Tag Archives: disease

A Little Give and Take

[Or, we could have titled this post, “The Original Old World to New World and Visa Versa Infectious Disease Vector].

Syphilis is not some god’s vengeful jest on humanity for certain “deviant” behaviors, according to various televangelists. But, it may well be revenge for the Bubonic Plague. And, Columbus and his fellow explorers could well be to blame for bringing Syphilis back to Europe in exchange for introducing the Americas to smallpox, measles and the plague. What a legacy!

From the Guardian:

Last month, Katherine Wright was awarded the Wellcome Trust science writing prize at a ceremony at the Observer’s offices at Kings Place, London. Wright, who is studying for a DPhil in structural biology at Oxford University, was judged the winner of category A “for professional scientists of postgraduate level and above” from more than 600 entries by a panel including BBC journalist Maggie Philbin, scientist and broadcaster Helen Czerski and the Observer’s Carole Cadwalladr. “I am absolutely thrilled to have won the science writing prize,” says Wright. “This experience has inspired me to continue science writing in the future.”

In the 1490s, a gruesome new disease exploded across Europe. It moved with terrifying speed. Within five years of the first reported cases, among the mercenary army hired by Charles VIII of France to conquer Naples, it was all over the continent and reaching into north Africa. The first symptom was a lesion, or chancre, in the genital region. After that, the disease slowly progressed to the increasingly excruciating later stages. The infected watched their bodies disintegrate, with rashes and disfigurements, while they gradually descended into madness. Eventually, deformed and demented, they died.

Some called it the French disease. To the French, it was the Neapolitan disease. The Russians blamed the Polish. In 1530, an Italian physician penned an epic poem about a young shepherd named Syphilis, who so angered Apollo that the god struck him down with a disfiguring malady to destroy his good looks. It was this fictional shepherd (rather than national rivalries) who donated the name that eventually stuck: the disease, which first ravaged the 16th-century world and continues to affect untold millions today, is now known as syphilis.

As its many names attest, contemporaries of the first spread of syphilis did not know where this disease had come from. Was it indeed the fault of the French? Was it God’s punishment on earthly sinners?

Another school of thought, less xenophobic and less religious, soon gained traction. Columbus’s historic voyage to the New World was in 1492. The Italian soldiers were noticing angry chancres on their genitals by 1494. What if Columbus had brought the disease back to Europe with him as an unwelcome stowaway aboard the Pinta or the Niña?

Since the 1500s, we have discovered a lot more about syphilis. We know it is caused by a spiral-shaped bacterium called Treponema pallidum, and we know that we can destroy this bacterium and cure the disease using antibiotics. (Thankfully we no longer “treat” syphilis with poisonous, potentially deadly mercury, which was used well into the 19th century.)

However, scientists, anthropologists, and historians still disagree about the origin of syphilis. Did Columbus and his sailors really transport the bacterium back from the New World? Or was it just coincidental timing, that the first cases were recorded soon after the adventurers’ triumphant return to the Old World? Perhaps syphilis was already present in the population, but doctors had only just begun to distinguish between syphilis and other disfiguring illnesses such as leprosy; or perhaps the disease suddenly increased in virulence at the end of the 15th century. The “Columbian” hypothesis insists that Columbus is responsible, and the “pre-Columbian” hypothesis that he had nothing to do with it.

Much of the evidence to distinguish between these two hypotheses comes from the skeletal record. Late-stage syphilis causes significant and identifiable changes in the structure of bone, including abnormal growths. To prove that syphilis was already lurking in Europe before Columbus returned, anthropologists would need to identify European skeletons with the characteristic syphilitic lesions, and date those skeletons accurately to a time before 1493.

This has proved a tricky exercise in practice. Identifying past syphilis sufferers in the New World is straightforward: ancient graveyards are overflowing with clearly syphilitic corpses, dating back centuries before Columbus was even born. However, in the Old World, a mere scattering of pre-Columbian syphilis candidates have been unearthed.

Are these 50-odd skeletons the sought-after evidence of pre-Columbian syphilitics? With such a small sample size, it is difficult to definitely diagnose these skeletons with syphilis. There are only so many ways bone can be damaged, and several diseases produce a bone pattern similar to syphilis. Furthermore, the dating methods used can be inexact, thrown off by hundreds of years because of a fish-rich diet, for example.

A study published in 2011 has systematically compared these European skeletons, using rigorous criteria for bone diagnosis and dating. None of the candidate skeletons passed both tests. In all cases, ambiguity in the bone record or the dating made it impossible to say for certain that the skeleton was both syphilitic and pre-Columbian. In other words, there is very little evidence to support the pre-Columbian hypothesis. It seems increasingly likely that Columbus and his crew were responsible for transporting syphilis from the New World to the Old.

Of course, Treponema pallidum was not the only microbial passenger to hitch a ride across the Atlantic with Columbus. But most of the traffic was going the other way: smallpox, measles, and bubonic plague were only some of the Old World diseases which infiltrated the New World, swiftly decimating thousands of Native Americans. Syphilis was not the French disease, or the Polish disease. It was the disease – and the revenge – of the Americas.

Read the entire article here.

Image: Christopher Columbus by Sebastiano del Piombo (1485–1547). Courtesy of Wikipedia / Metropolitan Museum of Art.

Addiction: Choice or Disease or Victim of Hijacking?

 

The debate concerning human addictions of all colors and forms rages on. Some would have us believe that addiction is a simple choice shaped by our free will; others would argue that addiction is a chronic disease. Yet, perhaps there may be another more nuanced explanation.

[div class=attrib]From the New York Times:[end-div]

Of all the philosophical discussions that surface in contemporary life, the question of free will — mainly, the debate over whether or not we have it — is certainly one of the most persistent.

That might seem odd, as the average person rarely seems to pause to reflect on whether their choices on, say, where they live, whom they marry, or what they eat for dinner, are their own or the inevitable outcome of a deterministic universe. Still, as James Atlas pointed out last month, the spate of “can’t help yourself” books would indicate that people are in fact deeply concerned with how much of their lives they can control. Perhaps that’s because, upon further reflection, we find that our understanding of free will lurks beneath many essential aspects of our existence.

One particularly interesting variation on this question appears in scientific, academic and therapeutic discussions about addiction. Many times, the question is framed as follows: “Is addiction a disease or a choice?”

The argument runs along these lines: If addiction is a disease, then in some ways it is out of our control and forecloses choices. A disease is a medical condition that develops outside of our control; it is, then, not a matter of choice. In the absence of choice, the addicted person is essentially relieved of responsibility. The addict has been overpowered by her addiction.

The counterargument describes addictive behavior as a choice. People whose use of drugs and alcohol leads to obvious problems but who continue to use them anyway are making choices to do so. Since those choices lead to addiction, blame and responsibility clearly rest on the addict’s shoulders. It then becomes more a matter of free will.

Recent scientific studies on the biochemical responses of the brain are currently tipping the scales toward the more deterministic view — of addiction as a disease. The structure of the brain’s reward system combined with certain biochemical responses and certain environments, they appear to show, cause people to become addicted.

In such studies, and in reports of them to news media, the term “the hijacked brain” often appears, along with other language that emphasizes the addict’s lack of choice in the matter. Sometimes the pleasure-reward system has been “commandeered.” Other times it “goes rogue.” These expressions are often accompanied by the conclusion that there are “addicted brains.”

The word “hijacked” is especially evocative; people often have a visceral reaction to it. I imagine that this is precisely why this term is becoming more commonly used in connection with addiction. But it is important to be aware of the effects of such language on our understanding.

When most people think of a hijacking, they picture a person, sometimes wearing a mask and always wielding some sort of weapon, who takes control of a car, plane or train. The hijacker may not himself drive or pilot the vehicle, but the violence involved leaves no doubt who is in charge. Someone can hijack a vehicle for a variety of reasons, but mostly it boils down to needing to escape or wanting to use the vehicle itself as a weapon in a greater plan. Hijacking is a means to an end; it is always and only oriented to the goals of the hijacker. Innocent victims are ripped from their normal lives by the violent intrusion of the hijacker.

In the “hijacked” view of addiction, the brain is the innocent victim of certain substances — alcohol, cocaine, nicotine or heroin, for example — as well as certain behaviors like eating, gambling or sexual activity. The drugs or the neurochemicals produced by the behaviors overpower and redirect the brain’s normal responses, and thus take control of (hijack) it. For addicted people, that martini or cigarette is the weapon-wielding hijacker who is going to compel certain behaviors.

To do this, drugs like alcohol and cocaine and behaviors like gambling light up the brain’s pleasure circuitry, often bringing a burst of euphoria. Other studies indicate that people who are addicted have lower dopamine and serotonin levels in their brains, which means that it takes more of a particular substance or behavior for them to experience pleasure or to reach a certain threshold of pleasure. People tend to want to maximize pleasure; we tend to do things that bring more of it. We also tend to chase it when it subsides, trying hard to recreate the same level of pleasure we have experienced in the past. It is not uncommon to hear addicts talking about wanting to experience the euphoria of a first high. Often they never reach it, but keep trying. All of this lends credence to the description of the brain as hijacked.

[div class=attrib]Read the entire article after the jump.[end-div]

[div class=attrib]Image courtesy of CNN.[end-div]