s GI tract. The good kinds of bacteria (that promoted by a low fat, primarily plant based diet) helps reduce risk of diseases like colon cancer, breast cancer (the former by producing short chain fatty acids and the latter by altering the reabsorption of estrogen that has been chemically altered by the liver and secreted into the GI tract).

 

There’s A Difference Between The Terms Hispanic, Latino, and Spanish

There’s A Difference Between The Terms Hispanic, Latino, and Spanish

As someone who’s learned some Brazilian Portuguese (and still has a lot to learn), something like this has been on my mind for a while. One of the things that us physicians are supposed to have is cultural competence. I think that before I started learning Portuguese, when I heard the term Latino/a or Hispanic, Spanish speakers typically came to mind. Though I’ve also recently read something arguing for treating those from Portuguese speaking countries as a distinct group (though in the US they’re often lumped in with those from Spanish speaking countries). Granted I realized that encompassed people from many places as cultures (a patient of Puerto Rican decent who’s family has been in the U.S. Mainland for a generation or two might not have all of the same concerns as people who came from Columbia, Peru or Mexico).

Even people who come from the same country might be very different, though more similar to each other than they are to the ‘average’ american. In this I think of people from China where there are many languages and dialects spoken. Even in the U.S., someone who grew up in New England might have a much different outlook than someone who grew up in the Mid West or South East of the U.S. They might have different dietary proclivities as well.

Does that mean it’s useless or futile to try to be culturally competent? No. But it does make it more interesting at times. I think it just means keeping an open mind and remembering people from other cultures might have different expectations of time, needs from their physicians, etc. It is also helpful to know who a patient might – or would – rely on for decisions and for help. What might be considered to be “on time” for an appointment for a physician, might not be for someone where the sense of time is more fluid.

Another reason for being culturally aware – and here I am also including having a knowledge of a country’s or ethnic groups history – is risks for certain diseases. For example, if one doesn’t know much about the colonization of Cape Verde, one might not know to test a patient for Cystic Fibrosis mutations in a couple who are concerned about genetic diseases before getting pregnant. In Jewish populations, one might think of Tay Sachs as being a “Jewish Disorder”. However the genetic disorders jewish patients who trace their ancestry to Spain prior to 1492 (Sephardim) or to the near east (E.G., Persia) actually mirrors the countries they come from (For example,they can carry mutations for certain forms of Muscular Dystrophy). Knowing this kind of history helps inform decisions about testing and treatment.

Insured Americans Up to 3 Times Likelier to Get Preventive Care: CDC: MedlinePlus

Insured Americans Up to 3 Times Likelier to Get Preventive Care: CDC: MedlinePlus.

While I don’t have any answers as to universal health care coverage, whether there should be one payer or many. However it’s nice to see something that shows a positive effect for having insurance.

some interesting thoughts

JAMA Network | JAMA Internal Medicine | A 300-Year-Old Solution to the Health Care Crisis.

Of note, I think when you click on the link above, you will have to download  the PDF.

I remember reading this article abut the time it came out. Though I don’t think it necessarily has all of “The Answers”, it does bring up some interesting points. I’ve often why some health insurance plans won’t pay for some preventive care when it would benefit the patient. When I’ve asked colleagues this the answer I  often get is “because the patient will be on different insurance [ie, medicare or  a managed care product from a private insurance].”

However many private insurances also have a managed care product for seniors. people may not ‘graduate’ into a plan from insurance they have while working. However there are people that might go from  Having Harvard Pilgrim Health Care to AARP’s program (through united health care). however, some might go from United healthcare to HPHC’s product (or an equivalent insurance in a different part of the country). This might even things out a bit.

Anyhow, I sugges you read the article and make your own conclusions.

Should doctors be environmentalists/advocates for the environment?

One thing that sometimes crosses my mind is whether physicians and other health care workers should also be environmentalists. After all the environment does play a role in people’s health. Contaminated water lead to outbreaks of water born diseases (John Snow, a London physician in the mid 1800’s is credited [at least in part] for ending a Cholera outbreak  by convince authorities to block use of a water pump at the center of the outbreak).  The cholera outbreak following the earthquake in Haiti several years ago is another example. Polluted air leads to increased respiratory disease.

Though in the U.S. and other developed nations with functioning governments, the chances of contaminating water with sewage is low. The one exception could be when severe weather overloads the septic systems in an area. However even in the Northeast U.S. where I live, beaches are monitored for coliform bacteria (this is a generic term for bacteria that live in our guts) and closed when the counts are too high.

Air quality effects health of populations – there were reduced hospitalizations in parts of Ireland after there were bans placed on burning coal.  When lead was taken out of gas (well, actually prevented from being put in gasoline…), blood levels of lead dropped. It’s a neurotoxin and high blood levels can affect brain development in children (hence the ban of lead in paint in the U.S.), and function in adults. For water, it’s not just bacterial contamination/pollution that is important. Chemical pollution can also affect health. Toxins can build up in the food chain – this is part of the reason why it’s suggested that pregnant women limit their intake of certain fish, for example. Mercury builds up in fish at the top of the food chain, such as in Tuna, and can adversely affect people neurologically and adversely affect developing brains. Studies continue to show an association between air pollution and respiratory  deaths.

Given the number of of medications that are derived in whole or part from the plant and animal world (aspirin, reserpine, taxol, digoxin, penicillin, streptomycin, are all plant and fungal products), an argument could be made that making sure plant and animal species don’t become extinct because it might affect future drug discovery. Before you say “but wait,….” think of this: heparin is derived from the linings of Pigs. ACE inhibitors were discovered through research on snake venom. There are some newer medications for Type 2 Diabetes which are derived/grew out of research on saliva from a lizard known as the Gila monster.

 

healthcare disparities

A few months ago there was an article in a prominent medical journal about an association with one’s income and place of death (it was looking at hospice patients only). The higher one’s income the more likely someone was to die at home with hospice rather than in a nursing home or hospital.

As a practicing physician,  that there are healthcare disparities bothers me. There are multiple factors that go into this. Some are patient related (limited english skills, little/no social support in cases of people with little mobility), some are patient and societal (I would put literacy here, not just health literacy). As of 2013 I would hope that being a member of a minority would not have an effect on one’s healthcare. There is evidence  – and i don’t recall which journal I saw this in – that minorities that go to hospitals that have good healthcare results do as well as non minorities, and those that go to hospitals with less good results have corrispondingly poorer outcomes. In this case I guess we could argue for putting systems in place for all health care institutions to give health care with good results.

One thing physicians get measured on are things like checking cholesterol levels, glycosylated hemoglobin A1c’s twice a year, etc. However  to just focus on measures like that take time and energy away from measuring and doing other things that ‘count’. Sending someone for a test and usually takes less time than spending 1/2 an hour educating patients as to why those measures count and how to take care of their health. There have been articles that have brought this issue up. There are easy answers. However, I have a feeling that at least as of 2014, having processes in place to be sure that patients are educated about disease prevention and self management would go a lot farther in preventing complications than would checking a glycosylated hemoglobin twice a a year.

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