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Everyone knows arsenic is bad for you. Today we discuss where arsenic comes from, its history as a medicine, how much is bad for you, and how it got its awful reputation. Welcome back, everyone.  I hope you are all weathering the Coronavirus pandemic well.  I’m sure the world will survive this pandemic like it has the others, but individually I hope you all stay safe and healthy. Today’s topic is Arsenic: who eats old lace anyway? Arsenic as a medicine As the world searches for a cure to the Coronavirus, could I make a suggestion?  Let’s not try arsenic.  Through the centuries, it seems that arsenic has been advertised as a cure for many major illnesses.  Since Hippocrates first recommended arsenic as a cure for ulcers and abscesses, it seems that arsenic was recommended for about every conceivable illness.  It has been used to “cure” skin conditions, stomatitis, gingivitis in infants, asthma, rheumatism, hemorrhoids, cough, a fever reducer, and an all-around great health tonic. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2009.07623.x From 1910 till the introduction of penicillin, an arsenic derivative known as Salvarsan was the primary cure for syphilis, and indications are that it actually did a pretty good job of killing the bacteria without killing the patient, something that not all syphilis cures could claim. https://www.sciencehistory.org/distillations/magazine/early-solution Today, arsenic trioxide is used to treat lymphoma and leukemia. https://pmj.bmj.com/content/79/933/391 However, arsenic is most famous as a cure for rich relatives who were too stubborn to exit this world and leave behind a well-earned birthright.  A little sprinkle of some inheritance powder and suddenly the money started to flow again. Arsenic is a metalloid element with an atomic number of 33.  While it can be naturally found as a pure element, it is often found bonded with sulfur or oxygen.  Mankind has known about arsenic since before the Egyptians used it to embalm their dead to preserve the bodies until heat and moisture could prevent natural decay.  Arsenic in groundwater The most common natural way to encounter arsenic is through contaminated groundwater.  While occasionally human activity is responsible for the presence of arsenic in water, generally most contaminated wells are a result of the leaching of naturally occurring arsenic.  As a child, I remember having our well tested several times to determine arsenic levels.  The areas most affected by natural arsenic in the US are the southwest, northwest, northeast, and Alaska.  Arsenic in groundwater can be a hazard because dangerous levels of arsenic don’t affect the taste of drinking water.  Generally, the only way to detect these levels is through laboratory testing.  The EPA limit for arsenic in groundwater is 10ppb.  They also estimate that 2% of water supplies exceed 20ppb.  2ppb is a normal level, but levels of up to 1000 ppb have been found in drinking water.  https://www.atsdr.cdc.gov/csem/csem.asp?csem=1&po=7  The USGS estimates over 2 million people in the US may be drinking water high in arsenic. https://www.usgs.gov/mission-areas/water-resources/science/arsenic-and-drinking-water?qt-science_center_objects=0#qt-science_center_objects Arsenic contamination can also be from sources such as arsenic-treated lumber, coal-fired power plants, smelting, and mining activity. Other sources of arsenic likely to be encountered in industry include algaecides, cotton harvesting, glass manufacturing, herbicides and pesticides, and treated lumber were common in the past.  Today, the electronics industry is one of the most significant modern users. https://www.atsdr.cdc.gov/csem/csem.asp?csem=1&po=5 Incidence of arsenic poisoning In 2005, there were almost 1000 cases of exposure to non-pesticide arsenic, with over ¾ of these being in adults.  For the 371 cases of exposure to arsenic pesticides that also occurred in 2005, things change and ¾ of the victims were children under six.  About ½ of those exposed requested treatment at a medical facility.  7% of all exposures resulted in moderate or major symptoms and only 1 resulted in death.  https://calpoison.org/news/arsenic-poisoning-2007 The LD50 of arsenic is 15mg/Kg.  To put that into perspective, the LD50 of cyanide is 3mg/Kg when ingested.  http://cures.lmu.edu/wp-content/uploads/2016/07/M4_L4.1_S_Key_Final-1.pdf For a normal 70kg person, this works out a lethal dose of about 1g. The medical effects of arsenic depends on whether it is ingested chronically, or in a large dose.  When ingested chronically, the primary symptoms include skin hyperpigmentation (darkening), waxy scaley areas of the skin, skin lesions, liver and kidney failure, and cancers of the skin or internal organs. https://www.who.int/water_sanitation_health/dwq/arsenicun4.pdf With large doses, the symptoms become more severe.  Arsenic contamination of sugar used to make English beer in 1900 resulted in 71 deaths and over 6,000 illnesses. The most common symptoms seen in these cases were dark blotches on the skin, muscle weakness & pain, lesions in the liver, localized swelling, and fatty degeneration of the heart.  The estimated concentration of arsenic in the beer was 2-4 ppm.  Ingestion of large doses results in severe gastrointestinal symptoms to include: nausea, vomiting, severe abdominal pain, fluid loss leading to low blood pressure, inflammation of the intestinal wall, and bloody diarrhea.  https://www.atsdr.cdc.gov/csem/csem.asp?csem=1&po=11  Multiple other organs can be affected as arsenic inactivates up to 200 enzymes, particularly those involved in cellular energy pathways.  Cellular functions such as DNA repair and synthesis are also affected by the destruction of these enzymes.  Disruption of these basic cell functions can rapidly lead to multi-organ failure. https://pmj.bmj.com/content/79/933/391 Arsenic murders Although intentional arsenic poisonings still occur, the last few centuries were full of arsenic murders.  The Borgia’s of Italy mastered the use of a special arsenic flavoring in their wine and grew very wealthy through strategic inheritances and untimely deaths.  The only thing that stopped their meteoric rise was the accidental ingestion of the wrong bottle of wine.  https://sites.dartmouth.edu/toxmetal/arsenic/arsenic-a-murderous-history/ Napoleon is rumored to have been murdered with arsenic. There were multiple cases of female mass murders in the 19th century including Mary Ann Cotton who poisoned at least 21 victims including 5 husbands, her mother and all of her children. And of course, as previously mentioned, arsenic took the center stage in speeding up the inheritance process.  In 1833, 79-year George Bodle was hurried along by a large pot of coffee.  Sharing of the pot and reuse of the grounds led to many members of the household rapidly falling ill.  Although the other members of the family managed to survive, poor George didn’t make it.  Perhaps by coincidence, George had recently changed his will, giving his fortune to his son-in-law. https://www.newyorker.com/magazine/2013/10/14/murder-by-poison As this case shows, arsenic which was commonly available, relatively cheap, could easily be snuck into food or drink.  Often, the symptoms were confused with other medical conditions, but even when foul play was suspected, there was no way to prove it. I wondered why we don’t hear of many arsenic murders now.  First off, arsenic is a little harder to get than it used to be.  Our safety-conscious society has removed it from most routine applications. However, most of the credit goes to a British scientist by the name of James Marsh.  He was obsessed with being able to detect the presence of arsenic in cases of foul-play.  Up until this point, the detection of arsenic required precipitating the metal out, often impossible from autopsy samples.  Additionally, since many industrial processes utilized arsenic, contamination of test reagents was a real problem.  https://pubs.acs.org/doi/abs/10.1021/ed024p487 Marsh’s test relied on changing organic arsenic into arsine gas.  The arsenic liberated as a gas was captured in a glass tube where it is heated.  As the gas cools, it deposits a mirror-like finish on the glass.  While other substances may do the same thing, only arsenic will dissolve when bleach is introduced.  As Marsh was developing the test, he attempted to prove that George Bodle was killed by arsenic.  At that point, his test was too crude to convince the jury, but failure only further motivated him.  By the time Mary Ann Cotton was discovered, the test was substantially improved and led to her swinging from the gallows.  https://www.wired.com/2012/02/arsenic-and-the-forgotten-serial-killer/ Thanks to the work of James Marsh, even the smallest amounts of arsenic could be easily discovered in a potential murder.  Arsenic lost its anonymity and soon fell out of favor. Today, arsenic screenings are common when foul play is suspected. Fear of being caught probably keeps many would-be murderers at bay, or at least requires them to be more inventive. Chances are, as long as you test your well water, don’t build campfires out of treated wood, and aren’t in the habit of licking old jars of pesticides, you have little to fear.  However, arsenic is just as toxic as it ever was and probably sufficient reason to turn down a special glass of wine from a new beneficiary of your will.

In today’s podcast we answer a listener’s question about the dangers of radon. What do you need to do to protect your family from this monster in the basement? Hello everyone.  Thanks for tuning in to another podcast.  I appreciate all of you taking time out of your day to listen.  As always, I’d love to hear from you if you have a topic you would like me to discuss or suggestions for improvement.  The best way to reach me is through my website sci-vs-fear.com. Before I get started with today’s topic, I got some feedback on the childbirth podcast from Gretchen.  She included some research from the CDC that showed a large disparity in maternal mortality between black and white women.  This study showed that black women had 2-5 times the maternal deaths of white women. https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html Upon looking into it, there were several studies exploring the reason for the discrepancy.  All of the authors acknowledged that attributing cause in cases like this is very difficult.  I really appreciate Gretchen bringing this to my attention.  In the 4-5 hours I have to research a topic, I am bound to miss something.  The interesting thing to me is that the study I cited in the podcast was also from the CDC, and it showed white women having slightly higher maternal mortality.  So, who is right?  I don’t know.  Usually, when there is a discrepancy in data the truth lies somewhere in the middle.  These studies are a good demonstration of how the sample population can change the study outcome.  One study that I looked at found that some of the discrepancy is possibly due to the quality of the hospitals more likely to be used by black mothers.  They found that white mothers using the same hospitals, had similar outcomes.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/#R20  That would make sense since much of the improvement in mortality we saw in the 1930s was attributable to improvements in medical care. Gretchen also mentioned that in the US, maternal mortality is on the rise and higher than Europe.  I too had found this during my research.  Determining the factors responsible for this uptick would certainly be worth investigating.  I suspect the answer is quite complex but worth pursuing.  Thanks again for checking my facts and the input. For today’s podcast, I got a question from Brett. “I recently had a salesman come to my house wanting to test it for radon.  He said that our area has high radon levels and that my house could be poisoning my family.  How dangerous is radon and am I putting my family at risk?” So, today’s topic is Radon: the monster living in the basement Well, Brett, deciding to get your house checked and potentially mitigated is a personal decision I can’t make for you but there is a lot of interesting information available. The US attention to Radon began in 1984 when construction engineer Stanley Watras headed into work at the Limerick nuclear power plant in Pottstown Pennsylvania.  The plant had recently installed monitors to detect any radiation contamination as workers left for the day, but as Stanley entered the plant, the alarms went off.  Eventually, the cause was traced to his home where radon levels were found to be 2700pCi/L.  http://hyperphysics.phy-astr.gsu.edu/hbase/Nuclear/radon.html#c4 This is the highest level ever detected in a home and is similar to concentrations found in Colorado uranium mines in the 1950s. http://www-ns.iaea.org/tech-areas/communication-networks/orpnet/documents/cn223/8-chambers-keynote.pdf What is radon? So, what is radon? If you will remember from my radiation podcast, nuclear isotopes have a half-life, or how long an isotope sticks around.  Now, these isotopes don’t just magically become non-radioactive, but rather they decay into other elements.  Eventually, they decay into an element that is happy with the ratio of protons, neutrons, and electrons and becomes a stable non-radioactive element.  We call this process a decay chain. https://www.epa.gov/radiation/radioactive-decay Uranium 238 has a decay chain consisting of 14 steps during which it transforms from Uranium with an atomic number of 238 to lead with an atomic number of 206.  Although high concentrations of U 238 can be found in certain areas, most of the US has uranium in the soil.  This radioactive decay doesn’t mean anything to us as it happens in the soil and is widely spread out.  However, on the 5th step in the decay chain, U238 has transformed to Rn 222.  Unlike all the other elements in the U 238 decay chain, Rn222 is a gas instead of a solid. https://sciencedemonstrations.fas.harvard.edu/presentations/radons-progeny-decay  Pressure from the ground can cause the radon to migrate to the top of the soil and into the air.  It has been estimated that every acre of the top 6 feet of soil has about 50 lbs of U 238.  That averages out to 6 radon atoms being emitted per square inch of soil every second. http://hyperphysics.phy-astr.gsu.edu/hbase/Nuclear/radon.html#c4 In open air, the radon rapidly dissipates, but in an enclosed space such as a house, it can accumulate.  As our houses have become tightly sealed to promote energy efficiency, the potential for greater radon levels has increased. It is generally agreed that Rn222 itself poses little hazard because as a gas, it is breathed out as readily as it is breathed in.  However, the half-life of Rn222 is only 3.82 days meaning that it rapidly decays into other elements that are solids rather than a gas.  These solids stick to particles in the air that are breathed in and deposited in the lungs.  These radioactive particles generally have short half-lives in the seconds to days range and many emit an alpha particle as they decay. http://hyperphysics.phy-astr.gsu.edu/hbase/Nuclear/radon.html#c4 How does radon cause cancer? In my radiation podcast, we talked about the different types of radiation, alpha, beta, and gamma.  I like to think of alpha radiation as a guy with a bowling ball.  I don’t have to run much faster than him to be out of range, but if I get close enough that he can hit me, it is really gonna hurt.  When you inhale or ingest alpha radiation, the guy with the bowling ball is standing right next to your cells.  Exposure from this range can damage, kill, or cause the cell to mutate.  Every once in a while, the immune system doesn’t take care of a mutated cell and it can turn into cancer. Alpha radiation is like a bowling ball. Easy to outrun the guy throwing it at you, but it hurts if it hits you. The EPA is the primary government agency in the US concerned with radon.  From their website, they estimate that radon is the second leading cause of lung cancer behind cigarettes and ahead of second-hand smoke.  https://www.epa.gov/radon/health-risk-radon  Radon’s potential effects They estimate 160,000 cigarette deaths every year with 21,000 radon and 3000 secondhand smoke deaths.  As you can see, radon lags far behind cigarette deaths and things get a little fuzzier because only 2900 deaths occur every year in people who have never smoked. The EPA believes the only safe level of radon is zero, but their acceptable level is 4 pCi/L, well below the 2700 pCi/L experienced by Stanley Watras.  At this level, they estimate 6.2% of people who smoke will get lung cancer from radon.  If you don’t smoke, they estimate 0.7% of people will acquire radon caused lung cancer. Studies validating EPA standards On their website, the EPA mentions that there was concern that since their model came from uranium mine workers it might not apply to residential expose.  They cited two studies that “conclusively” put these arguments to rest. The first was a fairly well-designed study looking at people living in Iowa who got lung cancer after living in a single house for at least 20 years.  They measured the radon levels in these houses and then the houses of controls who had also lived in their house for at least 20 years. They found that a significantly higher number of cases had previous lung disease compared to the controls.  Is this because radon makes you more likely to have lung problems or because lung problems make you more susceptible to cancer?  84% of lung cancer patients had smoked more than 100 cigarettes while only 33% of controls had.  Light smokers had an odds ratio of 8 and heavy smokers 29 compared to non-smokers for getting lung cancer. Interestingly, if you look at the radon levels found in cases versus control homes, there isn’t too much of a difference.  Basement levels in controls were actually very slightly higher while first and second floor levels were slightly higher in cases.  While the study was able to assign some excess risk to radon, the confidence intervals did not exclude no additional risk as a possibility.  They did, however, find that smoking resulted in significant excess risk. http://www.radonleaders.org/sites/default/files/Residential%20Radon%20Gas%20Exposure%20and%20Lung%20Cancer_Iowa%20Study.pdf The other study cited by the EPA looked at over 7000 people with lung cancer and 14,000+ controls from several different studies.  They found that for non-smokers the absolute risk with no radon exposure was 0.41%, 0.47% with an average exposure of 3pCi/L, 0.67% with an exposure of 11pCi/L and 0.93% with an exposure to 22pCi/L. For smokers, the story was different.  The absolute risk with no radon exposure was 10.1%, 11.6% with an average exposure of 3pCi/L, 16% with an exposure of 11pCi/L and 21.6% with an exposure to 22pCi/L. Their conclusion was “

We’ve all heard the stories, a simple cut rapidly turns into a life threatening infection that destroys muscle, skin, and tissue. Flesh eating bacteria, how worried should you be? Thanks for joining me again.  Thanks for all of you who provided feedback on the podcast.  Next week’s podcast will be a listener suggested topic.  For those of you who haven’t yet suggested a topic, I would still love to hear from you.  Sci-vs-fear.com Today’s topic is: Flesh-eating bacteria: It’s not just a flesh wound I first heard of flesh-eating bacteria as a young microbiology student.  It is pretty scary stuff.  It starts out as a minor scrape or cut and within a few days can result in a gruesome death. Take for instance the 2008 case of a 5-year-old Wisconsin boy.  He fell off his bike and skinned his chin and bit his lip.  Not an uncommon event in the life of a five-year-old.  One day later, he was in the ICU fighting for his life against flesh-eating bacteria.  Over the next three days, he underwent five different surgeries to remove dying and infected tissue.  As his body fought the infection, his blood pressure began to drop precipitously.  As the illness progressed, it became increasingly likely that he might not survive.  Thanks to aggressive antibiotic therapy and surgical interventions, after a week in the hospital, his condition began to improve and eventually he recovered completely. https://www.livescience.com/19722-flesh-eating-bacteria-early-treatments.html Flesh eating bacteria: also known as necrotizing fasciitis The medical term for the disease caused by flesh-eating bacteria is “necrotizing fasciitis”.  While many different organisms have caused necrotizing fasciitis, the most common bacterial cause is group A Streptococcus.  This is the same organism that causes strep throat, however, the infection takes a completely different course. Flesh eating bacteria is the same organism that causes strep throat Within 24 hours of infection, the symptoms are readily apparent.  The area of the cut or abrasion becomes red, warm, and swollen.  There is a significant amount of pain at the site of the infection, much more than you would normally associate with a minor cut or scrape.  The redness and swelling can begin to travel to other parts of the body.  Other symptoms include diarrhea, nausea, fever, dizziness, weakness and intense thirst. If not treated immediately, within 3-4 days the symptoms can become much more severe.  Swelling increases, often accompanied by a purplish rash.  This rash can spread, then it transforms into blisters filled with a dark, foul-smelling liquid.  The skin begins to discolor, flake and even peel away as it dies.  If not treated aggressively death can occur in four to five days due to a drop in blood pressure, toxic shock, and organ failure. https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria#2 While the most shocking cases are those who are otherwise healthy, most individuals who acquire the illness have underlying medical conditions that weaken the immune system.  These secondary causes include diabetes, kidney disease, cirrhosis of the liver, cancer and occasionally chickenpox in young children. Invasive strep infections The CDC estimates 11,000-13,000 cases of invasive group A strep occur every year in the US.  Of those 1100-1600 people die.  In addition to necrotizing fasciitis, these illnesses also include cellulitis, pneumonia, and toxic shock syndrome.  That’s roughly a 10% case fatality rate. https://www.cdc.gov/groupastrep/surveillance.html Flesh eating strep fatalities As a class, group A strep becomes more prevalent as people age.  For the 18-34 age group, 0.005% of people are likely to acquire the illness, while the 85+ age group had a prevalence of 0.02%.  Even with the increased prevalence associated with aging, group A strep diseases are relatively rare.  https://www.cdc.gov/abcs/reports-findings/survreports/gas17.html  According to CDC surveillance, about 5% group A strep isolates are associated with flesh-eating illness.  https://www.cdc.gov/abcs/reports-findings/survreports/gas17.html Other estimates predict 6-700 cases of flesh-eating illness with 25-30% fatalities. https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria#2 One study of 1500 patients with necrotizing fasciitis recorded a 19% mortality rate.  Risk factors for death included heart disease, cirrhosis of the liver, and being older than 60.  Delayed treatment also substantially increased mortality. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337692/ Rapid treatment of the illness is the key to surviving the infection.  The primary treatment is the surgical removal of the dead and dying tissue.  It is especially important to evaluate how deep into the muscle tissue and fat the infection has spread.  Following surgical cleaning of the wound, careful observation of is required as follow-up surgical cleanings are very common.  In addition to surgery, aggressive IV antibiotic therapy is crucial in the survival of the illness. While the general thought is that the illness is not spread person to person, other studies have indicated that close household members of patients are 200 times more likely to become infected than the general population.  In Canada, prophylactic antibiotic therapy with penicillin or first-generation cephalosporin is recommended for those in contact with the patient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828232/ Regardless of the bacteria causing the necrotizing fasciitis, the advancement of the disease is similar.  Once the infection begins, the bacteria produce toxins that inhibit the immune response as well as damaging or killing tissues.  This results in a loss of oxygen in tissues which further destroys them.  Additionally, the reduction of oxygen allows certain anaerobic bacteria to invade the tissues, causing further degradation particularly in connective tissues.  An infection of the wound by multiple types of bacteria is quite common in flesh-eating illnesses. https://www.medicinenet.com/necrotizing_fasciitis/article.htm Virulence factors Group A strep has several virulence factors that enable it to rapidly spread through affected tissues.  The bacteria has an outer capsule made of hyaluronic acid.  This capsule is non-antigenic as it is structurally similar to host connective tissue.  This capsule allows the bacteria to dodge detection by the immune system.  The main virulence factor of streptococci is known as the M protein.  This protein prevents the immune system from engulfing and destroying the bacteria.  Particularly, it is toxic to neutrophils.  If you will remember from high school biology, neutrophils are white blood cells that make up the largest number of immune cells in the blood.  Generally, they destroy bacteria through phagocytosis, triggering the release of cellular antimicrobial agents, and trapping the bacteria outside of cells.  Death of these cells is a major blow to the body’s immune response against group A strep infection. https://www.frontiersin.org/articles/10.3389/fphys.2018.00113/full Strep also contains a hemolytic (red blood cell destroying) factor known as streptolysin. Streptolysin is particularly effective at destroying red blood cells.  This is demonstrated by the clearing seen around colonies on blood agar.  This can reduce the amount of oxygen in the wound leading to anaerobic co-infections that can compound the infection damage and treatment complexity.  It also believed that they are toxic to leukocytes, the other major class of white blood cells. While less prevalent in necrotizing fasciitis, Streptococcus also contains toxins known as superantigens.  These superantigens result in the uncontrolled activation of the T cells.  This causes the area to be flooded with an uncontrolled immune response that releases an overwhelming amount of cell destroying molecules.  This huge wave of cell disrupting proteins can overwhelm the body leading to rapid shock and death.  This is known as toxic shock syndrome.  In the cases where the flesh-eating illness is combined with toxic shock, the prognosis is bleak indeed. Finally, the strep cells contain enzymes known as spreading factors.  As you will remember, the organism is surrounded by a hyaluronic acid capsule.  The organism also contains an enzyme that can destroy hyaluronic acid chains.  Because the connective tissues and clots also contain a large amounts of hyaluronic acid, the release of the enzymes destroys the host connective tissues.  This destruction of connective tissues allows for the rapid spread of the streptococcus. https://microbeonline.com/virulence-factors-streptococcus-pyogenes-roles/ Flesh eating strep antibiotic resistance While group A strep is highly invasive, one bright side is that generally, streptococcus has little antibiotic resistance.  A study of over 200 hospital isolates was conducted to determine the prevalence of antimicrobial resistance.  All isolates were susceptible to penicillin, vancomycin, and linezolid.  However, 53% were erythromycin-resistant and 58% were resistant to tetracycline.  This is important because erythromycin and tetracycline are commonly used to treat patients with penicillin allergies.  http://www.ijmm.org/article.asp?issn=0255-0857;year=2018;volume=36;issue=2;spage=186;epage=191;aulast=Abraham The large prevalence of multiple and varied organisms in infections also compounds the difficulty of antibiotic treatment.  In a rapid moving illness like necrotizing fasciitis, prompt application of antibiotics

Childbirth has been a constant in human history. Unfortunately, death among mothers was far from rare. We discuss how dangerous it was and how far we have left to go. Welcome, everyone.  With this episode, I have over 20 podcasts under my belt.  It has been a lot of fun and I appreciate all of you.  I have a completely self-serving request of you.  I’m trying to make my podcast better and I really need some good feedback to do so.  I would like to know your favorite episode and one topic that you would love for me to discuss.  Simply go to my website sci-vs-fear.com and click on the red contact button or if it is easier, email me directly at prometheusvsfear@gmail.com.  Again, I’d like to know your favorite podcast so far and one topic you would like for me to discuss.  Thanks again for all of your support! Today’s topic is: Childbirth: There’s got to be a better way As most of you could guess, the only direct experience I’ve had with childbirth is being born and those memories are a bit fuzzy.  I have four kids and so I’ve had plenty of experience on the Dad side, but doesn’t really count.  Not too long ago, we were in the hospital with our daughter, welcoming our first grandchild into the world.  As I watched her struggle to bring my grandson into the world, I thought “this has to be one of the most dangerous things ever.”  This episode goes out to my daughter and my wife. Today’s podcast is going to look at how dangerous childbirth is for the mother.  Making it to 5 years old is a big gamble for the baby and is a topic for another podcast.  US Childbirth deaths In the US, about 700 women a year die due to complications with pregnancy. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm  For a country with the population of the US, this is a pretty low rate.  Other causes of death with similar rates are slipping and tripping falls, falls from ladders, drowning in swimming pools, and freezing to death. https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/data-details/ As we will discuss in a minute, it has taken a lot of hard work to get to this place.  The leading causes of maternal death are cardiovascular conditions, hemorrhage, infection, embolism, cardiomyopathy, mental health conditions, and preeclampsia/eclampsia.  Interestingly, the death rates were very similar for black and white women, except that deaths due to mental health conditions were noticeably absent among black women. Of these fatalities, a quarter occurred during pregnancy, 15% on the day of delivery, 18% 1-6 days postpartum, another 18% 7-42 days postpartum, and the remaining quarter 43-365 days postpartum. The fatalities can be categorized as preventable, and non-preventable.  Hispanics had the lowest rate of preventable deaths at 62%, blacks at 63%, and white at 68%.  I found it interesting that of the maternal deaths in this CDC study, over 65% were still preventable. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/mmr-data-brief.html Childbirth in Africa and South Asia So that is in the US, but how about the rest of the world?  In 2015, over 300,000 women died from pregnancy-related causes.  Of those, the US contributed about 700 with Europe, the Middle East, and Latin America all having similar contributions.  The vast amount of pregnancy-related deaths come from South Asia and Sub-Saharan Africa.  Since 1990, South Asian deaths have shrunk from 200,000 per year to about 100,000.  However, Sub-Saharan Africa has held steady at about 200,000 deaths per year.  Clearly, Africa has some problems. Historic childbirth deaths Surprisingly, it could be much worse.  If we use the 1800 Sweden/Finland mortality rate of roughly 1% ( 900 deaths per 100,000 live births), the expected mortality would be about 1.25 million per year.  If we use the current European Union mortality rates of 0.01% ( 8 deaths per 100,000), the worldwide mortality would only be 11,000 deaths per year. The mortality rate for Sweden/Finland remained fairly steady for most of the 19th century.  There aren’t very good records before this, but those rates are probably a good indication of childbirth risk through much of human history. An early 1980’s study of a large sect in Indiana that lived modern lifestyles except that they would not use medical technology examined maternal mortality.  Mortality was very consistent with 1800s Sweden at 872/100,000 births even though the rest of Indiana averaged only 9 per 100,000. https://academic.oup.com/ajcn/article/72/1/241S/4729611 In the hand washing episode, we talked about Ignaz Semmelweis’s discovery of the importance of handwashing.  The Vienna maternity hospital had two wards.  One ward run by midwives had a mortality rate of 1 in 25 or shocking 4%( 4,000 per 100,000) while the other wing run by medical students had a mortality rate of 1 in 10 ( or a 10,000 per 100,000 death rate).  That is almost the mortality rate of Russian Roulette!  Once Semmelweis implemented handwashing procedures, the rates became similar.  This happened in 1846, but in the Western world, the mortality rates didn’t start to drop until 1900.  That is a long 50 years with no improvement. https://ourworldindata.org/maternal-mortality So, let’s go over this again.  Currently, in the EU the mother dies in 8 out of every 100,000 live births.  In 1800’s Sweden/Finland 800 women died per 100,000 live births.  In the 1850 Vienna hospitals, 4-10,000 mothers died for every 100,000 births.  That is just mind-blowing to me.  In the 19th century, childbirth had to be one of the riskiest things around.   It is interesting to me that now we think of hospitals as the safe place to have a child, but in the 19th century, having a child in the hospital was the last thing you wanted to do.  In 1927 only 15% of children were born in hospitals, 1946 saw 54%, 1970 was over ¾ but it wasn’t until 1980 that nearly all children were born in hospitals in the US. So, what accounted for this enormous mortality?  For most of the 1800s, the delivery techniques of formalized medicine may have been partly to blame.  Generally, you would see higher death rates among the working class than the ruling classes, but even as late as 1930 the working class had significantly lower death rates than the wealthier classes. Does poverty cause maternal mortality? Poverty and social condition are often blamed for poor maternal outcomes, but the story of Rochdale England indicates that proper medical care and hygiene has more of an impact that poverty or social conditions.  In early 1930 it had the highest childbirth mortality in all of England.  The appointment of an exceptional medical officer of health saw the rate drop from 900 per 100,000 births to 170 deaths even though all of England averaged 4-500 deaths per 100,000.  Even though the community remained poor and malnourished, focused attention on medical and public health practices led to sustained and marked improvement. All throughout the Western world, about 1937 there was a sudden and precipitous drop in maternal mortality.  There were likely many factors, but no doubt antibiotics, better treatment for hemorrhage, blood transfusions and improvements in medical education all played a role in this exceptional reduction. https://academic.oup.com/ajcn/article/72/1/241S/4729611 The effect of multiple births on mortality The next question I had was whether the first birth was the dangerous one, or if the risk continued to increase with each pregnancy?  I know that for my wife, each pregnancy was different, but didn’t know what the overall statistics had to say about it. A study of Tanzanian women who had delivered more than 5 children found that these women had a higher risk for maternal and neonatal complications.  These later children scored lower on most tests of newborn wellbeing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878019/ Another study compared women with 2-5 deliveries and those with greater numbers.  The mothers with more pregnancies had a higher incidence of postpartum hemorrhage, maternal anemia as well as prolonged labors, cesarean delivery, birth defects, and child mortality. https://www.ncbi.nlm.nih.gov/pubmed/20402567 A separate study found that having >10 children increase the risk of hemorrhagic stroke fourfold.  These mothers also had a 50% higher rate of obesity compared to mothers with 2-4 children. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465489/ A final study looked at adolescents with 1 or 2 births.  This study looked more at the outcome of the infant rather than the mother, but in young women, the infants did significantly better if their mothers had delivered a previous child.  Interestingly, second time mothers were more likely to deliver a pre-term infant.  https://www.ajog.org/article/S0002-9378(18)31348-6/fulltext Out of hospital births The long-established mistrust of hospitals and labor is evident by the multiple articles comparing hospital births to home births.  Keep in mind that the statistics will be somewhat skewed as high-risk pregnancies are more likely to occur in hospitals rather than at home so the figures aren’t completely apples to apples. A sampling of the studies found that home deliveries with trained midwives were less likely to have tearing or postpartum hemorrhage.  Those women delivering at home were also much less likely to have a cesarean delivery.  Consistent across studies was that first-time deliveries tended to have more complications, particularly those births out of a hospital.  Some studies found a slightly elevated risk to the child in home deliveries, while others

The next pandemic flu is an inevitability. The 1918 flu killed more people than WWI. Today we talk about steps you can take to protect yourself and family. Thanks for joining me for this bonus podcast.  As we talked in the flu podcast, a global flu pandemic is pretty much inevitable.  Proper preparation is the vaccination for fear, and today we will discuss what you can do. Today’s episode is: Pandemic influenza:  You can’t fight the flu with kung fu As we talked previously, if the next flu pandemic is like the 1918 Spanish Flu, the worldwide death toll could approach 1 million.  This is despite all the medical advances that have been made since 1918. Were we prepared for the 2009 flu? The problem with the flu is that it is a constantly morphing threat.  An evaluation of the 2007 pandemic flu strategy is a good illustration.  When this plan was made, the assumption was that the next pandemic would be a highly pathogenic avian strain in the H5N1 family.  To this end, vaccine for this family was strategically stockpiled for rapid response. Another assumption was that the virus would emerge overseas, lengthening the available response time. When the next pandemic strain emerged in 2009, it was from the H1N1 family, a swine-origin virus rather than avian.  Instead of emerging overseas, the strain emerged in Mexico and rapidly spread to California. Fortunately, the strain proved to have a fairly low lethality and so the consequences of being wrong were not catastrophic.  Once the strain was recognized in April production of a vaccine was immediately started.  However, the vaccine wasn’t completed until October-6 months later.  It wasn’t until December that enough vaccine could be produced to protect the general public.  That’s 8 months to produce enough vaccine to protect the public once the strain is identified.  Can’t we just make a vaccine for pandemic flu? These vaccines will be central in slowing a pandemic, but remember that the efficacy of most vaccines is only ~40% and the protection begins to wane rapidly.  Unless we get very lucky or better at predicting future strains, our most effective medical intervention will be unavailable for at least half a year. https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm If the strain follows the 1918 model, where the first wave of the pandemic isn’t particularly lethal, this delay before the more deadly waves may be the advantage we need to get ahead of the virus.  There is no telling whether the next pandemic will follow this model. I wouldn’t feel comfortable waiting 6 months before I took action to protect myself.  There are things we can do besides medical treatment.  The CDC calls these actions Non-Pharmaceutical Interventions. Communities fight the pandemic These include both community-based and personal protective measures.  Community-based interventions could include cancellation of schools, cessation of public gatherings and working from home or not at all. These measures would not be without difficulties.  As we are seeing in the coronavirus outbreak, interference with employment is likely to have nationwide and personal economic consequences.  School cancellations can further interfere with work attendance for at least one adult in the family.  While it would be easy to think that cancellation of community activities would be easy, remember that the mass fatalities will result in potential funerals.  While China appears to be having success disposing of bodies without funerals, I’m not sure this would fly here in the US.  Mass fatalities with a limited support network due to the pandemic could increase the mental health burden. How can you fight pandemic flu? As far as personal protective measures, the CDC recommends the following: voluntary home isolation of sick individuals, respiratory etiquette, use of face masks, and hand hygiene. https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm Let’s start with handwashing.  Most of you know I’ve already done a podcast on handwashing and protective benefits are real.  However, I heard today that the average man washes his hands for 6 seconds and the average woman spends 7 seconds.  CDC recommends 20-30 seconds and when I last visited the ICU, I was required to scrub for 5 minutes.  In the event of a pandemic, I would strongly recommend washing frequently, with soap, for longer than recommended. Face masks do lower the transmission of respiratory particles in sick individuals, but may be more useful in protecting well individuals.  However, not many people have a sufficient supply to change them out at recommended intervals.  This would be especially true in a protracted 6-month outbreak. I suspect that social pressure would force most people into proper respiratory etiquette.  Sneezing or coughing in public would rapidly make you a social pariah.  Containment of the sneeze/cough into clothing, tissue, or an area other than a hand is vital and I’m not sure I trust total strangers to have my best interest in mind. Containment of sick people in their homes would go a long way to preventing the spread of illness.  However, they may spread illness before they know they are sick.  It can also be difficult to know exactly when you are no longer contagious and can leave containment.  If a family member becomes sick, how do you care for them without infecting the rest of the family?  Should the entire family stay contained to their home for possibly a couple of months until we are sure none of them are asymptomatic, but contagious. Here are a couple of other ideas not specifically mentioned by the CDC.  I personally would consider reverse isolation.  Rather than waiting until I am sick to contain myself, I might self-quarantine myself and family to prevent exposure to the virus.  Cutting out all social activities to include work could have its own problems, but might be the best way to prevent person to person transmission.  The next couple of items all require prior preparation.  Creating an area in your home where you can treat a sick family member while keeping them separate from the rest of the family could limit the spread through the household.  Having all of the basic medical supplies available at home would prevent a trip to the hospital where you would almost certainly be exposed to multiple ill people, possibly with different variations of the strain. For these strategies to work, you must have a good supply of food, water, and household goods or you will be forced to interact with the public.  Additionally, if you won’t be working for possibly months, you can’t go wrong having a good emergency fund. https://www.moneycrashers.com/prepare-next-pandemic/ Having a plan of how you would respond to a pandemic isn’t a guarantee that you or your family will stay safe from the virus.  There are just too many variables.  But, if you have a plan, when everyone is scrambling around reacting to the crisis, you and your family can respond calmly and deliberately.  Knowing how you will respond goes a long way towards eliminating fear and worry. I hope that the next 1918-like pandemic is a long way off.  Given enough time, I think we will develop a vaccine that prevents infection of multiple strains.  Discovery of this vaccine would take a flu pandemic from a significant world threat to another irrelevant disease like polio, tetanus or the measles.  Until then, man and virus will continue the evolutionary arms race.

Tens of thousands of people die from the flu every year, yet most of us tend to ignore it. In today’s podcast we discuss the dangers of influenza, the effect it has had on history, and what the future holds. Greetings all.  Hard to believe that my podcast has been going for almost 4 months.  I really do appreciate all of you tuning in every week.  Hope you’ve enjoyed listening as much as I have enjoyed making them. Today’s podcast is Influenza: I think there is a shot for that All the coverage the coronavirus has been getting has made me want to talk about the flu.  It is always easy to be scared of the new unknown thing, while we easily disregard the common everyday hazards. Year-in and year-out the flu kills almost as many people as traffic deaths.  Yet, we almost completely ignore this illness every fall. I pretty much ignored the illness, after all, what’s the worst that could happen?  You just feel lousy for a couple of days and then get back to everyday life. Prevalence of the flu However, that illusion was shattered when one of my co-workers had a child catch the flu.  After a couple of days in the hospital, she passed away.  Everyone was shocked and heart-broken.  How does this happen in our day of advanced medical care? Turns out, these deaths aren’t really all that rare.  In the US, during the 2018-2019 flu season over 35 million people were infected.  Of those, 16 million sought medical care, half a million were hospitalized, and over 34,000 people died.  https://www.cdc.gov/flu/about/burden/2018-2019.html This was actually a fairly mild year.  In the 2017-2018 season, these numbers were almost doubled with an estimated 60k deaths due to the flu.  https://www.cdc.gov/flu/about/burden/2017-2018.htm Just to put that number in perspective, between 2016-2018 each year there were about 40k deaths due to traffic accidents in the US.  Who’s at risk from influenza? Of those 60k flu fatalities, the 0-5 age range fared the best, representing only 0.1% of all fatalities.  Generally, most diseases target the young and the old, but with our current influenza strains, the risk increases with age.  Only six percent of flu deaths occur in people under 50 years old even though they account for nearly 60% of all flu illnesses.  For this age group, the flu is generally just an unpleasant, but not fatal, experience.  On the other hand, the 65+ age group represents only 13% of total flu illness, but 83% of all flu deaths. https://www.cdc.gov/flu/about/burden/2017-2018.htm Clearly, the elderly are at much greater danger from the flu than the general population.  The reasons for this get pretty complex, but it is hard to argue with the numbers. Like the coronavirus, influenza is a virus.  While we have multiple antibiotics to treat bacterial infections, our viral treatment options are still amazingly limited.  Because viral reproduction occurs in a host cell, targeting of viruses is something we still have a long way to go on.  I believe we will eventually figure this out, but until we do, vaccinations are the best tool we have.  The flu vaccine Our immune system is remarkably efficient at destroying viruses, if it has seen them before.  Vaccinations are how we prime the body to effectively fend off viral illnesses. While vaccinations are the key, we still have a long way to go in preventing the flu among adults.  In the 18-19 season, only 45% of US adults were vaccinated for the flu.  Nevada, Louisiana, Florida, Wyoming, Georgia, and Mississippi all have less than 40% vaccination rates, while Rhode Island, Massachusetts, Connecticut, Maryland, and North Carolina lead the nation with greater than 50% vaccination rates. https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm A recent study looked at the effect increasing vaccination rates could have on illness.  They estimated that every nationwide 5% increase in vaccination could result in ¾ million fewer illnesses and 11K fewer hospitalizations.  That is a lot less suffering. However, for me, the most interesting part of the study was that improving the efficacy of the vaccine by 5% would reduce the number of illnesses by over a million and reduce hospitalizations by 25K.  Improving the vaccination itself by 5% could double the number of reduced hospitalizations.  It is apparent that we still have a ways to go with the influenza vaccine. https://www.ncbi.nlm.nih.gov/pubmed/31344229 This study made me curious about the actual efficacy of the flu vaccine.  The CDC has some pretty good data on flu vaccine efficacy since 2004.  During that time, the efficacy has ranged from 20-60% with an average of about 40%.  https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html So, the vaccination rates and the vaccine efficacy are roughly equal but for the most part less than 50%.  This surprised me quite a bit.   Two doses of the polio vaccine are about 90% effective while one dose of the MMR vaccine is 93%, 78%, and 97% effective for measles, mumps and rubella respectively.  Less than 50% efficacy means we still have a long way to go. There are a couple of reasons for this.  First, the vaccine consists of the 3-4 different strains of the virus, but scientists must predict 6 months in advance which strains are going to be most prevalent during the flu season.  This lead time is necessary to grow the amount of vaccine that is needed.  Also, while most vaccines are primarily designed to help children with little underlying disease and a robust immune system.  With the flu, the primary target age is the elderly population with underlying medical conditions.  Additionally, older adults have a complex history of prior infections and vaccinations. https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm Another interesting challenge is what is called intra-season waning.  While the body will remember the first flu virus it comes into contact with for a very long time, the body has a limited memory for additional strains.  In fact, the immunity from the vaccine has been shown to decline by 7-16% per month.  This means that if you get vaccinated early in the flu season, the effectiveness may be significantly eroded should you encounter the virus late in the season.  However, people that wait too long may contact the virus before vaccination or they may just decide not to get it for the season. https://www.statnews.com/2019/10/14/updated-guide-changing-science-flu-shots/ Flu evolution So why do we keep having to change the vaccine?  The flu virus is a negative-sense RNA virus in the Orthomyxoviridae family.  There are three types of viruses A, B, and C.  To make things even more complex, the virus can infect birds, pigs, cattle and other mammals as well as humans.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139605/    While strains generally can only survive in one species, every once in awhile, the strain will jump from one species to another just like we discussed in the coronavirus podcast.  These jumps are most likely to cause pandemics like the 1918 flu pandemic that we will discuss in a minute.  In the 20th century, the jumps occurred in 1918, 1957, and 1968. While these jumps are dramatic and potentially dangerous, our season to season variation is most influenced by another trait.  The influenza virus has a very high mutation rate.  The rate can be as high as 1 error per virus replication.  While many of these mutations are fatal to the virus, occasionally one of these mutations gives the virus an advantage over the human immune system.  This competitive advantage allows this virus to be more successful and gives rise to a new strain.  This is referred to as antigenic drift, or slow but steady change A final feature is the ability to reassort viral chromosomes.   The 8 RNA segments of the virus code for 10 or 11 different proteins.  When two or more influenza strains infect the same cell, the progeny viruses can contain a mix of RNA segments from both parent strains.  This leads to what is known as antigenic shift.  These abrupt changes are more likely to lead to pandemic type events.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674800/ 1918 Influenza pandemic The most devastating pandemic in recent history occurred in 1918, shortly following WWI.  While a normal pandemic type flu might have a case fatality rate of <0.1%, the case fatality rate of the so-called Spanish flu was >2.5%.  An estimated 1/3 of the world’s population contracted this virus.  The death toll was between 50 and 100 million.  Keep in mind that the total casualties for WWI were 40 million, with ~20 million deaths.  The lowly flu killed 2-5x as many people as one of the world’s most destructive wars. No one is sure exactly where the 1918 flu came from, but it occurred in three distinct waves almost simultaneous in Europe, Asia, and North America.  The first wave occurred in the spring of 1918 and lasted about 6 months.  More people than normal became sick, but the number of fatalities was not significantly more severe.  A second fall wave began in September of 1918.  This wave was deadly and accounted for many of the deaths. The final wave of illnesses began in early 1919.  This wave had high numbers of fatal pneumonias and severe complications. We already discussed the propensity for influenza to be highly fatal in the elderly population.  An unusual hallmark of the 1918 pandemic was a high number of deaths in the 20-40 year age range.  In fact, people under 65 were much more likely to die than those over 65.  These unusual fatality patterns made this pa

I thought it was time for an update on the Coronavirus or COVID19 now that things have progressed a little bit. Hope you enjoy listening to the update. I didn’t have time to transcribe the podcast, but below are my references. https://www.cnn.com/asia/live-news/coronavirus-outbreak-02-12-20-intl-hnk/index.html https://www.cdc.gov/media/dpk/diseases-and-conditions/coronavirus/coronavirus-2020.html https://www.cdc.gov/coronavirus/2019-nCoV/summary.html https://jamanetwork.com/journals/jama/fullarticle/2761044 https://jamanetwork.com/journals/jama/fullarticle/2761043 https://www.busiweek.com/the-economic-consequences-of-the-coronavirus/ https://www.bloomberg.com/graphics/2020-global-economic-impact-of-wuhan-novel-coronavirus/ https://www.bloomberg.com/graphics/2020-global-economic-impact-of-wuhan-novel-coronavirus/ Listen to the original Coronavirus podcast

I’ve wondered for a long time how dangerous energy drinks are. In today’s podcast we talk about caffeine and investigate the dangers posed by the booming energy drink industry. Glad you could join me today.  Hope you find today’s podcast as interesting as I did.  If you enjoy the podcasts, you could really help me out by sharing them with friends and family. Today’s podcast is: Energy Drinks:  I like to measure my caffeine intake in grams At work, we have recently been discussing energy drinks.  While we all partake from time to time, one individual ingests a remarkable amount of caffeine.  The last time we figured out his caffeine intake, it was almost 2 grams per day.  We all agreed that there is no way this could be healthy.  However, opinions based on gut instinct are rarely reliable and so I decided to dig into the facts and see what the science says. I realize I am treading dangerous ground by potentially interfering with people’s morning routines, but here goes. Caffeine has been a sacred part of the morning ritual for most of the history of mankind.  About 85% of Americans consume caffeine daily.  It is probably one of the most widely consumed substances in America.  This is great from a scientific standpoint as it gives us a huge human test population.  With these types of numbers, even very rare adverse outcomes should be readily visible. How does caffeine work? We all know that caffeine makes us more alert, but how does that happen.  I found a couple of different explanations but they all have to do with the adenosine receptor.  Adenosine is created by the brain to let the body know when it needs sleep.  Adenosine binds to the nerves slowing down nerve cell activity and prepares the body for sleep.  Caffeine preferentially binds to these receptors preventing the attachment of adenosine without slowing the nerves.  This increases neuron firing causing us to feel more alert and improves athletic ability by decreasing the reaction time of our nerves.  Over time, the caffeine degrades and there is a large amount of accumulated adenosine waiting to bind to the receptors.  This sudden binding is what leads to the crash after caffeine consumption.  https://science.howstuffworks.com/caffeine4.htm https://www.mentalfloss.com/article/54536/how-does-caffeine-work Can you die from caffeine overdose? Lethal overdoses of caffeine have occurred, but they are rare.  Most of these overdoses occur through ingestion (often intentional) of purified caffeine rather than through the ingestion of beverages.  In fatalities, 10 grams or more are ingested in a single dose. In 2016 there were over 3700 cases of caffeine poisoning reported to Poison Control Centers in the US.  Of these poisonings, 846 required treatment at a hospital and 16 of those had negative outcomes. https://www.ncbi.nlm.nih.gov/books/NBK532910/?report=printable How much caffeine is in an energy drink How much caffeine is in your typical energy drink?  While there is no “typical” energy drink, National Institutes of Health says the caffeine ranges from 47-80mg per 8oz serving.  Energy shots can have over 200mg of caffeine in as little as 2oz. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583516/ While energy drinks are popular, the majority of Americans get their caffeine from coffee and soft drinks.  A quick scan of different Starbucks coffee brews shows that caffeine content ranges from 75 to 280mg of caffeine per 8 oz serving.  The vast majority of the coffee blends have over 80mg which is the high end of the energy drinks.  I had assumed that energy drinks contained significantly more caffeine than coffee, but the reverse is actually true. https://www.caffeineinformer.com/the-complete-guide-to-starbucks-caffeine Soft drinks are a very popular way to get some caffeine on board.  In the same 8oz serving, sodas have between 15 and 35mg of caffeine.  https://www.math.utah.edu/~yplee/fun/caffeine.html From a caffeine perspective, energy drinks don’t seem too dramatically different from previously available sources of caffeine.  How much caffeine is safe? The FDA regards 400mg of caffeine a day as a safe level.  The WHO sets the threshold at 500mg.  Several meta-data studies also arrive at the 400mg per day level, while one sets the level at 300mg for those with high blood pressure. Depending on your coffee or energy drink size, it isn’t particularly hard to exceed these limits, but it would be pretty difficult to drink 10 grams of caffeine in any form, not mention cost-prohibitive. Caffeine effects and side effects As with any drug, there are negative side effects as well as desired outcomes.  On the negative side energy drinks have been associated with minor heart malfunctions, an increase in blood pressure, anxiety, insomnia, gastrointestinal upset, muscle twitching, and restlessness. Other studies have suggested a correlation between energy drinks and violent behavior.  Others suggest that the high amounts of sugar in energy drinks (similar to soft drinks and possibly coffee) could lead to Type 2 diabetes and obesity.  Caffeine is a diuretic that can lead to dehydration and possible electrolyte imbalance.  Swedish and American studies showed a correlation between energy drinks and dental erosion.  They point to high sugar content and low pH which are also present in soft drinks.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682602/ I probably don’t have to go into the desired effects of caffeine since most of us have experienced them first hand.  However, multiple studies validate what we already know.  Caffeine significantly improves alertness, improves mood, increases aerobic endurance, and an increase in performance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682602/ Honestly, many of the negative effects seem to be a bit of a stretch to me.  As we discussed in the episode on statistics, correlation doesn’t necessarily mean causation.  I could find three solid negative side effects.  Difficulty sleeping is a real thing.  Anyone who has enjoyed some caffeine a little too late in the evening can attest to this.  Headaches and irritablity, particularly during withdrawal, are strongly associated caffeine.  The final and perhaps most serious side effect is combining alcohol and caffeine.  Energy drinks combined with alcohol enable the consumption of more alcohol than alcohol alone.  Caffeine is pretty effective at counteracting the feeling a drunkenness.  This can lead to an incorrect evaluation of imparedness.  Additionally, this can contribute to fatal alcohol poisoning and has been a factor in several high-profile alcohol poisoning deaths. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583516/ Energy drinks contain other ingredients that could have their own health effects.  We’ve already mentioned sugar.  Like soft drinks, energy drinks are an easy way to consume a large amount of “empty” calories in the form of sugar or high fructose corn syrup.  This is something you should certainly consider.  Other ingredients include guarana, taurine, ginseng, B- vitamins, and carnitine.  The few studies I could find were unable to detect an improvement in alertness or other desired effects due to these additives.  Any potential negative consequences are poorly understood and there is room for further research.  Energy drinks and kidney stones I have often heard that energy drink consumption leads to kidney stone formation.  Having personally given birth to a kidney stone, this would be a significant reason to avoid energy drinks.  I found a study of over 200,000 medical professionals looking at caffeine intake and kidney stones.  The results of the study surprised me a bit. The quantile with the highest caffeine consumption had a 12-48% lower incidence of kidney stones.  I never would have guessed that caffeine consumption would lower the risk.  I guess that is why you should always back your gut feeling with science. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232021/pdf/ajcn10061596.pdf I wondered if the temperature of the caffeine when consumed made any difference on its effects upon the body.  A study using 24 subjects ages 18-30 found no differences in pharmacokinetic outcomes between caffeine consumed while hot or cold. https://www.ncbi.nlm.nih.gov/pubmed/27100333 Has caffeine consumption gone up? While energy drinks are getting all the negative publicity, it is interesting to note that the total amount of caffeine consumed by Americans hasn’t changed very much since energy drinks were introduced.  While I tend to think of teenagers and younger adults as consuming the most caffeine, several studies show the 50-64 age group consumes the most caffeine.  Among all age groups, the most common way to consume caffeine is through coffee.  However, the 18-24 age group consumes less than half the caffeine through coffee compared to 50-64 year-olds.  The younger age group consumes substantially more caffeine through energy drinks than older adults.  The average amount consumed by the young group is ~120mg per day, while the older group consumes ~220 mg per day.  I didn’t expect the difference between the age groups to be that substantial.  https://academic.oup.com/nutritionreviews/article/72/suppl_1/78/1930260 However, both of these age groups fell well within the 400mg limit suggested by the FDA. When I started researching this, I expected to find a significant increase in kidney illnesses, heart problems or even an increase in deaths.  While I could find isolated instances of this occurring, there doesn’t seem to be any data indicating l

Fentanyl has caused a large increase in opioid related drug overdoses. In today’s podcast we discuss fentanyl’s history, uses, why drug dealers love it, and the dangers it poses. Welcome back, everyone.  Thanks to all you who have shared the podcast with friends and family.  As a reminder, all my show references and as well as bonus content can be found on my website at sci-vs-fear.com Today our topic is: Fentanyl: When straight heroin just isn’t enough In the past couple of years, there has been a significant rise in the number of opiate-related overdoses.  Opiates like heroin are nothing new, they have been used by mankind for thousands of years.  As a pain-reliever, it is difficult to match.  However, the addiction associated with opiates has always been an unfortunate side-effect.  This addiction often leads to death by overdose as addicts continually chase a better high. In the US, from 2016-2017, opiate overdoses increased by 47% primarily due to the synthetic opioids.  That’s an additional 24,000+ deaths a year due to man-made opiate-like drugs.  These drugs have names like fentanyl, acetylfentanyl, acrylfentanyl, carfentanil, furanylfentanyl, and U-47700.  In this podcast, we are going to refer to all of these substances as fentanyl. History of fentanyl Fentanyl was invented in 1959 by Belgian physician Paul Janssen.  He synthesized a chemical similar to morphine, but slightly different.  It had a couple of medical advantages over morphine.  It acted faster and was much stronger.    https://www.npr.org/sections/health-shots/2019/09/04/757089868/fentanyl-as-a-dark-web-profit-center-from-chinese-labs-to-u-s-streets In fact, fentanyl is 50-100 times more potent than morphine. This means you don’t have to use nearly as much to treat the same amount of pain.  https://www.cdc.gov/drugoverdose/opioids/fentanyl.html  As we mentioned, there are different flavors of fentanyl, over 30 different unique compounds so far.  These different compounds have vastly different strengths.  For instance, carfentanyl is estimated to be 10,000 times more potent than morphine. https://www.cdc.gov/drugoverdose/data/fentanyl.html The normal IV fentanyl dose is ~ 120 ug which is roughly equal to 2 grains of salt.  The lethal dose of fentanyl for a normal adult is as low as 2mg (equal to about 32 grains of salt).  That’s not a lot. Now let’s look at carfentanil.  Its’ normal use is as a large animal tranquilizer.  Like elephant large.  It takes about 10 mg to sedate an elephant. The lethal dose for a human is ~20ug.  Keep in mind that a single grain of salt is ~ 60ug, so a single grain of carfentanyl contains 3 lethal doses.  Needless to say, this is pretty toxic stuff.  Fentanyl as an illicit drug As with any other legitimate medication, as soon as it enters common use, someone will find a way to abuse it.  One of the first people to profit from fentanyl was a self-taught chemist from Wichita, Kansas, named George Marquardt.  Not only did he figure out how to make fentanyl, he would make different batches so that they wouldn’t all have the same signature.  Some people have referred to him as the original Walter White (referring to the breaking bad character).  Agents who worked the case said that Walter White pales in comparison to real-life Marquardt. http://interactive.fusion.net/death-by-fentanyl/the-walter-white-of-wichita.html The fentanyl he made in 1991-1992 killed somewhere between 126 and 300 people, we will never be sure of the exact numbers. He was sentenced to 25 years.  The fentanyl he produced, also known as china white, was so potent that some of the Philadelphia drug users died so swiftly that syringes were still embedded in their arms.  Similar to today, the victims and the dealers probably thought they were buying heroin. https://www.baltimoresun.com/news/bs-xpm-1993-02-17-1993048223-story.html So why would anyone use fentanyl?  It is a matter of economics.  According to the DEA in Philadelphia, a distributor pays $50,000 to $80,000 for a kilogram of heroin.  After cutting and distributing the product, the drug trafficker can make about $500,000 in profit. A kilogram of fentanyl sells for $53,000 to $55,000 but is 50 times stronger than heroin so profits over $5 million are commonplace. https://www.jems.com/2019/05/07/fentanyl-facts-and-fiction-a-safety-guide-for-first-responders/ How are people being exposed to fentanyl? Like most of the addicts killed by Marquardt, many of today’s overdoses have no idea that they are even buying fentanyl.  An individual I know ran a drug testing program for a large organization.  They wanted to determine if they should be screening for fentanyl so they ran a small subset of their samples against fentanyl.  They discovered about 80 individuals who test positive, but interestingly almost all of these individuals were from the same location of the country and also tested positive for marijuana.  All of these individuals thought they were just buying marijuana, but the dealer had laced it with fentanyl to make his product more attractive. While some of the fentanyl is being sold as heroin, the majority of fentanyl is being sold as counterfeit pills.  There is a large subset of the population that are addicted to prescription medications.  Drug dealers are substituting the actual medications with fentanyl because it is so much cheaper.  The counterfeiters are so effective that often it is impossible to tell the difference between real and counterfeit.  While the pharmaceutical companies are held to very stringent standards about concentrations of medications in pills, the drug dealers have no such constraints.  They mix up the pills like making chocolate chip cookies.  We’ve all had the cookie that has almost no chips.  We’ve also had the cookie with double or triple the chocolate chips.  While more chocolate chips are a good thing, more fentanyl is not.  This sloppiness in production leads directly to death by overdose.  If you normally take three oxycodone to get the necessary high, a single counterfeit pill could contain a lethal dose. Where does fentanyl come from? So where is the fentanyl coming from?  Unlike the methamphetamine lab epidemic of the 1990s, fentanyl is rarely produced in clandestine labs in the US.  Most of the fentanyl responsible for the great increase in overdoses in 2017 came from China.  China has a loosely regulated pharmaceutical industry and can readily supply the drug or necessary precursors.  The amount of mail coming from China has increased exponentially, and so it makes detection of fentanyl being smuggled in a needle in the haystack proposition. Recently convicted drug dealer Aaron Shamo provides a perfect example.  He would buy fentanyl from China via the darknet.  It would be shipped to couriers via international mail.  In his garage, the fentanyl would be mixed with filler powder and stamped by pill presses purchased on the internet into perfect replicas of oxycodone.  It would then be mailed across the US using multiple mailing companies to buyers who would place orders via the internet. He was eventually caught when postal inspectors intercepted a 100g package of fentanyl coming from China.  This was enough fentanyl to make 100,000 pills.  On the day they arrested one of his mail runners, they intercept over 34,000 pills destined to be shipped out in a single day.  There is no way to know exactly how many people Aaron Shamo killed with his counterfeit pills. https://apnews.com/ce51cf7c958643629bce76764f71058d In the last year, a fair amount of progress has been made on both the US and the China side to limit the flow of fentanyl.  However, whenever a supply vacuum develops and another producer will surface.  Like the methamphetamine shift over a decade ago, much of the fentanyl synthesis and pill production now takes place in Mexico.  The drug cartels have found another way to make money.  https://www.insightcrime.org/wp-content/uploads/2019/02/Fentanyl-Report-InSight-Crime-19-02-11.pdf  27% of the tablets seized by the DEA between January 2019 and March 2019 and contained a potentially lethal dose of fentanyl. https://www.newschannel6now.com/2019/11/04/dea-warns-about-counterfeit-fentanyl-pills-mexico/ Symptoms and treatment So how does fentanyl kill its victims?  While symptoms of fentanyl overdose can include feeling faint, dizzy and confused, the main symptom is decreased respiratory drive.  Basically, after an overdose, you get so relaxed that you forget to breathe.  Obviously, you can’t forget to breathe for very long without adverse consequences. Victims can be kept alive through artificial respiration, but the most common treatment is the administration of naloxone or Narcan.  Naloxone works by removing the opiate from the receptor.  The reversal of the symptoms is amazingly fast.  Ask any EMT who has administered naloxone, an overdose victim can go from dead to fighting in a couple of seconds.  For addicted individuals, the administration of the antidote can lead to instant withdrawal, a fairly painful experience.  Hence, they wake up swinging. One of the hazards associated with the fentanyl epidemic is the increased hazard to first responders.  When a single grain of carfentanil can lead to an overdose, some precautions necessary.  While the actual hazard has been debated, to this point there’s been no toxicological evidence to support the conclusion that any first responders have actually experienced opioid toxicity. Fentanyl cannot pass through the skin, but inhalation does pose a hazard.  If a hig

Any time a novel disease emerges it gets a lot of attention. Today we discuss the history of the coronavirus, where this strain came from, and how dangerous it might be. Today’s topic is: Coronavirus:  I’d like mine with lime, chilled, and on a beach I first heard of the new coronavirus outbreak a couple of weeks ago.  First off, in full disclosure, I did terrible in virology while getting my first degree in microbiology.  Once something gets so small that I can’t see it with a normal microscope, I lose interest. Maybe you had better news coverage than I did, but the information I first heard wasn’t super specific or particularly informative.  The first report I heard made it seem like coronavirus was a newly discovered virus. What we know about coronavirus The first coronavirus was discovered in 1965 by Tyrell and Bynoe and named B814.  Pretty catchy name huh?  We’ve gotten better at making new diseases sound much scarier.  Since then, we have discovered dozens of corona viruses in a wide variety of mammals, birds, and reptiles.  https://journals.lww.com/pidj/fulltext/2005/11001/history_and_recent_advances_in_coronavirus.12.aspx Corona in Latin means crown.  The surface of the coronaviruses is covered with spikes that make it look like a solar corona under electron microscopy. The coronavirus is a  ~125 nm round particles.  For those of you like me, for whom the metric system is still a bit of a mystery, that’s 125 billionths of a meter.  Pretty dang small.  They are known as a positive-sense RNA virus.  I won’t go any further into what this means as it bored me to tears in virology, but I’ve referenced several papers in my show notes that explain it in depth. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747522/ There is still debate as to whether viruses are actually alive.  Viruses are essentially packets of DNA/RNA that hijack a cell’s machinery to produce more viruses.  Without a host, viruses cannot reproduce.   Coronavirus is no different.  The outside of the virus contains receptors that bond with the surface proteins in the cell.  Once it binds, the viron starts a process that enables it to become part of the cell wall, barfing its RNA into the cell cytoplasm.  This causes the cell to produce viral proteins and RNA.  These are then packaged by the cell using the Golgi apparatus and other processes which then releases the newly formed viral particles from the cell. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306801/ You have likely been infected by a coronavirus as some point in your life.  Fifteen to 30% of all common colds are caused by a member of the coronavirus family.  We’ve all had colds, and while they are pretty miserable, they are generally pretty minor and stay in the upper respiratory tract where they don’t interfere with breathing in a life-threatening way.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416289/  Serious coronavirus outbreaks Before 2002, due to mild disease symptoms, coronavirus was considered more of a pest than a serious health problem.  In 2002, the disease known as SARS (severe acute respiratory syndrome) emerged from China.  Now that’s a proper scary name.  In the 2 years it took to contain the outbreak, 8098 cases were identified with 774 deaths.  With a case fatality rate of nearly 10% (over 50% in elderly individuals), this disease got the world’s attention.  While the world wondered for a while if this might be the next great pandemic, person to person transmission of SARS is fairly inefficient and so outbreaks were generally localized to households and hospital settings.  Because of this trait, the outbreak was contained. In 2012, another strain known as MERS (middle east respiratory syndrome) emerged from Saudi Arabia.  In the early stages, the mortality rate was nearly 50%.  When the outbreak was finally contained there were over 2000 cases reported worldwide with a case fatality rate of over 30%.  Like SARS, MERS caused severe disease in individuals with underlying medical conditions.  What the case fatality rate would look like in the normal population is difficult to determine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/pdf/nihms671207.pdf Where new coronaviruses come from These two previous outbreaks, as well as the current developing disease, are all attributable to an animal strain mutating and crossing over to human hosts. While identifying the exact animals from which the strain emerges is difficult, research indicates that bats are the most likely vector.  Other animals implicated are snakes, camels, palm civets, and raccoon dogs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747522/ When a disease jumps species, it is often associated with increased lethality.  Generally, except for diseases like rabies, being highly lethal isn’t a successful model from the virus’s point of view.  A dead victim doesn’t do a good job of spreading the virus to other humans.  A victim in the hospital setting is also largely prevented from transmitting illness to the general population.  However, a single individual with a propensity to not wash their hands and runny nose can be a viral reproductive jackpot. Any time a new disease comes on the scene, the highest case fatality rates are almost always at the beginning of the outbreak.  As the virus or bacteria becomes adapted to the new human host, the lethality almost always goes down.  Therefore, dire predictions are easy to make but generally unsubstantiated by the end of the outbreak. We can’t get too complacent however, as history has several examples of pandemics that greatly reduced the population of the entire world.  Kudos to public health and hospitals for the fantastic job they usually do in containing these new outbreaks. How dangerous is the 2020 China coronavirus outbreak? So how dangerous is this latest outbreak known officially as 2019-novel coronavirus?  I’m sure they will come up with a scarier name soon. The outbreak was detected in December 2019 in Wuhan China and is linked to a large seafood and animal market.  However, many of the current patients have no connection to this market suggesting that the disease is now spreading person to person.  Since its discovery, the virus has caused illness in Taiwan, Thailand, Japan, South Korea, and the United States.  With our highly mobile modern society, this spread is to be expected. Unlike the SARS and MERS outbreaks, the gene sequence of the virus was determined and published within weeks of the outbreak discovery.  This provides a powerful tool in tracking the illness that was missing to some extent in previous outbreaks. https://www.cdc.gov/coronavirus/2019-ncov/summary.html As of the 21 Jan 2020, 440 cases have been confirmed across 13 provinces in China.  These cases have resulted in 9 confirmed deaths.  According to my math, that is a case fatality rate of about 2%.  This is considerably lower than the ~50% fatality rate reported at the beginning of the MERS outbreak.  The latest info I found in the Washington Post has the case fatality rate inching up to 3% as well as a second case in the US. https://www.washingtonpost.com/world/coronavirus-china-live-updates/2020/01/24/4e678f9c-3e03-11ea-afe2-090eb37b60b1_story.html A recent study estimated the actual number of cases at ~4000 with a range between 1,000 and 9700.  https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news–wuhan-coronavirus/ Reported versus actual incidence gets pretty tricky.  For the illness to be reported, the individual has to be sick enough to go to the hospital.  As a result, the statistics are skewed towards only seeing the most severe cases bumping up the apparent case fatality rate.  If there were 10,000 people who only got colds from this virus, it would appear to be much more dangerous than it actually is because we only measure it in people who visit the hospital. Another thing that will make this outbreak difficult to compare to SARS and MERS is the definitive test that exists for detecting it.  In SARS and MERS, individuals were diagnosed based on symptoms and case history rather than a lab test.  When a lab test was developed for MERS, the number of reportable cases shot up dramatically. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/pdf/nihms671207.pdf I don’t know, but I suspect that having a definitive laboratory test for this outbreak will cause the number of cases to be larger than previous outbreaks, but keep the case fatality rate much lower.  Whatever the outcome, comparing the outbreaks apples to apples with be difficult. What does this outbreak mean to us? Due to the outbreak, China has severely limited travel (something that might be more difficult in the US) which should curtail its spread.  To this point, CDC hasn’t recommended major travel restrictions for US citizens going to China.  They do recommend that travelers to China should avoid contact with sick people, avoid animals and raw meat products, wash their hands frequently, and not travel if illness develops.  If a traveler develops fever, cough or difficulty breathing, they should seek medical care.  Before going to the hospital, they should call ahead to make sure the facility is prepared to receive them properly.  https://wwwnc.cdc.gov/travel/notices/watch/novel-coronavirus-china For viruses, the prevention of disease through vaccination is much more effective than treatment of the illness.  To this point, developing a coronavirus vaccine has been difficult due to the rapid waning of coronavirus immunity.  Developing vaccines for at-risk populati

Have you ever heard of ricin? It is one of the most dangerous toxins out there. A favorite of terrorists and the KGB. How common is it and should you be worried? Hey all, thanks for listening again.  I especially appreciate everyone who has shared my podcast with their friends.  Thanks for giving me a reason to dive into each of these topics and put my thoughts into words. Today’s episode is: Ricin: These beans taste terrible I’m not sure if you’ve ever heard of ricin, but in my line of work, ricin seems to pop up quite often.  It is incredibly toxic, yet relatively easy to come by.  This combination makes it a favorite of terrorists, criminals, and even spy organizations.  In addition to this, there is an occasional accidental poisoning.  Where ricin comes from Ricin is a poison extracted from the castor bean.  Many of you may have seen the castor plant.  It is a very ornamental plant with large green and red leaves.  The first time I recognized one, it was in a planter in front of a local hospital.  I bet they didn’t know that their entrance was being guarded by one of the world’s most toxic plants.  While the entire plant can be toxic, the beans are the main source of the toxin.  Take a look at my website for a picture of the plant and the beans. You’ve probably heard of castor oil.  It is also extracted from castor beans, but the process removes the poison.  That’s a good thing because my Grandma was a big believer in castor oil for many different ailments.  Not sure if it ever helped, but the taste left something to be desired. Obviously, I’m not going to go into how the poison is obtained from the bean, but it is fairly easy.  Thankfully, it is a little more difficult than most of the illicit internet sites make it seem.  If you want a fairly pure ricin, that requires some advanced techniques. Accidental ricin poisonings Most of the accidental poisonings are a result of pets, children, and even occasionally adults eating the beans.  As long as the beans aren’t chewed, most people recover, but a couple of thoroughly chewed castor beans is enough to kill an adult.  I’m not sure of the episode, but one of the contestants on Discovery’s Naked and Afraid realty show, is shown eating some beans from an unknown plant and then getting violently ill.  When they showed the plant, I was surprised to see that it was a castor plant.  Apparently his preparation methods attenuated the toxin to some extent, but the man is lucky to have survived. In a case study from Morocco, 7 and 10-year-old girls became very ill in separate incidents after eating castor beans.  Both girls arrived at the ER unconscious and suffering from seizures. Both girls reported abdominal pain and vomiting about 2 hours after eating the beans.  When stomach contents were emptied, castor bean remnants were present.  With intubation and supportive care, both girls were able to completely recover. https://www.srlf.org/wp-content/uploads/2015/11/1209-Reanimation-Vol21-N5-p555_p556.pdf Intentional ricin poisonings Intentional poisonings are more common than you might think.  Looking at Wikipedia, there are 27 different ricin incidents listed.  I’m aware of a couple of others that aren’t listed, so it isn’t an all-inclusive list by any means, but that gives you an idea of its prevelence. https://en.wikipedia.org/wiki/List_of_incidents_involving_ricin Probably the most famous ricin poisoning is the murder of Georgi Markov.  Markov, a dissident from Bulgaria, was author, playwright, and outspoken critic of the Soviet Union.  He published multiple books and plays demonstrating the flaws of communism in his native Bulgaria.  At the time of his murder, he worked for the BBC. In September of 1978, he was waiting at a bus stop on his way home from work.  He felt a slight pain in his thigh and turned around to see an individual picking up an umbrella.  The man, who had a foreign accent, apologized to Markov. Within a couple of days, he developed a high fever.  He went to the hospital shortly after and died within 4 days of the incident.  An autopsy was performed at the Wandsworth Public Mortuary on September 12.   The autopsy showed his lungs were full of fluid, his liver was severely damaged, and his intestines, heart and lymph nodes, were full of small tears.  More interestingly, a small 1.5mm pellet was recovered from a small puncture wound in his right thigh.  There were two small holes drilled into the BB which was a watch bearing the size of a pinhead.  No poisons were detected in the pellet.  However, in an incident several weeks prior, another defector Vladimir Kostov had suffered a similar wound and the BB recovered from that case contained ricin sealed into the BB with a wax that melted at body temperature.  By their very nature, the .34mm holes in the BB could only have been drilled using very advanced technology.  The total dose of ricin in the projectile was estimated at 0.2mg.  Just to put into perspective how deadly ricin is, that’s about only about 0.2 thousandths of an aspirin tablet. https://www.ncbi.nlm.nih.gov/pubmed/19137875 https://www.cnn.com/2003/WORLD/europe/01/07/terror.poison.bulgarian/ https://www.ncbi.nlm.nih.gov/pubmed/19137875 https://www.youtube.com/watch?v=oDRtVI6UQM4 One more ricin assassination was attempted in the US in 1981. In August of that year, an exposed CIA double agent, Boris Korczak, was struck in his kidney by a similar ricin filled pellet fired from an air gun while he was shopping for food in Virginia.  Some people claimed that Russia was responsible, while others point fingers at the CIA.  Possibly due to a thick sweater, the pellet did not penetrate deeply and was discovered in a blood clot from the wound.  A picture of the pellet and the link to a youtube video describing the circumstances can be found on my website. https://www.rferl.org/a/russia-skripal-kremlin-foes-exotic-toxins/29083216.html https://www.youtube.com/watch?v=oDRtVI6UQM4 The ricin toxin The ricin toxin is a protein composed of two different protein chains.  The poison acts on the cells by destroying the ribosomes.  If you remember your high school biology, the ribosomes are responsible for protein production.  These proteins are vital to cell function.  The first chain of the toxin prevents the production of proteins, and the second chain allows the toxin to invade the cell.  A single ricin molecule can deactivate up to 1500 ribosomes per minute which may be enough to kill the cell.  https://www.ncbi.nlm.nih.gov/books/NBK441948/ The symptoms of ricin depend on the route of entry.  Ingestion is the classic route of exposure.  This leads to large amounts of vomiting and diarrhea (often bloody).  This generally causes dehydration, seizures and often leads to death due to multi-organ failure. Although ricin cannot be absorbed through the skin, injection leads to different symptoms.  As was the case in the Markov incident, high fever is the main symptom along with fast heartbeat and breathing followed by liver, kidney, and heart damage.  Swelling of the brain and vomiting and diarrhea can also be present. Probably the most dangerous route of exposure is inhalation.  It would be difficult for the average terrorist to make ricin that could be inhaled, but it would be very dangerous if they did.  Within a couple of hours after inhalation, victims would beginning having difficulty breathing.  Additionally, they would have fever, cough, and nausea.  Low blood pressure and respiratory distress could lead to death in a matter of hours. http://www.centerforhealthsecurity.org/our-work/publications/ricin-toxin-fact-sheet There is no antidote for ricin.  Following exposure, medical treatment would consist of treating the individual symptoms.  I did find one research paper that indicated that milk had the power to inactivate the ricin toxin.  It appears to bind to the ricin protein preventing it from absorbing into the cells.  This treatment would have to be performed very rapidly before the toxin entered the cells. The ricin toxin can be inactivated by heat greater than 80C.  If you are trying to deactivate ricin, the CDC recommends using pH neutral bleach. Ricin is clearly one of the more toxic substances out there.  Assuming you don’t routinely eat unknown plants, you probably are pretty safe.  Even if you should eat castor beans, you stand a pretty good chance of surviving unless you chew them thoroughly.  However, an intentional poisoning with ricin can be pretty deadly.  Based on my experiences, there are plenty of bad guys that have an interest in ricin so I would be willing to bet there will be more ricin poisonings coming soon to a newspaper headline near you. Listen to my other podcasts here.

In this podcast, we ask the question, how dangerous is football? As one of America’s most played sports, you need to know just what the risks are. Hi everyone.  I hope you have been enjoying listening to these podcasts as much as I have enjoyed recording them.  If you know anyone who might also enjoy listening to the podcast as well, please feel free to share it with them.  It would be much appreciated. Today’s podcast is Football: Who doesn’t love a concussion First off, for those joining me today outside the US, we are discussing American football.  I fully admit that for those of you who play rugby, are MMA fighters or bull-riders, American football isn’t that much of a contact sport.  However, for most of the US, football is the physical, high contact sport.  In my podcast on statistics, we discussed a study on brain injury among football players.  The claim often made about the study was that 99% of all football players suffered from brain injuries which wasn’t a valid conclusion for the study.  That study did get me wondering how dangerous football really is. Just for full transparency, playing sports isn’t something I enjoy much.  I played a little soccer as a kid and in high school, the closest I came to team sports was cross-country running and wrestling. As a father, one of my boys played football prior to high school and since he enjoyed it, I supported his decision to play.  However, I do remember attending his 6th-grade end of year football banquet.  The introduced the players individually and said something about their accomplishments.  I do remember that a large number of boys had spent at least part of the season not playing due to injuries.  At the end of the introductions, the coach mentioned it too saying “if you don’t get hurt playing football, then you probably aren’t playing hard enough”.  To this day, I’m trying to find something important enough about 6th-grade football to justify an injury that could be with you for a lifetime. However, I never really actually looked at the data to see if my opinion had any validity. First off, let’s take a look at youth football.  Most people would agree that youth football isn’t comparable to college football and that college football isn’t very similar to professional football. High school football injury statistics According to Stanford, 3.5 million children 14 and under get hurt every year from sports and recreational activities.  About 215k children visited the emergency room due to football injuries (both organized and informal).  Just to put this in perspective, the number injured in bicycling accidents was 200K, basketball 170K, skateboarding/inline skating 113k, baseball/softball 110k, soccer 88k, and trampolines 65K.  All of these were compared to 215K football injuries.  As you can see, a lot of children 14 and younger visit the emergency room. A different study by UC Denver has been tracking sports injuries at selected schools since 2005.  They estimate that annually there are 1.2-1.4 million high school sports injuries per year across all sports.  From 2013-2018 football accounted for 39% of all injuries.  For comparison, girl’s soccer was 17%, boy’s soccer 12%, boy’s basketball 6%, and girl’s volleyball 4% of high school sports injuries. However, keep in mind that the different sports have different team sizes.  A football team with 50 players would be expected to have higher total injuries than a basketball team with 15 players.  The injury rate, which takes into account the actual numbers of individuals playing each sport, for football from 2005-2018 was 3.9%.  With girls’ soccer at 2.4%, boys’ soccer 1.8%, boys basketball 1.5%, and girls volleyball 1.2%. As would be expected, football has higher injury rates than lower contact sports.  With football, the primary injury of concern has been head injuries.  In 2018, head injuries were 21.7% of football injuries, with ankle 12%, knee 7.9%, hip 5.6%, and shoulder 5.2% rounding out the top 5.  For comparison, in girls’ soccer which had the next highest injury rate, 21% were head injuries with 20% ankle, 15% knee, 11% hip, and 4% lower leg. http://www.ucdenver.edu/academics/colleges/PublicHealth/research/ResearchProjects/piper/projects/RIO/Documents/2018-19.pdf I was somewhat surprised that head injury rates were almost identical for boys’ football and girls’ soccer.  If we are looking at preventing high school head injuries, perhaps we need to look at girls’ soccer just as closely as boys’ football. High school football emergency room visits Another study looked at 658,000 high school football players that were seen in the emergency room.  Only 1.1% of injuries required admission to the hospital and the average length of stay for those admitted was 2.4 days.  The average hospital cost worked out to about $90 per participant per year.  Combining the youth and adult populations, there were 1900 spine injuries and 10 deaths (about 2.5 per year).  Looking from 1990-2010, of the 243 football-related fatalities, 67% were from indirect causes such as heat exhaustion, cardiac arrhythmias, and dehydration.  33% were from direct traumatic football injuries. Assuming 3.75 million participants per year over the 4 years covered in the study, the rate of neurologic injury requiring surgery was 0.0014%.  They did see an increase in reported concussions, but it is unclear whether this is an actual increase or just an increase in reporting due to heightened awareness and scrutiny.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937786/ Long term effect of high school football injuries One of the biggest questions is what are the long-term effects of concussions upon football players.  Almost every study points this out in the discussion section.  By definition, these studies will always lag behind and therefore their applicability will be questioned.  The best study I could find was a Wisconsin study that tracked football players who played in the 1950s.  Is 1950 football similar to 2020 football?  Hard to say, but my gut feeling is that due to better protective gear, 1950 football players were more likely to be injured. 3904 former high school football players averaging 64.4 years of age were compared to an equal number of equivalent non-football players.  The football players had no significant reduction in cognition or depression scores.   They also had no adverse association with secondary outcomes such as alcoholism.  Based on this single study, there appears to be little if any adverse long-term outcome due to head injuries associated with high school football.  At 35 years of age, the former football players were much more likely to engage in physical activity than non-sports players but equal to non-collision sports players. https://jamanetwork.com/journals/jamaneurology/fullarticle/2635831 Looking at the top 5 causes of youth concussion, rugby led the way with 4.18 per 1000 single player involvement in practices or games.  Ice hockey was next with 1.2.  Football was half of this with .53 followed by lacrosse at .24 with soccer at .23.  Among adults is was rugby at 3.0, football 2.5, women’s’ ice hockey 2.27, men’s ice hockey 1.6, women’s’ soccer 1.48 and men’s’ soccer 1.07. https://completeconcussions.com/2018/12/05/concussion-rates-what-sport-most-concussions/ College football injuries Now looking at college football, the NCAA football likelihood of being injured is 8.1 per 1000 individual practices or games.  However, injuries were 7 times more likely during games than practices. 7.5% of injuries resulted in surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011310/pdf/10.1177_2325967116664500.pdf NFL football injuries A 2017 analysis looked at the reported 35% increase in injury among pro football players.  They asked the question: how much of this increase is due to better reporting as a result of recent scrutiny?  They determined that at least 70% of the increase is due to more attention being paid to sports injuries, particularly head injuries.  This still leaves about a 10% increase unaccounted for.  https://www.footballoutsiders.com/stat-analysis/2017/truth-behind-rising-injury-rates As noted previously, there is little data on the long-term effects of multiple concussions due to football.  One study looked at 35 NFL players with a documented concussion history.  They completed a clinical interview and neuropsychological battery on the players.  They found no linear association between the number of concussions or years played in the NFL and cognitive outcomes.  This means that adverse cognitive issues experience by some players are not just the result of more concussion or extended NFL football play.  As one might expect, the effect of head injury is highly individualized. What about other injuries received during NFL play? Let’s look at knee injuries. 92% of quarterbacks and 67% of running backs with ACL tears corrected by surgery were able to return to play.  Additionally, post-recovery performance on multiple drills such as 40-yard dash, vertical leap, broad jump, and shuttle-run was not adversely affected.  Length of the career of players with successful surgeries also did not appear to be affected. However, if the player suffered multi-ligament knee injuries, the outcome was much less positive.  These players only returned to play 56% of the time, and this return took significantly longer.  They were also less likely to return to prior ability levels. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204640/ I was somewhat surprised

In this episode, we discuss Anthrax. It has a fascinating history of disease and use as a biological warfare agent. Learn how dangerous it really is. Hello everyone.  A Special thanks to all the new subscribers out there and to my veteran listeners.  The show has grown faster than I ever thought possible.  I would love to hear from everyone.  I have a list of about 200 topics, but if you have an idea or would like me to get to one sooner, drop me a note on my website sci-vs-fear.com. This week’s topic is: Anthrax: Almost 20 years since I’ve had a powdered brownie Anthrax: my experience I’ve long been acquainted with Anthrax.  My first introduction to Bacillus anthracis was my first day in my undergraduate microbiology lab.  The first experiment was to isolate Anthrax from soil.  Back in those days, it wasn’t uncommon at all to work with anthrax in the classroom and on the benchtop, it actually poses little hazard. My next brush with anthrax was in graduate school. Shortly following the Amerithrax event, my major professor was asked to determine the parameters for irradiating mail to kill any possible anthrax.  Anthrax is really hard to kill.  It takes about 40KGy (40,000 Gy) to kill it, where 3-8Gy will kill you and I.  2001 was a rough year between 9/11 and the anthrax letters.  My innocence was shattered and that was when I first realized the world could be a dark and dangerous place.  My desire to make sure my kids didn’t have to deal with these threats was what put me on my career path of evaluating and mitigating dangerous things. The next stop on the anthrax train was when I helped with a study on how to best sample anthrax.  The study used a cousin of Anthrax, Bacillus globigii in its weaponized form.  Anthrax powder is not at all like powdered sugar or coffee creamer.  The slightest breeze or wave of the hand will make it disappear into the air.  When a pea-sized ball drops from the height of couple inches, it never hits the table, it simply disappears into the air. Anthrax is really hard to kill.  I learned this when I assisted in sampling a building that had been exposed to the same cousin, then tented and fumigated with chlorine dioxide.  Immediately following fumigation, no samples were positive.  When we tested again 6 months later, a significant number of samples contained viable organisms. Every year I get a reminder of my relationship with anthrax when I get my annual vaccination.  No vaccination is pleasant, but anthrax always seems to take pleasure in stinging for a couple of extra days. Anthrax: What is it? Anthrax is a bacteria classified as a gram-positive rod, that is about 1/millionth of a meter long.  To give you an idea of how small this is, about 1000 organisms could fit on the end of a hair- give or take a few.  Anthrax belongs to a group of bacteria know as spore formers.  Most bacteria aren’t particularly tough, but the spore formers are a notable exception.  I think of a spore as a seed.  Being from the west, I’ve heard of corn seeds that were thousands of years old from cliff dwellings growing just fine once planted. When growing anthrax, known as vegetative cells, senses that the environment is changing, it begins a transformation.  It grows a tough outer layer that protects it from the environment and becomes a spore.  How tough you ask.  You can literally boil anthrax for 10 minutes and still not kill it.  If you want to kill anthrax with heat you need a pressure cooker. Anthrax: the natural cycle Anthrax outbreaks in animals follows a predictable cycle.  An animal dies from an Anthrax infection.  Once the animal dies, this changes the internal environment and triggers the formation of spores.  As the animal decomposes, the spores are released into the environment.  The spores will sit there, just waiting for an opportunity to start growing. Eventually, you will have a very wet spring, which washes away layers of soil exposing the spores, followed by a dry summer.  As the grass dries up and becomes scarce, the animals are forced to eat the remaining bits very close to the ground.  In the process, they inhale the spores and the cycle begins again. Artificial contamination of Gruinard Island off the northwest coast of Scotland occurred in 1942–1943 as a result of biological warfare bomb tests containing live anthrax spores. Almost 40 years later (1979) viable spores could still be detected. https://www.sciencedirect.com/topics/medicine-and-dentistry/gruinard-island Anthrax: biological warfare history From 1846 to 1877 Yorkshire had a mysterious illness.  This illness only attacked workers in the wool industry.  And not just anyone in the industry.  Particularly at risk were the people involved in the sorting and grading of the wool.  But strangely, it seemed to mostly affect those working with “dry, dusty, and low-class foreign wools”.  The symptoms were terrifying.  While the patient might exhibit pain, cough, and vomiting, most wouldn’t feel particularly ill.  Then suddenly they would feel a tightness in the chest almost like there was a huge weight preventing them from breathing.  Within a short time, they would die. The Bradford Observer noted in 1878 that within a month three workers from a single factory had died from this mysterious disease.  This article caused an autopsy of the workers and a Dr. Bell noted that the deaths didn’t appear to be caused by fibers or dirt in the lungs, but suspected that it might be caused by decomposing animal matter.  After consulting with colleagues, they began to suspect the presence of the anthrax bacillus recently discovered by Robert Koch.  Testing animals with infected materials from the autopsy resulted in similar disease.  Spores resting in the wool were being carried into the lungs of workers by dust particles. Once it was discovered that a bacteria was responsible for the illness, many factories began steaming all bales of wool in pressure cookers for a few hours.  This led to a sharp decrease in illnesses. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222232/pdf/0920754.pdf Woolsorter’s disease as it was called, didn’t escape the notice of countries looking for promising biological agents.  Japan, Russia, and the US all began researching anthrax.  Few are aware of Japanese unit 731 which committed many atrocities equal to or greater than the Nazis.  Human experimentation with Anthrax and other biological agents led to the death of more than 10,000 prisoners.  Corey J. Hilmas, … Jaime Anderson, in Handbook of Toxicology of Chemical Warfare Agents, 2009 Even after signing accords against biological and chemical warfare, Russia continued a robust Anthrax program. In April and May of 1979, and accidental release of anthrax from their production facility in Sverdlovsk may have resulted in the release of 10kg of military-grade anthrax.  Thanks to a wind that was blowing away from the city, only about 70 people died.  Had the winds been blowing towards town, thousands of people most likely would have perished. http://www.ph.ucla.edu/epi/bioter/sverd/sverd_geograph.html American anthrax event Of course, the reason most of us are familiar with anthrax is because of the 2001 American Anthrax dissemination.  The mailing of anthrax led to the death of 5 people with at least 22 people contracting the illness.  The first victim received a letter, the next two were postal employees and the final two became infected from mail cross-contaminated at postal facilities.  The effect of this single event was huge.  35 postal facilities were contaminated as well as seven buildings on capitol hill.  Cleanup of the capitol hill facilities alone cost $27 million.  https://www.justice.gov/archive/amerithrax/docs/amx-investigative-summary2.pdf   A seven-year investigation conducted by the FBI concluded that Dr. Bruce Ivins was responsible for the event, although it never went to trial due to Dr. Ivins’s suicide.  There is still some discussion to this day about the accuracy of the FBI conclusion, but I haven’t studied it enough to form an opinion. Anthrax illness There are three types of anthrax illnesses.  The first is inhalational anthrax as seen in wool sorter’s disease and the anthrax letters.  The second is gastrointestinal anthrax as the result of eating an infected animal.  The final is cutaneous anthrax where a cut or wound becomes infected.  During Amerithrax, 11 people suffered from inhalational anthrax and another 11 contracted cutaneous anthrax. Cutaneous anthrax is the least dangerous of the anthrax diseases.  Without any treatment at all, 20% or less of individuals would die.  With treatment, almost everyone survives. https://www.justice.gov/archive/amerithrax/docs/amx-investigative-summary2.pdf Gastrointestinal anthrax is more dangerous with about 50% of people dying without treatment.  Even with treatment 40% of people may still perish. https://www.cdc.gov/anthrax/basics/types/gastrointestinal.html Without treatment, almost 90% of people die after contracting inhalational anthrax.  With very aggressive treatment, about half of infected individuals can survive.  https://www.cdc.gov/anthrax/basics/types/inhalation.html Weaponized Anthrax Anthrax is everywhere in the environment, and this environmental anthrax is responsible for most cases of cutaneous and gastrointestinal anthrax and even an occasional inhalational event associated with hide drums in the US and UK. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090713/ However, given how common the bacteria is, cases are quite rare. The anthrax contained in the

In this bonus content podcast, we discuss the actions you should take in the unlikely event you should ever be contaminated by a chemical weapon. Thanks for listening to this bonus podcast.  Normally, my bonus podcasts are only available through my website, but I feel this information is really important so I decided to put it on my normal feed.  If you enjoy this podcast, feel free to listen to my other bonus podcasts by visiting my website sci-vs-fear.com In my previous podcast, we talked about the different types of chemical weapons. Today we will take about what you should do if you become exposed. Chemical weapons: I’ve been slimed, what do I do now? In this podcast, we will be discussing what you should do in the unlikely event you get slimed with a chemical warfare agent.  That’s a highly scientific term by the way. For the past couple of years, I’ve been asking myself this question from a professional standpoint.  Generally, when we deal with dangerous chemicals, we use a full suite of protective gear.  Removing someone from contaminated protective gear without getting the person dirty is very important.  It is much more complicated than I ever imagined, but some basic principles help us do a good job. Should you get chemical weapons or any other chemical on your clothing or skin,   there are some important steps you can take.  I’m not the only one who has been thinking about this.  Public Health England has been taking the question very seriously.  Public Health England, chemical weapons statement They state “The deliberate use of toxic materials represents a serious threat to society. In particular, chemical warfare agents are indiscriminate weapons that can have a devastating impact when used on unprotected civilian populations, as recently evidenced in Syria.  Any complacency based on the notion that chemical warfare agents are limited to politically unstable regions was recently dispelled by the use of a ‘novichok’ nerve agent in the UK. The current threat level for international terrorism in the UK is presently classed as ‘severe’. Exposure of individuals to liquid or particulate substances presents a particular challenge to the emergency services, as casualties will need to undergo immediate disrobe and decontamination in order to mitigate the risk of adverse health effects.” https://emj.bmj.com/content/emermed/36/2/117.full.pdf Because of this concern, they sponsored a series of research trials called ORCHID.  The principles I discuss today come directly from their research and conclusions.  To date, I’m not aware of any more thorough research available. Traditionally, response to a chemical agent exposure would be a water-based shower type of cleaning.  However, in a terrorist scenario, the resources probably won’t be available, therefore, they recommend using absorbent materials rather than water in most cases.  There are a couple of advantages to this.  First, it creates much less waste than the water-based cleaning, especially if the run-off contains toxic substances.  Water-based cleaning can tend to spread contamination all over a person while dry cleaning physically removes most of it.  Using water on contaminated clothing can also drive the chemicals through the clothing onto the skin.  Finally, water can actually drive chemicals through the skin. Step 1: Remove contaminated clothing Should you become slimed, the first thing you would want to do is remove your clothing.  While people can be reluctant to remove their clothes due to modesty concerns, removal of clothing by itself can eliminate up to 90% of the contaminant. Step 2: Pat down contaminated areas with absorbent material The quicker you can remove the “slime” the better your likely outcome.  Once the clothing has been removed, then any remaining chemical should be removed with an up and down blotting motion using paper towels, diapers, napkins, toilet paper, clean clothing or any other available absorbent material.  Once the agent has been blotted, then affected areas should be scrubbed with a clean absorbent material to help lift off the remaining material.  They recommend doing the hair/top of the head first, followed by face, then hands, then other exposed skin.  In the absence of absorbent materials, using dirt to absorb the slime can be relatively effective. https://emj.bmj.com/content/emermed/36/2/117/F3.large.jpg Step 3: Use RSDL if available Best case scenario, public responders will have some reactive skin decontamination solution (RSDL) available which will help neutralize the material that has already entered the skin.  The ORCHID study did point out that if the material is corrosive like battery acid or drain cleaner, then a shower-like cleaning method is better.  This also applies to any contamination that is a solid, rather than a liquid. See a demonstration of chemical weapon decontamination These are relatively simple methods that can make a large difference in outcome, should you be slimed.  Public Health England has an informative video on how to put these methods into practice should they be needed.  I hope you will never need this information, but knowing how to react properly in a rapid manner could greatly improve your outcome.  For me, knowing how to properly react to a threat always make it much less intimidating.

In today’s episode we discuss past chemical warfare agent attacks and talk about the different classes of agents and what they are used for. Thanks for joining me today.  As we start the new year, I just wanted to say thanks to all of you.  In just a few months, this project has gone from no listeners to over 300 subscribers.  Thanks for sharing this podcast with your friends and feel free to share it with a few more.  As always, my references are found on my website sci-vs-fear.com.  Please stop by and take a look. In future episodes, I plan on looking at some of the chemical warfare agents or CWAs in-depth, but before I do, I wanted to talk about the group as a whole to provide the big picture. So what is a chemical warfare agent?  A chemical warfare agent is simply any chemical that is used to harm or kill people. WWI chemical warfare While there are other historical instances, chemical warfare agent use began in earnest in WWI.  The first use was in August of 1914 when the French used teargas in the battlefield.  By October of 1914, the Germans had deployed over 3,000 shells of chlorosulfate, although they were relatively ineffective as the chemical was mostly destroyed in the explosion. In January 1915, the Germans tried again against the Russians using xylyl bromine, but this time it was ineffective due to the extreme cold.  In April of that year, the first large scale deaths (~1100 with 7000 injuries) due to CWAs are documented at Ypres, Belgium where the Germans deployed almost 170 metric tons of chlorine gas.  Chlorine gas tends to sink and so was quite effective in trench warfare applications, assuming the wind didn’t blow it back into your trench. By September, the British begin using chlorine against the Germans.  Shortly after that, the Germans introduce phosgene.  So began a CWA arms race.  By 1918, nearly 10% of all US arterial shells contain mustard.  Interestingly, Adolf Hitler was temporarily blinded by Mustard in October shortly before the end of the war.  There is some supposition, that this is the reason Germany didn’t use more CWAs during WWII.  All told, there were more than 1.3 million casualties and 90K+ deaths due to CWAs (mostly phosgene) during WWI. WWII chemical warfare preparations In the run-up to WWII, most nations developed mustard and nerve agents.  Among these are sulfur and nitrogen mustard, tabun, sarin, soman, and VX.  Many of these compounds were discovered in pesticide research, but most nations had a specific CWA development program.  In 1972, the Biological and Toxin Weapons Convention sought to end all offensive research into CWAs.  This was moderately successful with countries like the US and Britain abiding, with other countries, Russia, Iran, Iraq, and others, continuing with research and production. https://www.sciencehistory.org/distillations/a-brief-history-of-chemical-war Tokyo sarin chemical weapon attack Let’s look at two well-known uses of chemical weapons.  The first is of interest to developed countries, as our largest threat from CWAs is terrorism.  On 20 March 1995, a Japanese cult known as the Uhm-Shinrikyo released sarin on the Japanese subway.  Their attack was fairly crude, but it got the world’s attention.  Between 7:30 and 7:45 AM, five different cult members boarded trains headed to different parts of the city with 2-3 plastic bags full of sarin carried in an outer paper bag.  At 7:48, the members punctured the bags with sharpened umbrellas.  Although the sarin was only 30% pure and the dissemination method was somewhat crude, mass casualties soon ensued. https://www.belfercenter.org/sites/default/files/legacy/files/consequence_management_in_the_1995_sarin_attacks_on_the_japanese_subway_system.pdf Twelve people died with over 50 victims being so severely injured that they needed mechanical ventilation to survive.  The closest hospital received over 600 casualties at one time.  You can imagine the chaos that ensued due to this massive wave of patients.  In the end, 980 victims suffered moderate injuries and more than 5500 civilians suffered at least mild symptoms. At the primary receiving hospital, 23% of the medical staff were affected by  sarin after being contaminated by the victims. Halabja chemical weapon attack In 1988, chemical warfare agents were used in a different and much more destructive manner. On 16 March, the Iraqi air force attacked Halabja, a Kurdish settlement with some 70,000 residents.  In the days before the attack, the settlement had come under mortar fire and so the inhabitants were used to retreating to the protection of air-raid shelters.  On this day, however, low-lying places were the last place you wanted to be, although anywhere on the streets of the city was little better.  The Iraqi planes dropped chemical munitions on the town for almost 45 minutes. Those that survived described yellowish/white clouds of gas that sank to the ground.  Contact with the clouds led to burning eyes and skin and then the inability to breath.  Although it is impossible to know how many people died as a result of the attack, it has been estimated that over 5,000 men, women, and children died.  Another 7,000 were injured as a result.  Although the exact chemical weapons used is still a point of discussion, mustard and sarin were almost certainly deployed. https://link.springer.com/chapter/10.1007/978-3-319-51664-6_18 The photos of the incident are haunting.  Mothers holding infants in a futile attempt to protect them from the gas.  Entire families collapsed together as they attempted to flee the area.  If you want to fully understand the capabilities of chemical warfare agents and have a strong composition, these pictures can be found online.  I had an occasion to talk with a man who visited the town a day after the attack.  What struck him was the utter silence throughout the town.  Driving through the town, which he admitted was foolhardy, bodies were lying everywhere.  Ordinary people going about their lives, dropping within a few feet of where they were first exposed. Now that we’ve discussed the full potential of chemical warfare agents, let’s talk about the different classes of these chemical weapons.  CWAs can be broken down into 7 different classes of agent: Nerve, vesicant (blister), blood agents, choking agents, riot control agents, psychomimetic agents, and toxins. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148621/ Each of these different classes have different effects and purposes. Nerve agents Let’s start with nerve agents.  There are many different nerve agents, but they all have one thing in common.  They have what chemists call an organophosphate group.  This is a phosphorous double-bonded to an oxygen as well as other oxygens and/or carbon chains.  See the show notes for a picture.  This group is particularly effective at acting on the nerves.  When I tell my hand to move, a chemical called acetylcholine forces my nerves to act.  Because I don’t want to keep moving my hand, my body needs a way to shut the nerves off.  It uses a molecule called acetylcholinesterase to tell the nerves to stop firing.  When you are exposed to a nerve agent, it interrupts this process. More particularly, it prevents the signal telling the nerves to shut off.  The symptoms we see are a result of your nerves continuing to fire.  The first thing almost everyone exposed to nerve agent notices is that everything gets dark.  This is because your pupils constrict to their limit, we call these pinpoint pupils.  The symptoms are characterized with the acronym SLUDGE: Salivation, lachrymation, urination, defecation, gastrointestinal upset, and emesis.  Death is usually due to seizures, paralysis, and respiratory failure.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148621/ https://www.atsdr.cdc.gov/mmg/mmg.asp?id=523&tid=93 There is an antidote for nerve agents, atropine and 2 pam chloride as well as an anti-seizure medication such as diazepam. This is generally pretty effective if administered early. The lethal dose of these agents can range from 1-10ml to less than 1 drop of VX which is easily absorbed through the skin. Mustard The next class of chemical weapons are the vesicants.  In the military, sometimes the objective is not to kill the other soldier.  A wounded soldier takes several soldiers out of the fight which does more to reduce the fighting force.  This is the idea behind the vesicants and mustards.  Although it is commonly referred to as mustard gas, mustard is a thick oily substance.  One of the most descriptive paintings I’ve seen is a WWI painting of about 20 soldiers who cannot see, being led off the battlefield by a single guide. The primary effect of the mustards is severe damage to the skin and eyes.  The most common members of this group are sulfur mustard, nitrogen mustard, and lewisite.  The mustards generally have a delay of symptoms for up to 24 hours, although it needs to be removed from the skin fairly quickly to minimize symptoms.  This delay in symptoms can make it very difficult to detect and potentially deadly to those exposed.  On the other side of the spectrum, lewisite (an arsenic-based compound) and phosgene oxime produce very intense and almost instant pain upon contact with the skin.  Occasionally, a vesicant can be a mixture of both lewisite and mustard. https://emergency.cdc.gov/agent/vesicants/tsd.asp https://www.atsdr.cdc.gov/toxfaqs/tfacts163.pdf https://www.atsdr.cdc.gov/toxfaqs/tfacts165.pdf There is no antidote for the vesicants.  Immediate removal is the best treatment, followed by supportive care for the blisters as well as eye and respiratory tract dam

In this episode, we discuss how dangerous statistics can be.  People often confuse statistics with facts, but anytime someone quotes a statistic, there are a few things you need to keep in mind. This topic has bonus content Thanks for joining me for another podcast.  I really appreciate all my new subscribers and those of you that have left reviews on iTunes and other places.  As always, I appreciate both positive and constructive suggestions.  Today’s episode is: Statistics: 9 common ways the numbers are lying to you I’m not going to lie, this has been the most difficult podcast to produce so far.  I’m not a statistician, and trying to simplify complex statistical concepts is definitely tricky.  I have at least 15 hours into the production of this episode.  I hope you enjoy it. The content in this podcast is adapted from How to lie with statistics by Darrell Huff. As I mentioned in my intro podcast, statistics can actually be quite dangerous As a young grad student, someone much older and wiser than me recommended I read How to lie with statistics.  It was spot on when it was first printed in 1954 and is still very relevant today Today I am going to discuss some common pitfalls we can run into when interpreting statistics Statistics pitfall #1: Sampling bias For a study to be accurate, it must faithfully represent the population of interest.  For example, a political telephone survey that uses only landline numbers misses a large portion of the US population who only have cell phones.  No matter how much data a study collects, if it doesn’t represent the group in question, it is pretty worthless. The problem with studying humans, is that we can’t just randomly assign people to different groups for the sake of science and so almost all study participants self-select to some extent This sampling bias can be conscious, or unconscious.  We can correct to some extent for conscious bias, but unconscious bias is particularly dangerous because we often don’t realize it is happening. For example, when YouTube created a new video loading feature, about 10% of videos were loaded upside down.  When they began trouble shooting why so many users loaded them incorrectly, they discovered that most of the upside-down videos belonged to left-handed people.  Because of an unconscious bias towards right-handed people, the app left out about 10% of the population. https://www.eliinc.com/five-real-world-examples-of-unconscious-bias/ Another example of self-selection bias occurred in Boston University’s study of brain trauma in American football players.  The results of the study were widely reported as “99% of football players had CTE” even though the researchers admitted that the study population was biased.  How was it biased? All of the 202 brains examined in the study were from players who exhibited neurological symptoms while living.  For the results of the study to be accurate to the population, brains would have to be taken across a wide range of people who had at one point in their life played football, not just those with symptoms.  Additionally, nearly half of the brains studied were from professional football players, which is a very small subset of those who play football. https://greatbrook.com/biased-survey-samples/ Statistics pitfall #2: Different types of averages Another common pitfall is using the wrong type of average In statistics there are 3 types of averages: mean, median and mode Mean is the classic average that we are all used to: add up all the numbers and then divide by total numbers used Median is the middle value of a group of responses (five responses, order high-low, it is response #3) Mode is essentially the most common number in a group of responses Why does this matter you might ask? If you look at a graph of how long Australians live, the majority of people live longer than average.  How does that work?  This is because the majority of people die late in life (70-90s) but there is a small subset that dies very young.  These very young deaths drive down the (mean) average life expectancy more than the few people who live into their hundreds can bring it up.  Therefore, the majority of people live into their 80s but the average person dies in their 70s. An example that works the other way around is average income.  In the US in 2017, the average (mean) income was ~$55K, while the median income was ~$40k.  How does that happen?  I’d much rather be the average American making $55k than the one making $40K.  This happens, because an income of $0 is the bottom end of the scale, but the top end of the scale can go into multiple billions of dollars.  These drastic outliers at the high end of the scale shift the mean income up ~$15k.  So, if you are arguing that Americans are financially worse of then you use the median, and if you are arguing that they are better off you use the mean.  If you are being really dishonest then you could compare today’s median to last year’s mean https://towardsdatascience.com/how-90-of-drivers-can-be-above-average-or-why-you-need-to-be-careful-when-talking-statistics-3df7be5cb116 https://towardsdatascience.com/how-90-of-drivers-can-be-above-average-or-why-you-need-to-be-careful-when-talking-statistics-3df7be5cb116 https://towardsdatascience.com/how-90-of-drivers-can-be-above-average-or-why-you-need-to-be-careful-when-talking-statistics-3df7be5cb116 Statistics pitfall #3: Small sample size Another area where data can easily be skewed is by not using the right sample size.  When political pollsters try to predict an election, they attempt to use a small representative sample to determine the outcome.  However, the only way you can be 100% sure how the contest will go is to count everyone.  We call this an election. You can prove this to yourself.  When you flip a coin, the probability of heads/tails is 50%.  Take a coin and flip it 4 times.  Did you get 50%? Probably not.  If you flip 100 times, then you probably get pretty close.  If you flip sets of 4 long enough you will probably get 100% heads, 100% tails, and everything in between.  https://towardsdatascience.com/lessons-from-how-to-lie-with-statistics-57060c0d2f19 A well-known example of this is Colgate, claiming that 8 out of 10 dentists recommend them.  You can easily get these results when you only ask 10 dentists at a time.  To be even more sneaky, the dentists in the survey could recommend several brands and still be counted in the 8/10 number as long as one of the brands was Colgate. https://www.statisticshowto.datasciencecentral.com/misleading-statistics-examples/ Statistics pitfall #4: Confidence intervals In statistics, we use confidence intervals.  These are a little more complex than most people realize, but a simplification that most people will recognize is the +/- often associated with polls. Plus or minus 3%. In chapter 4 of how to lie with statistics Darrell Huff uses that following example.  A family has two children who took IQ test where average is 100.  The girl is the smart one with an IQ of 101 and the boy is below average with an IQ of 98.  But is that really the case?  Turns out IQs have a confidence interval, in this case +/- 3%.  So, the boy’s IQ could actually be as high as 101 and the girls as low as 98.  With IQ tests, it is more correct to call a range, say 90-110 normal rather than 100.  In a poll this is often referred to as a statistical dead heat. Statistics pitfall #5: Graphs Graphs are handy, but can be very misleading.  Never trust a graph that doesn’t start at 0.  If graphs don’t start at 0 you have no perspective on the magnitude of change.  An increase of $1000 in house prices of $50k houses is noticeable.  The same increase in million-dollar homes is almost meaningless. https://faculty.atu.edu/mfinan/2043/section31.pdf https://faculty.atu.edu/mfinan/2043/section31.pdf Always make sure every portion of the graph is clearly labeled, and that in pie charts everything adds up to 100. Pictographs also can be very misleading.  Say we use boxes to represent the fact that moving costs have doubled in the last 10 years.  So, we make the second box twice as big as the first box.  Makes sense, right?  Except that doubling the size of a square quadruples the area. https://faculty.atu.edu/mfinan/2043/section31.pdf Statistics pitfall #6: linking unrelated statistics Often statistics compare things that are not actually related or to the wrong thing One example is studies on the therapeutic benefits of massage.  The vast majority of studies on massage say that massage is much better than no treatment.  This sounds great, until you realize that almost all clinical trials don’t compare a treatment to nothing, but the new cure to a placebo or often the current best care practice.  Almost any medical intervention is going to do much better than no intervention.  The problem with studying massage is how do you do an effective placebo treatment?  Most patients know if they got a fake massage.  Until they come up with an effective placebo, it will be very difficult to tell if massage is actually an effective treatment. https://www.painscience.com/articles/statistical-significance.php Another example that I touched on in the vaping podcast is the number of vaping related deaths and illnesses.  As of mid Nov 2019, there have been 2,172 illnesses and 42 deaths.  https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html Compared to zero, this is a large number, but if you compare the data to the CDCs statistics on smoking the perspective changes.  CDC estimates there are 1300 smoking related deaths every day o

 In the previous episode we looked at 9 different statistical pitfalls. -Sampling bias -Different types of averages -Small sample size -Confidence intervals -Graphs -Linking unrelated statistics -Correlations -vs- causation -Computer models – Search engine results and social media That is an awful lot of things to keep track of.  Today I am going to simplify it a bit into 5 questions you can ask about any statistic.  Like the previous podcast, most of the ideas in this podcast come from Darrell Huff’s How to lie with statistics. Question 1: Who says so? Everyone who does research has a motivation.  That motivation will tell you a lot about what their conscious and unconscious biases may be.  For instance, in a study by a drug company an obvious conscious bias is the desire to sell more product.  That bias should be considered when interpreting the results.  An unconscious bias is that the majority of studies are done using educated, fairly prosperous individuals from first world countries.  Will the results be applicable to other populations?  Hard to say until we study it in those populations. Is the study backed by someone well known or famous?  As a general rule, if someone needs a famous spokesperson, then I am automatically suspicious.  However, the nature of the spokesperson can change that a bit.  If the spokesperson is a Nobel laureate in that field, then their endorsement may have a little more weight.  If they are an athlete, movie star, etc… I have to ask myself, what would make them an expert in this field they are endorsing?  Chances are probably not much. Question 2: How do they know? What was their sample size?  Sample size makes a huge difference.  Generally, with a couple of caveats we will talk about in a second, the larger the sample size the more we can trust it.  Have you ever had anyone who didn’t have kids try and tell you how to raise yours?  Their sample size is effectively zero.  When I only had one child, I thought I was getting it figured out pretty well.  When child number two came along, I realized that I still didn’t know anything. In a narrow field, say treatment for a very rare disease, a sample size of 10 or 20 might be enough.  In making general conclusions about a large population, a sample size of 100 or even 1000 might not be enough.  Most political polls have a sample size of ~1000.  Is asking 1000 people a question good enough to determine how the 300+ million people of the US would answer that question?  Have you ever wondered why so many medications are recalled for serious side-effects shortly after they go through the long and difficult FDA approval process?  It has to do with sample size.  If the serious side-effect only happens to 1/10,000 people, a study involving 5000 people isn’t large enough to detect the side effect.  However, when it is released to the general public, the sample size grows dramatically, and suddenly we start seeing many side effects never detected during the trials.  Sample size matters. However, a large sample size can be totally invalid if it was improperly selected.  Someone who is willing to talk about their political beliefs to a perfect stranger over the phone may not represent the average American very well.  If I only ask people on the east and west coast a question, I am likely to get a much different answer than if I ask that same question only to people from the center of the country. Is a person who is willing to try a risky experimental treatment (often because they are dying) really a good representation the total population with the illness?  This group of critically ill individuals may be so sick that an effective treatment would do them little good. If they have a good, well-chosen sample size, are they confusing correlation with causation?  Going back to Tyler Vigen’s spurious correlation site https://www.tylervigen.com/spurious-correlations is the US per capita consumption of margarine really connected to the divorce rate in the state of Maine?  They are highly correlated, but I don’t think that a US ban on margarine would end divorces in Maine.  It could be that divorced people are just drowning their sorrows through margarine consumption.  Finally, if you are getting statistics second hand, where did they come from.  Remember that search engine results and social media feeds are nowhere close to unbiased.  Generally, the more studies we have that say the same thing (repeatability) the more we can trust them.  However, if our method for discovering information is biased, we can have a false sense of repeatability because we are only being shown one side of an issue.  This can be very convincing to the untrained observer. Question 3: What’s missing? Often there is vital information missing from the presented fact.  The more we understand the background of a statistic, the better we can judge its validity. A result should always have a standard error associated with it, the +/- 3% we talked about earlier.  If this is left out, be suspicious.  If a candidate is ahead by 4 percent, but the standard error is 3% then they could actually be behind.  This is often left out when polls are being used to influence opinion rather than just measure it. If the statistic is an average then we need to know what type of average.  The different averages can actually be far apart.  If one type of average is being compared to another type of average then they are either ignorant or intentionally dishonest.  Be aware the different types of averages are more useful for different viewpoints and so an influencer is almost certain to use the average that makes their point the best. In and of themselves, statistics don’t mean too much.  They only begin to get meaning after they are compared to something else.  Often what is missing is the correct comparison.  A new medical treatment may save many more lives than no treatment, but if that treatment isn’t better than a placebo, or more importantly, an improvement on the existing treatment, then the results are meaningless. A final thing that could be missing is important labels on charts and graphs, or even the all-important zero.  If zero is missing from a graph then you have no reference for how significant the change really is.  A change of 2 on a graph that goes from 0 to 10 is probably important.  A change of 20,000 may have very little meaning on a graph that goes from 0 to 10 million.  To be useful all parts of a graph need to be labeled, and the numerical axis labels should always have the same interval between tics. Question 4: Did someone change the subject? One way for statistics to change drastically is to change the definition of the item being measured.  If in 2019, the definition of red heads was changed to also include strawberry blondes, in that year there would be a dramatic increase in redhead numbers, but nothing really changed.  The current US unemployment numbers only include those who are actively looking for work.  If the definition of unemployment was changed to include those who have given up looking for work, the US unemployment rate could double overnight.  Changing definitions is a powerful way to create a statistical change that doesn’t really exist. Another way to change the subject is to draw incorrect conclusions from a statistic and put them in a headline.  I have often found that if I read the whole article, the conclusions drawn by the author don’t really match the actual numbers given in the article.  The farther away we get from actual observations, the easier it is to draw incorrect conclusions. My podcast on radiation demonstrated a simple way to switch the subject.  Increased attention to a subject will most often change the prevalence.  In Japan, there was a many-fold increase in thyroid cancer following the Fukushima nuclear incident.  However, when you got down to the cause, it wasn’t due to the release of radiation, but the use of a more sensitive method of thyroid abnormalities.  Traditionally, thyroid cancer is detected by the presence of medical symptoms.  However, after the release, the government began screening thyroids with ultrasound.  This is a very sensitive technique that detects many natural anomalies that would never turn into cancer.  This was the cause of the large increase.  Because most of these people had their thyroids removed, we will never actually know how many would have progressed to real cancer and be detected using the old method.   As a high schooler, I remember switching the subject in a different way.  We would get anonymous questionnaires about everything from smoking to sex to drugs.  Someone I know may have admitted to many things they never actually did, but failed to mention some of their actual indiscretions.  Any time people self-reports, there is likely to be a large difference between the actual truth and the reported truth.  I strongly suspect that self-reported behaviors on topics such as internet porn, adultery, drug use, driving habits, relationships, etc may not even be in the same ballpark as the truth.  If there is anything with a socially acceptable standard, people will almost always fudge towards compliance.  Interestingly, the recent study that showed dramatic increases in teen vaping was a self-reporting study.  Has it really gone up to that extent, or are teenagers more aware of it and likely to report yes due to that reason?  Monitoring the Future (MTF) survey. Here we also have to ask the question why is the researcher interested in the subject.  Most people who study a subject are passionat

In this podcast episode, we discuss cyanide. We’ve all seen it in the movies and maybe even heard about it in real life. We discuss some poisonings in the past and the potential for future poisonings. Welcome back to all who have subscribed and a special thank you for those who are joining me for the first time. I couldn’t do the show without you and I’ve had a great time researching the show and also getting to know some of you.  I have some great topics planned in the near future. Today’s episode is: Cyanide: The reason I’m glad I am not a spy If you asked people to list off the most common poisons, I’m sure cyanide would make the top 5. I’ve come across it multiple times in my career. The most memorable incident involved 2 55 gallon drums sitting in the front yard. While one was completely full the other was only half full because there was a hole in the top and bottom of the barrel. A small gully led directly from that barrel to the next-door neighbor’s yard. I couldn’t make this stuff up if I tried. What is cyanide So, what is cyanide? Cyanide comes in two forms, a powder also known to chemists as the salt form, and a gas. Cyanide is made up of the elements Carbon and Nitrogen bonded together (by a triple bond which is unusual in the chemical world). This carbon/nitrogen group is combined with sodium/potassium/magnesium in the powder and hydrogen in the gas. See my show notes if you would like to see the chemical structure. https://www.atsdr.cdc.gov/toxprofiles/tp8.pdf By Epop – Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4300889 Cyanide and spies Probably the most common exposure (pun intended) people have to cyanide is in the movies where a spy is captured. Rather than talk, the spy breaks open a false tooth, swallows the cyanide inside.  They begin to froth at the mouth, and die almost instantly. As far as I can discover, this is just a Hollywood creation, but it is based on history. In May 1945, high-ranking Nazi Heinrich Himmler swallowed a cyanide pill shortly after being captured. Many prominent Nazis chose to end their lives this way.  https://www.atlasobscura.com/articles/cyanide-tooth-is-not-real Historical cyanide poisonings There is a certain poetic justice in Nazi leadership dying from cyanide poisoning. Beginning in Sep 1941, they killed at least a million Jews and others using a fumigant called Zyklon B. Zyklon B is just cyanide gas trapped in an absorbent such as diatomaceous earth. When the metal canisters it was stored in were opened, the cyanide gas was released. https://www.thoughtco.com/zyklon-b-gas-chamber-poison-1779688 Zyklon B used by Nazis during WWII In 1978, Jim Jones used a concoction including cyanide to poison his followers in Jonestown. This horrific incident left over 900 men, women and children dead. https://www.history.com/topics/crime/jonestown There have been several other well know incidents of cyanide poisoning. In 1982, someone who was never caught, placed cyanide in Tylenol capsules and then placed the bottles back on store shelves in the Chicago area. Seven people died. The tamper-resistant packaging we now fight with daily is a result of that poisoning. https://www.upi.com/Top_News/US/2017/10/05/35-years-after-landmark-recall-Tylenol-deaths-still-unsolved/9661507150232/    Cyanide poisoning prevalence In South Korea, from 2005-2010 there were 255 recorded cyanide deaths. The age of the victims ranged from 6-80 with a mean age of 42 (+/-)13 and they were predominantly male. 97.3% of these deaths were suicides. 14.5% of individuals died even after receiving medical treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834424/ In the US, for the year 2016, the National Poison Control System reported 268 cases with 198 single exposures. 132 of these reported for treatment at a medical care facility. For 51 we have no record of outcome, 42 were evaluated as minor, 17 as moderate, 7 were major, and 6 resulted in death. (https://doi.org/10.1080/15563650.2017.1388087 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report) How you might be expose to cyanide My experience has shown that cyanide isn’t exactly rare, but in the US, it can be hard to come by. So, how might someone encounter cyanide? The most likely place to come across a fatal dose is in the workplace. Cyanide is used in processes such as metal plating, gold mining, as a pesticide, tanning, and in the dye and pharmaceutical industry. Heard of nitrile gloves? Nitrile is the chemist name for cyanide. https://www.atsdr.cdc.gov/toxprofiles/tp8.pdf Industry produces large amounts of cyanides. In 2004, the US exported almost 4 million pounds of potassium cyanide. https://www.atsdr.cdc.gov/toxprofiles/tp8.pdf The most likely way that the average American might be harmed by cyanide is through smoke. Ever seen a package of cigarettes with the cyanide warning on them. The more likely type of dangerous smoke is burning plastics. Nitriles (cyanides) are very common components and are liberated during burning. However, you and I come across cyanide almost every day through the foods we eat. Foods containing cyanide include including almonds, millet sprouts, lima beans, soy, spinach, bamboo shoots, and cassava roots. Many stone fruits including peaches and apricots contain cyanide in the seeds as do apple seeds. Fortunately, with one exception, the amount of any of these foods you would have to eat to be affected by cyanide is beyond the capacity of the average human stomach. However, cassava, more commonly known as tapioca, contains high levels unless properly treated. Even properly treated, individuals who consume large amounts can have lingering side effects. In some parts of the world, where cassava is a major food source, disease from chronic cyanide exposure is common. https://www.atsdr.cdc.gov/toxprofiles/tp8.pdf The most dangerous way to come across cyanide is in the gaseous form. If cyanide powder is mixed with the wrong chemical, cyanide gas will form almost instantly. Cyanide gas smells like burnt almonds if you can smell it. For a large percentage of people, cyanide has no odor. My nose is very sensitive to cyanide and I smell the almonds even when handling the powder. This always makes me just a little bit nervous. Cyanide symptoms Cyanide has a strong affinity for the mitochondrial electron transport chain in cells. If you have brain dumped most of your biology, the mitochondria is where a cell makes it energy. Once cyanide interacts with the mitochondria, the cells are prevented from using oxygen. Your red blood cells are carrying plenty of oxygen, other cells just can’t use it. It is effectively like someone putting a plastic bag over your head. http://www.centerforhealthsecurity.org/our-work/publications/cyanide-fact-sheet Johns Hopkins Any time you are measuring how toxic something is we use what is called LD50s. If we gave 100 people this dose, 50 would die, 50 would live. The LD 50 for gas (LC50) is 524 ppm breathed for 10 minutes, or out of 1 million air particles, 524 are cyanide. Cyanide powder is a little easier to visualize. The LD 50 is 1.52 mg/kg so the lethal dose for an average 70 kg person is 0.1g. A gram is roughly equal to an aspirin tablet. The lowest recorded lethal oral dose was ~.04g. https://www.atsdr.cdc.gov/toxprofiles/tp8.pdf   Upon uptake of a large amount of cyanide, there is a brief sensation of dryness and burning in the throat followed by warmth and a hunger for air. This is followed by rapid breathing and an occasional outcry. In less than one minute breathing can stop, the victim will lose consciousness and convulsions may occur. The heart may continue to beat for 3-4 minutes after the last breath. Fair-skinned individuals often exhibit rose-colored skin. https://www.atsdr.cdc.gov/toxprofiles/tp8.pdf  There is an effective antidote if it can be administered in time. The antidote consists of sodium nitrite/amyl nitrite and sodium thiosulfate as well as oxygen treatment.   https://www.health.ny.gov/environmental/emergency/chemical_terrorism/cyanide_tech.htm Cyanide treatment While it is highly unlikely you will ever encounter cyanide unless you work in industry, cyanide gas is considered a likely terrorist weapon. The most likely indication would be the smell of almonds or people exhibiting the previously mentioned symptoms. This is most likely in an indoor area, as hydrogen cyanide dissipates very rapidly in an outdoor environment. The most important thing you can do is get outside as quickly as possible. If you cannot exit the building, move as far as possible from the source (perhaps indicated by hissing or vapor cloud) and get very close to the ground, as cyanide will tend to rise. If possible, move victims outside to fresh air when you evacuate. If available, administering oxygen may help until the antidote is available. https://emergency.cdc.gov/agent/cyanide/basics/facts.asp To summarize, cyanide is very dangerous if inhaled, ingested or even through skin contact. Some people may smell an almond smell. Symptoms will begin very quickly with loss of consciousness in as little as a minute. Treatment is available, but must be administered fairly quickly. Until help can arrive, get a victim to fresh air as soon as possible. If you don’t work in certain industries, the chance of being exposed to cyanide is very low, but cyanide is a likely terrorist weapon. Listen to more episodes or try out some of my bonus content

Thanks for joining me for this bonus podcast on what you can do to prepare for an EMP. As we discussed in the main podcasts, the probability of a man-made EMP is unquantifiable. Should one happen, it is likely to have severe consequences for the targeted area. Because this will be an act of war, little may be done to assist those affected by the event. Natural EMPs affecting our electrical grid have already occurred. They will inevitably occur again. The unknown is to what level the world, and your country, will be affected. During my research, I found some great articles by individuals that had obviously spent a great deal of time thinking through the subject. As always, their references are included in my show notes. What level you prepare to is up to you. I expect that it will be directly correlated to how realistic you think the threat is. Almost 15 years ago, I spent some time in New Orleans immediately after Hurricane Katrina. The effects of a natural disaster of this magnitude are pretty sobering. While there were many heroic deeds and real admirable displays of humanity, what struck me was how quickly society broke down. Within 12 hours of the hurricane, the expected civilized American values were abandoned. I would never fault someone for breaking into a store to acquire food in an emergency, but acquiring a big-screen TV doesn’t seem to have the same sense of urgency. The complete loss of order and the indescribable level of human filth on display at the Super Dome was shocking. Although residents had several days warning about the impending disaster, the vast majority did nothing to prepare. Instead, they expected that others would take care of them after the disaster. This is a really poor strategy. Even with pre-staging, the federal response took multiple days and there simply weren’t enough resources to take care of everybody. The bottom line was that if you didn’t prepare for yourself, it probably wasn’t going to go very well for you. As a side note, the hurricane response I did to Texas gave me a little more hope for humanity in the face of adversity. After an EMP, the immediate problems are going to be water. Followed shortly by food. If your water is pumped from the ground, no electricity means no water. If your water is from surface sources, no electricity means water purification is going to be difficult. Finding a source of water, preferably clean is going to be important. One source recommends having several metal buckets on hand that are specifically made to be lowered down well casings both for water and also for retrieving fuel from underground tanks. Along with drinking water, remember that if your sewer system requires lift stations, things are going to get unsanitary very quickly. If it is gravity fed, remember that without electricity, it will soon be dumping nasties into its outlet. See my episode on hand washing for why this is important. Food will be rapidly become a second priority. Preparation before an event will make this a much less pressing problem. If this is a long-term event, having the materials and skills to grow/harvest your own food could make all the difference.  If your devices or home electrical appliances still work, a generator or solar panels and batteries would be vital in keeping them functioning as long as possible. You will also need an inverter to power household appliances from solar. Fuel for generators and cars is likely to be difficult to find. Today’s fuel also has a short shelf life and so keeping enough on hand is pretty difficult for most of us. https://www.futurescience.com/emp/emp-protection.html Deciding whether to use these appliances is another concern. My experiences in Katrina convinced me that there will likely be hordes of “zombies” roaming the streets looking to take what they can from others. Being the only house with lights on for a mile may attract more attention than you want. I would feel very uncomfortable without a weapon to protect myself and more importantly my family in this situation. Desperate situations can bring out the worst in people. Under these conditions, the only language some people understand is violence. Be warned though, you must be mentally prepared to defend yourself or having a weapon could make your situation worse. Following a large EMP, going it alone likely won’t be an effective strategy. The skills of a community may be necessary to survive. If you aren’t willing to defend yourself with violence, you will need to find a community that will take care of this for you. Just remember, you will need to have a useful skill to provide to the community in exchange. In the event of a regional disruption, migrating out of the affected area may be your best bet. Remember that while cars will most likely work, fuel will be an ongoing issue. Part of the trek to unaffected regions may be on foot. This will necessitate carrying food and supplies over long distances. A water filter is also going to be necessary to prevent illness along the way. Remember, this will be a very sudden event. In 1989, the power grid in Quebec went from functioning to inoperable in only 92 seconds. If you are attempting to protect your electrical devices, a faraday cage will protect against nuclear EMP but will do little for a solar storm. http://www.futurescience.com/emp/EMP-myths.html If you are worried enough about an EMP to have a cache of electronics protected by a faraday cage, I would recommend one of those items be a short-wave radio. Of course, you will need a way to power it, so small solar cells might be advisable. There are a couple of simple ways to create a faraday cage for the storage of electronics. The first way is to place the device in a heavy-duty plastic bag. Next, wrap it completely in aluminum foil. Place the foil-covered device in another plastic bag. Wrap it again in aluminum foil. If you really want to be sure, wrap it in another layer of plastic and aluminum. An alternate method is to use a large galvanized trash can. Line the trash can with cardboard or thick plastic/rubber material. For sensitive devices, you might want to pair the first method with the second. https://www.futurescience.com/emp/emp-protection.html If you are going to protect electronics from an EMP, you want to be thoughtful in your selection. Keep in mind the environment that may exist should you need them. Getting information immediately following an event may be very difficult so communications devices could be very helpful.  Hopefully, you will never need the information in this episode, but many of the preparedness items in this episode could be useful in a large number of situations. Remember, in an emergency, prior preparation can make a significant difference in how traumatic the event ends up being and how successful you are in weathering it.

Today we will be discussing electromagnetic pulses (EMPs). EMPs can bring down our electrical grid and potentially our way of life with it. How likely are they and how bad could it get? Hi everyone. Today I just wanted to say thanks to all those that have subscribed to my podcast and for your kind comments on iTunes. That has really made this project a lot of fun. I have some great episodes around the corner that I can’t wait to share with you. Today’s episode is: Electro-Magnetic Pulse (EMP): When the lights go out (E8) When I began this podcast, I was trying to select my first ten topics. I asked my family to go through the couple of hundred topics that I had collected and choose their top 10. Not surprisingly, their responses were quite varied, but the one topic that was one everybody’s list was EMPs. This may be because we have a good friend who is heavily involved in electromagnetic research or because of the talks we’ve had around the dinner table.  For a second, I’d like you to imagine a world where all school classes are canceled, grocery stores lose their entire inventory of perishable foods, hospitals are running on generator power, restaurants are closed, lines are rapidly forming at the few working gas stations, and people are desperately searching for a place to charge their dying cell phones. Everything I’m describing has already happened in Oct 2019 when high winds caused California PG&E to shut off power to millions of customers. https://www.latimes.com/california/story/2019-10-10/millions-without-power-pge-blackouts-california  Although the blackouts were relatively short, the damages were estimated to be as high as 2 billion dollars https://www.cnbc.com/2019/10/10/pge-power-outage-could-cost-the-california-economy-more-than-2-billion.html While I would be interested in seeing exactly how that figure was reached, there is no doubt that it was a costly and traumatic event. Electro-magnetic pulse: End of the world? I think most of us recognize how dependent we are on electricity for our modern way of life. One of the biggest threats to our electric grid is an EMP, or electromagnetic pulse. In Oct 2017 the EMP commission which had recently lost all funding made some dire predictions. If you will remember, during that period North Korea wasn’t behaving themselves very well. They predicted that North Korea could use a short-range nuclear warhead to create an EMP capable of blacking out the Eastern electric grid. Such an incident could shut down the entire US electrical grid for years and potentially lead to the death of 90% of all Americans. They based their predictions off of the US Starfish Prime nuclear tests in 1962 over Johnston atoll that effected the electrical grid in HI over 800 miles away. Russian EMP tests over Kazakhstan in the same time frame had a similar effect. They also point out that our modern electronics are more susceptible and that destruction of just 9 key power transformers would cause long-term blackouts nationwide. https://docs.house.gov/meetings/HM/HM09/20171012/106467/HHRG-115-HM09-Wstate-PryP-20171012.pdf   EMP: Not so bad “Experts” in a business insider article called the idea of North Korea using an EMP attack “ridiculous” and “laughable”. They argue that if North Korea had the capability, they would cause more damage using it in a conventional manner. Additionally, they point out that the US would be sure to retaliate and the collateral damage to other countries wouldn’t win them any friends. https://www.businessinsider.com/north-korea-emp-us-what-would-happen-2017-10 So, who is right? Certainly, the threat of losing funding (and your job), gives you an incentive to make your department look as important as possible. On the other hand, businesses don’t necessarily want to spend millions or billions of dollars fixing something that may never be a problem. EMP: What is it? Let’s start with figuring out exactly what an EMP is. An EMP is a strong burst of electric energy. In nature, we have an example. Lightning. I have a few electrical devices that didn’t survive the power surge caused by a nearby lightning strike. Obviously, the effect of lightning is localized. In a nuclear EMP, the explosion causes a large burst of gamma rays (we discussed those in the radiation podcast). Gamma rays are pure energy (kinda like microwaves). When they hit molecules, mostly air, they are powerful enough to knock electrons off those molecules. If electron and electricity sound similar to you there is a reason. Electricity is just “flowing” electrons that do work. I think of it as a water wheel. If the water isn’t flowing, the wheel won’t turn and no work gets done. These electrons travel through the atmosphere at nearly the speed of light. Earth’s magnetic field causes these electrons to flow toward the poles in a variety of energy waves. If they encounter electronics (or transmission wires) along the way, they can overload them and cause them to fry. https://www.businessinsider.com/nukes-electromagnetic-pulse-electronics-2017-5 Think of a flash flood hitting our water wheel. If our water wheel gets washed away, it isn’t going to do us any good once the flow returns to normal. Types of electromagnetic pulses There are two types of EMPS: High and low frequency. Additionally, we have two potential sources: nukes and the sun. High-frequency EMPS (E1) affect the circuitry of computer-based systems. Low-frequency EMPs (E3) travel along electrical grid wires and affect the vital components of the grid, interrupting power transmission. Nuclear weapons have both high and low-frequency pulses while the sun only generates low-frequency pulses. While the effects of a nuclear weapon would be somewhat localized, low-frequency events from the sun could affect the entire earth. https://theprepared.com/emergencies/guides/emp/ While losing individual electronic devices would be painful (think smartphone addiction withdrawal) we could recover reasonably quickly. However, the destruction of the energy grid would be a much longer-term problem. The main vulnerability is the transformers we mentioned earlier. They are called EHV transformers and currently, only Germany and South Korea export them. Additionally, each one is custom made and typically requires at least 18 months to manufacture. https://www.afpc.org/uploads/documents/EMP%20Primer%20-final.pdf   Additionally, many power plants require a large input of energy to start up. Without access to other power sources on the grid, bringing up a repaired power plant or transmission system could be very difficult. https://www.ferc.gov/industries/electric/indus-act/reliability/cybersecurity/ferc_meta-r-319.pdf The Government Accountability Office (GAO) found that an EMP event that disrupts the electrical grid “could result in cascading impacts on fuel distribution, transportation systems, food and water supplies, and communications and equipment for emergency services, as well as other communication systems”. https://www.afpc.org/uploads/documents/EMP%20Primer%20-final.pdf The impact of an EMP related outage is directly related to the duration of the event and/or the geographic area affected. A short blackout affecting only a small geographical area would be economically difficult as the loss of electricity would affect 20-60% of industrial production. Short blackouts over narrow regions, while painful and economically challenging would pose little risk to national survival. Their effect might be similar to a large hurricane or earthquake.  A large area blackout however, could damage thousands of transmission components and jeopardize a nation’s existence. Large blackouts would affect food, heat, water, waste disposal, medical/police/fire response, and civil authority. Each of these has multiple trickle-down effects. EMP studies Multiple studies have been conducted to determine what effects an EMP might have on these areas. Cellular communication itself would survive an EMP relatively well, but secondary effects could impact communication severely. These include damage to personal cell phones, loss of the power that runs cell towers, and large spikes in cellular traffic. In one study, quite a few years ago, cars were subjected to an EMP exposure. 3/37 running cars had the motor shut off and coast to a stop. All of them were able to be restarted. 25 of the 37 exhibited some type of electrical anomaly, dashboard light malfunction, etc. 8 of the 37 showed no ill effect. Similar to cell phones, the issue that would rapidly develop is the production, shipping, and pumping of fuel to enable the use of vehicles. Many gas stations could have fuel in underground tanks that they are unable to sell because they have no way to pump it into cars. Another concern could be the effect of an EMP on traffic signals. Testing indicated that an EMP would probably not affect traffic signals, and in no instance did it cause a signal to show all conflicting green signals. As with cell phones, there could be significant disruptions due to loss of power to traffic signals. Every time I make a trans-Pacific flight, I can’t help but think what might happen if an EMP struck mid-flight. Due to the possibility of lightning strikes, airplanes already have up to four redundant levels built into each flight control system. There is no guarantee that airplanes are immune from EMPs, but they have significantly more precautions built-in than almost any other system on earth. Water treatment, both drinking and sewer are another concern. Water treatment uses a significant amount of energy. Often, so much energy that backup generators are impractical. Rather than use generators, they often have feeds from multiple power systems. Any widespread event that destroyed the grid would almost certainly collapse the water treatment system. https: