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 body as machine

Inventor spends Christmas with his perfect woman - a £30,000 custom-made fembot (The Daily Mail)

"Inventor Le Trung spent Christmas Day with the most important woman in his life - his robot Aiko. ... Her touch sensitive body knows the difference between being stroked gently or tickled. ... 'Aiko is always helpful and never complains. She is the perfect woman to have around at Christmas.' "

Celebrity health advice

Are celebrities crossing the line on medical advice? (USA Today)

"Many doctors say they're troubled by stars who cross the line from sharing their stories to championing questionable or even dangerous medical advice. ... Actress Suzanne Somers-- already well-known for her diet books and ThighMaster products -- in October released her 18th book, Knockout, which experts describe as a catalogue of unproven or long-debunked alternative cancer 'cures.' ... [Celebrities] 'can spread misinformation much faster than the average person with a wacky theory. ... Correcting that misinformation -- even with a mountain of evidence -- can be a challenge. ... 'It's much easier to scare people than to unscare them.' "

There's a long article in Sunday's New York Times on palliative sedation. I've also listed some older stories on the subject and an educational site.

Aging, end-of-life, and death

Source: The Why Files

Hard Choice for a Comfortable Death: Sedation, (The New York Times)
"Among those [end-of-life] choices is terminal sedation, a treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm. Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone's life, but only to make the patient more comfortable."

Part one of this post noted Paul Krugman's take on the health care legislative process and the political practice of soliciting money in exchange for votes. Beneath these surface issues, however, there's a deeper sense of disillusion with 20th century progress and with a lack of purpose to modern life.

We may tinker with a dysfunctional political process - whether it's the filibuster or corporate lobbying - but our efforts may amount to little more than putting a finger in the dyke. Americans are increasingly dissatisfied with the inability of their government to be effective. The problem is not simply a matter of two political parties with opposing ideologies and the influential economic interests that politicians represent.

When did we start calling the whole day before Christmas "Christmas Eve?" I thought Christmas Eve was the evening before Christmas. But no. Senators voted on health care reform at 1:00 AM on Thursday December 24th. To me, that's still Wednesday night, but it was widely reported as happening on Christmas Eve. Perhaps publishers want to save ink. Or we live in such fast times that it takes too long to say "The day before Christmas."

Anyway, here's a flock of interesting stories I've come across recently.

Aging, end-of-life, and death

The Breadth of Hope, Selling Hope, and More on Quelling Thanatophobia, (Pallimed: A Hospice & Palliative Medicine Blog)
One unspoken message behind the "sell hope for a cure" ads is "we will not only cure your cancer so that you can avoid death, but we'll also make it so it's a non-issue in your life so that you can return to the way things were before. It'll kind of be like getting your car's air conditioner recharged."

Penguins, like canaries in coal mines, are a leading indicator of climate change and other environmental hazards. Their frozen habitat is getting smaller. A warmer ocean means the migration patterns of fish have changed, so penguins are forced to travel much farther for food. The Magellanic penguins of South America now need to travel 25 miles farther than they did just a decade ago. Overfishing and oil pollution also contribute to the plight of penguins.

In honor of Thanksgiving - when we eat another bird - the Washington Post featured a story on a penguin rehabilitation center, the Southern African Foundation for the Conservation of Coastal Birds (SANCCOB). Most of SANCCOB's rescue efforts focus on birds who suffer from oil spills.

In the "old days," there were no electric clothes dryers. Laundry was hung outside to dry, weather permitting. Today almost everyone has access to an electric dryer. They're said to consume at least 6 percent of household electricity, at a cost of $5 billion a year in the US.

As we become more environmentally aware, it seems like a good idea to hang clothes outside whenever we can. Get that genuine fresh air smell and feel from Nature rather than from chemicals added during the wash and dry cycle. The problem is, though, most communities have outlawed outdoor clothes lines. Seems it's a "low class" thing to do and brings down property values. Kind of like rusting junked cars sitting next to the driveway.

Let's look at the facts. Global warming inevitably leads to a global health crisis. Health and disease are the province of the medical profession. Shouldn't doctors be speaking out on the health crisis of global warming?

Last month the two leading British medical journals - The Lancet and the British Medical Journal -- published an open letter to doctors on climate change. In the US, the Journal of the American Medical Association also published a commentary on this subject. Both the US and UK arguments drew on the same evidence and made the same dire predictions.

The US commentary concluded with an appeal to the public health profession: "This is a critical time for public health advocates to demand that political leaders safeguard the health of the world's population, with particular attention to the survival needs of the most disadvantaged."

The British publications appealed directly to doctors: "Doctors are still seen as respected and independent, largely trusted by their patients and the societies in which they practise. ... We call on doctors to demand that their politicians listen to the clear facts that have been identified in relation to climate change and act now to implement strategies."

Climate change is a more serious problem than we thought it was just a few years ago. A big rise in global temperature may not happen for another 40 years, but other changes are "imminent," according to Science magazine. A permanent drought, with Dust Bowl-like conditions, could become the "new climatology" of the American Southwest in a matter of years.

Next December, 190 countries will meet in Copenhagen to discuss a solution. It's very difficult for politicians, who represent the financial interests of the status quo, to tackle the problems of climate change. As Paul Krugman said recently, a response to global warming would "shuffle the economic deck, hurting some powerful vested interests even as it created new economic opportunities. And the industries of the past have armies of lobbyists in place right now; the industries of the future don't."

There's an unfortunate parallel between the politics of climate change and the politics of US health care reform. They differ in scale -- global vs. domestic. But consider this: Who suffers the most from the lack of universal health care in the US? The poor and unemployed. Who will suffer the most from climate change? The poor and unemployed. There are many reasons for this, but largely it's a matter of where the poor live: the tropics, underdeveloped countries, overcrowded slums.

The world's poorest populations will be the first to suffer from climate change. When they can no longer survive where they currently live, they will leave their homes and migrate. The Indian government is presently constructing a seven-foot-high fence made of double-thickness razor wire and steel. It will be 2,800 miles long (4500 km) and line the entire border between India and Bangladesh. Its purpose? To keep out terrorists, yes, but according to the BBC, it's also meant to keep out immigrants who will flee the impact of climate change.

Acetaminophen, whether it's in Tylenol, Arthritis Pain Relief, Nyquil, or Vicodin, is safe as long as you don't take too much. The new maximum dose likely to be recommended by the FDA is 2600 to 3250 milligrams a day. That's ten 325-milligram Tylenols.

Tara Parker-Pope has a question and answer post on the subject in today's NY TImes. One question is: As a precaution, should consumers switch to other types of over-the-counter pain relief?

Last year it was tomatoes contaminated with Salmonella. Except not really. After the tomato industry lost $200 million, it turned out it wasn't tomatoes after all, but jalapeno and serrano peppers from Mexico. Tomatoes aren't off the hook though. There have been 12 Salmonella-contaminated tomato outbreaks since 1990 serious enough to involve multiple states.

In 2007 it was the bagged spinach food scare, also a Salmonella problem. In 2006, spinach contaminated with pathogenic E. coli was recalled. That was traced by the FDA to a California town where spinach fields were bathed in the runoff from nearby cattle ranches.

A scant few hundred years ago we began to believe we could understand the world through reason and science. Not only that, we believed we could bring it under our control. These new beliefs brought many wonderful things: Electricity, modern medicine, iPods.

Risks have always been with us: natural disasters, wild animals, accidents, epidemics, and other 'acts of god'. But over the last century, especially since World War II, new categories of risk emerged. These modern risks follow from the negative byproducts and side effects of the very same science, technology, industrialization, and global economy that we otherwise benefit from and enjoy.

Global warming, environmental carcinogens, toxic waste disposal - all these effects of technology reach forward in time to touch future generations. Such trans-generational risk is uniquely post-industrial. Some of these, like species extinction - which can now result from human activity - are irreversible.

But modern risk has not only expanded through time. Tainted products from anywhere in the world - food, toys, or chairs - can end up on any local store or pantry shelf. These modern risks are not merely medical and ecological, but psychological as well: Is this can of tuna safe to eat?

As our dependence on technology and a global economy increases, the negative consequences are more difficult to predict, or to control when prediction fails. What are the implications of mapping and sequencing the human genome? Perhaps we'll recreate a long-extinct species. Will these make nice pets or nice nightmares?

Before and after science

In the heady days of the Enlightenment we looked towards a Utopian future, the promise of science, technology, rationalism. Yet only in Frankensteinian fiction did we ever consider the down sides of this brave new world. It's a bit like how the Bush administration failed to plan the post-invasion phase of the Iraq war. Compared to the impacts of industrialization, globalization, and mass media, that one should have been a no-brainer.

Today's risks get defined by scientists, lawyers, and politicians, whose differing interests are often reflected in those definitions. "Yes, there's mercury in your salmon and melamine in little Jenny's formula, but not enough to do any real damage."

Risks are communicated, breathlessly and repeatedly, by a media whose interests may not be identical with those of "viewers like you." Perhaps a lack of confidence in our information sources is an even greater risk than lack of confidence in our food supply.

Humans could never control natural disasters. Now we are losing control of the man-made ones. But we try to control what we think we can. So we regularly lift weights and practice yoga, or at least try to. We buy organic food and avoid trans fats. We practice a 'healthy lifestyle' (or at least try to) even though behavior has less influence on overall health than genetics, social status, economic inequality, and environmental degradation. Those are all beyond the direct control of individuals. So we drink pomegranate juice instead, distracting ourselves from the complex and real issues at the root of our suspicions, outrage, and despair.

Related posts:
Melamine, cadmium, and Heidi Montag
To make more money
Melamine update
Eat fish? Don't read this

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?