A day of rest
Last night I was falling asleep to a dubbed episode of Law & Order in Italian (didn't matter that I couldn't understand - I've seen just about every one of the several hundred episode half a dozen times, so the dialogue wasn't important) when I started to feel like something wasn't quite right. I got a screaming headache that came on suddenly, so I popped a couple of ibuprofen and tried to sleep through the rest of it.
Nope.
Within a half an hour, I was in the throes of food poisoning. Not the kind of food poisoning that grabs on and hangs in your gut for days, but the kind that hits you like a trainwreck and is gone before you've quite realized what it was.
So this morning I ditched most of the day's plans and instead slept til noon. I had to get up to eat before breakfast closed - and hungry I was, being that my stomach was entirely empty after the previous night's adventure. I woke up again when a maid knocked on the door to change the linens, but otherwise I was out cold.
I had planned to get up early and attend Palm Sunday services at the cathedral down the street, but I slept through that too. Catholicism has an interesting history in Malta, and I was curious to see its modern incarnation. Legend and history agree that Saint Paul was shipwrecked here on his way to stand trial in Rome, where he was eventually condemned to death. The more controversial story goes on to say that he performed a few miracles, preached a few speeches, and in the short time he spent on the island, converted the Maltese into one of the earliest Christian peoples on the planet, and they are to this day righteously devout. But, still suffering from stomach upset, I slept straight through the morning, which gives you some idea of how much less devout I am about the whole affair.
I went down to the beach-side tourist strip to hunt down some lunch - something that wouldn't cause any more upset, and wasn't too big. I had a hard time finding anything besides calorie-overloaded sit-down meals, though I did manage to locate some bottled water. I don't think it was the water that made me sick (if it had been, I think it would have hung on far longer), but I also didn't think that running a load of chlorinated water through my gut had helped at all with the ensuing intra-intestinal mayhem of last night. I finally found a sandwich, headed back to the Sunflower hotel, and established myself a small territory on the roof-top deck next to a multi-lobed swimming pool in the shape of a clover.
I spent the rest of the afternoon lounging in the sun and plowing through the initial notes and sketchy paragraphs of what is to become my masters thesis. I had hemmed and hawed for a considerable time last fall between going abroad to do some exotic research and staying around London to do a literature review, and between all the other things going on (among them med school, applying to residency this summer, and having a sick niece back home), I decided that this was not the time to be locking myself into a summer in some remote place that didn't at least have phone or internet connection from which I could keep on top of all those other goings on. So I came up with a topic that has just enough twists and turns to make for an interesting and worthy thesis project, which goes something like this:
Tuberculosis is very common (something like a third of the world's population carries it, even if not all are sick from it) but because it strikes poor people hardest, new innovations in treatment have stalled out over the last thirty years, and most of the drugs, lab tests, and vaccines are older than I am. The BCG vaccine pre-dates the era of flight, and though it's got a very spotty track record, it's the only tuberculosis vaccine on the market. But in the last couple of years, a drug called moxifloxacin (a close relative of ciprofloxacin) came on the scene that has a potential to change all that. Clinical trials seem to indicate that replacing this drug for one of the four drugs that TB patients must take for six months lowers the time to cure to about half that - around three months. Because of the enormous financial burden to patients and the health system alike from having to treat the disease for six months, cutting the time in half would probably greatly improve cure rates and lessen the chance of people dropping out of the treatment before cure, which inevitably leads to antibiotic resistant TB bacteria.
Sounds great. But there's a catch: this drug is very expensive (about $10 a pill), and TB mainly affects the poorest people and the poorest nations in the world. At the same time, the drug is used for many other diseases, and at least a few of those who have received it probably have tuberculosis too, and that means that the bacteria is probably gaining resistance to the drug as we speak.
So. Some people want moxifloxacin to be limited to only TB patients to slow the development of bacterial resistance to the drug. Some people argue that if you limit the drug's use for other things in wealthy nations, the profit margin on the drug will drop and companies will stop letting their products be registered for diseases of poverty like TB, malaria and HIV (this problem already popped up once with another potential TB drug called sparfloxacin - it looked great against TB in the test tube, but the patent-holding company yanked support for clinical trials out of fear that profits would plummet if it were labeled a tuberculosis drug). My project is to sort out the economic, clinical, and ethical implications of these opposing camps and to evaluate how different policies would play out. That means in addition to reviewing the clinical side (eg, who can use the drug and who can't - for example, it's not good for pregnant women), I am also delving into the world of patent law, international trade agreements, how the free market fails to provide for treatment when patients cannot pay, ethical concepts like efficiency and equity, and global health care policy.
After going at that for a few hours, I went out to get dinner and found a quiet place just up the street from the main square at the center of all the tourist action. Something involving techno music and a large crowd of teenagers to twenty-somethings was happening down the block, and I got a little taste of what Qawra probably looks like in the high season. Way too many people, way too much of a meat-market vibe, and I'm way too old for all that. I prefer the low season, peace and quiet and all that. I took a long walk in the cool night, around the perimeter of the peninsula, and turned in earlier than last night, and much more comfortably too.
Nope.
Within a half an hour, I was in the throes of food poisoning. Not the kind of food poisoning that grabs on and hangs in your gut for days, but the kind that hits you like a trainwreck and is gone before you've quite realized what it was.
So this morning I ditched most of the day's plans and instead slept til noon. I had to get up to eat before breakfast closed - and hungry I was, being that my stomach was entirely empty after the previous night's adventure. I woke up again when a maid knocked on the door to change the linens, but otherwise I was out cold.
I had planned to get up early and attend Palm Sunday services at the cathedral down the street, but I slept through that too. Catholicism has an interesting history in Malta, and I was curious to see its modern incarnation. Legend and history agree that Saint Paul was shipwrecked here on his way to stand trial in Rome, where he was eventually condemned to death. The more controversial story goes on to say that he performed a few miracles, preached a few speeches, and in the short time he spent on the island, converted the Maltese into one of the earliest Christian peoples on the planet, and they are to this day righteously devout. But, still suffering from stomach upset, I slept straight through the morning, which gives you some idea of how much less devout I am about the whole affair.
I went down to the beach-side tourist strip to hunt down some lunch - something that wouldn't cause any more upset, and wasn't too big. I had a hard time finding anything besides calorie-overloaded sit-down meals, though I did manage to locate some bottled water. I don't think it was the water that made me sick (if it had been, I think it would have hung on far longer), but I also didn't think that running a load of chlorinated water through my gut had helped at all with the ensuing intra-intestinal mayhem of last night. I finally found a sandwich, headed back to the Sunflower hotel, and established myself a small territory on the roof-top deck next to a multi-lobed swimming pool in the shape of a clover.
I spent the rest of the afternoon lounging in the sun and plowing through the initial notes and sketchy paragraphs of what is to become my masters thesis. I had hemmed and hawed for a considerable time last fall between going abroad to do some exotic research and staying around London to do a literature review, and between all the other things going on (among them med school, applying to residency this summer, and having a sick niece back home), I decided that this was not the time to be locking myself into a summer in some remote place that didn't at least have phone or internet connection from which I could keep on top of all those other goings on. So I came up with a topic that has just enough twists and turns to make for an interesting and worthy thesis project, which goes something like this:
Tuberculosis is very common (something like a third of the world's population carries it, even if not all are sick from it) but because it strikes poor people hardest, new innovations in treatment have stalled out over the last thirty years, and most of the drugs, lab tests, and vaccines are older than I am. The BCG vaccine pre-dates the era of flight, and though it's got a very spotty track record, it's the only tuberculosis vaccine on the market. But in the last couple of years, a drug called moxifloxacin (a close relative of ciprofloxacin) came on the scene that has a potential to change all that. Clinical trials seem to indicate that replacing this drug for one of the four drugs that TB patients must take for six months lowers the time to cure to about half that - around three months. Because of the enormous financial burden to patients and the health system alike from having to treat the disease for six months, cutting the time in half would probably greatly improve cure rates and lessen the chance of people dropping out of the treatment before cure, which inevitably leads to antibiotic resistant TB bacteria.
Sounds great. But there's a catch: this drug is very expensive (about $10 a pill), and TB mainly affects the poorest people and the poorest nations in the world. At the same time, the drug is used for many other diseases, and at least a few of those who have received it probably have tuberculosis too, and that means that the bacteria is probably gaining resistance to the drug as we speak.
So. Some people want moxifloxacin to be limited to only TB patients to slow the development of bacterial resistance to the drug. Some people argue that if you limit the drug's use for other things in wealthy nations, the profit margin on the drug will drop and companies will stop letting their products be registered for diseases of poverty like TB, malaria and HIV (this problem already popped up once with another potential TB drug called sparfloxacin - it looked great against TB in the test tube, but the patent-holding company yanked support for clinical trials out of fear that profits would plummet if it were labeled a tuberculosis drug). My project is to sort out the economic, clinical, and ethical implications of these opposing camps and to evaluate how different policies would play out. That means in addition to reviewing the clinical side (eg, who can use the drug and who can't - for example, it's not good for pregnant women), I am also delving into the world of patent law, international trade agreements, how the free market fails to provide for treatment when patients cannot pay, ethical concepts like efficiency and equity, and global health care policy.
After going at that for a few hours, I went out to get dinner and found a quiet place just up the street from the main square at the center of all the tourist action. Something involving techno music and a large crowd of teenagers to twenty-somethings was happening down the block, and I got a little taste of what Qawra probably looks like in the high season. Way too many people, way too much of a meat-market vibe, and I'm way too old for all that. I prefer the low season, peace and quiet and all that. I took a long walk in the cool night, around the perimeter of the peninsula, and turned in earlier than last night, and much more comfortably too.
posted by skylanda at 1:58 PM
0 Comments:
Post a Comment
<< Home