Doctors Target Gun Violence as a Social Disease

by Peak Positions

Story first reported from USA Today

MILWAUKEE – Is a gun like a virus, a car, tobacco or alcohol? Yes say public health experts, who in the wake of recent mass shootings are calling for a fresh look at gun violence as a social disease.

What we need, they say, is a public health approach to the problem, like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago, even as the number of vehicles on the road rose.

One example: Guardrails are now curved to the ground instead of having sharp metal ends that stick out and pose a hazard in a crash.

"People used to spear themselves and we blamed the drivers for that," said Dr. Garen Wintemute, an emergency medicine professor who directs the Violence Prevention Research Program at the University of California, Davis.

It wasn't enough back then to curb deaths just by trying to make people better drivers, and it isn't enough now to tackle gun violence by focusing solely on the people doing the shooting, he and other doctors say.

They want a science-based, pragmatic approach based on the reality that we live in a society saturated with guns and need better ways of preventing harm from them.

The need for a new approach crystallized last Sunday for one of the nation's leading gun violence experts, Dr. Stephen Hargarten. He found himself treating victims of the Sikh temple shootings at the emergency department he heads in Milwaukee. Seven people were killed, including the gunman, and three were seriously injured.

It happened two weeks after the shooting that killed 12 people and injured 58 at a movie theater in Colorado, and two days before a man pleaded guilty to killing six people and wounding 13, including then-Rep. Gabrielle Giffords, in Tucson, Ariz., last year.

"What I'm struggling with is, is this the new social norm? This is what we're going to have to live with if we have more personal access to firearms," said Hargarten, emergency medicine chief at Froedtert Hospital and director of the Injury Research Center at the Medical College of Wisconsin.

"We have a public health issue to discuss. Do we wait for the next outbreak or is there something we can do to prevent it?"

About 260 million to 300 million firearms are owned by civilians in the United States; about one-third of American homes have one. Guns are used in two-thirds of homicides, according to the FBI. About 9% of all violent crimes involve a gun — roughly 338,000 cases each year.

Mass shootings don't seem to be on the rise, but not all police agencies report details like the number of victims per shooting and reporting lags by more than a year, so recent trends are not known.

"The greater toll is not from these clusters but from endemic violence, the stuff that occurs every day and doesn't make the headlines," said Wintemute, the California researcher.

More than 73,000 emergency room visits in 2010 were for firearm-related injuries, the Centers for Disease Control and Prevention estimates.

Dr. David Satcher tried to make gun violence a public health issue when he became CDC director in 1993. Four years later, laws that allow the carrying of concealed weapons drew attention when two women were shot at an Indianapolis restaurant after a patron's gun fell out of his pocket and accidentally fired. Ironically, the victims were health educators in town for an American Public Health Association convention.

That same year, Hargarten won a federal grant to establish the nation's first Firearm Injury Center at the Medical College of Wisconsin.

"Unlike almost all other consumer products, there is no national product safety oversight of firearms," he wrote in the Wisconsin Medical Journal.

That's just one aspect of a public health approach. Other elements:

• "Host" factors: What makes someone more likely to shoot, or someone more likely to be a victim. One recent study found firearm owners were more likely than those with no firearms at home to binge drink or to drink and drive, and other research has tied alcohol and gun violence. That suggests that people with driving under the influence convictions should be barred from buying a gun, Wintemute said.

• Product features: Which firearms are most dangerous and why. Manufacturers could be pressured to fix design defects that let guns go off accidentally, and to add technology that allows only the owner of the gun to fire it (many police officers and others are shot with their own weapons). Bans on assault weapons and multiple magazines that allow rapid and repeat firing are other possible steps.

• "Environmental" risk factors: What conditions allow or contribute to shootings. Gun shops must do background checks and refuse to sell firearms to people convicted of felonies or domestic violence misdemeanors, but those convicted of other violent misdemeanors can buy whatever they want. The rules also don't apply to private sales, which one study estimates as 40% of the market.

• Disease patterns, observing how a problem spreads. Gun ownership — a precursor to gun violence — can spread "much like an infectious disease circulates," said Daniel Webster, a health policy expert and co-director of the Johns Hopkins Center for Gun Policy and Research in Baltimore.

"There's sort of a contagion phenomenon" after a shooting, where people feel they need to have a gun for protection or retaliation, he said.

That's already evident in the wake of the Colorado movie-theater shootings. Last week, reports popped up around the nation of people bringing guns to "Batman" movies. Some of them said they did so for protection.

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CAN DANDRUFF PREDICT DISEASE

Researchers are hoping a new analytic technique can someday help detect major diseases like cancer and Alzheimer's disease. In the meantime, the approach is proving useful at telling how bad a case of dandruff a person has.
The technique, known as metabolomics, enables scientists to track the metabolic processes in cells by identifying the chemicals, or metabolites, left behind from these processes. Procter & Gamble Co. says it has used metabolomics to find chemical markers on the scalp of dandruff-sufferers that indicate the severity of the condition. Researchers at the big consumer-products company say the discovery may help them develop better dandruff treatments, by monitoring changes in the scalp chemicals in the test lab. Currently, assessing the effectiveness of new treatments requires using employees known as "dandruff graders" who comb through people's scalps and rate the level of dandruff, a highly unreliable process.
Doctors routinely measure chemicals in the body to get health information, such as cholesterol and triglycerides. Metabolomics, however, involves measuring hundreds or thousands of chemical processes, such as the breakdown of nutrients from the diet, going on in the body at the same time, which could yield a lot more information. It can also account for environmental factors, such as how well a patient is absorbing medications. Since metabolism—energy generation or breakdown—gets disrupted in many diseases, figuring out how these metabolic pathways change could potentially yield better ways of diagnosing or treating a wide range of diseases.
One needs a composite picture of how the body works because multiple processes are going on at the same time and often interact with each other. By understanding, for example, that three or four pathways are disrupted in a disease, one can develop more effective treatments that target all, not just one, of those pathways.
One challenge in metabolomics is being able to sift through and identify all the chemicals in a sample. Often a tool called mass spectrometry is used, which delivers a print-out showing the chemical signatures as jagged lines of peaks and valleys. Each peak represents a metabolite present in the sample, which is typically taken from blood or urine. Researchers figure out what chemicals the peaks correspond to by analyzing its molecular weight. Sometimes additional chemical analyses are performed to confirm the initial tests.
Dandruff: Myth or Fact
Myth: Dandruff is just due to a dry scalp.
Fact: It's not. Dandruff is a complex inflammatory response.
Myth: Dandruff is always visible.
Fact: Flakes are only one sign of an unhealthy scalp.
Myth: Dandruff is contagious.
Fact: Dandruff may be a response to fungus, but it doesn't appear to be transmittable between people.
Myth: Dandruff is due to not washing enough.
Fact: Not so. Dandruff appears to be a reaction to a fungus that is on everyone's scalp.
Metabolomics is well suited to analyzing dandruff, which isn't just skin flaking as a result of a dry scalp. Dandruff is thought to be a complex inflammatory response to a common fungus on the scalp that disrupts the normal process of shedding skin cells. When people with a healthy scalp shed dead skin cells, enzymes digest the connections between the cells so the cells slough off individually, and invisibly. In some people, however, the immune system, for reasons that remain unknown, reacts to the fungus in a way that disrupts the typical enzyme process. This causes clusters of thousands of dead cells to be shed at the same time, resulting in visible flakes and itch. Dandruff affects millions of people in the U.S.
At Procter & Gamble, researchers hunted for molecules signaling inflammation of the outermost layer of scalp skin. The aim was to identify biological markers that indicate deeper changes going on within the skin tissue. Samples of skin cells were taken from the scalps of several hundred participants, some with dandruff and others with healthy skin. Researchers analyzed the chemicals that the cells from healthy scalps had produced and compared them to the dandruff sufferers. They eventually identified several markers of inflammation that differed between the groups. The markers can now be used to monitor participants in trials of new dandruff products to determine whether someone's condition is improving.
Another P&G dandruff study used similar methods to look for chemical markers that were related to itching, a symptom that dandruff sufferers often complain about. They identified elevated histamine markers in dandruff sufferers, confirming the idea that histamine is involved in itch and could be targeted in future treatments. The findings could help advance research in skin conditions, including psoriasis and eczema.
Extensive metabolomics research is being conducted in other medical conditions as well. At the Lombardi Cancer Center at Georgetown University, researchers are looking at the metabolites of smokers to understand why some get cancer and some don't.
In a small study presented at the American Association for Cancer Research this year, scientists examined hundreds of chemicals in the blood and urine from nine smokers and 10 nonsmokers. They found varying levels of nicotine-related metabolites in the smokers, which suggests that some smokers process nicotine differently than others. The goal is to figure out if these nicotine-related metabolites can be used to predict which individuals will get cancer.
Understanding how metabolism gets disrupted in Alzheimer's disease also is being investigated.
One doctor assessed more than 800 types of fats found in blood samples from 26 Alzheimer's patients and 26 cognitive normal adults. The study found for the first time an elevation of a particular type called sphingolipids in those with Alzheimer's.
The finding is important because lipids help make up brain cells, and may one day be used to help identify people with the memory-robbing disease.