When Texas nurse Anne Mitchell accused a doctor of unethical conduct, she had no idea how much trouble was in store. First of all, her complaint was anonymous, and second, she believed she was doing the right thing. When she was accused of harassment and faced a ten-year prison term, her reaction, according to the New York Times, was: "It was surreal. ... I said how can this be? You can't go to prison for doing the right thing."

The relationship between nurses - a predominantly female occupation - and doctors - still dominated by males in the more highly paid specialties - has not always been an easy one. Nurses have less power, not to mention fewer financial resources, which makes it less safe to blow the whistle.

Following the 2008 discovery in China of melamine-laced milk - an event that left six babies dead, 300,000 sickened, and over 50,000 hospitalized -- the Chinese government ordered all contaminated products to be burned or buried. The government was not directly involved in the destruction, however. That was left to those who had produced and distributed the tainted products.

Much of the contaminated milk was simply repackaged and shipped from the south (Guangdong province) to the northeastern part of the country. The government is aware of 170 tons of tainted milk powder, which were recalled earlier this week. The government also knows of another 100 tons that can't be located. Melamine-tainted candy is still being sold to children.

Melamine in milk is in the news again. Is this totally inexcusable or what?

Products from three Chinese companies were removed from shelves in southern China after they tested positive for melamine. Products included not just milk, but candy that used milk as an ingredient. Two of the companies had been cited in the last melamine scandal of 2008. That event was responsible for the deaths of six children and illness for 300,000 others.

It appears that milk contaminated with melamine in 2008 was not destroyed and was subsequently repackaged and sold. According to Reuters, "[H]ealth officials have continued to crack down on distributors who sell melamine-tainted milk to stores, but some distributors, wrongly assuming that the government has scaled back its crackdown, continue to sell it."

The LA Times had a story today on melamine in farmed fish from China, the source of 70 percent of farm-raised fish. This isn't exactly breaking news. Recent melamine-in-milk stories have mentioned melamine in animal feed, which means fish, shrimp, beef, pork, and poultry were likely to be contaminated. Melamine-in-fish stories go back to the 2007 pet food recall. On that occasion, melamine was an ingredient in gluten and rice protein, found in pet food and animal feed.

Another disturbing source of melamine in fish was suggested by Bill Hubbard, a long-time associate commissioner at the FDA and now an adviser for the consumer advocacy group Coalition for a Stronger FDA. The quotation is from a June 2008 Adweek.

[Hubbard] contends the fish are farmed in "polluted" coastal lagoons in the South China Sea, alongside chicken farms. The fish are fed feces from the chickens and eat algae blooms that grow from the waste .... When they get fungal and bacterial infections, ... the Chinese use anti-fungals like melamine (banned in the U.S.) that keep the fish alive long enough to harvest.

What was new (to me) in the LA Times story was the claim that while pigs and cows, like humans, excrete melamine in their urine, "fish appear to be different." This from Jim Riviere, a toxicologist who has published papers on melamine in pigs. I'm not surprised that fish metabolism is different from that of cattle and pigs and that melamine ends up in salmon steaks but not beefsteaks. I haven't yet been able to determine exactly why there's a difference.

After my last melamine post, a visitor to the site wrote to me:

My wife and I had a baby two weeks ago. We've had some problems getting breastfeeding going. The hospital had us on one type of formula and then another (don't remember the name of the first but the second was Nestle's Good Start). So we've had him on a combination of breast milk and Good Start since we took him home on 11/20.

Then, I read yesterday on Daily Kos that trace amounts of melamine have been found in most domestic formula, and also that the FDA has issued some kind of flash advisory indicating that the detected levels of melamine are 'safe'. So naturally, being the upstanding post-boomer parents that we are, we did a hard stop on the aforementioned formula and went to an organic powdered brand instead.

I'd still like a little more info about the underlying science of melamine. It's an organic chemical. Check. What does that mean? It has 66 percent nitrogen. Check. Well, the air I breathe is 70 percent nitrogen. I guess I'm asking you to do my homework for me -- but then, that's your new job as a blogger, right? ;-) Net, why has this chemical wrought the death and illness that it has wrought? What more can you tell us about the underlying chemical processes?

Thanks for asking, Suneel, and congratulations on that new baby boy!

Melamine combines with cyanuric acid

From what I can determine, the problem is not melamine by itself. If an infant eats melamine, it gets absorbed through the digestive tract, goes into the blood stream, and is excreted in the urine. It doesn't become part of the body, i.e., it's not 'metabolized.' In three hours, half the melamine would be gone.

But melamine can interact with a substance called cyanuric acid. This is a white, odorless solid used to make bleach, disinfectants, and herbicides. If you add water to a cyanuric acid tablet and drop in a pair of dentures, you get bleached-white teeth. If an infant eats both melamine and cyanuric acid, the two can combine to form a crystal called melamine cyanurate.

I need to say a few simple words about chemical bonding. In the diagram on the left, the melamine atoms are in green and the cyanuric acid atoms are blue. Together they form melamine cyanurate. Notice that the melamine and the cyanuric acid are joined at hydrogen (H) atoms. These hydrogen bonds are quite strong.

In the larger diagram below, you can see that when you get a whole bunch of melamine and cyanuric acid together, they form a more complex crystalline struture. These crystals do not dissolve easily.

And that's the problem.

I'm so glad September and October are over. In September melamine powder was sold to Chinese farmers and other food producers, allowing everyone along the food supply chain "to make more money," as one of those arrested later admitted. On the consumer side, tens of thousands of babies were poisoned. That same month In the US, the practices of Wall Street financiers managed to create the worst economic crisis since the Great Depression.

Then in October, the presidential candidates got down to discussing the need for healthcare reform. The US spends almost twice as much per person on healthcare as the average high-income country. If healthcare costs continue to grow faster than the rest of the economy, as they have for the past 30 years, they will be 30% of gross domestic product in another 30 years. Ouch!

The issues surrounding healthcare reform are difficult and complex, but at least part of the problem is something I mentioned in an earlier post: decisions in the healthcare industry are driven not by the needs of patients but, once again, by the need "to make more money."

All these things -- healthcare, the economic crisis, melamine adulteration of the food supply -- merged in my election-fevered brain into despair at how the selfish, if not reckless, decisions of a few can jeopardize the health and livelihood of so many. Together, they feed a crisis of confidence in the systems we depend on. In moments like this, it can be hard to be hopeful for the world.

Got Melamine?