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Swedish Council for Novel Therapies sets a limit for cost of medication to preserve life

June 8, 2015

The Swedish Council for Novel Therapies (NT-rådet) has recommended that certain medicines should not be given to patients if they are too expensive – even if the alternative is death. The recommendation is to the Counties who run the hospitals on behalf of the country’s health service. Effectively it means that patients who have atypical hemolytic-uremic syndrome (a-HUS) can no longer be prescribed Eculizumab. There is no known cure for this quite rare (1:500,000) genetic condition  which attacks the kidneys:

Atypical hemolytic-uremic syndrome is a disease that primarily affects kidney function. This condition, which can occur at any age, causes abnormal blood clots (thrombi) to form in small blood vessels in the kidneys. These clots can cause serious medical problems if they restrict or block blood flow. Atypical hemolytic-uremic syndrome is characterized by three major features related to abnormal clotting: hemolytic anemia, thrombocytopenia, and kidney failure.

With a population of just under 10 million, Sweden may have about 20 individuals suffering from this genetic condition. Eculizumab (trade name Soliris) is a medication that has recently been approved for the treatment of aHUS, an ultra-rare genetic disease that causes abnormal blood clots to form in small blood vessels throughout the body, leading to kidney failure, damage to other vital organs and premature death. But it costs approximately €430,000 per year for ongoing treatment.

Clinical trials in patients with aHUS demonstrated inhibition of thrombotic microangiopathy (TMA), the formation of blood clots in small blood vessels throughout the body, including normalization of platelets and lactate dehydrogenase (LDH), as well as maintenance or improvement in renal function.

The medicine does not cure the condition but inhibits the expression of some its fatal effects. It gives a patient a chance to live on.

But as Swedish Radio reports, the Swedish Council for Novel Therapies has decided that this cost of keeping a patient living is too high. For this council, the value of the life of a patient suffering from a-HUS is clearly less than about SEK 4 million per year.

Clearly there is an economic cost benefit analysis to be made for all medical treatment. Clearly also an unlimited cost for keeping someone alive is also not possible. But what about the value of the life to be prolonged? Even assuming that there is some cost limit which is not be borne, the “forbidden” cost level cannot just be an absolute value which takes no note of the value of the life preserved. If cost-benefit is to be the guiding factor, then should not all health costs be balanced against the life or the quality of life to be preserved?

Swedish Radio:

The Swedish Counties’ council of experts, the Council on Novel Therapies, has decided to discourage counties from using a drug for a very rare and life-threatening blood disorder. The reason is that the medicine will cost 4.5 million kronor per patient annually – making it one of the most expensive in the world. A small group of patients could thus eventually die of the disease that brings inflammation, clots and kidney failure. 

“I think it is a completely unreasonable decision. One can not deny the patients with this difficult disease to receive treatment. Although there is plasma and dialysis treatment, survival is most certainly not so long as with this treatment. So I think that they have to change their decision”, says chief physician Ingela Fehmarn-Ekholm.

The disease is called aHUS (atypical hemolytic uremic syndrome), where the blood cells break down and patients become anemic and can get blood clots, stroke, and renal failure.

Ingela Fehrman Ekholm describes one of the patients she treated with the new drug. Before it came, he had donated a kidney to his daughter who suffered from the disease, but the girl did not survive.

A year later he  himself got aHUS. After several years of dialysis and three kidney transplants, he received the new medicine. “It is now almost three years, absolutely no side effects and kidney works great and he feels great”, says Fehmarn-Ekholm.

But it would seem that for this patient, Stefan Persson, the treatment will not be able to continue if this recommendation is followed.

However the statement from the Chairman of the Council almost reads as if it is just a game – a price negotiation with the manufacturer with the death of patients being played out as one card in the game.

Stefan Back is the Chairman of the Council of Novel Therapies that has taken the decision stop using the medicine Soliris.

He believes that the responsibility lies with the manufacturer, who failed to show why the drug has such a high price.

“It is regrettable that it had to come to this because it’s not an easy decision to make. It leads to anxiety with the patients and we hope that the company will deliver significantly better economic evidence and perhaps a lower price”.

A price negotiation where patients’ lives and their peace of mind are just another card to play.

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Obamacare is not eliminating the short term cover it was supposed to

June 4, 2015

Somebody stated to me that history would remember Barack Obama for Obamacare. But I am not so convinced. I suspect that he will be remembered only for being the first “black” (actually only half-black) President. He may also be remembered for his tendency to allow fear to subordinate his actions. His tendency to overthink issues and take little action and his disinclination to develop strategies may also be remembered. Whether Obamacare will stand the test of time remains to be seen. In the short time it has been in force, large parts of it are counter-productive. That may just be a peculiarity of the “open enrollment” windows or something more fundamental.

The primary benefit of Obamacare (Affordable Care Act) was, ostensibly, to make health care affordable to all. For older people it is proving to be unaffordable and they have to seek alternative cover. As Reuters reports, the alternative cover that Obamacare was supposed to eliminate has risen by over 100%. Alternative cover is even being chosen by the young for “catastrophic” coverage. To make matters even worse, those who take out such alternative cover are deemed uninsured and are subject to penalties.

Reuters:

Despite the promise of coverage through the U.S. Affordable Care Act (ACA), the number of people applying for non-compliant, short-term health insurance policies was up more than 100 percent in 2014, according to new data available from companies who broker these policies.

This type of health insurance is exactly the kind that the ACA, known commonly as Obamacare, was supposed to upgrade. Short-term plans provide low-cost coverage for major medical events like hospital stays, with high deductibles and out-of-pocket costs, and are subject to denial if applicants have pre-existing conditions. They do not offer the protections of Obamacare for preventive care or maternity coverage, for example.

The government does not count these gap plans as qualifying health insurance, so people who have them are subject to penalties for being uninsured. ……..

….. Sign-ups at eHealth Inc to the short-term plans it offers through its website were up to 140,000 in 2014 from 60,000 in 2013, an increase of 134 percent, according to the company.

At another short-term carrier, Agile Health Insurance, a subsidiary of Health Insurance Innovations Inc, new policies were up 100 percent last year over the previous year, and are up again so far in 2015, according to Scott Lingle, the company’s senior vice president of business development.

Accounting for much of the jump are individuals who somehow missed the open enrollment period for an Obamacare plan. More than 11.7 million consumers signed up for Obamacare coverage through Feb. 22, according to the government. …… 

Both eHealth and Agile are also seeing new signups from retirees who are looking for a low-cost plan to tide them over until Medicare kicks in at 65. At eHealth, the 55 to 64 age group is now 9 percent of the market.

“If you shop for a 50-year-old on healthcare.gov, it is very expensive,” says Agile’s Lingle. “There are people who have looked at the prices and it makes more sense to buy short term.”

The largest constituency is young, healthy people seeking low-cost catastrophic coverage. Those aged 18 to 34 account for 57 percent of eHealth’s buyers. A typical policy could cost around $100 a month, depending on the state of residency and the features of the plan.

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Cold – not heat – is the real killer

May 24, 2015

Climate will change as it always has. While there is a religious belief among the radicalised of the true faith that man-made global warming is real, the reality is that there is no signature of man-made global warming that can be distinguished from the natural variations of climate. I have no doubt that whatever change occurs, humans will cope as well as they are able to, and history shows that even glacial conditions have not held back human development. When (not if) the current inter-glacial ends, humans will have access to energy levels and energy intensities magnitudes greater than what was available during the last glacial maximum (20 – 25,000 years ago). And we will have fossil fuels and nuclear energy to thank for that. Hydro Power will virtually vanish during glacial conditions. The more time we have to prepare, and the preparations we make, will determine how well we cope and how many deaths may occur while we do adjust.

It is cold which is by far the more dangerous and which requires the greater preparation. It is far, far better we prepare for the ice age that will undoubtedly come than for any imaginary man-made global warming.

A new paper in the Lancet reports on an analysis of over 74 million (74,225,200) deaths between 1985 and 2012 in 13 countries with a wide range of climates, from cold to subtropical. The results show that moderate cold or heat cause more deaths than extreme weather and that cold kills 20 times more people than heat.

Antonio Gasparrini et al, Mortality risk attributable to high and low ambient temperature: a multicountry observational study. The Lancet, May 2015 DOI: 10.1016/S0140-6736(14)62114-0

The Lancet (press release):

Cold weather kills 20 times as many people as hot weather, according to an international study analysing over 74 million deaths in 384 locations across 13 countries. The findings, published in The Lancet, also reveal that deaths due to moderately hot or cold weather substantially exceed those resulting from extreme heat waves or cold spells.

“It’s often assumed that extreme weather causes the majority of deaths, with most previous research focusing on the effects of extreme heat waves,” says lead author Dr Antonio Gasparrini from the London School of Hygiene & Tropical Medicine in the UK. “Our findings, from an analysis of the largest dataset of temperature-related deaths ever collected, show that the majority of these deaths actually happen on moderately hot and cold days, with most deaths caused by moderately cold temperatures.” 

…… Around 7.71% of all deaths were caused by non-optimal temperatures, with substantial differences between countries, ranging from around 3% in Thailand, Brazil, and Sweden to about 11% in China, Italy, and Japan. Cold was responsible for the majority of these deaths (7.29% of all deaths), while just 0.42% of all deaths were attributable to heat. The study also found that extreme temperatures were responsible for less than 1% of all deaths, while mildly sub-optimal temperatures accounted for around 7% of all deaths—with most (6.66% of all deaths) related to moderate cold. …

The study also shows that cold has greater impact in Japan and Italy than in Sweden but that is only to be expected. Warm countries will be more unprepared for cold and vice versa.

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And so it begins! UK writes off its over 75s

April 27, 2015

National health services all over Europe are facing an increase of costs as longevity increases. It is only a matter of time before state health services encourage those considered “too old” to expedite their exit from life and save them from the costly obligations of providing care. The first stage is when some medical services are denied for those considered too old and these initial indicators are already visible. Expensive treatments will be the first to go. I have already posted about prostate cancer treatment being denied to those considered too old (over 70) in some parts of Sweden. Physicians already discourage elderly patients – perhaps unconsciously – from expensive or long treatment as a matter of routine.

And now I read that patients over 75 are going to be encouraged by the UK NHS to start planning their exits. Private health insurance premiums for the elderly are already on the rise. Perhaps the over 75s will be uninsurable soon. Ostensibly it is just to get them to sign a “non-resuscitation” declaration – but it is the start. Next they will be asked to choose their preferred method of assisted dying. The sad part is that this is no longer about providing care or about dying with some semblance of dignity. It is all about saving cost.

And if you ever read about an over 75 who was not resuscitated after suffering complications from an ingrowing toe-nail, you can at least be sure that a great deal of money was saved.

Daily Mail:

Doctors are being told to ask all patients over 75 if they will agree to a ‘do not resuscitate’ order. New NHS guidelines urge GPs to draw up end-of-life plans for over-75s, as well as younger patients suffering from cancer, dementia, heart disease or serious lung conditions.

They are also being told to ask whether the patient wants doctors to try to resuscitate them if their health suddenly deteriorates.

The NHS says the guidance will improve patients’ end-of-life care, but medical professionals say it is ‘blatantly wrong’ and will frighten the elderly into thinking they are being ‘written off’.

In some surgeries, nurses are cold-calling patients over 75 or with long-term conditions and asking them over the phone if they have ‘thought about resuscitation’. 

Non-resuscitation is the new euphemism for assisted death. And it is also only a little further along this road before the assisted death is not even a voluntary choice but is mandated for all who are past a certain age and have the misfortune to be hospitalised. A mandatory death age to follow a mandatory retirement age. Maybe those past the mandatory age of death will not be actively terminated in their own homes but woe betide them if they are ever hospitalised.

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New moon gives higher blood pressure in children

April 24, 2015

Once upon a time, Astrology was the only science. It then became pseudo-science as the age of rational science took off. In the modern world it is considered a belief system and the stuff of charlatans. Tests of astrological predictions have shown that their forecasts are no better than would be expected by chance (here and here). It is generally considered absurd that distant celestial objects can have any impact on human life or behaviour.

But in recent times it has become clear that the near celestial objects (the Sun, the moon and even Jupiter) do interact with the earth sufficiently to give correlations between their relative motion and some aspects of human life and behaviour. Our internal body clocks not only reflect the 24 hour cycle of the earth’s rotation, but even have an “annual” component seemingly related to the earth’s period of rotation around the Sun and may even have a lunar monthly component. The season of birth has been linked to personality and that begins to sound like astrology. There are now also correlations showing other possible connections to the period of rotation of the moon around the earth:

That the moon may have effects on the results of cardiac surgery is apparently not just rubbish.

It seems that the lunar nodal cycle (18.6 years) is also reflected in happenings on earth:

The lunar nodal cycle does seem to correlate with happenings on Earth. The mechanisms leading to most lunar effects on tides and sedimentation and geologic accumulations and tidal flows and sea surface temperatures and climate can be put down to some interplay of gravitational forces.

It is not such a long stretch to think that the gravitational effects of the larger planets may have some quite unlooked for effects on life on Earth.

The Sun and the moon do affect us it seems  – even if not the stars. And now it is reported from Denmark that “the lunar cycle seems to have an effect on children’s health and activity levels, but scientists are at a loss when it comes to finding an explanation for this”. The effects are small but clearly significant.

Nordic Science reports:

Just a few decades ago, it was still widely believed that the full moon held special powers and could make people act strange or even go mad. This has long since been dismissed as unscientific superstition. However, it might be time to revise that notion.

A new study, published in the scientific journal Clinical Obesity, shows that the lunar cycle is associated with a negative effect on children’s levels of physical activity, blood pressure, and blood sugar levels.

“It’s a very mysterious finding.  We actually have no idea what the reason could be for these changes in children’s behaviour during the course of the lunar cycle. It’s the first time anyone has studied children’s health in relation to the lunar cycle,” says Mads Fiil Hjorth, postdoc at the Department of Nutrition, Exercise, and Sports at the University of Copenhagen.

“Perhaps the explanation is hidden far back in evolutionary history, when moonlight could influence chances of survival and reproduction among animals and small organisms,” he says.

Hjorth is the main author of the new research article that has been written in collaboration with a team of scientists from the research centre OPUS at University of Copenhagen.

During the study, the scientists collected data from 795 children aged 8-11, taking blood samples and measuring blood pressure, sleep, and activity levels. The information was gathered over the course of nine lunar cycles – i.e. months – and then analysed.

The results revealed that on the days around a full moon the children were on average 3.2 minutes less moderately to very physically active than at new moon; equivalent to roughly 8 percent lower activity levels.

Moreover, the children’s blood pressure was 0.8 mmHg higher – equivalent to an increase of roughly 1 percent – and had an average of 0.12 mmol/L higher blood sugar levels – equivalent to an increase of just over 2 percent. Finally, the children slept 4.1 minutes more on average at full moon. ……

…….. Sleep scientist Birgitte Kornum, PhD and senior researcher at the Molecular Sleep Laboratory at Glostrup Hospital’s Research Institute, is optimistic about the results.

“This is very exciting. At this stage there is good evidence to suggest that we all have a monthly cycle inside that influences our sleep and perhaps other areas, too,” she says.

“The question is whether it’s a coincidence that the cycle follows the amount of moonlight that shines down on us, or whether the human cycle is an innate part of our biology, like the female menstrual cycle.” ….. 

Hardly any Indian Hindu wedding today takes place without first checking with astrologers that the couples’ horoscopes are not in conflict and that the day and time of the wedding is auspicious. The astrologers may well be charlatans and their various calculations are clearly just so much mumbo-jumbo, but I would not be so quick to dismiss the social and psychological importance of getting their “stamp of approval”. Astrology is still just a system of belief and astrological approval then has the importance of any religious rite.

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Swedish health care provides inferior treatment of prostate cancer to elderly men

April 21, 2015

The Swedish health care system is often cited as an example. And in general that is probably justified. But there is little doubt that care is denied when the physician – for whatever reason – believes it is not worthwhile. The patient’s life expectancy plays a key part in this judgement. And that automatically leads to the elderly being denied treatment in some cases. After all, the common good requires that resources not be wasted! Perhaps it would be best to simply withhold all care for people over 70 – or should we say 75?

The Swedish health system does provide inferior treatment to men with prostate cancer if they are over 70 years old. A report from Lund University exposes yet another example of the age discrimination that is endemic in Sweden. And as the country ages, we can expect such denial of care to increase.

Until the over 70s start to exercise their political power.

Aftonbladet:

Many older men are not getting the cancer treatment they need. New Swedish research shows that men between 70 and 80 years are often under-treated despite having a high risk of prostate cancer. According to the national guidelines men should  have surgery or radiation treatment, but many are denied access to these treatments. The doctors believe that patients are too old, says Associate Professor Ola Bratt at Lund University in the research report that was presented at an international urology meeting in Madrid.

Prof. Ola Bratt has examined all the 19 000 men especially at risk and treated for prostate cancer  in Sweden between 2001 and 2012. He notes that doctors often misjudged the patient’s expected lifetime. The doctors have simply ignored vital treatment because they mistakenly believed that the patients would die soon.

“Such an old-fashioned and rather jaundiced view of today’s 70 year olds can have devastating consequences. It can not be the intention that Swedish men should die prematurely”.

Ola Bratt notes that there are large differences between different parts of Sweden. Between 2001 and 2012, the proportion of men over 70 years who received curative treatment was 15-38 percent, but the proportion varies greatly between counties – from 13 percent in Örebro County to 85 percent in Kronoberg County, according to the National Prostate Cancer Register. Many men are thus losers in the great cancer lottery. Those who want to survive, should stay in the right county and go to the right doctor.

There is a shortage of urologists and many of them are available in small clinics that may not keep up with the latest developments. Choice of care has also contributed to more private clinics taking responsibility for severe disease and the patient is then challenged to find the right treatment in a jungle of offers.

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WHO delayed Ebola emergency declaration by 2 months – for political expedience

March 20, 2015

In October last year it was revealed that the complacency of the WHO African country heads (mainly political appointees) and who “seem to have been unwilling to even acknowledge that there was a problem on their turfs” had caused avoidable delays.

Now the Associated Press reports (NY Times) that the WHO leadership delayed declaring an emergency by 2 months for reasons of political expediency; to avoid upsetting some African countries, to avoid economic damage and to avoid any interruption to the annual Haj pilgrimage to Mecca. The emergency was declared on August 8th 2014 but from emails obtained by AP, it should have been declared 2 months earlier. That probably means that about 1000 deaths might have been prevented. The death toll from the outbreak is now estimated to have reached over 10,000.

Ebola deaths in West Africa (Data: WHO / Chart CC BY 4.0: JV Chamary / Source: http://onforb.es/1sCVxE1)

The Hindu:

Among the reasons the United Nations agency cited in internal deliberations – worries that declaring such an emergency akin to an international SOS could anger the African countries involved, hurt their economies or interfere with the Muslim pilgrimage to Makkah. ….. 

In public comments, WHO Director-General Margaret Chan has repeatedly said the epidemic caught the world by surprise. ……

But internal documents obtained by AP show that senior directors at the health agency’s headquarters in Geneva were informed of how dire the situation was early on and held off on declaring a global emergency. Such an alert is meant to trigger a surge in outside help, or, as a WHO document put it, “ramps up political pressure in the countries affected” and “mobilizes foreign aid and action”.

When WHO experts discussed the possibility of an emergency declaration in early June, one director viewed it as a “last resort”.

The delay in declaring an emergency was one of many critical problems that hobbled the agency’s ability to contain the epidemic. When aid agency Doctors Without Borders warned Ebola was spiralling out of control, WHO contradicted it, even as WHO’s own scientists called for backup. When WHO did send staffers to Africa, they were of mixed calibre. Fellow responders said many lacked Ebola experience; one WHO consultant who got infected with Ebola broke his own agency’s protocol, putting others at risk and getting WHO kicked out of a hotel, the AP found.

……..  The vacuum of leadership at WHO was so damaging the U.N. created the Mission for Ebola Emergency Response to take over the overall fight against the disease.

….. By the time WHO declared an international emergency, nearly 1,000 people were already dead. Overall, more than 10,000 are thought to have died in the year since the outbreak was announced.

NYT: 5 Key Findings

1. WHO officials privately floated the idea of declaring an international health emergency in early June, more than a month before the agency maintains it got its first sign the outbreak merited one — in late July — and two months before the declaration was finally made on August 8, 2014.

2. WHO blamed its slow response partly on a lack of real-time information and the surprising characteristics of the epidemic. In fact it had accurate field reports — including scientists asking for backup — and it identified the unprecedented features of the outbreak. The agency was also hobbled by a shortage of funds and a lack of clear leadership over its country and regional offices.

3. Politics appear to have clouded WHO’s willingness to declare an international emergency. Internal emails and documents suggest the U.N. health agency was afraid of provoking conflict with the Ebola-stricken countries and wary that a declaration could interfere with the economy and the Muslim pilgrimage to Mecca.

4. An Ebola-infected WHO consultant in Sierra Leone violated WHO health protocols, creating a rift with Doctors Without Borders that was only resolved when WHO was thrown out of a shared hotel.

5. Despite WHO’s pledges to reform, many of the proposed changes are recycled suggestions from previous outbreaks that have never taken hold. Any meaningful reform to the organization would likely require countries to rewrite the constitution, a prospect many find unpalatable.

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Indian government plays down swine flu epidemic which has killed 833 so far

February 24, 2015

Over 14,000 people have been affected so far and the death toll till yesterday had reached 833. The swine flu epidemic in India is spread across the northern states – mainly – though deaths have also been reported in Telengana. But health officials both at state level and in the central government are resisting any discussion and insist that all is under control.

There are reviews and review committees galore and the bureaucratic process is in full swing. State and central government health departments are assiduously collecting data. But state assemblies will not allow debate. There is no shortage of medicines. Health departments “are on the job” but the number of states affected and the number of deaths are rising.

It is not so much being in denial as trying to sweep “unpleasantness” under some bureaucratic carpet. The public private partnership in health care is broken. It is the partnership of an underfunded and hopelessly inadequate public service and a rampant and avaricious private sector. Private hospitals are turning away “public” patients – who they are normally obliged to accept – on the grounds of lacking isolation wards. Private labs are charging exorbitant rates for tests. Tamiflu is being hoarded for the use of paying patients.

DNA: Every time a disease outbreak is reported, the government swings into action. High level review meetings are held in the health ministry and the cabinet secretariat, guidelines are issued for states, health minister visits hospitals and makes reassuring statements that  there is ‘no shortage of drugs and vaccines’. On the ground, however, government hospitals are crowded with patients complaining about lack of proper care, confusion prevails on diagnostic tests and medicines, and generally there is an atmosphere of panic among the general public. This is pretty much the picture whenever a disease outbreak occurs in India or there is a threat of a pandemic touching Indian shores. We have had a series of them in the past decade – Severe Acute Respiratory Syndrome (SARS), Avian influenza (bird flu), swine flu, Ebola and so on. The current outbreak of Influenza A (H1N1) — popularly called swine flu because it originally got transmitted to humans from swine — is no different. The last major outbreak of this flu in India was in 2009 when Influenza A (H1N1) was declared a pandemic by the World Health Organisation. ….. 

…. The private sector today provides nearly 80 per cent of outpatient care and about 60 per cent of inpatient care. However, when outbreaks like swine flu or SARS occur private sector draws into a shell. Patients are denied admission on the pretext of private hospitals not having isolation wards or the fear of losing medical tourists. Pathological labs start charging exorbitant fees for conducting diagnostic tests, as has been happening in the case of the current outbreak. Chemists begin hoarding or black marketing essential drugs like oseltamivir (trade name Tamiflu), working in tandem with private doctors and hospitals.

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Nasty, heathen, Asian gerbils were responsible for European plagues

February 24, 2015

It was fleas on the giant gerbils of central Asia which were to blame. Wet springs followed by warm summers caused giant gerbil populations in the heathen wilds of central Asia to boom. The plague carrying fleas they were infested with also boomed. The fleas jumped – as fleas are wont to do – onto domestic animals and onto humans. These thoughtless Asians forced their trade onto hapless, innocent, Christian Europeans along the Silk Road and through European harbour ports. The fleas, which carried the plague bacteria, jumped again to European rats, found the living good and multiplied. This was back in the 1300s. And for 400 years it was waves of Asian gerbils and their fleas which preyed upon the hapless Europeans. The plague outbreaks in Europe came 15 years after the wet springs and warm summers in Asia. The poor innocent European rats were demonised quite wrongly. This we now know by studying tree rings.

It is, in fact, the Asians who must be blamed for gerbils and the plague and also for language, for agriculture and for religion.

Boris V Schmid et al, Climate-driven introduction of the Black Death and successive plague reintroductions into Europe, PNAS, doi: 10.1073/pnas.1412887112

Abstract: The Black Death, originating in Asia, arrived in the Mediterranean harbors of Europe in 1347 CE, via the land and sea trade routes of the ancient Silk Road system. This epidemic marked the start of the second plague pandemic, which lasted in Europe until the early 19th century. This pandemic is generally understood as the consequence of a singular introduction of Yersinia pestis, after which the disease established itself in European rodents over four centuries. To locate these putative plague reservoirs, we studied the climate fluctuations that preceded regional plague epidemics, based on a dataset of 7,711 georeferenced historical plague outbreaks and 15 annually resolved tree-ring records from Europe and Asia. We provide evidence for repeated climate-driven reintroductions of the bacterium into European harbors from reservoirs in Asia, with a delay of 15 ± 1 y. Our analysis finds no support for the existence of permanent plague reservoirs in medieval Europe.

The gerbil theory is not implausible but it smacks a bit of confirmation bias. The 15 year time lag is less than convincing. A gerbil lives for 3 to 4 years. A flea lives 30 – 90 days. Correlation is not causation. That European outbreaks of plague came 5 gerbil lifetimes later than the population boom in Asia, and about 60 flea generations later than the flea which first infested the sorry gerbil, is a little far-fetched.

 

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Monkeys can learn how to use a mirror

January 11, 2015

Self-awareness is surely more than just passing a “mirror test”. There would seem to be a continuum between the two discrete states of “not being self-aware” (a stone) to being “fully self-aware” (higher primates and humans), though I am not entirely sure if even higher levels of self-awareness are conceivable. I take self-awareness to be on a higher plane than self-consciousness. Self-awareness is the recognition of a tree as “being in a forest” whereas self-consciousness is just being the “tree”. Empirically, sentience is an even higher cognitive capability where sentience requires self-awareness which in turn requires self-consciousness.

Most mammals are conscious of self or at least of self-interest. Even a tree for that matter could be said to exhibit self-interest. Passing the mirror test seems to be a fairly conclusive evidence of well-developed, self-awareness but that is not to say that some degree of self-awareness is not possible even when the mirror test is not passed. Whales, dolphins and some elephants have passed the mirror test along with most of the higher primates (gorillas, chimpanzees and bonobos). The magpie is the only bird known which has passed the test. Monkeys (rhesus monkeys, macaques) do not pass the test but are clearly self-conscious.

Now, new research has shown that rhesus monkeys can be taught to make use of a mirror such that they could pass the mirror test. Can awareness therefore be taught?

Liangtang Chang, Gin Fang, Shikun Zhang, Mu-Ming Poo, Neng Gong. Mirror-Induced Self-Directed Behaviors in Rhesus Monkeys after Visual-Somatosensory Training. Current Biology, January 2015 DOI:10.1016/j.cub.2014.11.016

EurekAlert: Unlike humans and great apes, rhesus monkeys don’t realize when they look in a mirror that it is their own face looking back at them. But, according to a report in the Cell Press journal Current Biology on January 8, that doesn’t mean they can’t learn. What’s more, once rhesus monkeys in the study developed mirror self-recognition, they continued to use mirrors spontaneously to explore parts of their bodies they normally don’t see. …

“Our findings suggest that the monkey brain has the basic ‘hardware’ [for mirror self-recognition], but they need appropriate training to acquire the ‘software’ to achieve self-recognition,” says Neng Gong of the Chinese Academy of Sciences.

In earlier studies, scientists had offered monkeys mirrors of different sizes and shapes for years, even beginning at a young age, Gong explains. While the monkeys could learn to use the mirrors as tools for observing other objects, they never showed any signs of self-recognition. When researchers marked the monkeys’ faces and presented them with mirrors, they didn’t touch or examine the spot or show any other self-directed behaviors in front of those mirrors in the way that even a very young person would do.

In the new study, Gong and his colleagues tried something else. They sat the monkeys in front of a mirror and shined a mildly irritating laser light on the monkeys’ faces. After 2 to 5 weeks of the training, those monkeys had learned to touch face areas marked by a spot they couldn’t feel in front of a mirror. They also noticed virtual face marks in mirroring video images on a screen. They had learned to pass the standard mark test for mirror self-recognition.

Most of the trained monkeys–five out of seven–showed typical mirror-induced self-directed behaviors, such as touching the mark on the face or ear and then looking and/or smelling at their fingers as if they were thinking something like, “Hey, what’s that there on my face?” They also used the mirrors in other ways that were unprompted by the researchers, to inspect other body parts. …… 

I note that Gordon Gallup Jr. who developed the mark test is not convinced:

Gordon Gallup Jr., an evolutionary psychologist at the State University of New York at Albany, who was not involved with the research, developed the “mark test,” which is essentially the gold standard for measuring whether an animal possesses self-recognition. [8 Humanlike Behaviors of Primates] ….

Gallup, who developed the mark test, called the study “fundamentally flawed,” because it merely demonstrated that the animals could be trained to do something, not that they understood what they were doing.

“I bet I could train a pigeon to pick the correct answers to the Graduate Record Examinations (GRE),” Gallup told Live Science. “If the pigeon got [the maximum GRE score], would it be qualified for Harvard University?”

Perhaps, given self-consciousness, much of what we call awareness can be taught. Maybe that is how babies develop; an inbuilt self-consciousness which then becomes self-aware as learning (mainly self-taught) occurs. Learning requires memory and maybe that is why this self-taught awareness is what also deteriorates with the memory loss that accompanies the onset of Alzheimer’s disease.

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Posted in Behaviour, Education, Medicine, Memory | Comments Off on Monkeys can learn how to use a mirror

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