Ah, chemistry
May. 10th, 2005 01:40 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
walkitoutI have a little trouble with chemistry. For one thing, I didn't take any chem (or bio) after high school. I felt that labs were time consuming and dangerous and worked hard to avoid them. A while back I subscribed to Nature for a year, and read it cover to cover assiduously. I spent a lot of the time on the phone to a friend who had taken relevant courses asking what various words meant. These days, of course, I would use google, but it's a very different world now.
After having read an appalling number of books which abstract medical studies on Stuff Done to Pregnant Women and Their Babies, I have noticed a trend: Prostaglandins. They seem to be involved in absolutely everything, and some of the Stuff has the effect of increasing production (or supplying synthetic, analog or precursors to prostaglandins) and other Stuff has the opposite effect. I have a well-developed set of beliefs about polypharmacy and medical treatments that require other treatments to deal with the less-desirable effects of the initial treatments. They can be summarized as Stay Away If At All Possible.
However, when my newborn niece's patent ductus arteriosus did not immediately close (and contributed to her non-standard respiratory distress) and I read up on drug treatment for that (which worked, yay, no surgery in the offing for the wee one), my trend sat up and became a full-blown Paranoid Conspiracy Theory. An aspirin a day. Why does it work? Prostaglandins. Cox-2 inhibitors were developed to have a more specific effect on some, rather than several, prostaglandins, with the unfortunate side effect of death. Want to make the cervix ripen or activate uterine contractions (whether to induce labor or an abortion)? Prostaglandins (or analogs, or precursors). And again, the more specific and effective the treatment, the more likely it is to have the unfortunate side effect of death (or disability. Reading about uterine hyperstimulation is creepy. Reading about uterine rupture with no history of C-section rendered me speechless.).
Okay, that's all weird. But then it turns out that inflammation is mediated by prostaglandins. Bone resorption, ditto. Essential fatty acids, either the wrong balance or not enough, are a component of this complicated control system. See what I mean? They're everywhere. Everything interesting in the way of drug development or nutritional news in the last ten years seems to involve prostaglandins. And sure enough, they've only relatively recently tracked down a lot of the details, and many are still being studied.
Last night, after asking Roland a few more questions about what he remembered from his AP, but high school, chem class about prostaglandins, we sat ourselves down in front of google and spent an hour or so digging for a nice diagram or summary of the current state of understanding. This is when we found out about the bone resorption (does that mean someone taking aspirin for arthritis, or heart protection, is setting themselves up for osteoporosis? It sure sounds like it.) thing. Oh, and the asthma thing. No useful diagram (a lot of interesting ones that showed one PG getting turned into another, but never showing the control system with the inhibitors and precursors, which is what we really want). As near as we can tell, people who go to medical school have to learn this stuff before (or during). They ought to be able to predict a lot of these side effects by understanding how a treatment or drug acts. But they (collectively even, so whoever is doing formulary or protocol design is missing it, too) do not appear to be anticipating these things -- just tossing in more drugs and treatments to deal with the effects as they appear. Couple of theories spring to mind. They don't want to alarm the patients, so they don't really talk about it. They don't want to admit they don't understand how this shit works, so they don't really talk about it. Or they're in a flaming hurry to try something, anything, and they blow right through any considered discussion as to whether this is really a good idea (hurrying to save lives, make money, whatever. Possibly just institutionalized hurry).
Consider this an open call for a reasonably accessible introduction to prostaglandins as a major control system in the (human) body. That means in a pinch, I'll take a college textbook, but I'd prefer to avoid reading an entire endocrinology text. Which is currently what it sounds like I'm signed up for, if I really want to understand what the hell is going on here.
Honestly, by comparison, knowing what sub-arachnoid space is and being able to point to it in a diagram is straightforward.
After having read an appalling number of books which abstract medical studies on Stuff Done to Pregnant Women and Their Babies, I have noticed a trend: Prostaglandins. They seem to be involved in absolutely everything, and some of the Stuff has the effect of increasing production (or supplying synthetic, analog or precursors to prostaglandins) and other Stuff has the opposite effect. I have a well-developed set of beliefs about polypharmacy and medical treatments that require other treatments to deal with the less-desirable effects of the initial treatments. They can be summarized as Stay Away If At All Possible.
However, when my newborn niece's patent ductus arteriosus did not immediately close (and contributed to her non-standard respiratory distress) and I read up on drug treatment for that (which worked, yay, no surgery in the offing for the wee one), my trend sat up and became a full-blown Paranoid Conspiracy Theory. An aspirin a day. Why does it work? Prostaglandins. Cox-2 inhibitors were developed to have a more specific effect on some, rather than several, prostaglandins, with the unfortunate side effect of death. Want to make the cervix ripen or activate uterine contractions (whether to induce labor or an abortion)? Prostaglandins (or analogs, or precursors). And again, the more specific and effective the treatment, the more likely it is to have the unfortunate side effect of death (or disability. Reading about uterine hyperstimulation is creepy. Reading about uterine rupture with no history of C-section rendered me speechless.).
Okay, that's all weird. But then it turns out that inflammation is mediated by prostaglandins. Bone resorption, ditto. Essential fatty acids, either the wrong balance or not enough, are a component of this complicated control system. See what I mean? They're everywhere. Everything interesting in the way of drug development or nutritional news in the last ten years seems to involve prostaglandins. And sure enough, they've only relatively recently tracked down a lot of the details, and many are still being studied.
Last night, after asking Roland a few more questions about what he remembered from his AP, but high school, chem class about prostaglandins, we sat ourselves down in front of google and spent an hour or so digging for a nice diagram or summary of the current state of understanding. This is when we found out about the bone resorption (does that mean someone taking aspirin for arthritis, or heart protection, is setting themselves up for osteoporosis? It sure sounds like it.) thing. Oh, and the asthma thing. No useful diagram (a lot of interesting ones that showed one PG getting turned into another, but never showing the control system with the inhibitors and precursors, which is what we really want). As near as we can tell, people who go to medical school have to learn this stuff before (or during). They ought to be able to predict a lot of these side effects by understanding how a treatment or drug acts. But they (collectively even, so whoever is doing formulary or protocol design is missing it, too) do not appear to be anticipating these things -- just tossing in more drugs and treatments to deal with the effects as they appear. Couple of theories spring to mind. They don't want to alarm the patients, so they don't really talk about it. They don't want to admit they don't understand how this shit works, so they don't really talk about it. Or they're in a flaming hurry to try something, anything, and they blow right through any considered discussion as to whether this is really a good idea (hurrying to save lives, make money, whatever. Possibly just institutionalized hurry).
Consider this an open call for a reasonably accessible introduction to prostaglandins as a major control system in the (human) body. That means in a pinch, I'll take a college textbook, but I'd prefer to avoid reading an entire endocrinology text. Which is currently what it sounds like I'm signed up for, if I really want to understand what the hell is going on here.
Honestly, by comparison, knowing what sub-arachnoid space is and being able to point to it in a diagram is straightforward.
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Re: Will Read Primary Papers
Date: 2005-05-12 12:28 am (UTC)Basic chemistry breakdown: arachidonic acid, the grandpa precursor, gets metabolized into prostaglandins, thromboxanes, and leukotrienes (and they're all related). Aspirin tends to work at inhibiting the initial steps away from AA, while COX-2 or COX-3 inhibitors are more fine-tuned against particular sub-products.
This one (http://www.amazon.com/exec/obidos/tg/detail/-/0521334837/qid=1115857055/sr=8-4/ref=sr_8_xs_ap_i4_xgl14/104-2044630-9636742?v=glance&s=books&n=507846), used, might be a decent start for you. Covering the prostaglandins in the immune response. (That ain't including prgs in pregnancy, ischemia, pain management, and so on).
Alternatively, start here (http://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.View..ShowTOC&rid=imm.TOC&depth=2) (free online reference text from the NCBI) and punch in search terms till your eyes bleed. Janeway's a good intro-level immunology textbook that might get you farther in the beginning. You can take off from there.
As for prostaglandins in relation to any particular condition (pregnancy, retinopathy, kidney disease, diabetes, etc.) and if you want to bang your head against the walls for a while, you can always work your way through <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed>PubMed</a> which is the dB for medical/bioscience articles. Some journals are now free-access entirely, some require subscription. In lieu of more specific search ideas, this is what I can offer. As always, you can take anything that catches your eye and either run it back through an amazon search, or feed it back into PubMed or the NCBI online books. Good luck...
Re: Will Read Primary Papers
Date: 2005-05-12 12:30 am (UTC)PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed) is what I meant to say. It's the free NCBI dB for medical/bioscience journals. Some journals have free total-access online, some are subscription only. If you can search from a UW machine, you might be able to get in via a UW site license for more journals.
Good luck...
Re: Will Read Primary Papers
Date: 2005-05-13 06:06 am (UTC)Anyway, thanks again, and if you come up with more ideas, please share!