Will Science One Day Prove There's No Time to Die? A Review of Kira Peikoff's Latest Novel

Imagine being on the cusp of a scientific breakthrough about to change the entire nature of everything we know about life. We’ve all been taught that living organisms are born, they develop, they age, and they die.  But what if aging—thought to be an axiomatic part of living—is really a pathological process that should be attacked with the same vigor reserved for influenza, Ebola, and other infectious diseases. After all, it was once a “normal” fact of life that people succumbed to infectious diseases. That is before antibiotics, vaccines, and antivirals were developed. Now imagine such a discovery was not welcomed (as it should be), but forbidden because it would bankrupt the social welfare programs that are premised on specific limited life spans as well as disrupt the “natural order” of things. What do the scientists and physicians relentlessly pursuing the quest for knowledge and understanding in this realm do?  Theirs is not an endeavor detached from life because they seek, not just to understand how to halt aging, but to use it to improve human life. Such is the premise behind Kira Peikoff’s second novel No Time to Die which I highly recommend.

Ms. Peikoff masterfully integrates cutting-edge science with her plot in a manner that made me eager to learn just how close we are to the discoveries that drive of the plot of the novel. Like she demonstrated in her first novel, Living Proof, Ms. Peikoff has developed a rare ability to credibly (and ominously) project a society of the near future in which those that oppose the advance of scientific and medical discovery—for religious or other reasons—have been granted the ability to arbitrate over what is allowed and what is forbidden. Such a world is not far-fetched; just peruse the debates regarding embryonic stem cell research, speculation about rapamycin's anti-aging properties, genetically modified organisms (GMOs),  gain-of-function virologic experiments, and the desire by some to die at age 75 to understand that this trend already exists in the non-fictional world of today.  The modern backlash against life-enhancing vaccines, which literally catapulted human lifespans, is also a case in point. 

If I were to attempt to identify the theme of this remarkable book, I would identify its abstract meaning to be the promise of science, a product of human reason, to illuminate the world, transforming what once was a terrifying mystery into a benevolent place in which humans can flourish.

A novel with such a theme is well worth immersing oneself in. 

Scabies vs. Measles: What Is Unseen is Worse Than What is Seen

It's often said that when you see healthcare workers practicing meticulous infection control the diagnosis of the patient being cared for is one of two things: lice or scabies. For some reason, ectoparasites (macro) visible to the naked eye strike fear in the hearts of the world. While an invisible potentially lethal virus like, for instance, measles is something to have a party for and wish on partygoers. 

Another ectoparasite that also merits this misplaced terror are bed bugs, which are really are incapable of transmitting disease to humans (with the possible exception of Chagas Disease in certain contexts). Case in point: a local community college in the Pittsburgh area cancelled classes  because a student had bed bugs in his home! 

Why? 

The action was taken "out of an abundance of caution" -- the familiar phrase used to justify serious threat misperceptions and excuse the performance of response actions for which there is no evidence.

Similarly, a recent episode of a television program mentioned scabies as a "complication" of promiscuity when much more dangers pathogens such as syphilis, gonorrhea, and chlamydia (not to mention HIV, hepatitis B, and HPV) shows how widespread this phenomenon of prioritizing macro ectoparasites reaches.

What accounts for this threat misperception?

My own speculation is that it is the same thing that stalled the development of the germ theory until more powerful microscopes were developed: people are much more accepting of what they can see vs. what they have to imagine, infer, or abstract. In other words, the more concrete an entity (like a scabies mite) seems the more it can be evaluated and judged; conversely, the more abstract an entity is (like a virus) the more distant and unreal it seems. This cognitive bias can be harmful because what isn't seen, in the case of infectious diseases, can be deadly.

Who Made Who? Enterovirus & Paralysis

Since enterovirus-D68  (EV-D68) emerged on the scene there has been increased attention focused on cases of acute flaccid myelitis (AFM)—the limb weakness that was once the hallmark of the almost eradicated poliovirus. 

The focus on AFM-associated EV-D68 stems from the fact that that polio itself is an enterovirus and viruses within the same family often produce similar symptoms. Thus far 112 cases have been found with many patients experiencing antecedent illnesses compatible with EV-D68 and only one recovering. There have now been several reports and at least one major paper linking EV-D68 to cases of paralysis but all have fallen short of definitively proving causation. This is not surprising since microbiological causation can be hard to definitively establish with a fleeting infection and when the paralysis could be caused by immunologic phenomenon rather than direct viral infection, explaining the inability to recover EV-D68 RNA from the CSF of paralyzed individuals. 

It may be some time before EV-D68’s role in the pathophysiology of paralysis is definitely determined but I believe, ultimately, EV-D68 and possibly some related enteroviruses will be found to be behind these cases, even if only as an immunologic trigger, for several reasons that include:

·      Antecedent upper respiratory infections, some of which were due to EV-D68

·      The emergence of EV-D68 and its widespread dissemination throughout the population

·      The ability of enteroviruses to cause flaccid paralysis

·       The seasonality of paralysis matching that of enteroviruses

However, I wouldn't exactly label these cases with the ominous-sounding adjective “mysterious," as some have done, despite the lack of finding EV-D68 in the spinal fluid of paralyzed cases, and invoke memories of fear-inducing polio, which--through direct viral effects--paralyzes at a rate of 0.5% and is easily demonstrable in spinal fluid, just yet. What remains to be done is to look at cases of AFM and compare them with non-cases in a case-control study that may point clues to the etiology. Also, since the genetic signature of EV-D68 was note found, are antibodies present in cases? Scouring the country for more AFM cases, which isn't nationally reportable, will also be needed to understand the baseline and account for increased case finding in the wake of widespread awareness of EV-D68.

It will be interesting to see how EV-D68, now the dominant enterovirus, behaves during this year's enteroviral season because the 1100+ confirmed cases with 14 deaths did not represent the full reach of this virus.

Treat Your Children Like Puppies: Vaccinate Them!

The origin of the measles virus, currently capturing headlines across the country with 121 cases in the US (and 147 in the region of the Americas) so far this year, is likely zoonotic. Like almost every infectious disease of humans, animals likely played a part and the virus jumped into humans. The virus that measles evolved--I wanted to use that word on Darwin Day--from is canine distemper. 

Canine distemper virus is a member of the same viral family as measles (paramyxovirus) and was first described in the early 20th century. The symptoms it causes include fever, nasal discharge, and eye inflammation (sound familiar?). Vomiting and diarrhea, lethargy and loss of appetite, labored breathing and/or coughing, and hardening of footpads and nose, and other symptoms can also occur. It is vaccine preventable and remains a leading cause of infectious disease death in dogs. 

There is good reason to believe that canine distemper virus (or the related and now eradicated rinderpest virus of cattle) jumped into humans and evolved into measles when human populations reached the threshold population density needed to sustain human-to-human transmission of the virus. Indeed measles vaccination protects canines against distemper.

It's puzzling to me that we don't hear about an anti-vaccine movement amongst dog owners yet amongst parents of human children we have no such luck.

Children deserve to be treated as well as their puppies.

Dissecting One of the Philosophical Underpinnings of Vaccine Opposition

Andrew Taylor Still DO, MD (1828-1917)

If one is to understand a cultural phenomenon, it is important to discover its root cause. The anti-vaccine movement is one such phenomenon. If one delves into this movement myriad roots will be found. One I find particularly intriguing—and misguided—is the belief that contracting illnesses “naturally” (as if it’s natural to be sick) and allowing the body to fight unaided is preferred to availing one’s self of the protection afforded by a vaccine.

Consider for instance, the ridiculous notion of the measles parties (they also come in the chickenpox variety) which California public health authorities had to actually warn people against. I am not certain where this idea originated but it seems to me to be an amalgamation of the cliché “what doesn’t kill you, makes you stronger” with the fact that humans have evolved exquisite immune systems that can dispense with various invaders quite easily.  But, our immune systems have limits and, in some cases, drive the pathophysiology of disease when the invading microbe is attacked (see the damage-response framework). Hence the need for vaccines to augment our defenses stems from the attributes of our immune system.

 The origins of this line of argument became a question I wanted to contemplate after I watched an excellent Johns Hopkins Bloomberg School of Public Health seminar on measles yesterday. In this seminar, an intriguing bit of data was presented showing that having a doctor of osteopathy (DO) as a primary care physician was associated with higher rates of abstention from vaccination.

 This was puzzling to me because in every day life I work side-by-side with DOs, I've trained with them, and I consider them equals. However, I am aware that the origin of the DO pathway in the 19th century began with a break from the approaches of allopathic medicine. Could the disparate philosophical origins of allopathic and osteopathic medicine be playing a role?

 To investigate this one facet of the anti-vaccine further, I did some more reading and found several facts that supported the notion of a DO/MD discrepancy (source Salmon, Human Vaccines 2008; Mergler, Vaccine 2013):

·      Doctors of vaccinated children are 2.5 times less likely to be DOs

·      MDs were found to be 2.8x more likely to have patients whose parents believed vaccines were safe

·      DOs were less likely than MDs to have a high confidence in vaccine safety

·      DOs were more likely than MDs to agree or strongly agree with the following statements:

o   Children get more immunizations than are good for them immunizations do more harm than good

o    any of the reports of serious side effects from vaccines are accurate

o   CDC/ACIP underestimate the frequency of vaccine side effects

·      DOs were less likely than MDs to agree or strongly agree with the following statements:

o   Immunizations are one of the safest forms of medicine ever developed

o   Immunizations are getting better and safer all of the time as a result of medical research

 So why the divergence between DOs and MDs, those who have essentially the same undergraduate and post-graduate training? I hypothesize that the answer lies in the philosophy of osteopathy, articulated by the founder of osteopathic medicine Dr. Andrew Taylor Still (MD). In particular, I am referring to the osteopathic tenet of the body having a natural ability to heal itself—a true statement, but only within a certain context.

 It’s important to note that when Dr. Still developed his ideas medicine was still in its infancy and many interventions did more harm than good. In that setting, leaving someone alone rather than bleeding or poisoning them was definitely an improvement.  But Dr. Still did not stop there. He went further and attacked the only vaccine available at the time—one which was ultimately responsible for the only eradication of a human disease in history—calling Jenner’s smallpox vaccine a “hopeless failure” and offered many of the same arguments against vaccines that are still heard today.

 Sure bones can heal and minor infections like the common cold dissipate on their own but severe infections like measles and smallpox are an entirely different matter.

 So where does that leave us today? The osteopathic physicians of today are much different than those of the 19th and early 20th century but clearly the mixed legacy and ideas of Dr. Still persists. This remanant may lend false credibility to those who advocate experiencing dangerous infectious diseases naturally. I know excellent osteopathic physicians in almost all specialties and subspecialties, including infectious diseases.  Indeed the American Osteopathic Association has voiced strong support for vaccination. I think it essential that these physicians extoll the benefits of vaccination to their colleagues in primary care and to the schools of osteopathic medicine to give the anti-vaccine movement no refuge.