Virulence Factor: Will Power

Currently, I am in the midst of studying viruses in medical school. Being the comic book geek that I am, my studies have reminded me of a certain member of the Green Lantern Corps:

Meet Leezle Pon, Green Lantern of Sector 119. Not only is he the smallest member of the Corps, he is a super-intelligent smallpox virus. Seeing as how it is debatable whether viruses are even true organisms, it is amazing that Leezle Pon has a name, a gender assignment, sentience, and the will power to overcome fear that is requisite of all Green Lanterns. If you still are not amazed, take into account that Leezle Pon has an archnemesis: Despotellis, another intelligent virus who is responsible for the death of Leezle Pon's partner (must have been some interesting stakeouts).

If you are wondering what creative mind came up with such a concept as a Green Lantern smallpox virus, look no further than Alan Moore. That's right. The same Alan Moore who is the genius behind Watchmen, V for Vendetta, The League of Extraordinary Gentlemen, From Hell, and much, much more. Leezle Pon was not the only weird Green Lantern Moore created for the Corps. Perhaps even more famous is his creation of Mogo, a Green Lantern who is an entire sentient planet.

I'm Very Proud of This

Topical Glutamine?

Don't get me wrong. I am a big Scott Snyder fan. American Vampire is one of the most interesting takes on vampires in a long time and his run on Detective Comics is one I will always remember. However, as a medical student, I could not help but notice a weird medical factoid that showed up in The New 52's Swamp Thing #1. In the opening pages, we find Dr. Alec Holland, brilliant botanist and former Swamp Thing, doing some good ol' hard labor, presumably to put his life as Swamp Thing behind him. Holland has apparently been doling out medical advice to his coworkers, telling one man to put cabbage on his knee to relieve the joint pain because cabbage is a good source of glutamine.

This set off a red light in my head. Glutamine for joint pain? Glutamine is not an anti-inflammatory and is not available in topical form (however, cabbage is indeed a good source of glutamine). Glutamine is medically used to maintain nutrition in people with short bowel syndrome and is often available as a supplement for muscle growth.

I really think that Mr. Snyder meant glucosamine. Glucosamine is a biochemical precursor to glycosaminoglycans which is a major component of joint cartilage. It is believed to have some anti-inflammatory action and can be applied topically. However, glucosamine is available over the counter so the construction would not need to go see a doctor and get a prescription. But at least Dr. Holland looked smart to the layman and earned his respect, right?

Interestingly enough, I came across a POEM (Patient-Oriented Evidence that Matters) that said that glucosamine and non-steroidal anti-inflammatory drugs (NSAIDS, like aspirin and ibuprofen) had no greater effect than placebo when used for knee osteoarthirtis (NSAID = glucosamine = chondroitin = placebo for knee OA, Essential Evidence Plus). So maybe it did not matter that Dr. Holland mixed up glutamine and glucosamine, after all.

.

Contagion: Go See It.

SPOILER ALERTS

Watching Contagion last night was probably the most appropriate way to herald my study of viruses in my Infection and Immunity course. The film was well done and the cast gave great performances. Jude Law and Kate Winslet played my favorite characters. As always, I like to judge these types of movies by their scientific accuracy. I was relieved to see that viruses and bacteria were not mixed up at all (as I have sadly seen in many comics and movies). Terminology that was thrown around was certainly correct (glycoproteins, valence, etc.) although I would need another listen to double check for anything that didn't really match up.

What is really great about Contagion and what sets it apart from similar movies is that it portrays the epidemic from multiple points of view. Each character's story deals with a different aspect of how epidemics are dealt with and responded to and each story is tangential to the story of the other characters. I especially liked the glimpse into epidemiology (a field whose members are either hit or miss with me). I really enjoyed Kate Winselt's portrayal of a no-nonsense Epidemic Intelligence Service officer and I hated to see her go relatively early.

Biological science fiction has been uncommonly good this summer between Contagion and the surprisingly-not-disastrous Rise of the Planet of the Apes. I hope Hollywood decides to keep up this level of plausibility and good storytelling.

A Great Find

First of all, I did not even know that Roueche had a second volume for the Medical Detectives. That's probably because they've only kept the first one has been reprinted. I found this on Amazon last week and it came in the mail today. I'm really excited to check out.

Good Episodes of House, M.D.: Occam's Razor

From a medical science standpoint, this is a pretty solid episode (there are the usual missteps that I chalk up to television being television). The patient, Brandon, presents with an unusual set of symptoms that the team cannot explain with one disease. House initially proposes that there are two processes going on: a sinus infection and hypothyroidism. Foreman brings up Occam's Razor, the philosophical principle that has been adopted in medicine as "the simplest explanation is often the most likely one." The principle of Occam's Razor is actually more accurately described as, when facing competing hypotheses, the one that makes the fewest new assumptions should be selected.

Anyway, Brandon starts to feel a little better and then his white blood cell count drops dangerously low and is put into isolation. After finding inspiration in almost picking up the wrong bottle on a Vicodin run, House spends quite a bit of time considering a new hypothesis. He admits that the principle of Occam's Razor still held and that colchicine poisoning due to a pharmacy mix-up for cough medicine explains all the symptoms. Additionally, Brandon got worse because someone continued to give Brandon his "cough medicine". The team hits a snag when Brandon's mother claims that the cough medicine was a round and yellow pill, just like the correct pill at the pharmacy. After some moping around and doubt, House sees that Brandon's worsening condition matches the progression of colchicine poisoning and bluffs that Brandon must have used ecstasy in the past which might be cut with with colchicine. The treatment for colchicine poisoning is started and Brandon improves.

Meanwhile, House, dissatisfied with the ecstasy explanation digs through the pharmacy for the different forms of colchicine. In another scene, Brandon comments on how the cough medicine Cameron gives him has a letter on them which his old ones do not. In the pharmacy, the determined House finds the colchicine pill that looks similar to the cough medicine.

On a side note, one of my favorite clinic patients appeared in this episode:

http://www.youtube.com/watch?v=BiAyIBoQiRo