Evolution of Evolutionary Thought: Darwin's Paradigm Shift

Herbal Medicine Ancient Practices Blood Transfusions A Vital Life Force Abortion Yesterday and Today 1 2 3 Infertility Searching for a Cure Evolution Darwins Paradigm Shift Medicinal Leeches New Uses 4 5 8 News Briefs ............................................... 2 Book Review ............................................. 5 3 Questions ............................................... 6 INSCRIPTO February 2011 Science Writers Association of Emory Ancient Medicine in Modern Biomedical Science Herbal Medicine PHOTO: WWW.CURCUMINRESEARCH.ORG Ancient Practices to Modern Medicine DEESHA PATEL M ore and more people are using complementary and alternative medicine (CAM)—taking supplements or participating in practices that are outside the normal realm of modern medicine—to increase their health and well-being, using these remedies to replace or supplement conventional treatment. One type of CAM is herbal medicine, or herbalism. Herbal medicine is the practice of using parts of plants, such as flowers, roots, and leaves, as medical treatment. While it may seem like a relatively new concept to many in the United States, herbal medicine has been used for thousands of years. It is still widely practiced in the East and has gained popularity in Europe. According to the University of Maryland Medical Center, written information about medicinal uses for plants can be dated back to ancient Chinese and Egyptian cultures, if not before. Most African and Native American tribes used herbs for healing rituals. In India and China, herbs are primarily utilized for treating physical ailments. Turmeric (often known as curry powder in the West) is a plant from the ginger family and a common herb used in India for cooking. However, according to Aggarwal et al., for over 5000 years, turmeric has also been used for medicinal purposes. Both Indian and Turmeric has been commonly used for cooking as well as medicinal purposes in India Chinese medicine use turmeric as an anti-inflammatory treatment for menstrual issues, dental pain, flatulence, and chest pains. In general, turmeric has been used as an anti-malarial medicine, insect-repellant, antioxidant, antiseptic and analgesic, as well as for cosmetic purposes. Curcumin, a vital component of tumeric, has been shown to be responsible for the plant’s healing effects. Recent scientific research has shown that curcumin works as an anti-inflammatory agent through a variety of bodily systems. Specifically, curcumin can modulate transcription factors, growth factors, cytokines, and kinases, all of which are involved regulating inflammation. There are numerous ailments in which inflammation plays a key role, such as fever, allergy, rhinitis, pancreatitis, arthritis, and autoimmune diseases. The anti-inflammatory effects of tumeric and its derivatives are currently being investigated in clinical trials. Another common herbal treatment is green tea. India and China were probably the first countries to cultivate tea, and both have used it for medicinal purposes throughout the ages. Indian and Chinese medicine have utilized green tea for a variety of purposes—to promote the excretion of urine, manage bleeding and mend wounds, enhance heart health, stimulate the body, control flatulence, regulate body temperature, normalize blood sugar, promote digestion and to improve mental health. continued on pg 11... News Briefs Monarch Butterflies Blood Transfusions Passing on a ‘Vital Life Force’ Since the 1st Century Can monarch butterflies heal themselves using medicinal plants? That is the question being asked by Emory University biologist and Assistant Professor Jaap de Roode, who was recently given a $500,000 grant by the National Science Foundation to further his research. De Roode focuses on the behavior of monarchs infected with a protozoan parasite. After his previous research has shown that female monarchs infected with the parasite prefer to lay their eggs on a toxic species of milkweed over less toxic species, de Roode began investigating if the monarchs have evolved the ability to medicate their offspring. Monarch butterflies are known for their annual and long-distance migration from North America to forested areas of central Mexico. The elegant mix of orange, white, and black on their wings ward off predators by hinting that they may be poisonous. Their colors, however, are unable to ward off Ophryocystis elektroscirrha, the parasite known to commonly infect the butterfly species. De Roode and his team of Emory researchers plan to use the NSF grant to replicate their previous findings in various regions of the world that are inhabited by monarch populations. Emory funding increase Emory research funding increased by 10.5 percent over the last fiscal year of 2009. Over $535.1 million from external funding agencies have been awarded to Emory University continued on pg 9... INSCRIPTO Editor in Chief: Mary Puckett Managing Editors: Justine Leipkans Features Editor: Dannie Perdomo Columns editor: Cheryl Ho Designer: Nachiket Kumar Contact Us: [email protected] http://www.students.emory.edu/sciencewriters/ Tranfusion donor bottles being readied, circa 1939 JUSTINE LIEPKANS & DANNIE PERDOMO O ver 14 million units of red blood cells (RBCs) are transfused each year in the United States. In 2006, one out of ten hospital procedures required a blood transfusion. Furthermore, according to the Health care cost and utilization project blood transfusions are the largest and fastest growing common procedure performed during a hospital stay. In ancient times, however, blood had a somewhat different meaning. From 770BCE-221BCE, the Chinese Huang Di Nei Ching believed that blood contained the soul of the person. For centuries, throughout much of Europe, blood was generally considered to be a tonic for various ailments. In 450BC Hippocrates (who came to be known as the father of medicine) believed that disease was caused by an imbalance of the 4 humors: black bile, yellow bile, phlegm and blood. Romans also drank blood from departed gladiators in the hopes of gaining their vigor. In the Elizabethan era, Countess Bathory of Hungary (referred to by some as the true source of the myth of Dracula) sought to drink and bath in blood in order to retain eternal youth. These stories demonstrate the extremely common belief that blood is a ‘vital life force.’ This idea of blood as a life force later transitioned into the medical field. In 1492, Pope Innocent VIII fell into a coma and was given blood orally, from 3 young boys who were promised a ducat (a French coin at the time). Unfortunately, none survived the procedure. Later, in 1667, Jean Baptiste Denis (one of Louis XIV’s physicians) performed multiple transfusions on a 34-year-old madman named Antoine Mauroy who was known to beat his wife, run through the streets after stripping off his clothes, and set fires to houses. Denis thought that animal’s blood was more pure than that of human’s because of man’s “debauchery and irregularities in eating and drinking.” These transfusions of calves’ blood were performed in the hopes of replacing the ‘bad’ human blood with ‘good’ animal blood. Mauroy complained of heat moving through his arm during the 1st transfusion. The 2nd transfusion however was with more blood and the patient complained of kidney pains. Mauroy later vomited and secreted urine “black as soot” (which was thought to be the ‘bad spirit’ leaving his body). It was later understood that Mauroy’s black urine was due to the excretion of dead red blood cells from the transfused incompatible animal’s blood. Mauroy continued on pg 10... 2 INSCRIPTO February 2011 Abortion Yesterday and Today ROULA ABISAMRA & AIMEE LEIDICH I n a country that only decriminalized abortion in 1973, it might be easy to think that abortion is a practice of the modern era. In truth, the procedure has existed in all regions, cultures, and religions, almost from the beginning of recorded history. The Royal Archives of China have the oldest written record of abortion, dating back to 3000 BCE. The two main approaches to abortion – invasive and non-invasive – have a long and varied history, and their methods are still being perfected today. Dioscorides, Oribasius, Serenus Sammonicus, and Pliny the Elder all wrote about the potent effects of common rue, which modern science has shown to contain three abortive compounds. cottonwood plant, while white colonists used parts of the juniper, pennyroyal, tansy, ergot, and seneca snakeroot plants. Some of these preparations were likely effective – for example, pennyroyal, rue and juniper have documented uterotonic effects (they stimulate uterine contractions) and pregnant women intending to carry to term are warned to avoid them. On the other hand, other popular herbs may have had no effect on an existing pregnancy but only “provoked menstruation” in women who Non-invasive techniques were never pregnant in the Ancient and present day nonfirst place. Still other remedies invasive abortion techniques may have called for substances encompass the ingestion, applior dosages that were poisonous to the woman herself – cation on the skin, or insertion for example, pennyroyal can into the vagina of agents (such be fatal when ingested as an as plant-based preparations, or oil rather than as an infusion, more recently pharmaceuticals) that interrupt fetal growth or and any exposure to mercury induce uterine contractions. is extremely toxic. Although While these techniques are still Soranus wisely warned against practiced today in many regions using sharp instruments that of the world, they have not risked uterine perforation, evolved in a uniform or linear he incorrectly claimed that fashion over time. Some meth- 13th century drawing showing woman being readied for abortion diuretics, enemas, fasting, ods were mainly passed on by and bloodletting were safe word-of-mouth, and even those that » In 1025, Avicenna, the Persian and effective abortion methods. While were recorded and disseminated were physician and foremost Islamic these methods are less widespread in still dependent on the agents available philosopher of his time, included a developed countries today, women in a community, limiting widespread chapter listing abortifacient herbs around the world still attempt to end use. A few historical examples of these their pregnancies with both safe and in his medical textbook. toxic herbal preparations. methods are below: » In the 1200s, Peter of Spain, who served as personal physician to More recently, safer and more effec» Around 2700 BCE, Chinese emperor Shen Nung wrote of recipes for Pope Gregory and would himself tive pharmaceuticals have become be elected Pope John XXI, wrote commonly used to induce non-invaabortion; one of which involved using mercury. the Thesaurus Pauperum as a hand- sive abortions. Misoprostol (Cytotec) book of medical remedies for the was originally developed for treating poor, including a lengthy chapter on stomach ulcers, but was also found to » In the fourth century BCE, the Greek physician Soranus wrote that using plants and herbs to prevent have a wide range of pregnancy-related every month women could drink the applications. A synthetic prostaglanor terminate pregnancy. juice of the now-extinct silphium din, misoprostol causes contraction of plant, which “not only prevents con- » In seventeenth-century North smooth muscle , the same muscle type ception but also destroys anything America, African slaves induced found in the uterus; pregnant women existing.” In addition, Soranus, abortions by ingesting the continued on pg 13... February 2011 INSCRIPTO 3 Searching for a Cure ADONIS BOVELL T he Nobel Assembly’s decision to award Robert Edwards the 2010 Nobel Prize in Physiology or Medicine for his work on the development of in vitro fertilization (IVF) has pushed the contentious moral and medical issue of IVF back to the center of public discourse. The Vatican’s top bioethics official, bishop Carrasco, summarized the dichotomy of views on IVF by acknowledging that Edwards ushered in “a new and important chapter in the field of human reproduction.” However, he still holds Edwards responsible for creating a market for eggs which leads to the destruction of human embryos without treating the underlying problem of infertility. Infertility and its attendant treatments have always been deeply entwined in human history. Biblical passages teach that one will be rewarded with fecundity for following a righteous path. Instances of grievous barren women past childbearing age, such as Sarah, the wife of Abraham, can be found throughout the Old Testament. Centuries later, in the pre-colonial Philippines, infertility still carried a strong negative stigma. Indigenous Filipinos took part in fertility rites that involved feasts, accompanied by song and dance around a phallic statue, in the hope that their gods would look favorably upon them by giving them a child. Their traditional pagan gods have been largely replaced with Christian saints, and although the Obando Fertility Dance Festival continues annually each May, it now serves more as a tourist attraction than as a cure for infertility. The search for a cure for infertility extends into antiquity. For ancient Romans the prospect of ending one’s lineage because of a lack of progeny was especially troubling. Soranus of Ephesus, the expert gynecologist of the 1st and 2nd century, has one of the few extant writings on the subject. In his treatise Gynaecology, paraphrased here, 4 INSCRIPTO February 2011 he gives us a good understanding of the beliefs of that time: For them, breath was the carrier of life, and so, sperm had to carry air to create life. This interpretation shaped their approach to a cure—men who wanted children had to eat foods that caused flatulence so that more air might enter Image of a single sperm fertilizing an egg their sperm. It was unclear to them whether women As with some other great scientific produced sperm or its equivalent, as the breakthroughs, this process was met physicians of the time had less access with apprehension. There was disagreeto (and knowledge of) the female body. ment about whether a baby made in this Their advice for women was to postpone manner would be healthy. This lack of intercourse until after menstruation. acceptance partly explains the 30 year After intercourse, the woman was to delay in awarding Dr. Robert Edwards’ remain in bed for a few days, with legs the Nobel Prize. To date, IVF has lead to crossed, to maximize the chances of the births of 4 million babies worldwide. pregnancy. These practices may seem From Louise Brown, the first IVF baby comical today, but for the Romans, born in 1978, IVF has continued its knowledge of anatomy was gained from march to acceptance in the fight against combat injuries, accidents, and the dis- infertility that has plagued humanity section of animals, so physiology was for millennia. more based on logic and analogy than on observation. This advance, however, has not been without challenges. The Emory ReproNonetheless, some ancient views ductive Center, for example, averages a aligned closely with ours. Men were 47% success rate for an implanted fersupposed to abstain from sexual activ- tilized egg to come to term in women ity until the woman was ready for sexual under 35, and even this is 8 points above relations. The motivation for this would the national average. To mitigate this, not meet today’s criteria, but the advice multiple eggs are implanted at once, was good, all the same. A good diet and which increases the risk of multiple rest was also advised- today these are births. Nadya Suleman (Octomom), thought to play a role in a healthy life- and Kate Gosselin, for example, have style, and are recommended to aid with gained notoriety because of this IVF fertility. shortcoming. These ancient mores clearly contrast with modern day advancements, where couples who experience difficulty getting pregnant have IVF as an option. IVF is a process in which eggs are harvested with the help of hormone treatments and fertilized with sperm outside the body in a Petri dish. Fertilized eggs are then transferred into the patient’s uterus in the hope that at least one embryo will attach resulting in pregnancy. Medical research continues to try to solve these problems. Renee Pera’s group at Stanford has shown that following video of developing embryos could be a good indicator of cell survival. Work like this may lead to improving the success rate of IVF. So, with IVF we may not yet have a cure for infertility, but we do have the next best thing–a scientific process that can bring a family their most cherished possession- a healthy baby of their own. p PHOTO: HTTP://EN.WIKIPEDIA.ORG/WIKI/FILE:SPERMEGG.JPG Infertility Evolution of Evolutionary Thought Darwin’s Paradigm Shift KATHERINE L. BRYANT E volution and Charles Darwin are essentially synonymous to most people. Yet the concept of evolution did not originate with Darwin – rather, he cracked the puzzle of the mechanism of evolution. Possibly the earliest concept of evolution can be traced to the Greek philosopher Anaximander, who used fossil evidence to support his ideas that animals had changed over time. Since then, we have been attempting to explain the diversity of life seen in nature. How do pre-Darwinian and Darwinian thought compare? Prior to the concept of natural selection, there were variable explanations for the diversity of life, but the majority of these invoked either an explicit God or an implicit one. Aristotle viewed God as perfect and unchanging, and his explanations for the relationships between species reflected that. Higher forms of life were described as being more ‘complex’ and more ‘perfect’ (that is, better adapted and therefore closer to Nature’s goal of perfection). Thus a lobster, because his body plan is more complex, is a higher life form than the simply constructed jellyfish. All life was connected, from the most primitive (worms) to the highest form (humans, or more specifically, “Man”); each link was a species connecting the lower form with the higher form. This was known as the Great Chain of Being, the Scala Naturae, or the Ladder of Life. Darwin wrote in his famous oeuvre, “It is absurd to talk of one animal being higher than another.” A sketch from his diary drawn while on the H.M.S. Beagle, shows a picture of what we would term now an ‘unrooted tree’ or phylogenetic bush. This is an excellent illustration of our current thinking on evolution. Not only does the Scala Naturae suggest progress, it also implies unidirectional changes (humans as the “goal” of evolution). But Darwin’s unrooted tree diagram shows how evolution can create complexity without requiring unidirectional change. Darwin allowed First evolutionary tree sketch by Darwin modern scientists to break free from goal-directed views of evolution and refine their theories to more accurately describe nature. Despite Darwin’s achievements, Aristotelian ideas have become entrenched in our collective wisdom. If you were educated in the 1950s, your biology continued on pg 12... Book Review The Spirit Catches You and You Fall Down by Anne Fadiman is at its heart a story of the senses and what happens when they fail. Recounting the true story of Lia Lee, the epileptic daughter of Hmong immigrants, Fadiman explores both the Lees’ and their doctors’ sides of what happened when two very different senses of entitlement, of honor and of proper medical treatment collided in the 1980’s. The Lees immigrated to the United States from a refugee camp in Thailand, to which they had fled from their wartorn home village in Laos. Hundreds of thousands of Hmong eventually sought refuge in the United States, with the largest proportion settling in Merced, California. Believing the US owed them a safe haven after many of their men had fought in the CIA’s Armée Clandestine against North Vietnam in the 1960’s, some of the Hmong felt that their welfare checks were the least their new country owed them. But for many, their unemployment and welfare status was actually a source of shame. In Laos, each family had built and maintained their own house and fields and had been self-sustaining. In Merced, many Hmong felt ashamed that they could not provide for their families and had to wait for handouts. They would have preferred to provide for their families themselves, but the scarcity of jobs and the fact that welfare often paid more than a minimum-wage job meant that many Hmong were left with no choice. Lia was born in Merced in 1982, the fourteenth child of the Lee family. At continued on pg 6... PHOTO: WWW.AMAZON.COM February 2011 INSCRIPTO 5 Book Review ... continued from pg 5 three months old she began experiencing seizures. Her parents immediately recognized her illness as qaug dab peg, which translates as “the spirit catches you and you fall down.” The Hmong culture attributes sickness to a variety of causes, the most common being the loss of one’s soul either through wandering or theft. The Hmong typically use a txiv neeb, a shaman who could barter with dabs (the soul-stealing spirits) for the return of a lost or stolen soul. Interestingly, epilepsy is common among the txiv neeb themselves, and the Hmong tend to view qaug dab peg as an important condition rather than a devastating disease. Whenever Lia’s seizures became prolonged, her parents would carry her three blocks to Merced Community Medical Center, or MCMC. The Lees believed that the Hmong form of healing would be best for Lia, but their experience had taught them that the United States medical system could also be beneficial. Lia’s American doctors diagnosed her as epileptic at eight months old and immediately set about trying to control what they viewed as a dangerous and potentially fatal disease. Neither side even thought to consult the other about the causes and treatment of Lia’s illness, although language and cultural barriers would have made it impossible even if someone had tried. MCMC could not afford staff interpreters, so the Lees and Lia’s doctors had to rely on a series of janitors, lab techs, and various relatives to imperfectly translate their concerns. In many cases, no translator was available. However, even if the language barrier had been removed, each side’s concept of proper medical care would have proven to be a much bigger obstacle. Each side felt they knew what was best for Lia, but their individual senses of proper treatment sharply contrasted with each other. Shortly after diagnosis, Lia’s American doctors, Neil Ernst and Peggy Philp, quickly devised an everchanging treatment regimen of medications and procedures in the search for the perfect combination that would control Lia’s seizures. Hmong beliefs do not typically allow for repeated blood draws, spinal taps, and “too much medicine,” all of which are routinely used by the US medical system. Adding to this, Lia’s family was on Medi-Cal for health insurance and over the course of her years of treatment they would never pay a cent in medical costs. To the Lees, it made perfect sense that medical treatment should be free. However, Lia’s doctors felt her parents ought to have acted gratefully and obeyed all of the doctors’ instructions. When the Lees failed to comply with medical instructions, the doctors were baffled. When compliance became a serious issue, Lia’s doctors put her in temporary foster care. While this worked to stabilize Lia’s medication routine, it destroyed any trust that the Lees had in their daughter’s doctors. Eventually Lia’s epilepsy resulted in a nearly two-hour grand mal seizure that had life-long catastrophic results for four-year-old Lia, her parents and her American doctors. The results of this event forced Lia’s parents and her American doctors tofinally find a way to compromise and begin to heal the scars from their four-and-a-half year battle. Lia’s American doctors began to get past the noncompliance issues and see the genuine love and concern Lia’s parents had for her. For their part, the Lees began to see that her doctors loved her, too, and were just as devastated by the results of her case. Fadiman’s unbiased retelling makes the reader truly feel the frustration and heartache of both sides, as well as the solace both found in each other as they worked for the best outcome for Lia Lee. Ultimately, that should be the goal of any interaction between ancient and modern medicine: for both sides to learn to work together to obtain the best results for the patient. p -Katie Anderson “Each side felt they knew what was best for Lia, but their individual senses of proper treatment sharply contrasted with each other” 6 INSCRIPTO February 2011 3 Questions We talked with Steven Wolf, Ph.D., PT, FAPTA, about his research using an ancient Chinese exercise practice called Tai Chi as an intervention to prevent falls in older adults. Originally developed as a martial art form in China and modified as an exercise form several hundred years ago, Tai Chi is now gaining popularity in Western medicine as one of several practices within the field of complementary and alternative medicine, which includes non-traditional practices such as herbal medicines, meditation, acupuncture, and music therapy. Dr. Wolf is a member of the Emory GDBBS Neuroscience faculty, a professor in the Departments of Rehabilitation Medicine and Medicine and associate professor in the Department of Cell Biology, and a professor of Health and Elder Care in the School of Nursing. What was the basis for your initial interest in using Tai Chi as a therapeutic intervention, and what were your major findings in this field? If you stand on the machine, there are sensors under the platform that are sensitive to changes in body weight and positioning, and the output from those sensors can be resolved as a cursor on a screen that moves as you move. In a way, that’s feedback about how your body is positioned and the forces exerted against the platform. About that time, the National Institute on Aging had a call for proposals to determine if there are ways you can reduce falls and improve frailty in older adults. They called the collection of funded projects the FICSIT trial–Frailty and Injuries Cooperative Studies on Intervention Techniques. The idea was that, people would apply for funding and come up with unique training tools, with the primary outcome to be reduction of falls. I was curious about these posturography machines, and I was going to propose that you could compare a control group to a group working with posturography machines. I put out a call to people in the Emory community, and a gentleman named Tingsen Xu, appeared. He was a professor of biochemistry, and also happened to be a Tai Chi Grand Master. I had heard of Tai Chi as a martial arts form, but I didn’t know until he gave me some books to read that it had been practiced as an exercise form by elderly Chinese for over 3400 years. SW: My training is as a physical therapist and spinal cord neurobiologist. For many years I’ve been interested in muscle feedback mechanisms. Well, what does that have to do with Tai Chi? Around 1990, several companies came up with posturography machines. They’re balance machines. In 1990, there was no alternative medicine at the NIH [National Institutes for Health]. The National Center for Complementary and Alternative Medicine didn’t come about until 7 or 8 years later. I started thinking about [Tai Chi versus traditional Western medicine]: East versus West, group • What are the therapeutic benefits of Tai Chi practice? Dr. Steven Wolf: Tai Chi is as much a philosophy, a way of life, as it is an exercise. It’s something you practice regularly. Elderly people who take Tai Chi have better control on the relationship between their center of mass and their center of pressure. Their weight shifting is better, they start walking better, and they don’t sway all over the place. They can control the trunk of their body better in relationship to their feet. There are other improvements as well: systolic blood pressure goes down, and body mass index (relationship of height to weight) improves significantly in the Tai Chi group, not because they are losing weight, but because they are standing up straighter and taller. There are many papers that demonstrate Tai Chi’s physiological effects: reduced cortisol secretion (cortisol is a marker for stress), heart rate and blood pressure and increased peripheral blood flow – just because part of the exercise is relaxation and controlled movement, so you become more aware of your body. •• activity versus individual activity, low-tech versus high-tech, multiple benefits versus single benefit – as a matter of fact, they’re diametrically opposed! So I said to the group, “You know, we should do a three-armed experiment. A control group, a balance training on posturography machines group, and a Tai Chi group.” We knew we were taking a big chance, because there were no studies in alternative medicine at all at the time. To make a long story short, they really loved the idea. And so we were one of eight sites in the FICSIT trial. Each site had different interventions – some people had hip pads to reduce fractures, strength training, endurance training, flexibility… And so the big outcome measure was, how long does it take before somebody falls? And is there a relationship between the nature of the intervention and the time to first or multiple falls? All of the data was collected independently, and in a blinded manner. As it turns out, Tai Chi had the greatest impact on delaying falls amongst all the interventions studied across the country. So we had a paper in JAMA in 1995 that indicated that the time to falling was delayed by 47.5%. So what that means is that, we presume that all older people are going to fall at some point. How much can you delay that when you provide intervention? So the strongest intervention that delayed falls the most was Tai Chi. After that, we decided to conduct another study that looks at what happens to a person’s movement control when they take Tai Chi. We began continued on pg 10... PHOTO: STEVEN WOLF February 2011 INSCRIPTO 7 Medicinal Leeches New Uses for Ancient Practices MARY PUCKETT A s early as the middle-ages and, by some reports, the 3rd century BC, medicinal leeches have been used to treat a wide range of human ailments. Tainted or excess blood was thought to be the cause of nasal congestion, poor digestion, and liver disease, fever, and even depression. To treat such conditions, this so-called “bad blood” was removed through blood-letting, a process often performed through the use of medicinal leeches. PHOTO: HTTP://WWW.FLICKR.COM/PHOTOS/PETRUNIAK/4090281719/ Medicinal leeches have been utilized throughout history. Evidence of medicinal leeches has been found on the walls of ancient Egyptian tombs. Their use was widespread in the 17th, 18th and 19th centuries. In fact, Europe suffered from a leech shortage in the 17th and 18th centuries due to their heavy use. To perform blood letting, leeches were first starved for one day and cleaned in water. The site of attachment was then scratched to increase blood flow and covered with oil. The leeches were then allowed to attach and often could only be removed by sprinkling salt on them. Leeches were normally placed at the site thought to be suffering from tainted or excess blood. The writings of one 6th century AD physician described the placement of leeches in a ring around the crown of the head in order to treat “mania.” The use of leeches, unfortunately, often had severe side effects for patients. Extreme blood loss of patients already weakened by fever only decreased their chance of recovery. In addition, bacteria found in the gut of leeches caused infections, which were attributed to inadequate removal of “poisons” after leeching. Some care, however, was taken by early physicians to prevent such side effects. Leeches were never to be reused, and the patients’ blood was often allowed to run freely from the wound from a period of time to remove any “poisons” potentially left by the leech. In the 1920’s, modern physicians renounced the use of medicinal leeches. However, in the 1970’s the use of medicinal leeches went through a revival, and is now approved by the FDA in the use of microsurgeries and venous congestion. The first such case of medicinal leech use in modern medicine involved the reattachment of a five-year old boy’s severed ear. In microsurgeries, such as the reattachment of a severed appendage such as a finger or ear, leeches can increase chances of a positive outcome. A common side effect in these surgeries is the pooling of blood in the reattached tissue, which can interfere with healing. Leeches can remove this pooled blood, allowing for blood to circulate normally and healing to begin. Additionally, modern medicine has taken a new approach to the use of leeches, using them as a starting point for the discovery of new drugs. In 1884, a physician named John Haycraft first noted that leech saliva has anticoagulant effects. It took another half century, however, for scientists to identify the protein responsible for these effects. Hirudin, named after the latin name given to leeches, Hirudo medicinalis, has been extensively studied. Hirudin acts by inhibiting thrombin, an enzyme involved in clot formation. Today, recombinant hirudin (a cloned protein that is more rapidly produced by being grown in bacteria) is an FDA approved treatment for heparin-induced thrombocytopenia. Other leech-derived anticoagulant enzymes, including bivalirudin and lepirudin, are being studied as possible alternative treatments for blood clots. Similarly, enzymes with anesthetic, vasodilation (blood vessel dilation) and other properties have been identified. Medicinal leeches have experienced a long history, dating back to ancient Egyptian, Greek, and European medicine. And, as it seems, their story is long from over. With constantly improving techniques for identifying and characterizing proteins, the use of medicinal leeches and leech-derived enzyme therapies may expand far beyond what ancient and even modern physicians thought possible. p Medicinal leeches for sale in Turkey 8 INSCRIPTO February 2011 News Briefs ... continued from pg 2 scientists. Research funding totaling $500.7 million was granted to Emory’s Woodruff Health Sciences Center (WHSC), which makes up Emory’s schools of public health, medicine, nursing, Emory Healthcare, Yerkes National Primate Research Center, and the Winship Cancer Institute. Federal agencies accounted for over 74 percent of funds, with the National Institutes of Health (NIH) contributing approximately $350.5 million. NIH funding has risen by 17.4 percent over the 2009 fiscal year and represents 88.4 percent of total federal dollars awarded to Emory University. Over the past five years since the 2006 fiscal year, Emory’s research funding has increased over 51.2 percent from $353.9 million to $535.1 million. The Rollins School of Public Health, which received $63.9 million, had a 6.5 percent increase in funding. Emory University School of Medicine’s $347.7 million marks an 8.1 percent increase from last year. Emory’s Nell Hodgson Woodruff School of Nursing and Yerkes National Primate Research Center also showed increased rates of funding. Funded research projects, for example, include a $6.2 million grant to the Emory Prevention Research Center whose mission is to prevent cancer and reduce health disparities among residents in rural areas of southwest Georgia. Meditation Study The Compassion and Attention Longitudinal Meditation Study (CALM) is one of the latest Emory University studies to test the value of meditation in helping individuals cope with stress. CALM scientists and researchers are investigating various compassion meditation practices to see if certain practices are able to reduce deleterious physical and emotional responses to psychological stress that have been associated with illnesses such as depression and cardiovascular disease. Associate Professor Charles Raisin, MD, of Emory’s Department of Psychiatry and Behavioral Sciences, is the study’s principle investigator. Previous evidence has suggested that mediation may improve both emotional and physical well-being, however, little is understood regarding the possible health benefits. The current study plans to enroll 360 Emory University freshmen who will be studied over a five-year period after being randomly assigned into different meditation interventions. The CALM study plans to compare a lojong-based (Tibetan mind-training) compassion mediation to mind and attention-based practices developed by researchers at the Santa Barbara Institute. Emory University’s Geshe Lobsang Tenzin Negi acts as the principle contemplative investigator and was the developer of the lobjong-based program. For more information regarding the CALM study, please visit http://www.sbinstitute.com/research_CALM.html. Chronic disease deaths Approximately 60 percent of deaths worldwide are due to chronic diseases. Emory university researchers are urging policymakers to focus on stopping the global spread of chronic and noncommunicable diseases including heart disease, diabetes, and cancer. Rates of risk factors for chronic diseases – hypertension, high glucose levels, and obesity – are also on the rise with the majority of the growth occurring in developing countries. It has been suggested that noncommunicable diseases will surpass infectious diseases by the year 2030 in sub-Saharan Africa. Estimated long-term costs of treatment for chronic illnesses and their consequences on economic development appear to be of great concern as well. A recently published article in the New England Journal of Medicine estimates that cardiovascular disease and diabetes together cost the United States over $750 million in national income. In addition, the article also projects that countries such as China, India, and Great Britain will lose $558 billion, $237 billion, and $22 billion, respectively, in national income due to preventable illnesses such as heart disease, strokes, and diabetes. Smoking related deaths According to Carla Berg, PhD, of Emory University’s Rollins School of Public Health and Rebecca Pentz, PhD, of Emory’s Winship Cancer Institute, more people die from tobacco-related deaths around the world than AIDS, tuberculosis, and malaria combined. However, even though overwhelming evidence has linked detrimental health effects to smoking, a large number of physicians around the world continue to smoke. With this fact in mind, the two Emory faculty members have urged oncologists to set a healthy example by not smoking and by advocating against the usage of tobacco as part of their professional duty. Berg and Pentz are urging their colleagues to advocate for insurance coverage for treatments that would assist people to quit smoking, as well as to support legislation in promoting smoke-free environments. In addition, they are asking for international support to endorse the World Health Organization’s Framework Convention on Tobacco Control that may include measures such as higher taxation on tobacco products and prohibiting tobacco usage in public places. The convention was adopted by the United Nations in 2003 and signed by the Bush administration, but has not been sent to the U.S. Senate for ratification. p -Alvin Tran February 2011 INSCRIPTO 9 3 Questions ... continued from pg 7 another study with collaborators, more intense Tai Chi, in a group of older adults who are serious fallers. Something happened that we never really anticipated. We hypothesized that if we could delay falls by 47%, we should be able to do at least that in a more intense study. Now the people that we were working with in the second study were much more frail. So we started a 48-week intervention, either in a wellness education (control) group or the Tai Chi group, across 20 locations, with 15 randomized participants per site. As it turned out, it was a negative study. There was no difference between groups over a 1-year period. Then we realized something we should have realized all along. Many of the patients used walkers or canes for support. Those taking Tai Chi took about three months before they could actually let go of their walkers and start moving independently. So if you start looking at the data, from three months after they were enrolled through the rest of the year, there is a big difference between groups. The Tai Chi group showed highly significant reduction in falls. But not over one year, over the last nine months. It took three months to build up the confidence, strength, and coordination to move independently. So the story is, that for older, more frail people, Tai Chi is successful, but it takes time, it’s not a quick answer. If Western medicine were to adopt practices of complementary and alternative medicine more broadly, how do you think this would influence our health? ••• SW: The key to successful health in any culture is prevention. Prevention takes many forms, the most important being diet and exercise. We can’t change our genes right now, but the value of Tai Chi allows you to clear your head and concentrate on breathing. The biggest thing for older adults is that, unlike what we do in the West, where everything is prescriptive – whether it’s a medicine or an exercise regimen – Tai Chi doesn’t give instructions, it gives you mental images. You don’t say, “I want you to shift your weight from here to here.” Who wants to do that? Especially an older person with cognitive deficits? Instead, you’d say for example, “I want you to imagine you’re a tree in the woods and your branches are swaying.” You don’t have to remember what to do; it’s natural imagery, simpler and easily absorbed by older adults. If you can engage in these kinds of activities, which are relaxing [as well as] mental and physical exercise, it can only have a beneficial effect. We don’t do that as much as we should. Pharmaceutical companies don’t teach us to take responsibility for ourselves. They say, “Do what you want, and take our drug.” Many of the Chinese approaches, such as Tai Chi, Qi-gong, [and] some say pilates – they all teach some form of exercise, mental preparation, and to do it habitually. So trying to commit to a routine to exercise your body and your mind is critical to successful aging and health, and Eastern culture has that embedded in it. p -Cheryl Ho Blood ... continued from pg 2 ABO and Rh ( + / –) blood type distribution in the US O+ 37.40% A+ 35.70% eventually died. This matter went to court for malpractice, however, once an autopsy was performed, Mauroy was found to have been poisoned with arsenic by his wife. Even though Denis was exonerated, human transfusions were banned by the French and English courts as well as by much of Europe as a consequence of these events. It was not until the late 18th century that the first human-to-human transfusions occurred. Jean Henry Leacock’s dissertation on “the transfusion of blood in extreme cases of hemorrhage” and his subsequent animal research showed that the donor and recipient of any transfusion needed to be of the same species. 10 INSCRIPTO February 2011 B+ 8.50% AB+ 3.40% O6.60% A6.30% Today, blood transfusions are a common practice. Incompatible transfusions are avoided due to the potentially fatal reaction that can occur called: Hemolytic Transfusion Reaction (HTR), which literally translates to ‘the bursting of the red blood cells.’ Symptoms of HTR include hypotension, a potentially fetal immune reaction, acute renal failure, kidney pain, blood clotting, and black urine- as mentioned above in the case of mad Mauroy. In order to avoid these reactions, blood banks match the donor’s blood with the recipient’s serum containing the antibodies, which is the problematic component of an incompatible transfusion. The respective blood and serum are mixed in a tube and if the blood B1.50% AB0.60% ‘clumps’ than this match is incompatible. Interestingly, as far as we have come with blood transfusions, there were still 11:138,605 cases of HTRs in the year 2000. Mistakes are often made at the bedside with the choice of the wrong blood and with patients simply having no compatible donors. The health care system tries it’s best to avoid these mistakes and find compatible matches for patients. The problem of incompatible transfusions is not yet solved, and so is only avoided. This is why blood donations are extremely important, in particular those from people with rare blood types. It turns out that blood is a vital life force after all. p Herbal ... continued from pg 1 Green tea contains high concentrations of polyphenols, which are antioxidant compounds . Antioxidants hunt for free radicals, which are molecules that can alter DNA, damage proteins, and even cause cell death, thereby contributing to the development of health problems. Antioxidants like polyphenols can counteract the effect of free radicals, and therefore reduce or prevent the damage free radicals can cause. Point in fact, green tea has been shown to reduce LDL (“bad”) cholesterol, to increase HDL (“good”) cholesterol and to reduce triglyceride levels. Because of these combined effects, it may also prevent coronary heart disease. Green tea may also reduce inflammation in patients with inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Green tea has been shown to regulate blood sugar, and Traditional uses of Curcurmin animal studies indicate that green tea could prevent or slow the progression of type I diabetes. Green tea may be protective against liver diseases, as well as toxic substances like alcohol. Finally, green tea, specifically the polyphenols, may reduce cancer risk or prevent cancer progression. Echinacea is a common American flower that has been used as an herbal remedy for nearly all ailments, from infections to wounds, by Native Americans for over 400 years. During the 18th and 19th centuries, it was a popular treatment in the United States for illnesses such as scarlet fever, blood poisoning, diphtheria, malaria and syphilis. Echinacea treatments are acquiring popularity in Germany, where most of the research on echinacea is currently conducted. Currently, Echinacea is used for generally improving the immune system, fighting inflammation, decreasing pain, and healing wounds. Although echinacea is typically used to reduce symptoms of cold, flu, and cough, it may also help treat yeast infections, urinary tract infections, ear infections, athlete’s foot, allergic rhinitis, and sinusitis. Additionally, it seems that the different parts of the plant offer different benefits. For example, in Germany, the roots are approved for flu-like infections, whereas the top part of the plant is approved for colds, respiratory infections, urinary tract infections, and wounds. Turmeric, green tea, and echinacea are just three types of herbal medicine; there are many more. Because herbal medicines are not regulated in the United States, and like traditional medical treatments, they have the potential for side effects and may interfere with traditional drugs, it is still important to consult a physician before taking any of them. p Potential modern uses of Curcurmin PHOTO: AGGARWAL ET. AL, ADV EXP MED BIOL 595:175, 2007 February 2011 INSCRIPTO 11 Evolution ... continued from pg 5 teacher likely infused a flavor of the Great Chain of Being in lessons on the taxonomical relationships of organisms. As a child, I remember my biology teacher matter-of-factly telling the class that humans were the “most complex species.” This was in 1993. That leads me to ask: is the legacy of pre-Darwinian logic still affecting us today? Stephen Jay Gould may have been the first scientist to bring this issue to the public eye, in his accessible book Full House: The Spread of Excellence from Plato to Darwin. He emphasized that natural selection leads to diversification, not increases in complexity. Previous to this, evolutionary biologist George Williams argued the same point in Adaptation and Natural Selection a book more accessible to his fellow scientists. Another modern scientist and public communicator, Richard Dawkins, popularized the “gene’s-eye view” of evolution by demonstrating how genes are the unit on which natural selection operates. In direct contrast to preDarwinian thinking, Dawkins’ “blind watchmaker” metaphor illustrates that evolution cannot have “goals,” instead it proceeds randomly, stochastically finding solutions to problems presented to it in the environment. One would venture to think that because Darwinian Theory and molecular genetics are now able to complement each other, that perhaps the scientific community would be ready to lay Aristotle’s Great Chain of Being to rest. As it turns out, the issue is in fact more complicated. Further investigation of Williams’ argument shows that evolution does create increases in complexity, which is in turn limited in its trajectory by chaos. That is to say, random mutations can break down genetic adaptations. The greater the number of genetic specializations, the greater the chance of one of them being destroyed by random mutations. Thus, Williams envisioned an upper limit to biological complexity. He further postulated that the limit of genetic complexity might have been reached in the Cambrian period (approximately 500 million years ago) which is well-known for its as-yet 1871 sketch satirizing Darwin as an ape unexplained explosion of floral and faunal diversity. Now, it apply to many other areas of science: seems, the issue has become murkier: Anthropology, psychology, neurosciAristotle’s universe progressed towards ence, etc. Hypotheses that rely upon a perfect absolute. Modern scientists, an anthropomorphic “Evolution” are having once abandoned the Scala Natu- throwbacks to pre-Darwinian thought. rae, now hypothesize that finite gains Modern scientists must take care to in complexity do occur, but this process remember Darwin, Williams, Gould, manifests in diversity rather than Aris- and Dawkins in order to remember that totle’s idyllic perfection. human ideals are not usually the goals of evolution. p Modern evolutionary scientists are presumably aware of these details of evolutionary theory; but these concepts “it is absurd to talk of one animal being higher than another.” 12 INSCRIPTO February 2011 Abortion ... continued from pg 3 who take it experience cramping, contractions, cervical dilation, and eventually expulsion of uterine contents. Thus it can be used under medical supervision to induce abortion – as well as to induce full-term labor and to control post-partum hemorrhage. Still, misoprostol alone is only effective in terminating around 85% of pregnancies. In 1988 France was the first country to license a new drug called mifepristone (under the research name RU-486) for use with a prostaglandin to induce abortion. Mifepristone is a progesterone receptor antagonist, blocking progesterone receptors in the body. When progesterone’s action is blocked, the endometrium (uterine lining) begins to shed, which causes trophoblast cells (future placenta) to detach from the uterine wall, thereby cutting off the usual positive-feedback loop of hCG production and corpus-luteum progesterone production that maintains the pregnant state. Mifepristone also causes the cervix to soften and dilate, and the uterine muscles to become more sensitive to the contractile effects of prostaglandins like misoprostol. Thus mifepristone and misoprostol can also be used together in a combined regimen, allowing for a lower dosage of each medication than if either is used alone. The US FDA, along with 39 other countries, has approved the use of mifeprestone (sold as Mifeprex) in combination with misoprostol. Invasive techniques Records of invasive or 'surgical’ abortion techniques date back to 200 CE. The Christian theologian Tertullian, in writing against abortion, wrote of a device “for opening the uterus first of all and keeping it open” that also had an “annular blade” and “blunted hook” for removing tissue from inside the uterus, and a “copper needle or spike” device probably for puncturing the amniotic membrane. Techniques for removing a dead fetus from the uterus were also described by Celsus in the first century and St. Augustine in the fifth century. The eleventh century Andalusian physician Abulcasis invented the forceps for extracting products of conception from the uterus. Even in these earlier times, the “surgery” rarely entailed incisions in the flesh, but rather was performed by introducing instruments into the uterus by way of the vagina and cervix. Over time, invasive abortion techniques have progressed from the insertion of various objects into the uterus to the use of the curette and finally to the widely-practiced suction technique. Tertullian’s “annular blade” device was an early version of the curette (from the French verb, curer, ‘to cleanse’) a tool shaped like a hook or spoon with a long thin handle, used in modern-day dilation and curettage (D&C) abortion procedures. France first used the curette in general surgery in 1723, but it was not until 1870 that the German physician Alfred Hegar introduced into popular practice the abortion procedure of D&C, which is used to scrape the uterus clean. Inserting a sharp curette into the uterus carried a risk of grave complications, such as uterine perforation leading to removal of the uterus or fatal hemorrhage; nevertheless, a properly-performed procedure did not cause scarring in a healthy uterus and was found to be more reliably effective than herbal remedies. To overcome the risks of D&C, Dr. Wu Yantai and Dr. Wu Zianzhen of China pioneered the vacuum aspiration method in 1958. Instead of a sharp curette, the procedure introduced a cannula into the uterus, and then emptied the contents using the pressure of a suction machine. The procedure took nearly 10 years to spread globally, but has not replaced traditional D&C in some parts of the world. In the early 1970s, Harvey Karman, who was not a licensed physician, refined the technique by using a flexible cannula (which reduced the risk of injury from rigid objects, and allowed local anesthetic to be used instead of general anesthesia) making vacuum aspiration one of the safest procedures in modern medicine. More recently, the introduction of the handheld manual vacuum aspirator (MVA) – which is based on the same technique but instead uses a syringe to create a vacuum, and thus suction, without the use of electricity – has made safe abortion possible in rural areas with poor infrastructure. Before the development of the curette – and still today in places where trained providers and specialized instruments are absent – pregnant women and backalley providers have used sticks, sharpened bones or coat-hangers as tools for clearing the uterus. In nineteenth-century America, after the wave of state abortion restrictions spurred by Connecticut’s criminalization of abortion in 1821, women reported attempting abortions with knitting needles, crochet hooks, hairpins, scissors and buttonhooks. The risks associated with both sharp curettage and the back-alley uses of household objects for abortion are the likely basis for ongoing misperceptions that abortion causes infertility or worse. In truth, using today’s technology and trained providers, infertility is not a sequela of abortion, and casefatality rates for both surgical and medication techniques are less than one in 100,000, making abortion safer than full-term childbirth, a tonsillectomy, or a shot of penicillin. p February 2011 INSCRIPTO 13