Archive for the ‘behaviour’ Category

Stating ”race” enforces racism? Should the US Census ask people to state “race”?   Leave a comment

Stating ”race” enforces racism? Should the US Census ask people to state “race”?

On the web site of Time magazine, US Census Bureau Director Robert Groves is interviewed http://ti.me/jxmHcq. He is reporting that a large number of US citizens state more than one race. In Europe we do not state “race” when counting the population, because it is so difficult to understand what it means. And it supports feelings such as racism.

The New York Times had a series of articles on the topic earlier in the year http://nyti.ms/hf5trL. More and more Americans do not know what to tick when they have to state “race”. Personally I think the term “race” should be skipped, as it more describes social structures and history, rather than genetically important differences. Actually, race implies that the individuals “phenotype” is related to “geographic ancestry” http://en.wikipedia.org/wiki/Race_(classification_of_humans). The definition is certainly drifting away from the genetic definition, towards a more social explanation. However, it is also discussed that scientific studies through the twentieth century has found no biological basis for the classification of race, and perhaps a primary factor in racial classification has been the social conventions established during the colonial period. For example, what is “African American”. There is no clear definition to be found, except “at least one ancestor from sub-saharan Africa”. If we reverse that definition, it is absolutely clear that Barack Obama is IRISH (next time, plese do not tick “black or African American”! Actually, tick nothing…

I think the US Census should stop requiring citizens to state“race” because it is a term that enforces racism http://bit.ly/ilkptl. One could just as well describe “culture”, because that would better explain how society develop and how cultural interactions shape the world. Most NY-times readers seem to agree http://nyti.ms/e6tE6k.

Posted May 31, 2011 by Jan Lötvall in behaviour, psychology, race, science, US Census

The core of science and politics, wise words by Bertrand Russel   Leave a comment

There is a lot of politics in science, and arguing about this that and the other. We scientists see it all the time, and perhaps we sometimes forget the core of science: Finding the Truth. And only the Truth… And when we find the truth, there is not much to argue about… As long as we agree with it…

And in politics, there is one core principle that is important. Live in peace!

These two core principles of humanity were well described by Bertrand Russel in this old interview, when asked “what advice would you like to give to future generations”:

Thank you Maneck for directing me to this video.

In the exosome field we are searching for consensus to be able to establish the truth. By using crowdsourcing. Are we trying to bridge science and politics, to avoid conflict. Maybe. And to find the truth and provide opportunities to communicate that truth.
From my previous blogpostings:
http://bit.ly/kOLMAv
http://bit.ly/kSn7lM

Exercise, asthma and allergy – why medicines are crucial   Leave a comment

In today’s Expressen and Aftonbladet, Swedish tabloids, it is discussed about Marit Björgen’s asthma and her medication for it. Some asthma medication is unfortunately classed as “doping”, even though they are NOT shown to increase exercise performance. For a simple emotional reason, the International Olympic Committee 2008 decided to remain strict control of asthma medication, the only argument being: “Because of the widespread use and potential for misuse of inhaled beta-2 agonists by athletes, there was consensus to continue the strict control of the use of this class of drugs in sport.”

http://multimedia.olympic.org/pdf/en_report_1301.pdf

Personally, I am sure that Björgen’s asthma medication use has no performance-enhancing effects, beyond controlling the disease.

Also in 2008, the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma and Immunology (AAAAI) published a task force discussing the different aspects of allergic reactions in sports, not only restricted to asthma, as exercise may cause symptoms of rhinitis, urticaria (hives) or even anaphylaxis (allergic chock). It was published in the journal Allergy, and took a very practical view on these aspects:

Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). Schwartz LB, Delgado L, Craig T, Bonini S, Carlsen KH, Casale TB, Del Giacco S, Drobnic F, van Wijk RG, Ferrer M, Haahtela T, Henderson WR, Israel E, Lötvall J, Moreira A, Papadopoulos NG, Randolph CC, Romano A, Weiler JM.

This is the abstract of that publication: http://bit.ly/g1MpWM

Asthma in athletes needs to be treated efficiently. Extreme exhaustion can cause very severe airflow obstruction also in those with very mild disease, and every measure to avoid such attacks should be taken, including chronic medication with appropriate doses of asthma medications such as inhaled corticosteroids and sometimes LABAs. It does happen that asthmatics die from an attack during exercise http://www.aftonbladet.se/sportbladet/innebandy/article95942.ab and http://www.highbeam.com/doc/1G1-79032563.html. With appropriate preventive medications, such sad effects of asthma are exceedingly rare.

http://www.expressen.se/sport/vintersport/1.2328157/bjorgen-berattar-om-sin-hemliga-medicin

http://www.aftonbladet.se/sportbladet/vintersport/skidor/article8561792.ab

http://www.aftonbladet.se/sportbladet/vintersport/skidor/article8561792.ab

Posted February 14, 2011 by Jan Lötvall in Allergy, asthma, behaviour, EAACI, health care

Cat allergic, but no immediate response to cat exposure?   1 comment

Cat allergic, but no immediate response to cat exposure?

I have been arguing in earlier blogs that exposure to your pet may not cause you immediate responses, but can explain chronic disease in the nose and in the lung. It can explain those daily symptoms of asthma, and even exercise induced asthma. Now there is more scientific evidence that this can be true. Very late responses to allergen exposure have been described, and a recent publication in Annals of Allergy Asthma & Immunology emerging from the Netherlands discusses this phenomenon.

Recent paper: http://bit.ly/hGLUeN

Paper 6 months ago: http://bit.ly/eoqnGs

Briefly, individuals with allergy and asthma were exposed to an allergen, and responded with bronchoconstriction starting at 26 to 32 hours after exposure. The asthmatic response reached a maximum at 32 to 48 hours, and was associated with dyspnea, wheezing, tiredness, increased peripheral blood leukocyte count, lymphocytosis and neutrophilia, but was not related to eosinophilia. The response was resolved after three days. The investigators call this type of response Delayed-type asthmatic response delayed asthmatic response (DYAR). Commonly, allergen exposure otherwise is related to an immediate response, occurring within a few minutes of exposure and resolving within an hour, and a late asthmatic response starting at 4-7 hours after exposure. The existence of “DYAR” further argues that exposure to your pet may not cause immediate allergic symptoms, but can certainly explain chronic disease.

This is an extension of my blogs last week related to the “expressen dilemma” published in http://www.expressen.se in Swedish. Here is the resolution:

http://www.expressen.se/nyheter/dilemmat/1.2325640/dilemmat-kattallergi-avslutning

My GOD, I am allergic to my cat, or “the dilemma of pet allergy” – thoughts and reflections from an allergy doctor   Leave a comment

Today the Swedish newspaper Expressen is posting articles about the “cat allergy dilemma”.

today: http://www.expressen.se/nyheter/dilemmat/1.2321744/dilemmat-del-2-kattallergi

yesterday: http://www.expressen.se/nyheter/dilemmat/1.2320390/dilemmat-del1-kattallergi#comments

Scenario:

What happened? My eyes are red and itchy, my nose is blocked, I sneeze all the time, and sometimes I get wheezy and have difficulty to breathe. My doctor tells me I am allergic to my cat. ARGH! What does this mean? What can I do? How do I deal with this? I love my cat, I don’t want to get rid of my cat! STOP THIS, I AM ANGRY. I DON’T WANT TO BE ALLERGIC, CURE ME NOW, I LOVE MY PET!!

This is a very common problem, and a perfectly normal psychological reaction, occurring every day in every country of the world. People that have a furred pet suddenly develop symptoms of allergies, and the doctor coldly and bluntly state “you have to get rid of your cat or dog”.

This is clearly not an easy situation to deal with as a patient and as a doctor, and involves complicated issues such as allergy diagnosis, complications of allergies, psychology of the individual becoming allergic, and the welfare of the animal.

Research is unequivocal. If you are truly allergic to a pet, and maintain exposure to that pet, chronic allergic symptoms develop. The nasal mucosa is more swollen than normal, eyes are red and inflamed, and some individuals develop symptoms of asthma. The allergic symptoms become chronic, influencing everyday life and quality of life, and can make you more tired. The risk of developing difficult asthma is obvious.

The tricky detail is that many patients say “I am NOT allergic to my own pet, only other people’s pets”. This is not so strange actually, but the fact is that the cat at home is hugely responsible for chronic symptoms, but not for the immediate symptoms. What happens is that long-term exposure to an allergic stimulus, such as cat, reduce immediate reactions, but the chronic inflammation becomes more enhanced, causing chronic daily symptoms also away from the pet. Scientifically, this has been shown by repeated low dose allergen exposure increasing allergic inflammation (http://bit.ly/fW9WTl), but reducing allergen responses (http://bit.ly/fkxXza). That chronic blocked nose and itchy eye, and that chronic asthma, is still caused by the cat at home.

Can I take medicines to remove my allergy? Medicines such as inhaled and nasal glucocorticoids can reduce the inflammation. But they are seldom sufficient to remove symptoms totally, except in those with really mild allergy. But in the end, if this allergy is perpetuated, the efficacy of medication is often inefficient to eliminate the allergic symptoms. And the medication is fairly short term, and if you forget a dose the effect is more or less gone (http://bit.ly/glA0qJ )

What is the general advice if you have a furred pet allergy in a skin-prick test, but do not have or have ever experienced any symptoms? Well, there is no or very little evidence to say what is best. If the sign of allergy on the test is strong, it is likely that symptoms will develop, but it is not universal.

Can I be vaccinated against cat? If you have a cat, it is not recommended that cat allergy immunotherapy should be performed. This treatment is usually reserved for those exposed to cat allergens indirectly, for example teachers at school exposed to cat dander from the clothes of children.

Can I have another type of pet if I am allergic to another? Thus, can I get a dog, if I am not allergic to dogs, but to cats. Clinicians avoid giving advice on matters like these. It is possible that a new allergy will be developed, but the likelihood that it will not happen is probably greater.

Are there some pets that spread less allergens? The answer is yes, but the importance is really nothing. Allergy is usually an “all or nothing” response, and small reductions in exposures are seldom sufficient. Elimination is required to achieve significant effects on symptoms. There is one company that has claimed to have developed a “hypoallergentic cat”, which they sell at very high prices, but there is controversy how true and effective this is for allergic individuals http://abcn.ws/ezDySP .

If I am allergic to pollen, and the prick test says I am allergic to pet, should I avoid getting a pet, even though I have never felt any symptoms? There is no real reason to argue either way. If you have one allergy, you have a greater risk of developing a new allergy.

How about the psychology and thoughts when dealing with this dilemma? It is easy to understand the emotional distress and even anger when the doctor’s advice is to “get rid of your pet”. Health is important, allergy is difficult, allergy makes the sufferer more tired and less productive, and increases the risk of asthma.

I sometimes ask “what do you think your pet would advice you, had he or she understood the dilemma”.

Posted February 8, 2011 by Jan Lötvall in Allergy, asthma, behaviour, EAACI, medicine

What is “asthma endotype” – asthma is a syndrome encompassing several disease entities, “asthma endotypes”   Leave a comment

What is “asthma endotypes”?

Asthma is a syndrome encompassing several distinct diseases – asthma endotypes

I placed a blogposting here last week with the abstract included http://bit.ly/h6B2ff

In a recent publication in Journal of Allergy and Clinical Immunology, EAACI together with AAAAI publish a PRACTALL paper discussing the issue of understanding the subgroups of asthma http://bit.ly/e0Trz5. The terminology “asthma phenotype” has received extensive attention over the last years, but the term “phenotype” relates only to “observable characteristics”, and does not take into account which core molecular mechanism is causing the disease in each individual. This publication attempts to encompass those thoughts into a series of examples, and is arguing that a fundamentally different approach to studying clinical mechanisms of asthma. Please read it and comment, the debate is crucial to move forward.

www.theallergynews.com

http://www.jacionline.org/article/S0091-6749(10)01858-0/abstract

Asthma endotypes: A new approach to classification of disease entities within the asthma syndrome.   1 comment

J Allergy Clin Immunol. 2011 Feb;127(2):355-60.

Lötvall JAkdis CABacharier LBBjermer LCasale TBCustovic ALemanske RF JrWardlaw AJWenzel SEGreenberger PA.

Krefting Research Center, University of Gothenburg, Göteborg, Sweden.

Abstract

It is increasingly clear that asthma is a complex disease made up of number of disease variants with different underlying pathophysiologies. Limited knowledge of the mechanisms of these disease subgroups is possibly the greatest obstacle in understanding the causes of asthma and improving treatment and can explain the failure to identify consistent genetic and environmental correlations to asthma. Here we describe a hypothesis whereby the asthma syndrome is divided into distinct disease entities with specific mechanisms, which we have called “asthma endotypes.” An “endotype” is proposed to be a subtype of a condition defined by a distinct pathophysiological mechanism. Criteria for defining asthma endotypes on the basis of their phenotypes and putative pathophysiology are suggested. Using these criteria, we identify several proposed asthma endotypes and propose how these new definitions can be used in clinical study design and drug development to target existing and novel therapies to patients most likely to benefit. This PRACTALL (PRACtical ALLergy) consensus report was produced by experts from the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology.

Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

PMID: 21281866

 

Posted February 2, 2011 by Jan Lötvall in Allergy, asthma, behaviour, COPD, EAACI, medicine, science

Is “African American” a “race” or a term more related to “social” issues   Leave a comment

Today I read an article in the New York times describing the necessity to remove the American tradition of listing people as belonging to a “race”. Is race a genetic entity or a social structure?
(http://www.nytimes.com/2011/01/30/us/30mixed.html?hp)
Being a medical scientist, I am often exposed to research that is discussing medical findings related to the “race” which is denominated ”African American”. From a European perspective this is an incomprehensible term. What is “African American”? A term defining a person with dark skin living in America I presume? Looking for a definition, it seems that it is more a political or social term rather than something that is defined by genetic background. Well, perhaps partial Sub-Saharan African ancestry is required, which includes being a descendant from the slavery era, but also immigrants from African, Caribbean, Central American or South American nations are included in the definition. Thus, clearly the term “African American” is by definition involving a diverse group of people with fundamentally different genetic background. And from that perspective, individuals belonging to this “group” has very little genetically in common.
Therefore, I was so happy to see this article, because maybe it is time to start removing the conceptual thinking away from “race”, and start thinking about the “individual” as a unique entity where “race” is unimportant. The example of Ian Winchester, the partly Ghanian, partly Scottish, partly Norwegian mentioned in the article, illustrates very well that family history and cultural background is more important than “race”.
Medical research reporting differences in health outcomes in “African Americans” and “Whites” often imply differences in genetic background as explanations of different findings. That could of course be correct in some instances, but I would argue that differences in the social situation, health-related behaviour and health care utilisation, including health insurance access, are of much greater overall importance than small differences in genes and gene expression.

comments from NY times readers, most agreeing that race should become unimportant: http://nyti.ms/e6tE6k

Cost effectiveness of asthma medication in children – a dollar a day keeps the doctor away…   Leave a comment

It is not easy to quantify cost effectiveness of treatments in any area of medicine, but Wang and colleagues from the “Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute” have attempted to compare the effects of fluticasone by inhaled route and mometasone given by oral route. The investigators state: “For example, fluticasone treatment cost $430 less in mean direct cost (P < .01) and resulted in 40 more asthma-control days (P < .01) during the 48-week study period.”

http://www.ncbi.nlm.nih.gov/pubmed/21211651

I have no access to the full article at this time, but a major issue with cost-effectiveness evaluations is of course the huge difference in pricing of drugs in different countries. It is absolutely clear that cost in the US has no relevance for any other country. Medical costs are overall higher, doctors charge substantially more, and medications are generally higher priced than anywhere else in the world. Regardless, if we start thinking about the cost of medication on a daily basis, USD 430 in 48 weeks, the cost of treating a child with asthma was USD1.30 per day. In view of the very high efficacy such drugs have, and the substantial improvement in quality of life and “asthma free days”, this cannot be seen as very expensive in any western country. We even know that these drugs can reduce mortality. If we compare these prices with anything else we spend money on most days, perhaps a cup of coffee in the cafeteria, treating asthma is not so expensive?

In developing countries with large populations that have very little financial power, effective medicines certainly need to be provided at even lower prices. Asthma and allergies are on the rise in these countries, and the world needs to start thinking about how to provide to a global asthma population that most likely will reach 300-500 million individuals in a few decades. In 2050, the world population will probably be approximately 9 billion individuals, and if the prevalence of asthma in the developing world increases to levels of the western world (currently 6-12%), my estimate here is probably not exaggerated.

Asthma will obviouosly be a huge global health issue in the decades to come. And if it’s cost will be 1 dollar per patient per day, that is a daily expense of 300 million dollars per day globally, and thus more than 100 billion dollars a year. Is that expensive?

____________________________________

Just saw this (see link below), arguing that asthma prevalence in Puerto Rico is huge. The post is just over a week old. Will seek the scientific evidence supporting this statement, and will comment in a few days. It supports my argument above, that asthma is going to rise in developing countries. And it probably has very little to do with genetics… And it will have a financial impact on soicety…

http://www.huffingtonpost.com/2010/12/27/skyhigh-asthma-rate-in-pu_n_801487.html