CSD/B. henselae

Pre-Med & Medical School High School Student Topics
21

<p>That’s not how scientific research works. And let’s make it EXTREMELY clear: I’m not suggesting that Bartonella is at all linked with anything more serious in a public health sense.</p>

<p>This is the current viewpoint on Bartonella: It’s a self limited condition. The number of cases of infection is probably significantly higher than reported rates of incidence, but because most people don’t seek medical attention we have no way of figuring that out. If you are patient who has HIV/AIDS or some other immunocompromised state, then you are at a higher risk of developing CSD and it’s complications, but you are also at increased risk for a whole host of OTHER infections as well, so CSD is not any more significant. Additionally, there have been reports of significant mortality and morbidity associated with Bartonella in immunocompetent patients, but these are exceedingly rare, generally single case reports, or case series with very, very, very few patients. Because of this generally mild set of circumstances, CSD is relegated to merely being an interesting disease, but otherwise mainly limited to pimping medical students.</p>

<p>So why not work on a way to limit this bacterium? This introduces the concept of number-needed-to-treat (NNT). Let’s say for this example it’s actually easy to create a vaccine for cats for Bartonella, it’s effective, and well tolerated, just so that we don’t cloud our picture with other details. What we can do is look at how much “badness” is caused in HUMANS (because let’s be honest, no one cares about cats, thousands of them are euthanized every day), and then based on transmission rates, and rates of that “badness” and so on, we can determine how many cats need to be treated in order to prevent ONE death (or one ICU stay, or whatever end point you desire) in a human. Based off what we need know about CSD at this point, I’m willing to bet that the NNT would run into the millions. We can then take the cost per treatment (in this case the commercial cost of the vaccine for each cat), and compare THAT cost to the standard value of a human life - which has been appraised and published in the literature. In general if the NNT x cost of intervention > value of life saved, then the intervention is unlikely to be cost-effective and worth the expenditure. </p>

<p>It’s this type of evaluation that is done by the US Preventative Task Force for things like Mammograms, PSA screenings for prostate cancer and colonoscopies. You may remember last year the uproar about changing mammogram guidelines for women between 40 and 50. In part the change was due to a NNT analysis along with the increased cost to society for having benign lesions discovered, and evaluated only to discover it’s a lesion that does not pose a risk.</p>

<p>While it would be nice to prevent everything, we have to remember that every intervention has consequences whether they are medical complications, or expenditures of time, money, or other resources. Certainly as we go further into reforming health care, these sorts of analyses will become more and more important. The resources we have are scarce and it’s important that we make wise investments.</p>

22

<p>^Wait. So how would you then explain NIH giving a million dollar grant to develop this “simple vaccine” to ONE lab? If what you say is true, apparently NIH doesn’t know how scientific research works.</p>

<p>You’re right. There are plenty of other infections that are dangers to immunocompromised people. And many people research them and discover breakthrough stuff. Also, B. henselae is an emergent species. Research needs to be done on a species that hasn’t been known in existence for more than a few decades. I’m not saying what you say is completely false, but your logic seems to have some holes.</p>

23

<p>One lab and one million dollars is not a lot, at all. Not in the slightest. It’s actually very paltry. I’m not sure why you think that’s a big deal as far as research goes.</p>

24

<p>^1 million dollar grant for a 5-person lab for one project? there are obviously more grants being given to the lab, but for a small lab to get 1 million dollars for one project from NIH must mean that NIH doesn’t think researching on B. henselae is a waste. I never said 1 million dollars was a huge sum. I’m just trying to show that some people actually think that this topic is worth investigating.</p>

<p>Also, Bartonella species (mostly quintana and henselae) have been found to be critically related to Lyme disease. (although I’m not 100% too sure on that. I’ll check up more on it).</p>

25

<p>I’m still not sure what the purpose of this thread is. Do you just want us to say, “you’re right crimsonuser, CSD is the most important disease in the world. We have seen the light and will preach the gospel from now on”? Wouldn’t that purpose be better served someplace that gets more traffic than here?</p>

26

<p>Okay, I don’t what you want from this thread either. You asked for opinions on whether preventing Cat Scratch Disease was a “huge thing in medical society”. You’ve had one 4th year medical student (soon to be MD) and one 2nd year resident who has actually dealt with patients who have CSD offer opinions. Opinions that are based off of CLINICAL experience and give reasons why it’s not a “huge” thing in modern medicine. And to each explanation you get indignant and try to convince us that we’re misguided for not agreeing with you. </p>

<p>The NIH has an annual operating budget of over 30 Billion dollars, it provides funding for tens of thousands of projects, including a great many that will never amount to any iota of CLINICAL impact. </p>

<p>There is a significant difference between things that are important in the lab and those that actually matter in the course of taking care of patients. It is in fact a battle that plays out between MD’s and PhD’s at every level of post-secondary education. Every pre-med has a story about an undergraduate professor (or PhD Grad Student TA, or even classmates headed towards a PhD) in which they’ve been lambasted for not “caring enough about the science”. Most pre-clinical medical students have had MD’s come in for a lecture only to hear the clinician disparage the bench scientists. A great many clinical med students have pimped on some obscure basic science fact only to ask “what’s the clinical significance” or “so what am I supposed to do about it”. As residents, if they’re looking towards a fellowship, it determines which fellowship program they go to because some centers place a priority on fellows to pursue bench research vs clinical research. It’s a situation that extends even up into routes of tenure for academic physicians as they decide if they’re going to be clinician-scientists or clinician-educators. It’s this disconnect that has lead to translational research as a concept coming to prominence and international priority.</p>

<p>This is not say that one type of research is better than the other. You can’t practice evidence based medicine without both realms. But because there is a disconnect, there’s going to be a difference of opinions as to what’s “important”. Certainly, the bench research your friend is involved in is important in his mind and that of his PI. And they probably have a host of ideas on how their research may someday in the future make an impact either through direct changes in treatment of cats and/or humans, or in ways that they may find new information that affects our knowledge of other diseases/conditions. I can certainly come up with my own list of research questions based on Bartonella, starting with identifying host factors that make immunocompetent individuals susceptible to major complications. But just because those questions are there, doesn’t mean that something is a “huge deal” to many physicians.</p>

27

<p>There is a lot of politics that go into the distribution of NIH funding. For example, the breast cancer research lobby is very strong which is why breast cancer research consistently gets overfunded despite the fact we already have good screening and excellent treatments as well as great survival rates for breast cancer. The amount of NIH funding is rarely proportional to the urgency of the medical need. This is especially true in basic science research. I worked as a research fellow at the NIH for a year. I can tell you that grant writing and obtaining research funding is one of the most convoluted and enigmatic processes out there.</p>

<p>No one is saying that no research should be done on CSD at all. But, the amount of funding and the # of labs devoted to CSD should be proportional to the medical impact of the disease. This means 2-3 labs across the country devoted to CSD research is probably sufficient. </p>

<p>In any case, your original question was whether this is something the entire medical community is worried about. We answered your question.</p>

28

<p>Let’s just kill all the cats. I’ll make a trophy for the OP out of the teeth.</p>

29

<p>^LOL. I appreciate it, but no thanks. Thanks for the replies.</p>