Cuba health mystery: Diplomats had inner-ear damage early on
By JENNIFER KAY and LAURAN NEERGAARD
Thursday, December 13
MIAMI (AP) — American diplomats affected by mysterious health incidents in Cuba showed damage in the inner ear shortly after they complained of weird noises and sensations, according to their earliest medical exams, publicized Wednesday.
The detailed findings were published in a medical journal nearly two years after what the U.S. calls “health attacks” began — and they shed no new light on a possible culprit.
“What caused it, who did it, why it was done — we don’t know any of those things,” said Dr. Michael Hoffer of the University of Miami Miller School of Medicine, who led the exams.
The U.S. says since late 2016, 26 people associated with the embassy in Havana suffered problems that include dizziness, ear pain and ringing, and cognitive problems such as difficulty thinking — a health mystery that has damaged U.S.-Cuba relations. Cuba has adamantly denied any involvement.
The Miami researchers examined 25 of those people, who reported hearing a piercing noise or experiencing a sensation of pressure before their symptoms began. The patients failed a variety of tests that detect inner-ear problems associated with balance, what’s called the vestibular system — although there were no pre-symptom medical records to compare.
Testing of 10 other people who were in the same building at the time of the incidents found they were fine, Hoffer reported in the journal Laryngoscope Investigative Otolaryngology. Hoffer also traveled to Cuba to check 100 other Americans stationed there, who also turned out to be healthy.
Those inner-ear balance problems have been central to the government’s ongoing health investigation. And earlier this year, a team of doctors at the University of Pennsylvania who also examined many of these patients, but months later, reported they suffered a concussion-like brain injury, despite no blow to the head.
In a brief interview with The Associated Press, Hoffer said the two studies aren’t contradictory, but they have different findings because patients were tested at different times and in different ways.
“Is the brain affected from the ear? Is the brain affected directly? We don’t know yet,” Hoffer said at Wednesday’s news conference.
For doctors, Wednesday’s paper adds specifics about the pattern of damage, abnormalities in structures involved with sensing gravity and acceleration, said Dr. Maura Cosetti of the New York Eye and Ear Infirmary of Mount Sinai. She isn’t involved with research related to the Cuba incidents.
“This provides an important step in creating a picture of the injury that people sustained,” she said. She added that often people with long-term balance problems also report a “brain fog.”
Cuba has expressed doubts that anything happened to the diplomats.
“There’s no evidence that can prove that something occurred in Cuba that could have damaged the health situation of a few U.S. diplomats,” Carlos Fernandez de Cossio, Cuba’s director-general of U.S. affairs, said Wednesday.
The U.S. has not said what caused the incidents, although initial speculation centered on some type of sonic attack. The AP has reported that an interim FBI report last January found no evidence that sound waves could have caused the damage.
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
The key to our humanity isn’t genetic, it’s microbial
December 13, 2018
Author: Ian Myles, Head, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Diseases
Disclosure statement: Ian Myles receives government funding from The National Institute of Allergy and Infectious Diseases.
What if the key to perfecting the human species were actually … yogurt?
The fantasy of trying to perfect humanity through genetics was recently reignited by the announcement of the Chinese scientist claiming to have made the first “CRISPR babies,” which were named for the technique used to edit the DNA of the embryos. While major ethical and regulatory concerns are present, fears that CRISPR will lead us into the dystopian world depicted in the movie “Gattaca” are unfounded. In fact, if the movie were remade today it would likely be a story about the government mandating probiotics and healthy eating.
Eugenics is the belief that humanity can be perfected through genetic manipulation. Past eugenic policies placed restrictions on marriage and immigration, justified slavery and forced sterilizations, and ultimately culminated in the Holocaust. I am a physician-scientist specializing in allergies who became interested in eugenics not in relation to skin color, but skin rashes. Most prominent researchers who study a a skin rash called eczema were convinced that the vast majority of the disease is determined by fixed genetic sequences. Many still are. However, just like the studies of intelligence and criminal behavior that came before it, research into the genetics of eczema has fallen well short of what the 15th-century techniques had predicted.
To be fair, the public’s fascination with this subject is understandable. Commercial breaks are filled with pseudoscientific claims that your DNA can reveal, for example, that you are 12.4 percent Italian, 3.1 percent Neanderthal, and 1/512th Native American. Spoiler alert: It can’t. Prominent magazines, podcasts and newspapers have pushed the debunked claim that intelligence is genetically encoded. In reality, genetic studies that were supposed to explain at least 80 percent of being a genius have explained only 5 percent. This means your genes, at best, have less impact on your IQ score than a good night’s sleep. However, modern misunderstanding of how complex traits are passed down isn’t just burdening society with hucksters and racists. Ignorance is causing us to overlook opportunities for improving health and treating disease.
Where did ideas like a ‘gene for IQ’ come from?
Most of the ideas of “genes for” complex traits come from twin studies that assumed that identical twins and fraternal twins would differ only by the amount of shared DNA. What twin researchers either didn’t realize, or willfully ignored, is that the influence of the environment is also stronger for identical twins. Because identical twins are more likely to be dressed alike and confused for one another, they form more of a shared identity.
Thus, identical twins are more likely to share the same hobbies, eat the same foods, and run in the same social circles than fraternal twins. Modern research shows these differences are more psychology than biology. Furthermore, since identical twins share the same embryonic sac in the womb, their environmental exposures are also more biologically similar than fraternal twins. As such, researchers claiming that twin study data is indicative of genetics are, at best, ill-informed.
What is the modern understanding of heritable traits?
It may seem counterintuitive, but just because one change can worsen a gene’s function, that doesn’t mean that a different change can enhance it. When scientists say a gene “contributes to intelligence” they are referring to situations in which mutations in the gene cause a loss of intelligence or delay in cognitive development. They are not implying that a special version of the gene can guarantee a college degree.
Enhancing the functions of genes is most often accomplished via epigenetic modifications – chemical tags that are attached to the DNA but do not alter the genetic code. If genes are words, sentences and paragraphs, then epigenetics is the cadence, emphasis and diction. This is akin to having Hamlet performed by Gilbert Gottfried versus Benedict Cumberbatch. While epigenetic changes can be passed on from parents to children, they can also be altered by stress, diet, environment and behavior. Therefore, I believe that environmental modification, not CRISPR, would be needed to enhance the vast majority of genetic functions.
Another way to inherit traits
A more recently appreciated influencer of heritable traits is the microbiome, the term for all of the microorganisms (bacteria, fungi and viruses) that peacefully co-exist with humans.
From a genetic standpoint, your human genes are probably outnumbered over 100 to 1 by microbial genes. Modern research suggests that the microbiome may be directly involved in diseases ranging from autism to obesity. The microbial influence can be passed from mother to child during and possibly before birth, but remains partially sensitive to diet and environment into adulthood.
The microbiome can even influence your epigenetics. Researchers are just beginning to tap into the potential of microbial treatments for diseases. Similar to our lab’s experimental treatment for eczema, live bacterial therapies for food allergies, depression and anxiety, heart disease and select cancers are in development. As scientists clarify which strains of microbes are most helpful, these treatments are expected to become even more powerful.
Think of it this way: The current and former U.S. presidents share 99.9 percent of their genetic sequence, despite being slightly more than 0.1 percent different. As such, modern scientists do not hide from eugenics-based ideas because they are controversial; they dismiss them because both “Gattaca” and The Bell Curve are to genetics what Flat Earthers are to astrophysics.
While properly conducted gene therapy does offer real hope for curing rare genetic diseases, its limitations stop well short of sci-fi. As just one example, feeding mice one specific type of bacteria significantly enhanced their memory, whereas genomics has failed to find any genes that could do the same. Ancestry charlatans and neo-eugenicists may deny the fact that people are more a product of their experiences than their genetic heritage, but perhaps their mothers just didn’t breastfeed them long enough.
No president should assume office without a ‘fitness for duty’ exam
December 5, 2018
Author: Bandy X. Lee, Assistant Clinical Professor, Yale School of Medicine, Yale University
Disclosure statement: Bandy X. Lee does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Since the beginning of Donald Trump’s presidency, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone who exhibits what we have called his “dangerous” signs.
The observed signs have included “grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality.”
As a psychiatrist and expert on violence, I worked with my colleagues to put our observations into a book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President,” responding to the hunger for understanding on the part of the public.
I was never interested in domestic partisan politics until it coincided with my concerns for public safety as a violence scholar. As a scientist and physician, my training leads naturally to making conclusions that are based not on ideology or personal preference, but on research evidence and medical needs.
Now, since the Democratic Party will have the majority in one-half of the legislative branch of government and can provide some oversight of the presidency, it seems a propitious time to begin an important, civilizing conversation about mental health in the presidency.
All American military personnel must pass a fitness for duty exam before they serve. Further, those who handle nuclear weapons undergo an especially rigorous screening process that is updated every year.
That United States commanders-in-chief are not put to the same test before they are allowed to lead the troops or to order the use of nuclear weapons is, I believe, a serious omission.
Assessing fitness for the job
Evaluations of fitness, or capacity, or competence, are specific to the requirements of a task or job. The exam can be suited to any job.
The U.S. Army’s field manual, for example, includes elements that are critical for fit leadership: trust, discipline and self-control, judgment and critical thinking, self-awareness and empathy.
One can deduce, for example, that the minimal requirement for a U.S. president is to have the ability to take in proper information and advice, to process that information and to think about consequences before making sound, reality-based decisions.
Fitness for duty tests also assess an employee’s capacity to work without putting their own or others’ health and safety at risk.
In the case of Trump, there have been numerous, concerning signs that suggest he may lack that capacity.
The potential for violence is best assessed through a past history of violence, including verbal aggression and incitement to violence, and a structured checklist of personal characteristics.
Courts and employers may legally request capacity evaluations, which forensic mental health professionals – who practice at the interface of mental health and the law – usually perform. They are independent of the interested parties and are not engaged in treatment with the person being evaluated.
Ideally, these exams would be given before a person takes the job. They can also be ordered after a worker has shown signs of incompetence.
Incapacity is not the same as mental illness. Mental illness per se does not make a person unfit for duty, just as one can be unfit and yet not have a diagnosis of mental disorder. Abraham Lincoln famously suffered from debilitating depression, which may even have helped him to be a better, more empathic leader.
Mental capacity should inform political discussion
Since President Trump took office, news reports have revealed that discussions had been held among GOP members and even high-level government officials about the 25th Amendment. That amendment allows the removal of a president who is unable to discharge the powers and duties of his office.
I have been asked to comment on the applicability of the 25th Amendment to Trump in multiple forums, including to members of Congress.
As a forensic psychiatrist, it is of utmost importance that I make the boundaries of my expertise clear. I should not comment outside my area, but within my expertise, I can speak authoritatively.
The removal of a president because of inability is ultimately a political decision, but politicians and the public would to well to proceed in an informed manner.
Disability, incompetence and unfitness are legal and not mental health concepts. Yet no court of law would consider making these determinations without input from medical experts.
To invoke the 25th Amendment without relevant evidence could also expose the process to endless use and misuse for partisan purposes. Medical expertise can serve as a neutralizing ground. It is based on verifiable clinical observations and uniform standards of practice. A panel of experts could bring forth consensus where there are sufficient, high-quality data.
In the current situation, if the patterns of impulsivity, attraction to violence and detachment from reality we are observing in the president are psychological pathology and not political strategy, it is incumbent on mental health professionals to inform the appropriate authorities, regardless of the context in which they are occurring. Non-experts can then be alerted to the need for more detailed examination.
The 25th Amendment
The proper role of the medical professional regarding the 25th Amendment is to wait for a consultation to be requested and not to interfere in the political process.
However, taking steps to protect the public’s health when there are dangers is very much the health professional’s domain and may entail alerting the public about the need for an urgent evaluation.
Scholars have pointed out at least four instances where the 25th Amendment would have been useful but was not invoked or not available. The most conspicuous example is the case of Ronald Reagan, who may have been suffering from early manifestations of dementia.
Furthermore, White House physicians have covered up presidential impairments in the past.
To avoid this predicament in the future, we can require fitness for duty testing for all presidential and vice-presidential candidates, preferably before they take office and annually thereafter.
In a healthy democracy, it is reasonable for the people to require that their leader meet the minimal mental and physical capacity to serve in the office, and for them to be informed if he or she fails to do so.
Members of the National Coalition of Concerned Mental Health Experts are already in the process of forming a nongovernmental expert panel, based purely on medical criteria, to serve in a rigorous consulting role if called upon or to advise on the need for urgent assessments.
We believe that President Trump’s numerous signs of impairment have long called for an urgent evaluation.
In addition to a capacity evaluation, a thorough neuropsychiatric examination would help us to understand better if the president’s behavior will continue or rapidly grow worse.
Mental pathology can be powerful when severe. Decisions about impeachment or other measures to contain the dangers that Trump – or any other president – could present should not be made without this information.
Dirty air now could harm hearts of offspring later
Ohio State News
Dec. 5, 2018
Study in mice first to suggest pollution’s dangers can be passed on
COLUMBUS, Ohio – A parent’s exposure to dirty air before conception might spell heart trouble for the next generation, a new animal study suggests.
Wondering about the possible health risks for children of people routinely exposed to highly polluted air, including soldiers and residents of some of the world’s largest cities, researchers from The Ohio State University studied the effects of dirty air on mice.
And they found an abundance of evidence of harm to the offspring of parents that routinely breathed dirty air prior to mating.
“We found that these offspring had a variety of heart problems during the prime of their lives and the effects were so robust that it was somewhat shocking,” said study senior author Loren Wold, director of biomedical research at Ohio State’s College of Nursing.
Heart function was impaired. Inflammatory markers linked to increased heart disease risk were high. They had markers of oxidative stress, a condition in which levels of beneficial antioxidants are low. Calcium regulatory proteins, which are critical to the function of the beating heart, were altered. And these mice were young and otherwise healthy – comparable to 20-year-old humans.
The first-of-its-kind study appears online today (Dec. 5, 2018) in the Journal of the American Heart Association.
“This suggests that heart problems related to pollution exposure could start even before conception, and if that’s true it has implications worldwide,” said Wold, a professor of nursing and medicine at Ohio State.
Wold and his team also uncovered evidence of gene-related differences that might explain the cardiovascular changes they saw. They examined epigenetic regulators, which play an important role in the expression of genes – meaning that they have influence over predisposition to health problems, including cardiovascular disease.
“I looked at important epigenetic regulators in the offspring, and some were activated, which could explain the differences we saw. The next step will be a more-detailed analysis,” said study lead author Vineeta Tanwar, a research scientist at Ohio State.
To conduct the study, researchers concentrated air from Columbus, Ohio, until the level of harmful particulate matter – particles suspended in the air – reached a level on par with large cities such as Los Angeles and Beijing. The research focused on the presence of PM2.5, particles that are small enough to pass from the lungs into the bloodstream.
The test mice breathed this air for about 30 hours a week.
“They were, on average, exposed to less particulate matter than what the U.S. Environmental Protection Agency has set for daily air quality standards,” Tanwar said.
Then, the mice were kept in normal air during mating and the researchers compared their offspring to the offspring of mice that were not exposed to the polluted air.
“The first thing we did was to do a basic echocardiograph and we could see profound heart dysfunction in the offspring of particulate-matter-exposed mice,” Tanwar said. “Then, we began to look at single cells and at typical markers of heart disease and found a lot more evidence that preconception pollution could harm the offspring.”
The study focused only on male offspring because the research team wanted to narrow its focus on this first experiment. Going forward, they plan to compare male and female offspring, try to determine which parent’s exposure might matter more to offspring, evaluate heart health later in the lifespan of the mice and explore potential changes in the eggs and sperm of mice exposed to dirty air.
“A key question here is how are changes in the sperm and eggs passing on the information to the offspring to cause this heart dysfunction?” Wold said.
Though more animal research is needed, this study also opens the door to exploring the role of air pollution on the health of future generations, he said. For instance, it might make sense to begin by working with adults with high levels of exposure to particulate matter, such as residents of New Delhi and Beijing, Wold said.
“We already know that humans have dramatic cardiovascular effects from exposure to dirty air, high blood pressure in particular. And we know that babies can be harmed by pollution both before and after birth,” Wold said.
“Understanding whether the damage may begin even before conception is critical.”
Other Ohio State researchers who worked on the study were Jeremy Adelstein, Jacob Grimmer, Dane Youtz, Aashish Katapadi, Benjamin Sugar, Lisa Baer and Kristin Stanford.
The study was supported by the National Institutes of Health.