Health Headlines - November 6

Did Orwell's TB Frame '1984'?

Well-known British author George Orwell was hardly Mr. Sunshine, given the grim worlds he created in his books, especially the foreboding novel "1984." So why all the gloom?

In a new study, an infectious-disease specialist suggests that a bad case of tuberculosis may be partially responsible, along with the drastic treatments Orwell underwent toward the end of his life.

Orwell was "always a gloomy, pessimistic sort," said study co-author Dr. John J. Ross of Caritas Saint Elizabeth's Medical Center in Boston. But by the time Orwell wrote his masterpiece in the late 1940s, he was very sick and even more out of sorts, Ross added.

" '1984' would have certainly been a very different book, and maybe a less powerful book, had he not been so desperately ill at the time," Ross contended.

Ross has already made a name for himself in the field of diagnosing historical figures. Earlier this year, he wrote a controversial study suggesting that evidence in the life and writings of William Shakespeare showed the playwright probably suffered from syphilis.

In the new study, published in the Dec. 1 issue of the journal Clinical Infectious Diseases, Ross looks at Orwell, who lived from 1903 to 1950. Orwell published his political allegory "Animal Farm" in 1945, four years before "1984," his depiction of a totalitarian government that turns language into a weapon against its own people. Today, the book is perhaps best known for its invention of the concepts of "doublethink" and "Big Brother."

Orwell -- whose real name was Eric Arthur Blair -- always had respiratory problems, and appears to have developed tuberculosis while living in Burma and in the cities that provided the subject matter for his book about underground life called "Down and Out in Paris and London."

In the 19th and early 20th century, tuberculosis -- also known as consumption -- often struck artists and authors who lived in crowded, germ-filled slums. In many cases, infected people slowly wasted away, giving the victims a romantic cast, as seen in the film "Moulin Rouge."

Antibiotics weren't available until near mid-20th century, so treatments involved bed rest or the dangerous "collapse therapy," in which doctors actually collapsed the lungs of patients to stop oxygen from feeding tuberculosis infections, Ross said.

Orwell underwent just such a treatment in the late 1940s. Around the same time, "his writing acquired a great deal of urgency," Ross said.

Why? It was partly because he had returned from the Spanish Civil War and was appalled by the "lies, deceit and murder he'd seen," Ross said. But he also thinks Orwell's illness instilled "a sense of his own mortality," even if he tried to deny how sick he was.

Overall, Ross said, Orwell's illness may have played a major role in his writing because it forced him to lie in bed. "You probably spend more time in your head than other people, more time to be creative and think," Ross said. "It makes you rely on your own resources, and it gives you time away from the world to formulate your creativity."

Peter Stansky, a British history professor at Stanford University who has studied Orwell, said the author appears to have ignored his bad health.

"I think he was pretty much a wreck, but he just went on," Stansky said. "There was a Puritanism and asceticism about him and also the English tendency to regard taking too much care of yourself as too self-indulgent."

But did Orwell's illness turn him into one of history's most powerful and influential writers? "I don't think his bad health drove his vision," Stansky said. "But it might have been a small factor."

Orwell died in 1950, before antibiotics began to make tuberculosis a much more treatable -- if often still deadly -- disease.

China responds to bird flu under shadow of SARS

In the blaze of speeches, meetings and regulations about bird flu that China's leaders have fired off in recent days, SARS has never been mentioned.

But memories of that epidemic two years ago are shadowing China's increasingly urgent response to the latest health threat, say Chinese experts and journalists.

Severe Acute Respiratory Syndrome, which started in southern China in early 2003, killed 349 Chinese after officials hid or underplayed the flu-like illness, and China faced international censure after SARS spread to Hong Kong, then Asia and North America, killing hundreds more.

China dismissed two senior officials and blamed them for the cover-up.

On Friday, China announced that it was mobilizing a national "command headquarters" under the country's top emergency official, Hua Jianmin, to bring together six government and party departments and coordinate the fight against bird flu.

With rising global fears about the H5N1 avian flu virus, even parts of China's state-dominated press have recently said habitual government secrecy and cumbersome bureaucracy could again undercut efforts to contain an epidemic.

Scientists fear H5N1 could mutate into a form communicable between people, triggering a pandemic that could kill millions and overwhelm health systems.

"At present, the information about avian influenza cases released to the public here is clearly too tardy and inadequate," the outspoken business weekly, Caijing, said in an editorial that cited parallels with SARS.

While several Chinese experts interviewed also called for more official candor, they also said Chinese officials appeared to be reporting outbreaks of bird flu faster than they did during the SARS epidemic.

And central leaders have stepped in to ensure that disparate government agencies, especially the agriculture and health ministries, pull together.

"SARS is the model nobody wants to repeat. The public health system and official incentives have changed and I wouldn't expect the same problems," said Mao Shoulong, a government policy expert at the People's University of China who has studied official reactions to both SARS and the bird flu.

China's leaders have good reason to improve transparency. Bird flu has already killed more than 60 people in Asia and China on Friday reported its fourth outbreak in birds in a month. But so far, the country has not had any cases of humans being infected with H5N1, officials have said.

If China does succumb to bird flu, it will not be for lack of official plans. On Tuesday, China's Ministry of Agriculture issued an "emergency response" for any bird flu epidemic among birds and livestock in coming months, joining dozens of similar documents from central and local bureaucracies.

The agriculture ministry's plan demands that local officials report suspected cases of infection to the ministry within four hours.

"Those responsible for hiding, overlooking or delaying reports will be harshly punished according to the law," Chinese Premier Wen Jiabao told a high-level meeting about bird flu on Tuesday.

"NO INCENTIVE TO HIDE"

Mao, the policy expert, said these demands from national leaders mean central government agencies will cooperate more and local officials will be much less likely to hide cases of bird flu than they were SARS.

"Officials have no incentive to hide bird flu outbreaks," he said. "Their political career won't be damaged if they report, but they would be ended if they hid information." Farmers are also given compensation for culled poultry, he noted.

Pressure on local officials to report all possible cases may even lead to "systemic overload," as junior officials report even unlikely cases out of fear of punishment, said Lan Xue, a public policy researcher at Tsinghua University in Beijing who has advised China's leaders about dealing with emergencies.

Since SARS struck, China has also invested in a new nationwide network of emergency offices and plans. These preparations include one master plan, 25 plans for specific emergencies such as disease outbreaks, floods and earthquakes, and 80 plans for government departments, Xue said.

The government has established a national office to coordinate response to emergencies, and it has also drafted a law to encode the responsibilities and powers of officials in emergencies and pumped over 5 billion yuan into local disease surveillance offices, Xue said.

"Once the government realizes something is wrong, it can really go all the way. But now the challenge is implementation," he said.

But rapid response to a large outbreak among birds or possible human infection could be made more difficult by official reluctance to share information about specific outbreaks with citizens, said Chinese experts.

"Risk communication is not an easy task -- there's always the problem of over-reaction -- but the best way to deal with this is to get the general public educated," Xue said.

And in a country as large as China, even the $248 million that Prime Minister Wen promised to fight bird flu may be stretched if the virus spreads.

Each Chinese province has received tens of thousands of yuan to monitor migratory birds, which are thought to carry the virus, said Chu Guozhong, a Beijing-based ornithologist who is advising Chinese wildlife authorities on the disease.

"Local officials are now paying attention, but that's not much money to build up monitoring, and in some places it hasn't arrived yet."

China Turns to WHO for Bird Flu Help

China said Sunday it had asked the World Health Organization to help it determine whether the death of a 12-year-old girl last month was caused by bird flu. If it is confirmed, it would be China's first known human death from the lethal and virulent H5N1 strain of bird flu, which has killed at least 62 people across Southeast Asia.

There have been four outbreaks of the bird flu among poultry in China in the past three weeks.

Three people living in central China's Hunan province came down with pneumonia from unknown causes last month following an outbreak of the H5N1 strain among local poultry, the official Xinhua News Agency reported.

The girl, He Yin, died three days after developing a high fever on Oct. 13. She had had "close contact with sick birds," Xinhua said. Her 9-year-old brother was also hospitalized with similar symptoms but recovered.

The third victim was a 36-year-old middle school teacher who reportedly cut raw chicken while he had a minor injury on his hand and later fell ill, Xinhua said. He was identified only by his surname, Song.

All three lived in or near Wantang, a village where the government says 545 chickens and ducks died of bird flu last month.

Chinese officials initially said the girl and her brother had tested negative for the bird flu virus.

However on Sunday, Xinhua reported that experts "cannot rule out the possibility of human transmission of H5N1 bird flu. The specific cause needs further laboratory tests."

Roy Wadia, a spokesman for the WHO in Beijing, confirmed that China had asked the organization for help last week.

"This is a reiteration of how much of a public health threat bird flu really is," said Wadia. "Sometimes it takes a human case or a suspected human case to raise the alarm, to remind us that no country, whether China or anywhere else, can afford to be complacent."

Xinhua said China has asked the WHO for help in testing the blood and throat swabs from the three victims.

Since late 2003, the H5N1 strain of bird flu has ravaged poultry stocks and jumped from birds to humans. Most of the human deaths have been linked to close contact with infected birds. But experts fear the virus could mutate into a form easily passed among humans and possibly spark a worldwide pandemic.

China, which was heavily criticized during the 2003 outbreak of severe acute respiratory syndrome for initially covering up the illness, has pledged it will be more open about reporting on bird flu.

Wadia said he did not think China had delayed its announcement of the suspected cases but that instead it was trying to be thorough before going public.

"I think the information they have shared with us has been shared as soon as they can corroborate it," he said.

Also Sunday, 1,700 officials and 100 police finished culling about 370,000 birds in northern China's Liaoning province after bird flu killed 8,940 chickens there.

The outbreak in Liaoning's Badaohao village, east of Beijing, was China's fourth reported outbreak in three weeks.

State television news on Sunday showed dozens of officials in white face masks and blue protective suits spraying disinfectant on empty poultry cages and the wheels of vehicles.

Xinhua said late Saturday that Badaohai lies along a route used by migratory birds heading from East Asia to Australia, contributing to fears that wild birds could spread the disease.

More than 20 magpies and other migratory birds had been spotted in the area, it said.

Chinese authorities have said they are concerned wild birds might spread the virus, particularly following an outbreak last spring that killed more than 6,000 migratory geese and gulls at northwestern China's Qinghai Lake.

The State Forestry Bureau said last month it was activating a reporting network to detect outbreaks among wild birds.

New regulations went into effect in Beijing on Sunday that allow detention for up to 15 days and fines of up to 200 yuan ($25) for anyone who fails to immunize their birds, the Beijing Morning Post reported.

The rules, announced jointly by the Beijing Agricultural Bureau and the Beijing Public Security Bureau, are aimed at ensuring a 100 percent bird vaccination rate in the capital, the newspaper said.

Experts Offer Free Memory Screenings Nov. 15

Experts will offer free in-person memory screenings at more than 700 sites across the United States on Nov. 15 -- National Memory Screening Day -- as part of National Alzheimer's Disease Awareness Month.

The free service is sponsored by the Alzheimer's Foundation of America and is held each year to promote early detection and treatment of Alzheimer's disease and related illnesses, and to provide information about successful aging.

The non-invasive, confidential memory screenings will be administered by social workers, doctors and other health care professionals. Each screening takes about 10 minutes and consists of tasks designed to assess memory and other intellectual functions.

The most commonly used screening method is the Mini-Mental State Examination, which has been documented to be an effective screening tool for dementia.

These screenings are meant to detect a potential problem, not to diagnose any specific illness. People who have abnormal screening scores will be urged to undergo an extensive medical evaluation.

"Early detection enables persons to benefit most from available medications that can help slow the progress of symptoms, and psychological and social interventions that can ease the journey for families. And it enables individuals to exercise self-determination related to future care, and legal and financial issues," AFA board member Dr. Richard Powers, chief of the Bureau of Geriatric Psychiatry at the Alabama Department of Mental Health and Mental Retardation, said in a prepared statement.

Existing drugs for Alzheimer's disease do not treat the underlying cause of the brain-robbing illness, which is still largely unknown. However, they can temporarily slow the progression of symptoms.

Workouts Can Lighten Heavy Hearts

The millions of Americans stricken each year by debilitating depression may want to consider running away from their problem -- or walking, swimming or dancing it away.

"What the studies are showing is that exercise, at least when performed in a group setting, seems to be at least as effective as standard antidepressant medications in reducing symptoms in patients with major depression," said researcher James Blumenthal, a professor of medical psychology at Duke University in Durham, N.C.

According to Blumenthal, other studies are beginning to suggest that solitary exercise, such as workouts at the gym or a daily jog, can be just as effective as group activities in beating the blues, and that "duration of exercise didn't seem to matter -- what seemed to matter most was whether people were exercising or not."

Blumenthal was lead author on a much-publicized study released five years ago that found that just 10 months of regular, moderate exercise outperformed a leading antidepressant (Zoloft) in easing symptoms in young adults diagnosed with moderate to severe depression.

And another study released earlier this year, by researchers at the University of Texas Southwestern Medical Center at Dallas, found that 30-minute aerobic workouts done three to five times a week cut depressive symptoms by 50 percent in young adults.

Theories abound as to how revving up the body helps uncloud the mind.

Robert E. Thayer is a professor of psychology at California State University, Long Beach, and the author of Calm Energy: How People Regulate Mood with Food and Exercise. He said that while workouts probably affect key brain chemicals like serotonin and dopamine, physical activity may also trigger positive changes in other areas, too.

"Depression is a condition characterized by low energy and moderate tension, something I call 'tense tiredness,'" he said. But exercise has a clear "mood effect" that seems to ease that anxious but lethargic state, he said.

According to Thayer, moderate exercise -- a brisk 10-minute walk, for example -- results in a boosting of energy, although it may not be quite enough to relieve stress.

"More intense exercise -- the amount you'd engage in with a 45-minute aerobic workout -- does give a primary mood effect of reducing tension. It might also leave you with a little less energy because you'd be tired, of course," he said. "However, there's also some indication from the research that there's a 'rebound' effect an hour or so later, in terms of [increased] energy."

Blumenthal pointed to the more lasting psychological boost regular workouts can bring. "People who exercise might also have better self-esteem; it may help them feel better about themselves, having that great sense of accomplishment," he said.

Still, the experts acknowledged that truly depressed individuals often find it tough to jump into an exercise routine.

"Why do people not do the thing that's perhaps the most important thing for them to do?" said Thayer. "It's because a drop in energy is such a central component of depression -- you just don't have the energy to do the exercise."

He said the key to breaking that cycle is to start small.

"Thinking about going to the gym and doing all the stuff that's involved with that can be overwhelming for a depressed person," Thayer pointed out. "But if you think 'Hey, maybe I'll just walk down the street 30 yards or so, at a leisurely pace,' that's a start. And it turns out that your body becomes activated then -- you have more of an incentive to walk farther, to do more."

Loved ones can play a key role, too, urging a depressed friend or family member to join in with them as they work out. "Social support, peer pressure, family support -- all of that can be helpful, certainly in getting people to maintain exercise," Blumenthal said.

No one is saying that exercise is always a substitute for drug therapy, especially for the severely depressed. "But we also know that these drugs aren't effective for everyone -- about a third of people aren't going to get better with medication," Blumenthal said.

For those patients, exercise may prove a viable, worry-free alternative -- with one great fringe benefit.

"In addition to its mental health benefits, there are some clear cardiovascular benefits to exercise which we don't see with antidepressant drugs, of course," Blumenthal noted. So, he said, what keeps the mind fit strengthens the body, too. "You're killing two birds with one stone."

Food Fact:
Ginger, no ail.

Want a neat trick for making health-giving ginger easier to grate? Freeze it first. You'll be glad you did: Spicy, lively, fresh ginger has a way of waking up all the other flavors around it. Look for large, firm, buff-colored knobs when buying fresh ginger. Traditionally used in Asian cooking, it's making its way into all sorts of savory dishes and delivering loads of healthful antioxidant compounds. Ginger may also decrease your heart attack risk. A few studies have found that both fresh and dried ginger inhibits blood levels of thromboxane B-2, a compound that promotes dangerous blood clots. It also has a longstanding folk reputation as a remedy for nausea. Clinical studies have found it useful in treating motion sickness, as well as post-surgical nausea.

Fitness Tip of the day:
Change the pace.

A few simple steps can make your walking routine a better cardio workout. The trick is to break from your usual pace with bursts of fast walking. For example, walk fast for one minute, then resume your usual speed for the next three minutes. Over time, shorten the slow intervals to two minutes and then one minute.

FAQ of the day:
Can I be fit and fat?

While obesity is strongly associated with increased health risks, recent population studies suggest much of that risk may stem from poor fitness. Increased physical activity makes a difference when combined with a calorie-controlled diet. As your fitness improves, you'll boost your health and feel better, even with only modest weight loss.