TB or TBD?

     So cough, cough.  Not a smoker?  Or feel that you just have allergies?  A bad cold?  Throw in some nights sweats and a fever and you might want to think about having yourself checked out for TB, as in tuberculosis.  Wait, what??  Turns out that tuberculosis has not only climbed to its highest levels in three years in the US, but remains the number one infectious disease killer in the world, reported Dr. Michelle Barron, UC Health’s senior medical director of infection prevention and control: When people think of deadly diseases, they think of COVID-19, malaria, HIV and diarrheal diseases.  Many are surprised to find that TB kills the highest number of people in the world.  As in 10 million each year...still!  And TB can show up in other places besides your lungs (would you believe, your ankles?).  Left undiagnosed, this highly contagious disease could kill you (walk into a room where someone with TB has coughed and you could inhale their bacteria, even if that person had left the room; it can be cured but generally takes 6-12 months of many meds).

     So what brought that up?  Don't ask me why but lately I've returned to reading about the body, and well, the lungs came up.  Even beyond the lungs, one has to admit that from beginning to end, our bodies are quite simply a miracle, everything from what happens in our brain when we die (yes, studies have been done at the moment of death, with Steve Jobs last words being, "Oh wow!, Oh wow!"), to how something as "simple" as how our lungs, like our heart, continuously make it seem that keeping us alive in the background is child's play, even if what's happening inside of us it is pure chaos.  No interest?  Well then before you depart, just answer this simple question: why don't our bodies rust?  You chemistry students know that oxygen loves to bind to iron (oxygen will actually seek it out), and our bodies are full of both oxygen and iron.  So why aren't we all as rusty as a highway bridge?  TBD...

      Our lungs, which when deflated amount to little more than two fist-sized sponges, split in two directions just past our throat, then continue to each split over and over into ever smaller branches another 21 times, eventually developing over 2400 kilometers of passageways (nearly 1500 miles), wrote Dr. Giulia Enders in her book, Organ Speak.  But if that wasn't impressive enough, Dr. Enders added: To get to grips with oxygen you have to understand its aims: it doesn't have any.  In the air it moves according to completely random patterns.  If oxygen comes across a suitable molecule, it's happy to combine with it...When a torrent of oxygen molecules comes into our lungs, these molecules begin by whizzing around aimlessly.  But that soon changes.  When these start to enter the blood, the body regulates and orders them.  The first highlight is the iron in our blood.  Oxygen wants to combine with iron to make rust (one of its classics), but our blood is one step ahead.  In the blood cells iron is folded in protein so that, although oxygen comes very close to reacting with it, it's not close enough to succeed... When blood cells laden with oxygen pass a cell that needs energy, they push the oxygen further away from the iron.  Now it abandons its belief that it will ever combine with the iron and wanders into a new realm.  But this doesn't last long either, as the oxygen is snapped up by an enzyme complex reminiscent of a millwheel... The millwheel enzymes (more specifically ATP synthase and cytochrome c oxidase) derive energy from oxygen!  For this they take the tiniest leftovers from our food (individual hydrogen atoms) and give them to someone who isn't at all picky -- oxygen!  When oxygen is grabbed by the wheel and thrown at scraps of hydrogen, it can finally (!) rotate freely and do what it does best: react wildly!  It combines with two bits of hydrogen to make water and flows away.  The energy released through this reaction drives the millwheel and supplies our cells.  When we breathe, new oxygen arrives.  If the wheel is turning, there is life.  If it stops, we die.  Okay class, quiz tomorrow...

      Even for me, that was a lot of "doc" speak.  How did anyone ever discover such a thing?  And imagine if it was you and running into the other room to explain to your aunt or sister about what you had found?  Check out these iron cells in my microscope!  Would any of that make sense to the everyday person?  And all of that was explained without the chemistry symbols and such (another of my weak subjects in school).  But wait, no worries because while you may be bracing yourself for an entire post on how such "researchers" are no longer being supported or working for the CDC, instead replaced with a host of unqualified mega-donors or whomever (most of it true), this post isn't isn't going to be some sort of chem quiz (as if).  But you do know that the rising cases of measles and other childhood diseases like congenital syphilis are likely because of our new (and also unqualified) head of health, a snake charmer (an ironically appropriate name for what seems our entire government of late).  Wait, what?  Did I just mention babies and children getting syphilis?  From STAT: A child born with congenital syphilis could suffer dire consequences: bone deformities, brain damage, blindness, deafness, and more.  But that should be a ‘never event’ as public health officials say: A pregnant person can receive an injectable form of penicillin to prevent the infection.  Somehow, rates keep going up anyway.  Between 2012 and 2024, the U.S. saw an 800% increase in babies born with the disease.  And since last year, there’s been a shortage of the drug.  Penicillin, for heaven's sake, that old drug from back when I was a child.  Isn't that one of the basic medicines?  As it turns out, the version currently used (Bicillin L-A) is only sold by one company, Pfizer, and is apparently not so easy to get...so cases of miscarriages and even infant death are soaring.  

     And it is here that I stop, because back to that "ennui" of an earlier post as the divide continues over anti-vaxxers and old meds, the issue is apparently not that certain parts of our country don't want to partake, but perhaps more importantly, don't want others to have access as well, even if it means letting such usable medications and such rot on the shelf by expiring.  This recently happened with contraceptives meant for low income countries, wrote the NY Times: $360,000.  That’s about how much money the U.S. spent between January 2025 and March 2026 to store millions of dollars worth of contraceptives that were meant for international aid, according to a USAID Office of Inspector General advisory issued last week. (Monthly storage costs increased from more than $17,000 to $24,000 in that time.)  The birth control was originally meant to go to low-income countries in Africa but was left in Belgium after the Trump administration made massive cuts to USAID last year.  Out of $9.7 million in family planning supplies, only about $1.7 million remain usable, as they’ve been stored in climate-controlled facilities.  But expiration dates starting in April 2028 loom.  

     Speaking of the rotund one in the rotundra, the new obesity drug by Eli Lilly, retatrutide, was reportedly given to Trump, according to three different clinicians (all denied by the White House).  According to the drug company Eli Lilly, this person was a 79-year-old man at the time the request was made in April.  Again according to STAT: Eli Lilly and the FDA have allowed one person to gain access to the drug through the FDA’s “compassionate use” program, a pathway that gives patients with serious and immediately life-threatening medical issues access to experimental treatments.  Wrote The Independent: The patient in question reportedly sought the medicine to treat refractory obesity with obstructive sleep apnea and pulmonary hypertension, high blood pressure in the lungs, which can be life-threatening...“In rare situations, when individuals can’t join a clinical trial and have run out of treatment options, Lilly may provide an investigational medicine in coordination with a requesting physician,” a Lilly spokesperson told The Independent in a statement.  “We make these decisions following all applicable regulations.  We do not comment on the specifics of individual cases.”  The president has gotten early access to a treatment before.  Makes one wonder how compassionate it is to let goods and medicines expire or be buried (as happened in Gaza) instead of being given to those truly in need...although, since Trump was seen by 22 specialists at his last physical, one of those could have been a clinician from Eli Lilly.

      Now if you're thinking this is all a bunch of crap, you may want to read You've Been Pooping All Wrong by Dr. Trisha  Pasricha.  Wait, before you chuckle and giggle about that topic, the author finished first in her class in both college and med school, and has her own gastroenterology clinic, so she knows about what she writes.  And her book covered every topic about our rear ends, such as our colon having two layers, one quite flexible and able to contract (that "push" when you're on the toilet), but the other as rigid as a garden hose.  And how often do you (or should you) poop?  Once per day?  Twice or three times per day?  Once every other day?  Once every three days?  Not to worry as each of those bowel movements is normal, as is the fact that we men and women pretty much expel gas (fart) 10-20 times daily, much of it while sleeping.  All normal.  Now the color of your poop? (it's her first question in the book): do you regularly (at least once per week minimum) turn and check the color of your poop before you flush (uh, nope).  To hear someone such as myself say "rarely" brings an audible gasp from her.  White or silver poop (yes, there is such a thing) means head to the ER like immediately since your life may be on the line.  And the consistency of your poop?  Well, let's just say that she covers everything you may or may not want to know about something we all take for granted on a near-daily basis (who knew that the colon absorbs 98% of the remaining liquid headed its way).  Ahem, see what I mean about the body?

    

     Yet as fascinating as all that was, what really grabbed my attention was that "what happens in Vagus" nerve (she uses that joke terminology in her book).  It's the longest cranial nerve in our body (actually 100,000 vagal nerve fibers on each side of our neck) extending down both sides and tapping in to virtually every organ, "mediating how we cough, swallow, sweat, breathe, and pump blood through our hearts."  In addition to calming us down, the vagus nerve can help dampen inflammation (think meditation).  But Dr. Pasricha adds: But its connection to the gut is different from that of other organs -- after all, other organs (even the oft-venerated heart) don't have their own nervous system.  So in addition to those jobs, the vagus nerve is constantly transmitting all kinds of important information between the brain and the gut.  Much of this bidirectional signaling, in fact, is dependent on the vagus nerve.  Take the satiety-inducing hormone, glucagon-like peptide 1 (the very GLP-1 of Ozempic fame), for example.  These drugs aren't merely enacting local changes in the lining of the stomach or intestine to curb hunger.  Instead, the sense of fullness produced by these drugs requires a functional vagus nerve to work (as does its subsequent effects on how the brain decides what size meal it wants).  Many signaling pathways like this between the gut and the brain simply can't operate without the vagus.  On the negative side, scientists now feel that having mis-folded proteins which affect movement and possibly leads to Parkinson's (some scientists now believe this may start from childhood ulcers in the stomach), originates in the gut and is helped up to the brain by the vagus nerve.  Severing the nerve (a vagotomy) often decreases patients' chances of getting Parkinson's disease.  Wait, didn't she just tell us how dependent we were on that nerve?  And by the way, Trump's experimental drug also apparently targets that GLP peptide...

      Backing up a bit, how much do you know about peptides?  And more importantly, would you consider yourself a drug user?  If you're following podcasters such as Joe Rogan or any of the many "wellness" influencers who promote injecting yourself with compounded peptides for a purported longer more pain-free life, then yes, you are indeed a drug user.  Wait, why?  Let's back up a bit more and ask yourself that if someone or some company you didn't know offered to inject you with a liquid over and over, or send you such an elixir, even if you were or are against vaccines, would you let that happen?  And would that be any different than a heroin user on the street?  Uh, not much because most of the peptide combos out there not only come from China (or small unlicensed labs across the world) but are unregulated and in many cases, untested.  According to an article in Ars Technica, on June 30, 2026: ...the Food and Drug Administration updated its list of advisors who will review the peptides, adding nine new members—almost all of whom personally promote peptide use and/or have financial ties to wellness clinics that offer peptide treatments.  Look at it this way: call your product a "drug" and you fall under a slew of production rules and regulations; but take that same drug, throw in a vitamin or some herbal powder and call it a "nutricicle" or "body protecting" formula (BPC-157 of Joe Rogan fame, stands for Body Protection Compound, although you wonder how the prior 156 formulations turned out) and you're pretty much home-free to market to anyone.

     Dr. Dhruv Khuler of Weill Cornell Medical College, wrote in an article in The New Yorker: ...in the three-plus decades since BPC-157 was discovered, no controlled human trial of the peptide has ever been published.  In the nineties, Sikiric [Croatian scientist Predrag Sikiric,who discovered the peptide in human gastric juice three decades  ago, yet no human trials outside of his "lab" have been published in those 30 years] licensed the compound to a Croatian company called Pliva, which sought a treatment for ulcerative colitis; the results were never released.  In 2006, the research-and-development arm of Pliva was acquired by GlaxoSmithKline, which has ample resources for clinical trials, but the company has not commercialized the peptide...On a page called Peptide Nexus, which had more than ten thousand followers, I watched animated vials of personified peptides that looked like the emotion avatars in the movie “Inside Out.” “Yo, I’m TB-500!” a smirking red vial declared, a fire raging in the background.  “I’m the recovery peptide people call Wolverine mode.” ...The vial of BPC-157 [obtained and tested by the author of the article] contained lead, the vial of TB-500 contained endotoxins, and the vial of CJC-1295 contained less than forty-two per cent of the advertised dose...In some cases, peptides have been clearly linked to harms.  Last year, at the Revolution Against Aging and Death Festival, in Las Vegas, two women received peptide injections at a conference booth; shortly thereafter, they developed elevated heart rates, swollen tongues, and trouble breathing.  By the time they reached the hospital, one of them had lost control of her neck muscles, and the other had been intubated.  Both were ultimately connected to ventilators. (The peptides involved have not been disclosed.)...Trump’s F.D.A., which reports to Kennedy, is also unlikely to aggressively enforce restrictions on peptides.

      So after reading all of that, would you still want to inject yourself with something advertised by an unknown and, like RFK, Jr., probably medically unqualified "influencer?"  Hmm, does the term drug user come back to mind?  But what the heck are peptides anyway, and have they always been around?  Here's a brief explanation from the medically-trained professor and author of the piece: The human body produces thousands of peptides.  Many are portions of proteins which send messages or regulate systems in the body, often in ways that scientists don’t fully understand.  Researchers have known about some peptides for decades, and dozens have been turned into safe and effective drugs.  The hormone insulin is a peptide that moves sugar from the bloodstream into cells; GLP-1, or glucagon-like peptide-1, spurs the pancreas to release insulin and slows the passage of food through the gut. (Peptides are usually defined as having about fifty amino acids or fewer; more than that and they’re proteins.)   All that he says in the article is that the world of peptides may be great, but the world of those promoting or manufacturing those hundreds of unregulated peptide compounds may prove harmful...

    I belatedly picked up Viktor Frankl's book, Man's Search for Meaning, and what surprised me upon reading it wasn't the horrible life he endured in a concentration camp (picture walking in wet and tattered shoes in the snow, no heat even back in camp, working outrageously hard day after day, and your only food each day being a slice of bread and a bowl of watery soup with an occasional pea or a bit of potato from the bottom IF you knew the server) he wrote that his goal wasn't to repeat what so many had already written about the hardships of being such a prisoner, but to emphasize that each of us is responsible for his or her own life, and no matter the situation, to look beyond ourselves: A painter tries to convey to us a picture of the world as he sees it; an ophthalmologist tries to enable us to see the world as it really is...widening and broadening the visual field of the patient so that the whole spectrum of potential meaning becomes conscious and visible to him.  By declaring that man is responsible and must actualize the potential meaning of his life, I wish to stress that the true meaning of life is to be discovered in the world rather than within man or his own psyche, as though it were a closed system.  Trump has long wanted to have his face on a proposed $250 bill, but current laws make clear that only someone who has died can appear on either a postage stamp or on legal tender in the US.  Does Trump or a few of his 22 medical specialists know something we don't?  TBD...

     But never one to end on a bad note, I focus on a group started by 3 Stanford University students some years ago.  Disillusioned by what they saw as wanton waste, they formed Sirum, making use of unwanted and  unused medical supplies --often still usable-- and distributing them to those in need, saving them from the trash or from going to waste because of expiring.  To date, Strum has helped over 800,000 people receive medicine they either couldn't afford or wouldn't be given, noting that nearly $11 billion in unopened, unused medicine typically goes to waste each year.  As co-founder Kiah Williams told one foundation: My co-founder Adam [Kircher] actually came up with the idea for SIRUM, inspired by what he saw overseas after a massive tsunami in Indonesia: Tons of donated supplies were going unused because they had no way of getting to the people and communities who needed them.  It turns out that there was a similar problem happening right here in the U.S.  Perfectly good medicine was going unused, with no way of getting to the millions of patients whose prescription costs were prohibitively high.  This is a massive injustice.  We didn’t think we had all the answers, but we all believed that it was unacceptable not to try to solve it.  If no one else was solving it, why not us?  We knew it wasn’t going to be easy, but we thought it just might be possible...The idea of transforming “waste” into access has broad applications, and you can already see it at work in industries like food.  What makes SIRUM unique is that we built the systems and safeguards to do this in one of the most highly regulated industries.  If we can do it with medicine, it opens the imagination for what’s possible in other sectors too.      

      

     In the end, I felt that this expanded worldview of things was captured in a children's book called Sight: There is a Japanese belief that contemplating nature brings a person closer to grasping the principles of life and beauty.  This is why in some Japanese buildings a window that has a nice view is often framed as a picture, and the landscape is perceived as an exquisite work of art in and of itself.  But if all of this talk of peptides and the workings of our bodies has seemed too serious and just too much to take in, just stop and remember that like our bodies, we're all connected -- after all, hysterical comes from hystera, the early Greek definition of uterus (hysterectomy).