The Medicinal Life of Bees

Forms of apitherapy or bee venom therapy (BVT) have been in use for centuries in a number of cultures worldwide. As early as 800 BCE Charlemagne is said to have been treated with bee stings, and in 1888 Australian physician advocated the use of bee venom for rheumatism. Apitherapy is defined as the medicinal use of products derived from bees, including honey and royal jelly, as well as bee venom. While BVT has not been proven through clinical trials and testing, practitioners claim that bee stings contain an anti-inflammatory agent that relieves chronic pain and can be used to treat a number of diseases. BVT, which can involve either the application of live bees or the injection of bee venom, has been used to treat arthritis, multiple sclerosis, migraine headaches, psoriasis, and herpes. Raw honey and other ingested bee products are believed by some to contain B-complex vitamins, antifungal, and antibacterial properties.

The use of BVT has gained some attention as a potential homeopathic remedy for the treatment of multiple sclerosis (MS) symptoms. Discovery Health reports that apitherapy can be used to lessen the pain, loss of coordination, and muscle weakness associated with MS. It is commonly held that compounds in bee venom, including melittin and adolapin, help to reduce inflammation and pain. Because of the lack of major studies to date regarding the effectiveness of BVT, only about 50 physicians in the United States use it as a treatment for MS and other diseases. Anecdotal evidence from patients with MS being treated with apitherapy is reassuring, however, and has prompted thousands of beekeepers, acupuncturists, and other alternative medicine providers to offer the treatment. Those who chose to use apitherapy methods based on the application of live bees may chose to raise their own colonies or rely on mail-order services.

Researchers at Georgetown University (Washington, D.C.) conducted a preliminary study to evaluate the safety of bee venom extract as a treatment for patients with progressive forms of MS. Although no serious adverse reactions were observed during the year-long study, four of the nine participants experienced a worsening of neurological symptoms, requiring termination of the study. It is important to note that this worsening could not be ascribed to side effects of the study, and three participants self-reported an improvement in their symptoms, and two demonstrated objective improvement. Larger scale studies would be needed in order to conclusively prove the effectiveness of BVT for patients with multiple sclerosis.

Delivery of melittin, the main component in bee venom, is also being studied by researchers at Washington University in St. Louis. By utilizing nanoparticles tipped with bee venom – so called “nanobees” – the researchers are seeking a cancer treatment with fewer side effects than conventional treatments. Nanobees work by delivering melittin, which destroys the cells around it by puncturing the cell membranes, directly to the cancer cells. However, unlike the melittin from bee stings, melittin attached to nanoparticles attacks only cells that have one particular protein on their surface, the protein that helps cancer cells to grow new blood vessels which is found only on tumor cells. After less than a week of treatment using nanobees, the growth of human breast cancer cells in mice had slowed by about 25 percent, and melanoma tumors in mice shrunk by 88 percent.

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On Apitherapy from cancer.org - Additional information on Apitherapy - Discovery Health on BVT for MS - Georgetown University Research on BVT - Discovery on Nanobees - CNN on Nanobees - Additional information on Ferris Apiaries, a Maryland-based bee supplier - Additional information on Pat Wagner, “the bee lady”

A Killer in the Developing World

HIV/AIDS and malaria are major health concerns worldwide, however the World Health Organization (WHO) reports across much of Asia and Africa secretory diarrhea - which accounts for 1.6 million deaths annually - is an even greater threat. Each day in India, diarrhea-related diseases kill 1,250 people, only slightly fewer than the H1N1 virus has killed globally to date (1,500), according to the WHO. Caused by E.coli, cholera, and other bacteria, viruses, or parasites, diarrhea affects individuals more often in areas that lack safe water and appropriate sanitation. In individuals with secretory diarrhea, infectious agents cause too much water to enter the bowel and be evacuated from the body, leading to excessive dehydration and eventually death if appropriate treatment is not received.

In nations of the developing world, including Bangladesh, India, Mali, and Pakistan, aid organizations and government agencies have begun distributing zinc supplements to villagers as a treatment for diarrhea. Data from recent studies documented in the August 2009 issue of the Journal of Leukocyte Biology suggest that zinc may help to activate the T-cells needed to destroy viruses and bacteria, including those that cause diarrhea. Time Magazine reports that in tablet or liquid form, zinc can be used in combination with oral-rehydration therapy (ORT). While it is not entirely clear how zinc helps halt diarrhea, Oliver Fontaine, a diarrhea specialist for the WHO, explains that a single course of zinc treatment can stave off diarrhea for three months.

Unlike zinc, which often produces an immediate improvement in an individual’s health, the glucose present in ORT (a solution of sugars and salts) slows the evacuation of fluids allowing for the absorption of electrolytes in the intestines, and halting the progression of dehydration to a chronic state. Because of the delay in the improvement of symptoms with ORT, “Mothers don’t see ORT as real treatment,” according to Eric Swedberg, senior director of health and nutrition at Save the Children U.S. Though ORT is an effective treatment for diarrhea, only about 35 percent of families in diarrhea-stricken countries utilize the method.

By offering zinc in combination with ORT, government-run programs in Ethiopia and Tanzania hope to increase the number of people surviving diarrheal outbreaks. Additionally, efforts are being made in Mali to add zinc to the country’s list of essential drugs, a step towards improving the distribution of the tablets. To halt the recent outbreaks of diarrhea in Nepal that have led to 235 deaths to date, the Office of the Prime Minister has begun coordinating efforts to construct a toilet in each household, provide sources of potable water, and improve waste disposal systems. In addition, the Nepali government has mobilized 298 personnel to aid in providing treatment in the area through 89 health camps.

To support these and other similar efforts, funding for the provision of the potentially life-saving drugs, and awareness of their effectiveness must be increased. In 2007, only four percent of all U.S. funding for research of epidemics in the developing world was devoted to finding solutions to decreasing the number of diarrhea-related deaths. Support from organizations like the Bill and Melinda Gates Foundation have provided some support, but additional funding is still needed not only to ensure that zinc tablets are more widely distributed, but also to assist in efforts to improve the quality of available water and waste treatment measures.

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WHO on Water Treatment and Safe Storage - On Diarrhea and Tuberculosis in India - Time Magazine on Zinc to Treat Diarrhea - Diarrheal Deaths in Nepal - On Zinc Fighting Infection

Innovative, Low-Cost Medical and Diagnostic Tests

In the developing world, the availability of many medical technologies is limited by cost, durability, and ease-of-use. This is especially true of expensive diagnostic devices, which are critical for detecting diseases that are endemic in developing countries. However, researchers are working to develop low-cost, user-friendly alternatives that could improve the ability of healthcare providers to diagnose a range of conditions.

Harvard researchers have developed an alternative microfluidic device that replaces standard silicon, glass, or plastic substrates with treated paper. Fluids flow through the microchannels in the paper device in the same way that they would in a standard chip. Researchers have used the device to test for glucose and protein in urine, but hope to adapt it for the possibility of testing blood samples for HIV/AIDS, dengue fever, or hepatitis. While a traditional microfluidic device costs between $10 and $1,000USD, the materials to create the paper devices, known as microPADS, cost only three cents. The design of the microPAD device allows for several tests to be conducted simultaneously, furthering the cost and resource savings.

To help better diagnose infectious diseases such as malaria and tuberculosis, researchers have developed a microscope that attaches to any cellular telephone with a camera feature. The device, known as a CellScope, is able to illuminate pathogens in a sample treated with fluorescent molecular “tags.” It is estimated that the production of first CellScopes will cost roughly $1,000 each, but with further developments the price could drop to just a few hundred dollars, including the cell phone. Not only can an individual use the microscope to view the pathogens, but they can also send an image to a healthcare facility for assistance making an appropriate diagnostic determination.

Efforts have also been made by scientists at the Burnet Institute to improve HIV-testing procedures. A prototype monitoring test has been designed for use in remote settings. The new test, which uses a finger-prick blood sample, allows individuals to determine their CD4+ T-cell count within 30 minutes. The CD4+ T-cells are critical for healthy immune system function and their levels are a deciding factor with regard to starting anti-retroviral therapy. Standard CD4 tests are often not available in the developing world due to their cost, the need for specialized equipment and trained personnel, and the long wait period to obtain test results.

Though these diagnostic technologies offer improvements in the developing world, as The Wall Street Journal reports, acceptance may be slower in the United States. Some researchers have found success when applying African healthcare models to rural areas of the U.S., and results using low-cost technologies originally conceived for use in the developing world may follow this trend. The use of innovative low-cost testing methods may also assist with telemedicine initiatives, as they allow healthcare providers to conduct necessary tests and provide better diagnostic information to consultants. Through discussion among global health experts – as allowed by telemedicine initiatives like iCons in Medicine - innovative diagnostic tools and other cost-saving measures may become more popular, and help to provide improved care worldwide.

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IEEE spectrum – Inside Technology - Discover Magazine on the microPAD and on the CellScope - Burnet Institute CD4+ T-cell Test

Nutrition and Obesity

The Centers for Disease Control and Prevention indicates that over 26 percent of Americans are obese, and the National Institutes of Health (NIH) recently noted that an estimated 97 million adults in the United States are overweight or obese. For the adult population, obesity and being overweight are defined based on an individual’s body mass index (BMI) - between 25 and 29.9 is considered overweight, and over 30 is considered obese. Obese individuals are at an increased risk for a number of diseases and conditions including: hypertension, type 2 diabetes, coronary heart disease, and stroke.

Time Magazine reports that, according to a report from Trust for America’s Health and the Robert Wood Johnson Foundation, Mississippi has the highest rate of adult obesity nationwide – 33 percent. In addition to being noted as the most obese state for the fifth year in a row, with 21 percent of the population living below the poverty line (per the U.S. Census Bureau), Mississippi is also noted as one of the poorest in the nation. Recent reports indicate that areas with lower rates of obesity such as Colorado, which has the lowest national obesity rate (18.9 percent), are not only usually more affluent than the heavier southern states, but also possess more temperate climates and easier access to outdoor activities.

A report from the Baltimore Sun indicates that in addition to obesity, Americans, particularly children, are also at risk for malnutrition. Despite consuming an adequate or excessive number of calories, obese individuals are not selecting foods that are nutritionally beneficial. Though slightly different from the malnutrition seen in developing nations, Americans lacking vitamins and minerals may also have weakened immune systems. A 2008 study by the Baltimore Health Department indicated that 13.5 percent of Baltimore families with young children lived in a state of “food insecurity,” meaning that they routinely ran out of food or were worried that they would not have enough food. These families often inhabit areas that do not have ready access to supermarkets and grocery stores, known as “urban food deserts.” This lack of options leads individuals and families to select items that are higher in calories but less expensive, and that are also available from convenience stores or fast food restaurants.

In an effort to increase the availability of food with substantial nutrition, many communities have established community gardens or have encouraged residents to purchase shares in community supported agriculture (CSA) programs. Through community gardens, participants are able to gain a sense of increased food security, save money, increase their environmental awareness, and provide nutritious food to their families. For individuals in urban settings or those who may not be able to participate in programs to grow their own produce, CSA programs may be available. By supporting local farms and farmers, those who choose to buy shares are able to receive locally grown fruits and vegetables and may see a cost-savings over commercially available produce. In cities like Chicago and others worldwide, individuals and businesses may also participate in “greening” efforts aimed at lowering carbon emissions and producing nutritious foods. Rooftop gardens also help to lower heating and cooling costs and reduce rainwater runoff as well as providing nutritious food.

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CDC Information on Obesity - NIH Report on Obesity - Time Magazine on Southern Obesity - Trust for America’s Health Report - Baltimore Sun Report - Press Release on Chicago’s Urban Food Desert - On Rooftop Gardens

Air Travel and Disease

As the number of cases of influenza A(H1N1) (“swine flu”) continue to rise, researchers are seeking solutions to slow the spread of the virus. A recent report from CNN indicated that the World Health Organization (WHO) has recorded 29,669 cases and 145 deaths in 74 countries. The virus has been categorized as a phase 6 “moderate pandemic” by the WHO, meaning that most individuals who are infected will recover. However, amidst recent reports of mothers bringing their children to “swine flu parties” to expose them to the virus (a practice that the British Medical Association has spoken out against), an individual has presented with drug-resistant swine flu. Efforts to create effective vaccines are ongoing, as are alternative means of tracking and slowing the spread of the virus.

A group of Canadian researchers have analyzed the correlation of the spread of the disease (specifically focusing on influenza virus A (H1N1)) and air travel patterns. The project, known as BioDiaspora, tracks the movements of 2.2 billion airline passengers annually which can then be used to map the possible and probable spread of disease. As reported in the New England Journal of Medicine, the researchers gathered data from the International Air Transport Association (IATA) from the period between March and April 2008. Information about a total of 2.35 million passengers who flew from Mexico to 1,018 cities in 164 countries was mapped and compared to the spread of A(H1N1) to date. According to Dr. Kamran Khan, preliminary data indicated “If you had fewer than 1,400 arrivals from Mexico, you had only a 7 percent chance of getting an imported case.” In countries with more than 1,400 arrivals, the chance of infection in the area increased to 92 percent.

By tracking the spread of outbreaks of disease and comparing them with air travel patterns, researchers can predict which regions are at the highest risk of early infection. According to Dr. Michael Gardam, director of infectious disease prevention and control for the Ontario Agency for Health Protection and Promotion, disease-tracking tools may prove invaluable when dealing with outbreaks of infectious diseases, particularly those with short incubation periods. With this information, it will be possible to inform physicians in potential hotbeds of infection about how to identify a given disease, and ensure that vaccines are prepared and available in order to help stop the spread.

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WHO Information on Pandemics - CNN Report on A(H1N1) - New England Journal of Medicine on BioDiaspora

Food Shortage in Ethiopia

As a result of poor harvest yields and food shortages, food prices have increased 52 percent between 2007 and 2008, according to the Food and Agriculture Organization (FAO). Areas of Asia, the Pacific, and Sub-Saharan Africa are experiencing particularly large increases in food costs. The Humanitarian Practice Network reports that for individuals with limited means, these higher prices make it difficult or impossible to meet their food needs. The FAO indicates that the number of people classed as under-nourished worldwide increased by 75 million in 2007, reaching a total of 923 million individuals. Women-headed households, the urban poor, and those affected by conflict situations or natural disasters are among those most likely to be affected by food shortages.

The World Food Programme (WFP) has identified 30 countries and territories as being “in crisis” with regard to food shortage and other humanitarian concerns. Ethiopia, Africa’s second most populous country, is among the countries for which food shortages and rising prices are a pressing concern. 4.6 million Ethiopians are threatened by hunger and malnutrition, and 10 million have been affected by droughts. In addition to six major droughts in the last two decades, the region has been denied access to the ports of Eritrea following a border war. The BBC reports that following the United Nations’ food deliveries to Ethiopia this month, no further deliveries will be made until September or October. Because of worldwide food shortages, the UN has stated that it has “no option but to cut back” on the provisions, which have already been reduced by a third since July 2008.

In areas like Ethiopia where food and medications as well as medical services are often scarce, telemedicine initiatives may allow for the provision of better care to those suffering from illnesses related to malnutrition and/or poor quality food and drinking water. By utilizing the Internet, telemedicine programs like iConsult make it possible to provide humanitarian healthcare assistance without the cost and risk associated with traveling to conflict-affected areas.

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Food and Agriculture Organization - United Nations World Food Programme - BBC News Report on Food Shortage

Jaspars, S. and Wiggins, ODI, S. (2009). “The global food crisis: an overview” Humanitarian Exchange. Humanitarian Practice Network, Number 42.

Image from a report on hunger in Ethiopia from The Economist

Global Healthcare Worker Shortage

The World Health Organization (WHO) reports a shortage of healthcare workers worldwide, especially in rural areas. Healthcare workers are defined as those whose main activities are aimed at enhancing health – including doctors, nurses, and laboratory technicians, as well as management and support staff. Of the estimated 59.3 million healthcare workers worldwide, approximately two-thirds (39.5 million) provide health services. Rural areas of the United States are facing a shortage of healthcare personnel, and 57 countries throughout Africa and Asia are facing a severe healthcare workforce crisis. The WHO estimates that in order to fill the gap, at least 2.36 million service providers and 1.89 million support staff are needed. Between developing and developed nations, a large imbalance can be seen in the healthcare staff available. For example, in sub-Saharan Africa, an area with 11 percent of the global population, there are only three percent of the world’s healthcare providers.

According to the Grosse Pointe News, Institute of Medicine figures indicate that by 2030 77 million Americans will be 65 or older. For the nearly 20 percent of these individuals who have five or more chronic health conditions, access to healthcare workers able to provide elder care is essential. Further, a report from Minnesota Public Radio indicates that though 13 percent of the state’s population lives in rural areas, only five percent of the physicians practice there. This shortage of doctors and other healthcare providers in rural areas is a national trend, and ultimately causes patients to experience longer non-emergency wait times, providers who are fully booked and/or not accepting new patients, and more care provision by mid-level practitioners. CNN reports that the findings of Barbara Starfield at the Johns Hopkins University Bloomberg School of Public Health indicate that an increase of one primary care physician per 10,000 people would result in a 34.6 fewer deaths per 100,000 people at the state level.

Increasing the availability of healthcare and health services is a major aim of the Millennium Development Goals (MDGs). The Goals also seek to reduce child mortality, improve maternal health outcomes, combat HIV/AIDS and diseases like malaria and tuberculosis, and ensure the availability of medications. In order to increase the availability of healthcare in rural areas, the WHO suggests a number of measures, including reassignment of needed healthcare workers during conflict situations. While this may increase the health outcomes for the population in the region, it also poses a risk to the providers – one that could be avoided through the use of telemedicine and teleconsultation programs like iConsult. Through teleconsultation, specialty care physicians can remotely provide advice and support to doctors within a region.

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WHO Information on Healthcare Worker Shortage - Grosse Pointe News - Minnesota Public Radio - CNN Report