August 27, 2013 10:24 am
Inspectors from the United Nations are attempting to determine whether the Syrian government is responsible for the use of chemical weapons in attacks there—a line that, if crossed, could warrant intervention by outside nations. For doctors on the ground, though, the question is less who used the weapons and more how they are going to treat the victims. This morning the New York Times published a harrowing account of what hospitals are like right now:
Thousands of sick and dying Syrians had flooded the hospitals in the Damascus suburbs before dawn, hours after the first rockets landed, their bodies convulsing and mouths foaming. Their vision was blurry and many could not breathe.
Overwhelmed doctors worked frantically, jabbing their patients with injections of their only antidote, atropine, hoping to beat back the assault on the nervous system waged by suspected chemical agents. In just a few hours, as the patients poured in, the atropine ran out.
Atropine, the drug these doctors are using, is an extremely common drug. The World Health Organization has it on their “Essential Drugs List,” a list of drugs that constitute the baseline of medical care. It is also the most common drug used to combat nerve agents—the chemicals that block the communication between nerves and organs. The symptoms described by the Times—convulsions, foaming mouths, blurry vision, difficulty breathing—are all associated with the use of these nerve agents.
Understanding how atropine works depends on understanding how nerve agents work. Essentially, when the body is working normally, a neurotransmitter called acetylcholine moves between nerves to carry signals. Once the acetylcholine does its job, an enzyme shows up to break it down. Nerve agents destroy that enzyme. Acetylcholine builds up and continues to make the nerves connect over and over and over again.
Atropine, on the other hand, blocks the acetylcholine receptor. So even if there’s a huge buildup of acetylcholine between the nerves, the connection never happens. This, of course, can also be dangerous, because if your nerves can’t talk to one another your body can’t function. But in situations where the acetylcholine is unchecked, atropine can help stop seizures and convulsions. It must be dosed carefully, and administered quickly, but in nerve gas attacks it is really the only treatment doctors in Syria have.
Humans have known about the power of atropine for a long time. The active ingredient comes from plants in the Solanaceae family like nightshade, Jimson weed and mandrake. Egyptian women used atropine to dilate their pupils, to look more attractive, and the Greeks used it before surgery to numb pain. It wasn’t until 1901 that pure atropine was synthesized in the lab by combining tropine with tropic acid.
Today, it’s used for all sorts of things beyond chemical warfare. Doctors use it before anesthesia, it’s used during heart surgery, to dilate eyes during eye surgery, and to treat scorpion stings and other venomous bites.
Despite its many uses and its key role in fighting nerve agents, the atropine supply is relatively low. The doctors in Syria are running out of it, and in July the American Society of Health-System Pharmacists added atropine to the list of current drug shortages. They cite a few reasons for the drop in supply:
- American Regent had temporarily suspended manufacture of most drug products in April, 2011.
- American Regent resumed manufacturing in Shirley, New York in early-May, 2011.
- Hospira states the shortage is due to manufacturing delays.
- West-Ward acquired Baxter’s atropine injection products in May, 2011. NDC codes began changing for these products in early, 2012. West-Ward is not manufacturing the 0.4 mg/mL or 1 mg/mL 1 mL vials.
- Amphastar has atropine on shortage due to increased demand.
This isn’t the first time people have had to consider a dip in supply of atropine. In 2004, researchers at the NYC Poison Control Center looked at just how long after its shelf life doctors could use atropine in emergency situations. “A massive nerve agent attack may rapidly deplete in-date supplies of atropine,” they write.
Which seems to be exactly what’s happening in Syria. Doctors Without Borders estimates that in the past few months they’ve sent 1,600 vials of atropine. Ghazwan Bwidany, a doctor treating patients in Syria told the BBC that along with being understaffed, they were running out of medicine. “We are lacking medical supplies now, especially atropine,” he said.
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August 16, 2013 2:13 pm
The Vikings “discovered” Canada in the same way that Christopher Columbus “discovered” America and the British “discovered” Australia—that is, not at all. Depending, of course, on your point of view. Much of the history you probably know is crafted from a strictly European point of view, so from that perspective, all of these wild lands were conquered by valiant European explorers and sailors. But from a less Euro-centric version of history, one that treats all humans equally and doesn’t totally ignore the existence of a wide range of advanced cultures, Europeans actually didn’t do all that much discovering.
This map by Bill Rankin, a Yale historian and cartographer, shows all the places that Europeans actually discovered. That is, the places they found where people weren’t already living. Mostly, it’s a bunch of tiny islands. The map sure paints a different picture of the age of exploration, doesn’t it?
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August 15, 2013 10:55 am
Yesterday, hundreds of supporters of Egypt’s recently-ousted president Mohamed Morsi were killed in Cairo. Morsi was the first democratically elected leader in Egypt after the Arab Spring protests in 2011 pushed out Hosni Mubarak, but Morsi’s short tenure as president, at the helm of his Muslim Brotherhood party, was highly controversial. He was forced out of office last month by Egypt’s military amid violent protests.
But protests followed Morsi’s exit from office, too. Last week CNN reported that the new military-backed government was planning to “disperse supporters of deposed President Mohamed Morsy.” On Wednesday, for more than 12 hours, the demonstrators were attacked with “armored vehicles, bulldozers, tear gas, birdshot, live ammunition and snipers,” the New York Times reports.
How Many People Died?
“The attack,” says the New York Times, was “the third mass killing of Islamist demonstrators since the military ousted Mr. Morsi six weeks ago, followed a series of government threats. But the scale…and the ferocity far exceeded the Interior Ministry’s promises of a gradual and measured dispersal.”
Who is Doing the Killing? Who is Being Killed?
Egyptian riot police, says the Associated Press, “smashed two protest camps of supporters of the deposed Islamist president” in Cairo, and the violence spread from there. There have been casualties on both sides, but in general the death toll comprises supporters of Morsi.
Though the military-backed government was leading the attack, the army hung back while police engaged in the conflict. The AP: “Army troops did not take part in the two operations, which began shortly after 7 a.m. (0500 GMT — 1 a.m. EDT), although they provided security at the locations.“
What is the U.S. Doing?
President Obama spoke this morning about the conflict. He announced that the U.S. was canceling its biannual military exercise, which would have taken place next month. “America cannot determine the future of Egypt. That’s a task for the Egyptian people,” he said. ”We don’t take sides with any party or political figure.”
But, for now, says the Guardian, the U.S. is still saying that the overthrowing of Egypt’s President Morsi was not a military coup. The U.S. gives Egypt $1.3 billion a year in military aid, and calling it a coup would ban that exchange of money. “The United States,” says Reuters, “has been reluctant to cut the funding for fear of antagonizing the military and losing what influence it has in the Arab world’s most populous nation.”
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August 8, 2013 1:02 pm
As Russia moves into the final stages of preparation for hosting the Winter Olympics, a movement is heating up to pull the games out from underneath them. Recent violence against homosexuals and a government ban on “pro-gay” activities has people concerned that gay athletes and fans will not be safe at the games. Activists have started circulating petitions to have the games moved out of Russia and have garnered support from high-profile advocates like George Takei and Stephen Fry. But how feasible is a move this late?
Preparing to host the Olympic games is an incredibly expensive venture. The London Olympics cost something like $15 billion to set up. Business Insider estimates that the Winter Olympics in Russia could cost the nation $51 billion, and much of that money has already been spent on building venues and housing and the trappings required for an Olympic game. This budget would make Sochi the most expensive Olympic games ever. For comparison, Vancouver only dropped $6 billion on its 2010 Winter Olympics.
Vancouver is, in fact, the place where many are suggesting the games be moved. The petition that seems to have the most signatures (84,852 at the time of writing this post) says:
We’d like too see the IOC move the games to Vancouver who held them (very successfully) in 2010. The venues are there already so getting them up and running again wouldn’t be too much of a hassle and could be done in the limited time allowed.
But just because Vancouver has hosted the games in the past doesn’t mean its facilities are still in working condition. There’s a long history of Olympic venues being modified for new uses, torn down or abandoned. The speed skating oval has been converted into a massive community recreation center, with gyms and an ice rink. Whistler, the famous skiing area, is used by tourists and visitors throughout the winter.The Olympic Village that Vancouver built has been turned into hard-to-sell apartment units. (The city will probably have to absorb nearly $300 million of the cost of building them.)
And it’s not just physical spaces that have to be sorted out before the games begin. The jockeying for broadcast rights, media coverage and advertising begins long before the buildings are even begun. The rights to broadcast the Olympics is worth over $4 billion dollars to NBC. Ten Network Holding secured the rights to broadcast the Russian games for $20 million. Advertisers have spent millions of dollars, and months planning ads for Sochi.
Some have pushed the International Olympic Committee to refuse Japan’s 2020 Olympic bid due to their dolphin and whale hunting policies. But this is the largest concerted effort to pick up and move an already planned Olympic game.
And the games have never been moved this late. In 1916, the games were supposed to be held in Berlin but were cancelled due to World War I. Similarly, the 1940 Summer Olympics were cancelled when World War II broke out, and the games didn’t resume until 1948. But they’ve never been moved from the host country.
Despite support from the petition, most admit that moving the games away from Russia simply isn’t possible. Yahoo’s sports blog calls the idea “delusional” and the site Think Progress admits that it’s simply not doable. Instead, TP says that the Olympic Committee needs to commit resources to protecting LGBT athletes. Since the games almost surely won’t be moved, LGBT supporters will have to shift their support and energy elsewhere.
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July 22, 2013 11:09 am
Helen Thomas was a lot of things to a lot of people. She was the first woman ever elected as an officer of the White House Correspondents’ Association, and the first to be elected to the Gridiron Club, a group of Washington journalists that, 90 years after it was founded, had never included a woman in its membership. Her questions were blunt, and her work ethic incredible. On Saturday, Thomas died in her home at the age of 92.
The New York Times calls Thomas “a trailblazing White House correspondent in a press corps dominated by men and who was later regarded as the dean of the White House briefing room.” The Washington Post‘s obituary headline calls her the “feisty scourge of presidents.” President Obama gave her a cupcake for her 89th birthday, and on Saturday said of the reporter, “She never failed to keep presidents — myself included — on their toes.”
Thomas had a reputation as an incredibly tough journalist. In a 2006 interview with the New York Times, the reporter asked her how she tells the difference between a probing question and a rude one, to which she replied “I don’t think there are any rude questions.” And for nearly 30 years she asked whatever questions she pleased from her front row seat at presidential news conferences.
In an interview with Ms. Magazine, Thomas expressed her view of the presidency. “I respect the office of the presidency,” she told them, “but I never worship at the shrines of our public servants. They owe us the truth.”
She also told Ms.,“We don’t go into journalism to be popular.” And she certainly wasn’t, in certain crowds. Conservative talk-show hosts and pundits often wondered when she would go away. In 2003, she told another reporter that she thought George W. Bush was “the worst president in American history.” He went for three years not calling on her at his news conferences. When he did, she reminded him that nothing had changed. The Washington Post remembers:
“I’d like to ask you, Mr. President. Your decision to invade Iraq has caused the deaths of thousands of Americans and Iraqis, wounds of Americans and Iraqis for a lifetime. Every reason given, publicly at least, has turned out not to be true. My question is: Why did you really want to go to war? From the moment you stepped into the White House, from your Cabinet — your Cabinet officers, intelligence people and so forth — what was your real reason? You have said it wasn’t oil — quest for oil — it hasn’t been Israel or anything else. What was it?”
She and Bush went toe to toe, interrupting each other as the president attempted to respond.
In another characteristic interaction in 2009, Thomas confronted Obama’s spokesperson Robert Gibbs every day about whether or not a public option would be part of the health care reform package. CNN reports:
In the back-and-forth that ensued, Thomas said that she already had reached a conclusion but could not get a straight answer from the presidential spokesman.
“Then why do you keep asking me?” Gibbs inquired.
“Because I want your conscience to bother you,” Thomas replied.
Her outspokenness got her into trouble too, when in 2010 she was caught on camera saying that Jews should “get the hell out of Palestine.” Thomas apologized, stating that her remarks did not reflect her true feelings, and that she hoped one day for peace and that one day both parties would learn “mutual respect and tolerance.” The incident lead Thomas to retire.
Many credit Thomas with breaking the glass ceiling for women in journalism. President Bill Clinton and Secretary of State Hilary Clinton remembered Thomas’ tenacity together, writing, “Helen was a pioneering journalist who, while adding more than her share of cracks to the glass ceiling, never failed to bring intensity and tenacity to her White House beat.”
Thomas’s death on Saturday came after a long illness. She will be buried in Detroit, and her family is planning a memorial service in Washington in October.
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