Vitals and Bits Inaugural Entry: The Thymus Gland
I’ve always found it really strange that I’m unable to see and touch vast portions of my own body. Never will I hold my own heart in my hands and explore its chambers with my own eyes. I don’t actually know what my lungs, my liver, my kidneys, my spleen, my stomach or my brain look like. All I can see on myself is a bunch of dead skin cells, some tooth enamel, a couple of eyeballs and a smattering of hair. And that’s kind of a shame, if you think about it. I mean, what if my pancreas has a pleasing texture? What if my liver is the Cindy Crawford of livers? What if one of my adrenal glands is shaped like the Virgin Mary? I’ll never know.
Still, Mother Nature has a good reason for keeping these vital bits of anatomy hidden. And she was nice enough to give us plenty of subjective clues about their existence. I can’t see my stomach, but I can feel desperately contracting in anticipation of the cupcake I’m about to shove down my face. And when I lie on my back, I can see and feel the slight pulsation beneath my sternum where my aorta descends into my abdomen. I enjoy how it feels to take in a lungful of Pecos wilderness air. And we’re all familiar with the squirmy discomfort of a dangerously full bladder.
The list of bodily sensations goes on and on. Yet some organs never really reveal themselves. They hum along happily, almost completely obscured from detection. They exert their effects stealthily, content to hide behind the scenes as other major players get credit for their work.
One such ghostly organ is the humble thymus gland (not the be confused with the thyroid). The fact that I’m not dead is the only reason I know I have one.
The thymus gland is part of your immune system. It sits in the middle of your chest, behind your breastbone and on top of your heart. The two lobes that make up the thymus gland can be joined or separate, and they differ slightly in size and weight.
The thymus gland is one of the only organs that reach its peak size in children. At the time of puberty, the thymus begins to shrink and continues to atrophy throughout life. This is because the thymus is responsible for maturation of part of the immune system, which is a process that peaks in childhood.
Immature immune cells known as thymocytes are produced in the bone marrow and then ferried to the thymus, where they grow and mature into T-lymphocytes, or T-cells (T for Thymus! Duh!). T-cells are white blood cells that fight off infections and other nasty problems. Your body produces several different types of T-cells, but they all play a role in immunity.
The importance of T-cells in maintaining health is made evident by the destruction that HIV wrecks upon the human body. This infamous virus behind the AIDS epidemic destroys up to 2 billion T-cells per day, leaving the victim dangerously vulnerable to infection and other immune problems. HIV/AIDS patients often die of opportunistic infections, or infections that rarely cause problems in healthy people. HIV/AIDS patients succumb to these infections because they have so few T-cells to help fight off pathogens.
So what actually goes on in the thymus gland? And why do T-cells need to mature anyways?
It’s vital that your immune system be able to distinguish “self” from “non-self.” For instance, if your T-cells begin attacking your pancreas, you could end up with type 1 diabetes. If your T-cells start picking on your nerve cells, you might wind up with multiple sclerosis. At the same time, if your immune system fails to recognize invaders like bacteria and viruses, you probably won’t be able to survive past infancy. This happens to some children who are born with severe defects of the immune system.
T-cells learn how to differentiate “self” from “non-self” in the thymus. Once they have completed their education, they can be released into the blood stream or other areas of the body to hunt down the bad guys. But the maturation process is very complicated and riddled with pitfalls. About 98 percent of T-cells do not survive the maturation process! Only 2 percent complete the process and graduate to become mature, competent T-cells. Selection of properly functioning T-cells occurs in the thymus.
In the thymus, immature T-cells are tested with potentially dangerous molecules. If the immature T-cell fails to react to these potentially dangerous molecules, the T-cell won’t receive a vital “survival” signal and will die. Similarly, the immature T-cells are tested with bits of “self.” If the T-cell reacts too strongly to the body’s own molecules, the T-cell will self-destruct. Eliminating T-cells that fail either one of these tests ensures that your immune system responds appropriately to dangerous things like bacterial infections but doesn’t go overboard and start attacking everything in sight.
This process, although extremely effective, isn’t perfect. Sometimes defective T-cells survive the selection process. Sometimes healthy T-cells are killed off. Problems with the selection of healthy T-cells can stem from the T-cells themselves, from the thymus, or from any of the other cells and chemicals involved in the process.
Once the thymus gland stocks the body with a good supply of mature, competent T-cells, it begins to shrink and fewer immature T-cells are processed. Active thymus tissue is gradually replaced with fat. Still, some thymus tissue continues to function throughout life. Mature T-cells can also proliferate long after they leave the thymus.
The two main problems we see with the thymus are various immunodeficiencies and cancer. Thankfully, both are relatively rare.
So today, while you feel your muscles burning at the gym or listen to the tympanic gurgle of your post-dinner intestines, take a moment to remember your silent little thymus gland. It may not be palpably pulsating in your chest like your heart, but it’s every bit as important when it comes to producing the sensation of being alive.
Launching “Vitals and Bits” Tomorrow
Better know your body parts
Carl Sagan believed that “humans are the stuff of the cosmos examining itself.” This statement of his draws upon a corner of philosophy arguing that human beings are proof that the universe is a conscious entity. Humans are part of the universe, and humans are conscious beings. Ergo, the universe is at least partially conscious.
Consciousness, whether human or otherwise, is a phenomenon that invites endless existential pondering. It’s fair to assume that Sagan thought of human consciousness as an instrument through which the universe comes to know itself. Humans, after all, have struggled throughout history to understand the big wide world of the cosmos. Since we are by definition a part of the cosmos, it’s possible that human consciousness evolved as a mechanism through which the universe can explore itself.
I think this philosophy sounds like a really lovely stoner thought, but I’m not sure I’m buying it. Still, it doesn’t seem so wacky that the universe might be designing living gadgets to help figure itself. After all, we human beings have designed thousands upon thousands of gadgets and instruments to help us unveil the mysteries of our own existence.
We’ve designed little cameras that go up people’s butts in order to explore the human colon. PET scans and CAT scans and MRIs and EKGs and EEGs and a whole host of imaging techniques allow us to peer inside our brainwaves and heart activity and other various biological crevices. We have psychoanalysis and cognitive behavioral therapy and such to help peel back layers of thought, behavior and identity to unearth the nugget of our humanness. We’ve developed the arts to help us express and refine our understanding of the human condition. And now we have reality TV to undo all the millennia of valuable insight that our self-exploration has given us.
Clearly the apple does not fall far from the tree. Human beings are as skilled at self-voyeurism as Madame Universe herself. The endless study of ourselves means that there’s a whole world of information on the body and the mind out there. This wealth of information makes me really happy, given my endless fascination with each tantalizing morsel of the human body, from cortex to crotch.
Which is why I’m pleased to introduce my weekly “Better Know a Body Part” blog series to Alibi readers. Each week, we’ll take a quick, down-and-dirty look at whatever body part I feel like waxing poetic on that week. So if you’re ready to follow the universal imperative to Know Thyself, stay tuned. After all, it’s less traumatizing to learn about your body by reading a blog than by sticking cameras where the sun don’t shine.
Medicaid is Not a Herpes Cream
A health reform tutorial
Before becoming a nurse, I would have guessed that Medicaid was something you buy over the counter to rub on private ailments. More than anyone, I understand that the world of health policy can be confusing. Here’s a list of select terms to ease the pain of reading about health reform, (which you can do pain-free in this week’s news section here and here). Study up! At the very least, knowing the distinction between Medicare and Medicaid will help you impress bookishly cute fox at the coffee shop you’ve been eyeing.
Medicare: Government-run health insurance for the elderly and disabled. Medicare beneficiaries must meet certain eligibility criteria and typically pay premiums, deductibles and other out-of-pocket expenses to receive benefits.
Medicare Part A covers hospital-related stuff, while Medicare Part B covers other medical stuff like outpatient services and medical equipment. Medicare Part D covers prescription drugs.
The Medicare program also funds physician residency programs. The federal government funds Medicare.
Medicare Advantage: Also known as Medicare Part C. Medicare plans that are managed by private insurance companies. Instead of the government directly supplying a senior’s insurance, the senior can opt for an Advantage plan instead, where the government pays a private company to insure the senior.
Part D “donut hole”: Refers to the coverage gap for prescription drugs under Medicare Part D. Once Medicare beneficiaries have exceeded the prescription drug coverage limit, they are responsible for the entire cost of medications until they reach the “catastrophic” threshold. Medicare coverage kicks back in at the catastrophic threshold.
For 2009, Part D covered 75 percent of the cost of prescription drugs (after the beneficiary pays their $295 deductible) up until drug costs exceed $2,700. Drug expenses between $2,700 and $6,154 were NOT covered by Medicare, and the person had to pay 100 percent out of pocket. Once drug expenses exceeded $6,154, Medicare Part D kicked back in and covered 95 percent of the cost of drugs beyond this threshold. Many seniors get caught in the donut hole and pay thousands of dollars out-of-pocket for their medicines.
Medicaid: State-run insurance program for those with low incomes. The federal government sets certain regulations for Medicaid and supplies funds, but up to half of Medicaid funding occurs at the state level. Medicaid programs differ from state to state. Rather than being an entitlement program like Medicare (which all people over age 65 can participate in, regardless of income), Medicaid is a needs-based program.
Primary Care Providers: Primary care typically refers to the sector of the health care system that handles general medical concerns, prevention, screening and health/wellness promotion. Primary care providers serve as the “gatekeepers” into the medical system and refer more complicated patients to specialty services, such as neurology or dermatology.
Family physicians or general practitioners, pediatricians, some OB/GYNs, nurse practitioners and certified nurse midwives are examples of providers that often serve as primary care providers.
First Round of Shots on Me!
Let's all raise our syringes in a special toast to the upcoming National Influenza Vaccination Week Jan. 10-16.
The Centers for Disease Control and Prevention state that H1N1 vaccine is now available to everyone in most states. Here in New Mexico, two special flu shot clinics will make 2,000 doses of H1N1 vaccine available on a first-come, first-serve basis Saturday, Jan. 9. You can get vaccinated 1 to 4 p.m. at the Stanford Public Health Office (1111 Stanford, near the UNM Law Center) or from noon to 7:45 p.m. at Sam's Club, (10600 Coors Blvd Bypass NW). Visit www.flubusters.com or call 1-866-358-2878 for more information.
But National Influenza Vaccination Week would be unthinkable without a robust National Folic Acid Awareness Week preceding it. This week of Jan. 4-10 serves to remind all women of childbearing age to consume at least 400 micrograms of folic acid daily before and during pregnancy to help prevent neural tube defects. The month of January, in fact, is National Birth Defect Prevention Month, and you can obtain more information on prevention of birth defects here.
Secret Chemicals and Public Health
The Centers for Disease Control and Prevention released a report Dec. 18 regarding the prevalence of autism spectrum in its Mortality and Morbidity Weekly Report publication. The report found that, on average, there was 57 percent increase of autism between 2002 and 2006 in 8-year-old children. Although such an increase could be attributable to more accurate and timely diagnoses of the condition, the CDC concluded that a true increase couldn’t be ruled out.
The report also found the average IQ of children diagnosed with autism is going up, and autism is more likely to manifest as a scatter in cognitive abilities—rather than a pervasive and global developmental delay. This indicates that the way we identify and diagnose autism has changed. As such, whether autism is actually on the rise is debatable. Yet the fact that about 1 in 110 children is now identified as autistic is enough to drive fear into the heart of any parent. Concerned parties are still scrambling to identify a cause and a cure. Weary parents and researchers continue to suspiciously eye vaccines and their easily vilified additives—such as the mercury derivative Thimerosal—for evidence of a link between childhood exposure to vaccination and development of autism.
Despite the mountain of evidence suggesting vaccines don’t cause autism, the stain of suspicion continues to mar their reputation. Yet as linkages between vaccines and autism dry up, parents and researchers are broadening their gaze in order to identify other potential toxins or factors that could contribute to autism.
Enter an article published in today’s Washington Post regarding the fact that potentially harmful chemicals must be kept secret under law in order to protect the bottom line of chemical manufacturers. According to the article authored by Washington Post staffer Lyndsey Layton, a provision in the 1976 Toxic Substances Control Act prohibits public disclosure of the names and physical properties of certain chemicals if such disclosure would unveil trade secrets in the highly competitive industry.
This means that consumers and public officials are not allowed to know the identity of certain chemicals. As such, regulators are unable to control the potential dangers of these unknown substances, and consumers are barred from knowing what toxic substances they have been exposed to.
According to the report, most of the 700 chemicals that are introduced annually carry some sort of secrecy provision, and as such 17,000 of the 84,000 chemicals used commercially are now secret. In certain cases, the identities and addresses of manufactures are also hidden from the public. Many of these secret chemicals are produced in mass quantities and some are used exclusively in children’s products. Some of these secret substances pose “substantial risk” to the environment or public health, according to mandatory notices that manufacturers must file with the Environmental Protection Agency. So, in essence, a manufacturer must disclose to the EPA that they are unleashing a chemical that carries substantial health or environmental risks but does not need to share the name or properties of that chemical. This means the EPA’s hands are tied when it comes to regulating that chemical or assisting people who fall ill after exposure, even in the case of health emergencies.
Now, I am not claiming that one or even many of the thousands of chemicals used commercially, whether secret or not, contribute to autism. But whether Thimerosal is being injected into a child or Mystery Substance X is being leached into groundwater, it seems prudent to fully understand the health risks of all the substances to which we subject ourselves. It’s the government’s responsibility to facilitate this understanding and protect the public’s safety accordingly.
Some die-hard childhood vaccination opponents (such as the Jenny McCarthy-led anti-vaccers) have suggested the government concealed the risks of vaccines in order to protect the bottom line of vaccine manufacturers. I don’t personally believe this is true due to the number and strength of studies from independent researchers. But the fact that the government has given chemical manufacturers so much power over consumers, regulators and the environment is not only alarming but also a great argument in the arsenal of those who no longer trust governmental agencies charged with protecting the public’s health.
Convincing parents that the benefits of vaccination outweigh the risks will become more difficult as rates of autism continue to rise and Uncle Sam continues to allow chemical manufacturers to hide their products behind a veil of secrecy at the expense of public and environmental health.
While the Washington Post article notes the Obama administration is pushing for greater transparency in the upcoming renewal of the Toxic Substances Control Act, you should contact your national representatives and voice your support for transparency in all commercial matters that affect the health and wellbeing of our bodies and our planet. From the food industry (ever heard of a CAFO, or confined animal feeding operation? Yeah, the public’s not really allowed to see what happens in those pits of despair) to the pharmaceutical industry to the chemical industry, we need to know. Without transparency, the factors that contribute to disease and death may remain hidden behind a shroud of corporate secrecy.
That doesn’t sound much like a free market to me.
Health Reform Status Update
It's 2 a.m,, and you can't sleep. You've run through all the latest episodes of “The Daily Show” on the Comedy Central website. You've finished watching all the “30 Rock” episodes on Hulu. As the world sleeps, you desperately search for distraction from the lonely emptiness of graveyard shift wakefulness. You scan your friends' blogs, you check the weather, you pay some bills online, and you do everything you can to avoid the siren song of a certain social networking website that you're trying to quit.
But your resistance is ultimately futile, because you are an exhausted insomniac at your most vulnerable, and you eventually seek the sweet salve of Facebook company. You gingerly log on, scan the news feed, and check out some newly posted photos before noticing your own blank status bar. "I should really update this," you think to yourself.
So you begin composing your status update, mindful of your word choice. Keep it simple, you think. You try out several different angles, from honest statements like "awake and bored" to music-themed puns like "Haulin' Oats…" before settling on something you judge to be clever without trying too hard. But mere moments after clicking "share," you decide status updates are inherently lame and delete what you just wrote. Your status update bar remains blank, and you eventually make it to bed feeling ashamed and dehumanized by the whole ordeal.
Just admit it. You've been there. We've all been there. The challenge of navigating the social landmine of status updates has stumped even the best of us on occasion. Even if you're so cool (or so old) that you're not on Facebook, I bet you're still familiar with the task of balancing the need for self-disclosure with the need for not appearing pathetic.
Well, it turns out that composing a news brief on a story as monumental and widely covered as health reform can prove equally difficult. There's a need to take information that can be accessed via a multitude of alternative avenues and repackage it in some sort of clever or insightful way.
"Squeaked through the Senate and now on to conference committee!"
"New Year's Resolution: Make it to Obama's desk!"
"Lost the public option but gained Lieberman's vote!"
"2010: A Medicaid Odyssey!"
And so, dear Alibi readers, I challenge you to compose your own health reform status updates below. Here's the lowdown: A health reform bill cleared the Senate with 60 votes on Christmas Eve. The Senate bill now must be blended with the House bill in a special conference between the House and the Senate before it can go back to each chamber for final approval. This is expected to happen in January.
If each chamber approves the bill, it goes to Obama for a signature. The final version of the health care reform bill is expected to look more like the Senate version than the House version, since Senate "moderates" have made it perfectly clear that they won't approve any bill with a public option or additional spending. So put that it your status bars and update it. Good luck.
Miss Diagnosis Uses Drugs to Prove a Point
In a country where practicing medicine has become nearly synonymous with prescribing and dispensing medication, it’s no surprise that the pharmaceutical industry has a prominent place in the health care reform debate. The controversy over whether to allow importation of prescription drugs from abroad has jeopardized the weird alliance between Big Pharma and health care advocates. Obviously, allowing foreign drugs in has serious economic implications for drug-makers and consumers. But a report regarding contaminated drugs published in the Thursday, Dec. 10 edition of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report highlights safety concerns as well.
According to the report, 54 Nigerian children died from contaminated acetaminophen (the same drug as Tylenol) in a children’s teething medication. The medication was contaminated with diethylene glycol (DEG), a toxic alcohol used illegally as a cheap substitute solvent in drug manufacturing. The contamination resulted from failure to comply with safe manufacturing processes.
I’d like to give us all a moment to imagine the response if 54 American children had died from drug poisoning.
The report may bolster the position of those against the proposed amendment to allow importation of prescription medications from abroad approved by the Food and Drug Administration. The CDC stated “countries that inadequately implement safe manufacturing standards, poorly enforce quality controls, or lack adequate training programs remain at risk for medication-
However, before people jump on the notion that foreign countries represent a unique risk to drug safety, it’s wise to consider the issues surrounding drug safety in our own country. For instance, New Mexico's Attorney General Gary King completed a $10 million settlement against drug-maker Eli Lilly for illegally promoting the use of their anti-psychotic medication Zyprexa in children. Although it is legal to prescribe medications for unapproved or “off-label” uses, it is not legal to market them for off-label uses. Earlier this year, the company plead guilty to promoting the drug's unapproved uses and concealing serious side effects like weight gain and diabetes.
In my humble opinion, drug-makers are as powerful as consumers allow them to be. Though many drugs are absolutely necessary for saving or sustaining life, I’d hazard a guess that most aren’t. Though I’m certainly not anti-medication (hey, I practically live on Ibuprofen for a week out of every month), I don’t believe medications should be the first line of defense against all of our ailments. For example, there’s no harm in medicating your teething child with hugs and kisses and soft things to chew on rather than a bioactive elixir with serious side effects. It’s easy to see why weighing the risks and benefits of medication use is so important. It’s also easy to see why drug companies must be held to extremely strict standards when it comes to marketing and disclosure of risks.
Still, cost should never be a reason to deny someone a needed medication. Rather than importing drugs, which opens a whole new can of regulatory worms and broadens the carbon footprint, perhaps financial regulation of domestic companies would be more prudent.
In any event, we can all hope decent regulatory efforts at ensuring safety and affordability of necessary medications succeed. At the same time, let’s encourage our couch-riding, medicated masses to trade the remote for real friends and the La-Z-Boy for a pair of jogging shoes. This way, we can all jazzercise our way into a future of cardiovascular fitness and mental well-being. That would do more for the health of our nation than any pill.
Cheery Health News From Miss Diagnosis
Health reform developments continue to roll in at press-defying speeds. The Senate bill's public option may be on its death bed, as Democrats consider replacing it with a Medicare buy-in option for people 55 or older and expansion of Medicaid from 133 percent to 150 percent of the federal poverty level.
Another option on the table is allowing the government to contract with insurers to set up coverage for uninsured people, similar to the Federal Employees Health Benefits Program. Additionally, the Senate rejected Sen. Bill Nelson's amendment, which was nearly identical to the House bill's Stupak amendments and would have further restricted abortion services.
Drug makers, however, are still on the docket, with an amendment under consideration that would allow pharmacies and and drug wholesalers to purchase FDA-approved generic prescription drugs from certain foreign countries instead of Big Pharma. Guess who doesn't want to see that amendment pass?
Not to be outdone, H1N1 jostles for a place on the front page. A new study published by the Public Library of Science estimates that illness, hospitalization and death from the fall and winter H1N1 season will NOT exceed that of regular seasonal flu.
However, the prevalence of death and severe illness will be primarily experienced by young adults and young children rather than the elderly. The authors warn that their estimates depend upon an assumption regarding the total rate of infection, and that severity could increase if the virus mutates or if stress on the health care system leads to suboptimal treatment of severe cases.
Another study from NYU and the NIH found severe airway damage upon autopsy of H1N1 victims as well as an increased risk of death for young people, obese people or those with chronic underlying conditions such as asthma.
Hot H1N1 Update from Miss Diagnosis
The Centers for Disease Control and Prevention (CDC) released a report on H1N1 vaccine safety based on all the information that has been collected since the vaccines have hit the market. The report’s take-home lesson? So far, so good.
This means that Miss Diagnosis feels pretty smart about telling you to get vaccinated in her column this week. And she continues to stand by the recommendation, given that the risks of vaccination remain marginal compared to the risks of contracting H1N1. Miss Diagnosis plans to celebrate her excellent judgment with plenty of hand washing. This way, her decontaminated hands will be perfectly poised to vaccinate anyone who asks.
Of course, if you’re not in one of these lucky priority groups—pregnant women, household members/caretakers of infants younger than 6 months old, children 6 to 59 months of age, children and adults 5 to 64 years of age with certain chronic health conditions, and healthcare workers—you’ll have to be patient and wait. But Miss Dx will be happy to poke ya when it’s your turn. The caring and compassionate medical staff (of one: me) here at the Alibi will let you know as soon as Uncle Sam says it’s okay to begin vaccinating everyone.
Unless you’re in an emergency without the time or resources to check the facts, it’s never a good idea to make a medical decision just because someone says, “trust me. It’s safe.” Since I want all of you lovely Alibi readers to be informed medical decision-makers, I’ve included a breakdown of the CDC report below in order to demonstrate how I reached the conclusion that risks associated with vaccination are small.
The report was released Friday, Dec. 4 in an early edition of the CDC’s Morbidity and Mortality Weekly Report. The publication posts the most current data from two vaccine safety monitoring programs, the national Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD). The VAERS is a passive reporting system, and as such is unable to establish cause and effect between vaccination and adverse events, although it does provide nationwide surveillance for potential problems. The VSD, on the other hand, uses data collection techniques and comparison groups that enable the system to detect associations between adverse events and vaccination. This means the VSD is superior in terms of establishing cause and effect.
So far, people are reporting adverse events following H1N1 vaccination to the VAERS at a higher rate than that of seasonal flu reports, with 4.4 serious adverse events reported per 1 million H1N1 vaccines distributed, as compared with 2.9 serious adverse events per 1 million doses of seasonal flu vaccine. This contrasts with the VSD, which has followed over 438,000 people but has not seen the same relative increase in adverse events. The CDC postulates that increased reporting of H1N1 vaccine-associated adverse events to the VAERS is due to increased awareness and increased motivation to report events associated with a high-profile disease like H1N1 than with regular ol’ seasonal flu.
Over 46 million doses of H1N1 vaccine have been distributed in the U.S., and 13 deaths have been reported to the VAERS. Of these 13 deaths, 9 were found to occur in people with serious underlying illness, one occurred because of a motor vehicle accident, and three are still under investigation. To me, it looks as though two of the deaths could be vaccine-related, but I’m not a coroner with a complete autopsy report in my paws, so my opinion is purely conjecture.
The VSD, on the other hand, has received one report of anaphylaxis (or an acute, life-threatening allergic reaction) and no reports of Guillian-Barre syndrome, which is a serious neurological reaction seen in about 1 per 100,000 vaccinations during the infamous 1976 flu vaccination campaign. No increased rates were detected for other potential adverse events, like seizure or allergic reaction.
Taken together, the VAERS and the VSD show that there aren’t any unexpected or bizarre side effects cropping up. So let’s all celebrate with a big drunk make-out party once everyone’s vaccinated! Until then, though, keep your mucus membranes to yourself and continue washing those germy mitts!