The Forgotten Pandemic

The Spanish Flu in 1918 infected roughly 500 million patients across the globe, killing 50 to 100 million of that number. Unlike most influenza outbreaks, it killed more healthy, juvenile patients than it did the very young or elderly; this is because the robust immune systems of younger people triggered cytokine storms - immune reactions characterized by high fever, swelling and redness, extreme fatigue and nausea. This is the immune system’s attempt to kill the virus and somatic cells infected with the virus: fever denatures viral proteins and renders them inoperable, while swelling and redness are caused by the same chemicals (histamines) that cause allergies. T-cells and macrophages are recruited to the site of infection, attracted to these histamines, and they in turn produce more histamines to enable further recruitment of white blood cells. Children and middle-aged adults had lower mortality rates in the pandemic, because their bodies did not produce cytokine storms.

                                                        Patients affected by the pandemic

Unlike recent pandemics such as AIDS, SARS and Ebolavirus, we don’t know the disease’s exact geological origin; did it come from the hot zone in Africa? Was it an import from the Asian or Southeast Asian countries? Or was it European in nature? It was called Spanish Flu because the American press at the time selectively reported the outbreak as being in Spain, whereas state censorship blocked reporting of its existence in Britain, Germany, France and the U.S., giving the illusion to the American Public that Spain was particularly hard-hit. What IS certain is that massive troop movements and deployments in World War I were the vectors responsible for the global spread of this disease. As with all pandemics, it spread as far as the people infected with it could move - which corroborates with scientific consensus that quarantine is the most effective method of containing any outbreak of any disease.

When the bubonic plague, smallpox and syphilis ravaged through Europe, certain countries were notable for having an infection rate of nearly zero. Venice was the first European country to impose a systematic quarantine after the black death in the 14th century depopulated the city, in which incoming ships had to remain anchored in the port for 40 days before making landfall. The Republic of Ragusa, a city-state located in modern-day Dubrovnik, Croatia, required quarantine for a month for ‘purification by sun and wind’ before merchants could enter the city. Both countries were much less affected by subsequent plagues than neighboring countries

The modern city of Dubrovnik, which still retains the fortified walls from its days as a city-state

In 24 weeks, the Spanish Flu killed 3-6% of the global population at the time. Of those infected, however, only 10-20% actually died from the illness. This is startlingly low compared to the more recent Ebola outbreak, whose mortality rate averages at around 50% of infected patients. Clinical symptoms included nasal, gastric and intestinal hemorrhaging, as well as pulmonary edema. These were unusual enough at the time that initial cases were often mistaken for Typhoid Fever, Dengue Fever, or Cholera. Although the American public has largely forgotten about this pandemic, it WAS significant - and the lessons it taught remain applicable today: the best weapon again SARS, Ebola, H1N1 ‘swine flu’, and any other pathogenic virus is still quarantining patients away from those who are not infected. This has been proven by successful efforts in West Africa to contain Ebola outbreaks by mandatory, military-enforced quarantines. It’s remarkable to me that one of the primary vectors for the outbreak was the open-casket funerals held for Ebola victims in these countries, and that those attending these funerals would come into physical contact with the body. Even more incredible is how difficult it was to convince the populace that the virus could spread that way!

Quarantining is what has kept Ebola from spreading here in the U.S. It applies to every single contagious illness, and if there is one take-home message I would impart to my audience, it woudl be to stay home if you are feeling unwell. Don’t go to school, don’t go to work. I recently saw on reddit a claim that Americans who do not get paid sick leave as part of their jobs are responsible for much of the spreading of seasonal flu and other communicable diseases. One can only hope that, if this claim is substantiated, our leaders in D.C. will realize that expanding sick leave is one tangible way to boost economic productivity. Assuming they have the stones to do it.

A Novel Treatment for Depression and Bipolar Disorders: Ketamine??

I've read some fascinating articles in nature magazine in the past couple of days, which provide evidence for a therapeutic role in the dissociative anesthetic Ketamine in the treatment of depression and bipolar disorder. Not only does ketamine - a widely-used therapeutic agent in veterinary medicine and a favorite club drug under the name 'special K' - alleviate anhedonia in depression and bipolar syndrome, which is something that SSRI's cannot do, but significant relief in patients' symptoms of MDD and BPD are seen in a mere matter of hours. Current antidepressants have an onset of effect in the order of weeks, if they work at all! Moreover, it causes a unilateral reduction in suicidal ideation and suicidal attempts in these patients. It's almost like the fog is lifted from the brains of these patients, which is a godsend for psychiatrists everywhere. The most recent issue of Nature cited a figure in which some 64% of patients with either disorder respond positively to Ketamine injections, which - when compared to only around 28% response rate for any given SSRI.

I think it's too early to say whether or not this is a panacea for depression-spectrum mental disorders -  after all, that's what meta-analyses are for - but it is certainly a ray of hope in the ongoing battle against depression. Since the only true 'cure' for depression, Electroconvulsive Therapy (ECT) has had its reputation shot to pieces by movies like 'One Flew Over the Cuckoo's Nest', let's hope the general public is more willing to give this party drug a chance to treat them & their loved ones.

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An Interview With Santa

So who makes the presents - really?

We used to have our own workshops and factories in the North Pole, but we've outsourced most of our labor force: the elves mostly handle the gift wrapping and delivery logistics these days.

Have there been any layoffs?

Ho ho ho! No need! The elves don't need wages - they're immortal, and they eat the same diet as my reindeer. They also enjoy working just for the heck of it: we've been in business now for two thousand years, and they don't want to stop.

How, exactly, do you decide who's naughty and who's nice?

I've always crowd-sourced people's opinion of others. If your friends think you're nice, then so do I. If they think you're naughty... watch out.

But nobody gets coal anymore in their stockings, right?

Worse: they get fruit cake gift baskets.

I see. So what country is the most difficult to get presents for?

Right now, I'd say France; whatever I make for the French, their grinch of a president insists on taking 3/4ths of it for himself.

Do you get upset if people forget to leave cookies and milk?

Yes I do! In fact, if they do, I 'forget' to leave one of their presents under their tree.

What if they leave out beer instead of milk?

Then you'll get TWO extra presents that year. Santa likes to get hammered.

Do you ever leave notes for people, if they've been especially good or bad?

Not anymore: otherwise it'd be all over the internet the day after Christmas. Santa prefers to keep his privacy.

What do you do if the kids are awake?

I try to stay hidden as best as possible, or at least blend in with the tree. Mrs. Claus made me a camo suit recently, to help me out in those situations.

What if all else fails and a kid sees you?

That's why Santa keeps a tranquilizer gun in his sleigh.

Surviving the holiday rush (and having fun in the process)

Growing up, I only rarely went shopping with my parents, and I remember well the reluctance that we (my mother, father, sister and I) felt whenever we drove to malls and outlet stores, because of the hassle. That reluctance I have carried into adulthood, even if I'm shopping for necessities. Now, however, I can enjoy the atmosphere of some stores, and actually enjoy the process of shopping under many conditions. I believe this is because my girlfriend, over the past two years, has shown me that gift giving is a good way to show someone how much you care about them. To her credit, she has also coached me step-by-step on what to look for when shopping, and how to differentiate CLEARLY between one's wants and needs.

We have been extensively Christmas shopping these past few weeks, at many more stores than I could count on my fingers; this has given me a fresh perspective on the similarities and differences between "point-of-sale" stores, and provided me insight as to why some places are a 'hassle' while others are a pleasure to shop at.

The first thing I noticed about these stores is that, for businesses that cater to the same socioeconomic levels, there are general trends in their in-store atmospheres, which play a big role in their sales pitch. In stores that offer cheap, this-season-style clothes like H&M and Forever 21, the muzak they play consists of radio hits played at an ear-splitting volume, and their displays are lit with garish, bright-as-the-sun spotlights, which, together with the muzak, is designed to force you to stop thinking. They want shoppers to make impulse purchases, and to ignore the cost of the item(s) they buy or their dubious quality fabrics. The thrill of the purchases you make wears off the minute you've left the store - especially when, later on, you see ten guys (or girls) on the street wearing the exact same shirt, dress, or skirt as you.

In direct contrast to these low-tier stores, designers like BCBG, Guess, and J. Crew have a smooth yet bouncy ambiance, playing catchy techno music at mid-range volume, and illuminating their displays with subtler spotlights. They do this because they know that you are already looking to buy something when you walk in, and perhaps you are even a return customer. Thus, their stores have no need to scream "buy this now, or you'll miss out!" Instead, the message of their ambiance is; 'take your time to enjoy the displays, browse around, and make a purchase that you will feel good about both now and later.'

High-end retailers, which I've only been in recently, also aim to put you at ease in their stores. Not only do they have even softer ambient lighting and play quieter, more easy-listening mood music, but they also have ample floor space for people to browse their wares without fear of bumping and jostling others. No self-respecting bargain basement store has more than a foot or two of aisle space between the racks; they want to whip people up into a frenzied rush to find something, check out, and leave the store as quickly as possible. This is also why they usually have no places to sit down; they want you in and out ASAP.

Pricier stores are much more accommodating by nature; there are multiple places to sit, whether in the shoe section, the dress section, or by the fitting rooms. Whoever in a party is not actively shopping or trying things on can rest in peace and comfort. I believe this is because, while bargain stores profit by selling cheap things in great quantity, designer stores profit by selling smaller volumes of expensive, yet quality, pieces.

Similar trends exist in department stores, and based on my observations, Bloomingdales appears to be an ideal medium between the frantic atmospheres of Macy's and j. C . Penny and the dignified, sedate, atmospheres of Saks and Neiman Marcus. Although it lacks the finer points of shopping, such as the live DJs, jazz bands and Christmas Carolers found in Saks around the holidays, it does offer quality designer clothes and accessories, not to mention jewelry, handbags and home goods. What's more, it has the floor space, music, and acceptable lighting to make even a reluctant shopper like me enjoy being in their stores.

One big thing I learned about shopping in point-of-sale stores is that much of the hassle of shopping can be avoided simply by having a concrete plan of a) where to shop, b) what items you want to try on (which can be accomplished online) and c) how much you plan to spend. Most stores offer to match their online prices in-store, which means that, for anyone who isn't 100% certain about what they want to buy, it's still worth the schlep.

To everyone gearing up for (or are currently) holiday shopping, don't fret! Just have a plan, and bring plenty of food and drink (read: coffee) with you when you go. These humble tips should save you a lot of headache between now and the 25th.

Happy holidays, ladies and gents.

R.I.P. Lou Reed

If this is all there is, that wouldn't be so bad; there's so much of it, you can get lost in the mandala-like spiral of love and wonder that comes from being truly connected to the world, to those around you. What I have seen and done the past two years are more than I've experienced in the previous eighteen years combined.

I have learned what it is to love and to be loved. I have learned to be patient with myself, to be kind to others, but also to think and stick up for myself when the situation calls for it. Moreover, I have learned to let go of the anger, the resentment and the frustration I held against certain people, as I discovered that my time and emotions are better invested elsewhere. As a result, I am now content with both myself and my place in the world.

There's so much I have wanted to write here, but held back because it is a public space. I am no longer afraid; I will speak my mind, but I will not be cruel.

Be well, all.