www.aana.com/aanajournalonline AANA Journal April 2021 Vol. 89, No. 2 97

THE EDITOR’S DESKScience and Clinical Potpourri for Your Life and Your Practice Epidemics Brought Under Control

Many people alive today have had no experience with infectious dis-ease epidemics until the appearance of COVID-19 in the early Spring of 2020. With COVID vaccines just beginning to be rolled out, let’s gain a bit of perspective by looking at two major US epidemics and how they were managed.SmallpoxSmallpox is caused by either of two virus variants — Variola major and Variola minor. The earliest evidence of smallpox is found in medical writings from 1500 BC in India, and 1122 BC in China. European rulers who died of small-pox include Queen Mary II of England in 1694, Tsar Peter II of Russia in 1730, and King Louis XV of France in 1794. Smallpox survi-vors include the composers Mozart and Beethoven, Queen Elizabeth I of England, Frankenstein author Mary Shelley, and US presidents George Washington and Abraham Lincoln.

Smallpox begins with a fever and vomiting, then small reddish spots (enanthem) appearing on the mucous membranes of the mouth and throat. Once these lesions rup-ture, they release large quantities of the virus into the body, which becomes covered with fluid-filled blisters called macules. The macules

even extend to the palms of the hands and the soles of the feet. After a week, if the sufferer hasn’t died, the macules scab over and fall off, however, they leave behind large scars and possibly cause blindness.

The English physician Edward Jenner is generally credited with creating the smallpox vaccine after noticing that milkmaids who con-tracted cowpox from the cows they milked were immune to smallpox. In May of 1796, he did the unthink-able, he scraped pus from cowpox blisters on the hands of a milkmaid and inoculated an 8-year-old boy named James Phipps then exposed Phipps to smallpox to which the boy proved immune. By 1840, the British government was providing free cowpox vaccinations to its pop-ulation. Jenner called the material he used for the inoculation vaccine, from the Latin word vacca which means “cow.” Napoleon, who at the time was at war with Britain, was so impressed by Jenner’s vaccine that he had all of his troops vaccinated, calling him “one of the greatest benefactors of mankind.”

If you were born before 1972, chances are good that you have a smallpox vaccination scar on your upper left arm made by a bifurcated needle that had been dipped into the vaccine then used to puncture the skin of your arm several times.PolioDuring the early decades of the 20th century, poliomyelitis, or polio, haunted the Summers and Falls of the world’s children. In tropical regions, it posed a threat year-round. Polio is spread by infected fecal mat-ter that enters the mouth, or by food

or water exposed to human feces or saliva. This made the virus especially prevalent in swimming pools and water holes where children released GI contents and people swam with their mouths open.

Unlike many other communica-ble diseases, polio occurs naturally only in humans. While some cases of polio are mild or even asymptom-atic, in about 1% of cases, the virus enters the CNS where it affects the spinal cord, the brain stem, or the brain’s motor cortex. It can then cause paralysis.

In 1921, 39-year-old Franklin Delano Roosevelt had just failed to be elected as Vice President in the 1920 presidential election when he contracted polio. The disease perma-nently paralyzed Roosevelt’s legs, and he recuperated at a polio rehabilita-tion clinic that he founded in Warm Springs, Georgia. Overcoming his handicap, in 1929, Roosevelt became governor of New York state, and in 1932, he defeated the incum-bent president, Herbert Hoover, to become our 32nd president.

Other well-known people who have contracted polio are actress Mia Farrow, who was hospitalized for eight months, actor Donald Sutherland who developed a love for reading while bedridden, and direc-tor Francis Ford Coppola who was confined to bed for over a year.

Confined to his house by polio, Franklin Mars helped his mother make candy in their kitchen, and he went on to found the Mars Candy Company maker of delights such as M&Ms, Snickers, Mars Bar, 3 Musketeers, Dove, Skittles, and Twix. Fiction author Arthur Clarke

98 AANA Journal April 2021 Vol. 89, No.2 www.aana.com/aanajournalonline

contracted polio in 1962 and was confined to bed for months. Before his death in 2008, Clarke spent his final years in a wheelchair due to post-polio syndrome where symp-toms return after years of being dormant.

In 1950, the first polio vaccine was developed by a Polish-American virologist using live, but weakened virus. In April of 1955, University of Pittsburgh physician Jonas Salk introduced the first inactivated poliovirus vaccine. Administered by injection, the vaccine was 99% effective.

In 1954, microbiologist Albert Sabin created an oral vaccine, that was administered widely to Russian citizens. In 1961 Sabin’s vaccine became widely available to US citi-zens, and it went down especially smoothly since the vaccine was dripped onto a sugar cube.

Another great example of a suc-cessful national vaccine campaign is that of measles. In 2021 it’s pretty easy to lose perspective that COVID-19 is just one in a long line of diseases that have menaced us, and we have to thank an equally long line of scientists who have cre-ated vaccines that have kept these diseases in check. We have every reason to be equally optimistic about COVID-19.

Our 5-senses Extended!

Consider the man-made technolo-gies that led to radar guns, magnetic compasses, and infrared detectors that enable us to extend beyond the five natural senses of sight, taste, smell, feel, and hearing. Yet these “inventions” are far from original, as nature has equipped many animals with these very “senses” long before humans had any notions about them.EcholocationToothed whale (marine mammals that also includes dolphins), bats, and some ground- and tree-dwelling shrews use echolocation to navigate their surroundings. Emitting high-

frequency sound pulses, that are very high-pitched to human ears or essentially inaudible, they detect the echoes produced by those sounds. Special ear and brain adaptations enable these animals to build 3D pictures of their surroundings. Consider how the enlarged ear flaps of bats collect and direct sound toward their thin, super-sensitive eardrums.Infrared and Ultraviolet VisionWe may greatly fear rattlesnakes and other pit vipers, but we should marvel at their employing infrared sensory organs to detect and hunt warm-blooded prey that would otherwise be completely invisible. Their “infrared eyes” are cup-like structures that form crude images as infrared radiation hits a heat-sen-sitive retina. Some animals, such as eagles, hedgehogs and even shrimp, can also see into the lower reaches of the ultraviolet spectrum. We humans have no such luck, as we are unable to see either infrared or ultraviolet light with the naked eye.Electric SenseElectric fields are produced by some critters, functioning like senses. Electric eels and some species of rays have modified muscle cells that produce electric charges strong enough to shock and sometimes kill their prey. Other fish use weaker electric fields to help them navigate murky waters, home in on prey or monitor their surroundings. Using what are known as “lateral lines” on either side of their bodies, that is a row of sensory pores in the skin that detect electrical currents in the water, some marine animals are able to gain a lot of information about their environment including finding prey and avoiding predation.Magnetic SenseThe geophysical flow of molten material in the earth’s core and the flow of ions in the earth’s atmo-sphere create a magnetic field that surrounds the planet. Just as compasses point humans toward magnetic north, many animals pos-

sess a magnetic sense that can orient them in specific directions and navigate long distances. Honeybees, sharks, sea turtles, rays, homing pigeons, migratory birds, tuna, and salmon, just to mention a few, possess this magnetic sense. The actual physiology is bewildering, but something that is suspected is the presence of small deposits of magnetite in these animals’ nervous systems. These tiny magnet-like crystals align themselves with the earth’s magnetic fields and may act like microscopic compass needles—a remarkable adaptation to deal with the challenges of the natural envi-ronment.

How in the World Did “lbs” Get to Mean “Pounds”?

The word “pound” is short for “pound weight,” which was libra pondo in Latin. The use of “lb” as an abbreviation for libra was appar-ently its genesis. But what exactly is a “lb” (pound)?

There are actually a number of definitions for the mass of a pound, depending on what coun-try one resides in. Here in the United States, the pound unit is defined as 2.20462234 pounds per metric kilogram. There are 16 ounces in 1 pound. However, in Roman times, the libra (pound) was about 0.3289 kilograms and was divided into 12 uncia or ounces. In Britain, the Imperial Standard Pound is defined as having a mass equal to 0.45359237 kilograms, which matches the definition of the international pound, as agreed upon (although not adopted by the United States) in 1959.

This can all cause some interna-tional confusion and disagreements about shipping weight and costs, etc. So, the international standard is the kg. If you have ever wondered just what that entails, here you go (hold on!):

The kilogram (kg) is defined by taking the fixed numerical value

www.aana.com/aanajournalonline AANA Journal April 2021 Vol. 89, No. 2 99

of the Planck constant h to be 6.62607015×10−34 when expressed in the unit J⋅s, which is equal to kg⋅m2⋅s−1, where the meter and the second are defined in terms of c and Δνcs. This definition makes the kilogram consistent with the older definitions: the mass remains within 30 parts per million of the mass of one liter of water.

1962 Was a Very Big Year, in a Lot of Ways…… Drug Safety Being a Major One

You may not recall much about 1962, with many readers not yet even born (!), but consider drama….we literally came to the brink of nuclear war over the pres-ence of Soviet missiles in Cuba, John Glenn became the first American to orbit the Earth, Dr. No, the first James Bond movie was released, and the actress Marilyn Monroe died. But it was also the year of the Kefauver-Harris Amendments to the Federal Food, Drug and Cosmetics Act.

This act came in the wake of Kevadon, a brand of thalidomide that the William S. Merrill Company hoped to market as a sedative in the United States. The company was stopped in its tracks by FDA medical officer Frances Kelsey, PhD, MD, who refused to approve the drug application because of insuffi-cient safety data, with the submitted evidence being more anecdotal than clinical. Furthermore, the devasta-tion caused by this drug in other countries had become big news in the United States, with thousands of children worldwide that had been born with shortened, missing or flipper-like arms and legs.

The public furor was immediate. Unknown to FDA, the company had already distributed the thalidomide to 1,200 physicians in the USA—including those treating pregnant women. The agency launched a nationwide campaign to recover all supplies of the drug. At a press

conference, President John Kennedy warned Americans that they might have a dangerous drug in their medicine cabinets, with 17 births of deformed infants tied to thalidomide in the US.

The Kefauver-Harris act (as it was to become widely called) changed the way the FDA did business, not only empowering it, but leading to a wide range of drug effectiveness and safety testing. Two (of the many) authorities given to the FDA that had particular moment included: 1) transfer to the FDA, control of prescription drug advertising, which would have to include accu-rate information about side effects, and 2) control of the marketing of generic drugs to keep them from being sold as expensive medications under new trade names.

The true heroine of this story was Dr Frances Kelsey who worked tirelessly in refusing to approve the new drug application for Kevadon, the brand name for thalidomide in the United States, not once, but seven times. She was greatly con-cerned about the drug’s safety. The suffering she prevented, well-appre-ciated by epidemiologists to this day, is absolutely incalculable.

So You Think You Know Your Planet? Let’s See About That!

No matter whether you are pro or con space exploration, and there are a lot of us on both sides of the matter, recent probes to Mars, from several different countries, help to remind us all of how connected we really are. So, what about this planet we call home?

Earth is unique among the planets of our solar system; its extraordinary conditions allow life of great diversity—millions of plant and animal species—to thrive. We have mountains, valleys, rivers, lakes, wet forests and bone-dry des-erts, warm climates and cold. We currently (and this can change!)

comprise 195 countries that now house 7.5 billion people. And yes, we have those large oceans.

Let’s look at a few facts about Planet Earth, this place the Princeton astronomer called the “pale blue dot” based on a photo of us taken from a long way away in a probe destined to exit our solar system.

• We all live on the third planet from the Sun, with a composition and distance from our star that sup-ports an incredible range of plants and animals.

• We take about 24 hours to rotate (at over 1,000 mph) on its axis once, and about 365.2425 days to complete one orbit around our star. That creates a need for that thing we refer to as a leap year, which gets factored in every 4 years….a bit like when we consider the need for deciding who our presi-dent should be.

• Subject to change…..our highest record temperature is 134 degrees Fahrenheit, and its lowest, minus 128.5 degrees Fahrenheit.

• Our equatorial measured cir-cumference is 25,901.55 miles, but not a perfect circle, that is because if we measure the circumference from pole-to-pole, the distance is 24,859.82 miles. Therefore, we are wider than tall, technically termed an ellipsoid, and even more techni-cally, as a geoid shape.

• We have a moon. Just one, who never reveals its “backside” to us (is it shy?), that averages 238,857 miles away, and yes that varies somewhat, hence an “average.”

• We are 70.8% covered in water, that makes us less than a third land-based, and that water-world is likely to increase in the years ahead making coastal living somewhat challenging. Over 96% of that water world is ocean the other less than 4% is found within freshwater lakes, glaciers, and polar ice caps.

• Earth is 34.6 percent iron, 29.5 percent oxygen, 15.2 percent sili-con, 12.7 percent magnesium, 2.4

100 AANA Journal April 2021 Vol. 89, No.2 www.aana.com/aanajournalonline

percent nickel, 1.9 percent sulfur, and 0.05 percent titanium, and our atmosphere is 78 percent nitrogen, 21 percent oxygen, and traces of argon, carbon dioxide, and water.

• Our highest land-based pointis Mount Everest, a Himalayan peak that reaches 29,035 feet above sea level. The first confirmed ascent of the mountain took place in 1953, but our tallest mountain as mea-sured from base to peak is Mauna Kea in Hawaii, which measures 33,480 feet. It reaches 13,796 feet above sea level.

But that’s enough for now. We’ll save some of her other cool features for a later installment!

Are Plants Going To Be the “New Meat”? Maybe Not (But They Are Trying!)

Despite some early (cardboard like) failures, increasingly, meat alterna-tives are becoming tastier and even more meat-like. A “meatless burger” may have sounded unusual (unbe-

lievable?) just a few years ago, but it’s now becoming more and more common—even among non-vege-tarians.

When the Impossible burger first went on sale, it catalyzed a literal movement, and literally disappeared off the shelves. Now sold in Burger King, the difference between the plant-based iteration and the origi-nal Whopper is hard to tell by some. Beyond Meat, another plant-based alternative, is now found in Dunkin Donuts all around the United States, and appears to be available to the general market.

There are various reasons put forth for this movement, including environmental issues, health con-cerns, and animal rights advocates: whatever is driving this, traction is gaining with consumers, and manu-facturers (established and start-ups).

Recent surveys reveal that over 30% of all Americans consider themselves “flexitarians,” attempt-ing to reduce meat consumption. Many say they would like to become

more vegetarian in predominance, though there is admission that this is not an easy transition to make and nutritional concerns—some justified and some not—weigh on many folk’s minds.

Meat is an enormous, big-busi-ness enterprise, and meat lobbying and advocacy groups have power-ful voices with policy makers. So indeed, this industry is fighting back, of course. And not just with lobbying dollars, though there has been plenty of that. There has also been attacks on the scientific meth-odology of studies, the majority of which recommended a reduction in red meat consumption.

Both sides seem to be taking the low road by demonizing one another, but in the long run there is likely to be room for both, as consumers (here in the USA and worldwide) will make their own buying (and eat-ing) choices. The real thing, which tastes really good, and the “meat alternative,” which tastes pretty good as well, offer alternatives.