Brain Parasites, California’s Hidden Health Problem | Hacker News Reader

Brain Parasites, California’s Hidden Health Problem

blogs.scientificamerican.com

95 pointsgeorgecmu54 comments

One prominent (at least in this community) sufferer of this is Sarah Lane (of TechTV and TWiT).

http://en.wikipedia.org/wiki/Sarah_Lane#Personal_life

"On October 11, 2009, Lane was at a Los Angeles restaurant with a friend when she experienced a severe tonic–clonic seizure, went into spasms and blacked out. It was apparently her first such seizure. She was rushed to a nearby hospital, where she apparently stayed for a couple of days before being diagnosed with a lesion on her brain and eventually put on anti-seizure medications and discharged. Lane wrote on her blog that further diagnosis revealed that neurocysticercosis tumors have developed as a result of her contracting cysticercosis."

http://www.sarahlane.com/blog/2009/11/1/sarah-the-goddess-of...

IIRC, she also spent a year traveling the world before this happened. I think I remember her saying she picked up the parasite abroad.

The CDC says an estimated 1,900 people are diagnosed with neurocysticercosis within the United States yearly.

In other words, on the same order as the number of people who die from cancer per day in the US. I guess I'm going to continue to be more worried about other health problems.

Whether you choose to worry about it or not, California might be able to save an awful lot of money with interventions that avoid a $66,000 surgery.

Or they might not. According to the article, the early treatment is "hundreds of dollars" - for simplicity I'll assume it's $660. If we apply early treatment to 100 people for every surgery prevented, we merely break even.

Early treatment and disease screening is not a panacea. Sometimes it makes sense, sometimes it's more harmful than doing nothing.

Sure, that's why I said might, the specifics matter a whole lot.

We also avoid a lot of misery for that one person who'd need surgery.

And if we are playing economics, while they experience that misery they also aren't earning money or paying taxes resulting in lost productivity. Their family is also likely sidelined for a while so that adds to reduced productivity, taxes and income to places they frequent.

On the other hand, all the people who are getting unnecessary screenings and medical treatments are also not working, resulting in lost productivity. And the medical professionals wasting time on screenings/treating people with non-symptomatic parasites could be helping people with emergent problems.

Quantitative cost/benefit analysis or GTFO.

Well, if we posit a world where people are regularly getting "unnecessary" screenings for this condition, we're probably also positing a world where people are seeing their doctors regularly and getting a whole host of "unnecessary" tests for all kinds of conditions whose initial symptoms are subtle and easy to blow off.

So this is probably part of a world where all KINDS of conditions are detected and corrected early. Take, I dunno, one day out of every quarter, get some blood drawn, a few scrapings taken, and have a zillion tests run on it. Then spend the next quarter feeling pretty secure that You Are In Good Health. Or that You Have Something Wrong But It Is Being Handled. Less stuff to worry about - better quality of life. Which, if you only look at things in terms of the ALMIGHTY DOLLAR and WORKER PRODUCTIVITY, also means happier workers who have one less thing distracting them.

As opposed to the current state of things in America, where any and all interactions with the medical world are to be feared because costs are insanely high, and insurance companies fight like crazy to avoid any and all payouts.

I hate to get political with this, but really, I think any attempt to think about the cost/benefit situation of something like this is going to pretty quickly lead into considering the overall state of health-care.

...we're probably also positing a world where people are seeing their doctors regularly and getting a whole host of "unnecessary" tests for all kinds of conditions whose initial symptoms are subtle and easy to blow off.

In that case, we are positing a world in which thousands of people are receiving false positives, suffering side effects from unnecessary treatments, and dying of infections they received while their non-cancerous mri blip was biopsied.

Even in a world where MRIs and HIV tests are free, full body scans and HIV tests for everyone would be a dumb idea.

A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall... we don't do one.

In this pig case the PERSON himself might not be willing to spend $XXX given the odds. Let's face it we make such decisions each day: we face a million types of diseases and a million ways to die. Not to mention that we smoke, drink, eat red meat, buttered popcorn, ice cream...

True.

Red meat isn't bad for you.

Red meat in a high glycemic index and/or calorifically high diet is bad for you.

There are probably leaner sources of protein you could go for, but the fats in quality red meat are the closest thing to a nutritional panacea for humans.

Admittedly, these boons mean little when all of your health problems are from eating too much or eating junk food (candy, soda, etc).

Also worth pointing out this is one cheaply preventable dangerous medical treatment.

If people start going to doctors before they get sick, we

a) save a huge amount of money

b) create an incentive to advance preventive, low-cost medicine

c) get a better understanding of how medical conditions evolve within the community

All three are worthy goals (and b may even spur a very profitable industry)

This parasite can be eradicated worldwide. We need pigs to be penned where they cannot eat human feces - its that simple.

Who else thinks that if the Hebrews had figured that out long ago, then Hebrew and Muslim diet restrictions might today be more permissive?

This parasite can be eradicated worldwide. We need pigs to be penned where they cannot eat human feces - its that simple.

Not simple at all. A trip outside the first world will tell you that raising pigs is not as easy as you make it. Not every family has land and resources avail to raise pigs as you said it.

Perhaps the goal is simply stated, but the solutions are complex. The main resource lacking is education about proper pig husbandry.

See: http://cnia.inta.gov.ar/helminto/A%20Cisticercosis/Improving...

Moreoever pigs are in direct competition with humans for food. That's almost certaily why ancestral middle-eastern tribes had taboo on raising pigs and favoured goose and cows that feed on herbs (humans and pigs can't digest grass wich is based on azot).

Agree with your premise, but fault the probability of your conclusion due to the written record left by Hebrew scholars who described pigs as "unclean". Its easy to see how an animal that eats human feces could be viewed that way.

Their ability to eat everything is actually an asset, they're relatively easy to raise. Cows and sheep not so.

Any health issues are seen as a cost of doing business, after all they are a million ways to get sick and die in the third world.

> Its easy to see how an animal that eats human feces could be viewed that way.

Not necessarily that easy. For example, they didn't think farmyard manure was unclean but nonetheless used it to grow vegetables. My intuition is that it's easier to remember pig as "filthy", "unclean", "kosher", "forbidden" than their place in a complex and ever moving ecological system. Written record left by scholars could be deductions made about the current state of things and its lost meanings (that's actually part of my intuition).

Chickens eat human feces too, but they are not considered "unclean".

Plus, the one doesn't exclude the other. The taboo could be because of the reasons the parent mentioned, and the "unclean due to eating feces" could just be a post-fact rationalisation of it.

> Its easy to see how an animal that eats human feces could be viewed that way.

Pigs were considered unclean more for their consumption of human flesh than for their consumption of human feces. Geological conditions in the Levant meant that bodies were typically interred in crypts or caves rather that being buried 'six feet under' where the decomposition couldn't be smelled by scavengers.

Not really -- pigs are really useful for cultivating land. You pen them in an area and they turn over the soil when they go "rooting" (foraging for roots and bugs).

Historically, pigs are a recycling engine as well. You set them loose on garbage pile and they eat all sorts of stuff, producing rich fertilizer in return.

This stuff all originates from the ancient Egyptian practices, and the reasoning for the taboos aren't precisely known. I always thought they had more to do with the people who kept the pigs -- who were (and still are today in Egypt) non-Muslim/Jews who are associated with garbage.

Yes, but not only that

Vegetables should be properly cleaned before eating

If you eat contaminated pork, you won't get NCC (or other cysticercosis) , you get a worm.

You get Cysticercosis when you eat food contaminated with human faeces (sorry about that). Because then the human is "playing the part" of the pig.

Cooking and basic hygiene goes a long way.

> If you eat contaminated pork, you won't get NCC (or other cysticercosis)

You are wrong

https://en.wikipedia.org/wiki/Cysticercosis

You were so quick to dismiss me you haven't even read the link you posted, so please read this https://en.wikipedia.org/wiki/Cysticercosis#Transmission carefully

"Humans are T. solium reservoirs. They are infected by eating undercooked pork that contains viable cysticerci."

They are infected -> they get a worm by eating undercooked pork. Not cysticercosis

Normal lifecycle: Pork eats tape worm eggs -> the pork gets cysticercosis -> Humans eat pork meat -> humans get tape worm -> worm releases eggs in human faeces -> back to step one

Cysticercosis happens when the human plays the role of the pork

The very first line of the link I sent says "Cysticercosis refers to tissue infection after exposure to eggs of Taenia solium, the pork tapeworm."

Correct

Contaminated pork meat has no tapeworm eggs, it has cysticerci, which is the tapeworm larvae. Not eggs

You're confusing things.

I think Hebrew dietary restrictions may be more instructively viewed as a mechanism to enforce group cohesion than as a primer on suggested health practices. It is difficult to mix with other groups when you cannot eat with them. Matrilineal line of descent serves the same function. Children fathered by in-group men with women outside the group are simply excluded, while in-group women face censure for the same behavior. There are structural reasons why Jewish culture has remained distinct in diaspora, while many other disjoint populations are absorbed by host populations over time.

Longstanding practices are often multiply-determined, and the relative balance of benefits may change according to the situation. (In high-sanitation environments, the rules help enforce cohesion/segregation; in low-sanitation environments, the rules provide protection from endemic parasites.)

Why forbid pigs, and not cows? Why catfish, not cod? Vulture, not chicken? Even within a framework, there are reasons for specific decisions.

Agreed, there are always reasons for specific decisions. In the three cases you've mentioned, the banned flesh is from animals that are carrion eating scavengers.

Pork production in the United States is monitored and tapeworm free. You're much safer eating American pork than you are eating fish.

As noted in the article, the discussion is about human to human spread of this parasite. The solution there is even simpler, though more difficult: wash your hands regularly and thoroughly.

Agreed. Sanitation practices that seem obvious in the developed world assume infrastructure not available in many other areas. People who live in these places are not stupid, and I, for one, am glad that my morning ritual doesn't involve hauling fresh water from a mile away.

And even more importantly, wash your hands regularly and thoroughly when you are preparing food for others.

This was figured not by Hebrews (ancient Israelites), but by ancient Egyptians.

Cysticercosis was endemic in ancient Egypt. Pork was a staple food for common people in Egypt, but priests had strict dietary laws and they knew that Cysticercosis caused by tapeworms from swine.

Ancient Israelites just adopted a lot of customs from Egyptian Priestly caste, like circumcision, calendar and dietary laws. Not surprising, considering Moses was raised as Egyptian.

>...priests had strict dietary laws and they knew that Cysticercosis caused by tapeworms from swine.

> Ancient Israelites just adopted a lot of customs from Egyptian Priestly caste...Not surprising, considering Moses was raised as Egyptian.

Even allowing the existence of Moses (which, if we're feeling skeptical we can reinterpret as the long cultural shadow of Egypt), this still seems like a "just so" story.

Do you know if there's any evidence that Egyptian priests actually had medical justifications for their taboos? Similarly, how do we know that ancient Israelites adopted certain beliefs due to direct Egyptian influence, rather than participating in widespread regional practices also found in the Canaanite populations from which they emerged?

I don't think at the time there was distinction between religion, astrology, science, medicine and healthcare. The priests had the knowledge, while the commoners were mostly illiterate.

During the Predynastic Period pigs were considered unclean in Upper Egypt but were domesticated and eaten in Lower Egypt. During the Dynastic Period Pigs were thought to be unclean in some areas and among the wealthier classes. Herodotus states that people who raised and ate pig were shunned but archaeological evidence suggests that although technically unclean, pork was still popular with many poorer Egyptians.

http://www.ancientegyptonline.co.uk/dietmeat.html

Moses or not, the word "Israel" was found in Egyptian scripts. "Hapiru" king "Yakubu" also mentioned in Egyptian sources - cognates with Hebrew Yaakov.

There are enough evidence, that ancient Egyptians and ancient Israelis had a contact.

I took a biblical archaeology class as an undergrad and both our teacher and every text we read were very cautious about making this link. There simply isn't very much evidence for who the 'PRW (apiru or whatever) were; we don't even know if it's a particular tribe/identity or just a catch-all for brigands and outlaws. Similarly, we don't have any historical evidence for what Israelite society was like before ~1000BC and definitely nothing about 2000BC (when the word apiru starts appearing).

I agree that the ancient documents about marauding apiru might be referring to Hebrews, but we really should keep our Bayesian hats on when evaluating archaeological evidence.

As for "Yakubu" and "Israel", any citations? Are those in one of the Amarna letters?

http://en.wikipedia.org/wiki/Merneptah_stele#.22Israel_is_la...

http://en.wikipedia.org/wiki/Yaqub-Har

Cool, thanks.

Not directly related to the article, but it seems pretty risky (and potentially not HIPAA compliant) to release photographs of software with protected health information on them.[1]

I do a lot of work with security in the healthcare field, and I'm pretty sure it's a big no-no to release information like that. Where it gets interesting is that I'm confident that the patient herself okayed the information... so where does that leave responsibility for the PHI?

I don't actually know the answer, but I'd certainly be interested in finding out.

[1]: http://blogs.scientificamerican.com/guest-blog/files/2012/09...

Cursory googling suggests it is fine. E.g.:

http://www.rtnda.org/pages/media_items/rtndas-guide-to-healt...

I was half expecting an article about startup fever.

Thanks... and now I have something else to be paranoid about.

Your risk isn't far off from your risk of getting struck by lightning, and a tiny fraction of the risk you'll get in a car crash.

There's no limit of the ills that might befall you, if you're willing to dip that low (honestly, I've no idea why the article is written as if this is a big deal); so you can save your paranoia for something a bit higher up the scale. :)

Adds to the list of things I won't miss about California.

Actually, in the details of the story you find that you can "enjoy" the infection elsewhere...

"Only five states — New York, California, Texas, Oregon and Illinois — report the disease, and the data is inconsistent. Oftentimes, departments rely on each other to deal with paperwork, and the numbers are never recorded, Smith says. As a result, not much is known about tapeworm outbreaks in the U.S. — or the parasites themselves."

It also sounds as though the long dormancy of the symptoms make it extremely difficult to determine where it was contracted.

all other things aside, that $66K tag can send 95% to see a bankruptcy lawyer.

"The most common form of payment is Medicaid, a tax-funded public service. In Los Angeles County, the economic impact is even more pronounced, costing $66,000 on average, the increase likely due to the high cost of health care in the state, says Frank Sorvillo, a University of Los Angeles professor of epidemiology."

not everyone has Medicaid, usually the lower middle class gets hosed (too much money to qualify for Medicaid, but barely making ends meet.)

Now that you mentioned it, they probably they charge individuals well over $100K if Medicaid pays $66k

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