Editor's Note: This week we have the first of two special reports on pesticide drift.

In this week's Quest radio piece, I talk to two pregnant organic onion workers who got sick after an apple farmer sprayed pesticides on a nearby orchard. Following a nearly three month investigation, the Kern County Ag Commissioner issued citations finding both the apple grower and the organic company at fault (see the citations here and here). Workers told me that even after the drift started, the organic farm's supervisor encouraged them to keep bunching onions, telling them to put handkerchiefs over their mouths to block out the smell of the insecticides.

Whenever a big pesticide drift accident like this happens, it raises important questions: How often do these kinds of incidents occur? Are things getting better for people in communities near where pesticides are sprayed?

That's hard to tell, because of the way the Department of Pesticide Regulation (DPR) and County Ag Commissioners keep track of the data. There's no single enforcement code to categorize incidents as "agricultural drift affecting humans."

DPR does keep a statewide database of acute illness related to pesticides, as documented in worker’s comp or physician's records. Pesticide activists say those numbers are low, because many victims don't see a doctor. And doctors don't always know how to recognize symptoms of pesticide illness, or that they are supposed to report those cases.

And here's another twist: back in 2000, DPR changed its criteria for how it evaluates pesticide illness. So you can't compare the number of incidents from the 1990s with incidents today. All that makes it very difficult to determine if growers and regulators are really doing a better job keeping the public safe from chemicals drifting off the farm, especially after the passage of bills like the 2004 law sponsored by State Senator Dean Florez.

While that law clarified rules for emergency responders and required growers to pay medical bills for uninsured victims, it doesn't seem to have led to a dramatic drop in pesticide drift incidents.

In 2006, Governor Arnold Schwarzenegger vetoed a bill that would have sped up pesticide drift investigations and increased penalties. Instead, he directed DPR to streamline the enforcement guidelines for counties. Ag Commissioners can now issue a maximum fine of 5,000 dollars for each person sickened by pesticide drift.

That's a penalty some advocates, like Californians for Pesticide Reform think is far too low to act as a deterrent.

Meanwhile, County Ag Commissioners are facing budget cutbacks that may shrink their enforcement teams. Many agriculture commissioners already have just six or seven pesticide enforcement inspectors to police thousands of farms.

The Department of Pesticide Regulation says it can't enforce the law unless drift incidents are reported. The department has launched a new campaign to educate fieldworkers about pesticide drift, printing up wallet-sized cards with a toll-free hotline number in English and Spanish.

Listen to the Catching the Drift radio report online.

You've probably heard about some of the breakthroughs in personal genome sequencing, where companies take a look at your DNA and send back your risk profile. That can be confusing information to have (check out this post from Quest blogger Dr. Barry Starr for his take on it). But there's a flip side to all this genetic research that doesn't have to do with risk: personalized medicine. That's where doctors can customize medical treatments to fit your genetic profile.

Right now, there are only a handful of drugs that are labeled with genetic information, so doctors can take it into consideration. (Here's an article from the New York Times that gives an overview).  But that doesn't mean existing medications are left out.  I spent some time with Deanna Kroetz in this story, who studies pharmacogenomics at UC San Francisco.  She explained that differences in our DNA can cause some of us to process drugs at different rates. We all metabolize drugs with enzymes in the liver, but based on expression of our DNA, we may have different levels of enzymes or our enzymes may not function as well.

There are plenty of other things that affect how we process drugs, like our diet or other drugs we're taking. But these genetic differences mean some people metabolize drugs quickly and others metabolize them slowly. One example that many people are familiar with is codeine.  Codeine is converted into morphine by our bodies and it's the morphine that actually has an effect — but that conversion depends on a particular enzyme. Some people have very low levels of the enzyme that's needed, so codeine doesn't do much for them.

They're also studying another drug response mechanism at UCSF and it has to do with our cells. Many drugs have to go inside our cells in order to have an effect, but if you think back to high school biology, you might remember that cells are protected by membranes.  It takes transporters – those special gatekeepers sitting on the cell membranes — to allow things in.  They also can spit things out of cells.

I spent some time in the lab with Rachel LaFond, a graduate student at UCSF.  She was running experiments on one particular transporter known as ABCG2. This transporter is particularly good at spitting things out of cells. Normally its job is to kick toxins out, but some cancers have been able to hijack this machinery.  Cancer cells with an over expression of this transporter can spit out chemotherapy drugs, which means they aren't helping the patient.  LaFond is working to understand this variation better, so they could one day develop a genetic test for it.

Listen to the Personalized Medicine radio report online.

Often at the California Academy of Sciences, you will see docents out on the floor of the museum with an example from our live animal collection.

You've probably heard of this bacteria before, as an unpleasant bug that sometimes finds its way into high-protein foods such as meat, fish, and eggs. It is also naturally found on and in many reptiles, and does not usually make the animals sick, but if passed to humans– particularly young children, the elderly and infirm — it can cause a serious infection called Salmonellosis.

But selecting the right anti-microbial was not as easy a choice as we thought it would be.

Food and Drug Administration published reports question the use of antibacterial soap and hand sanitizers, saying that it found no medical studies that showed a link between a specific consumer antibacterial product and a decline in infection rates. Plus, regular soap kills 90% of bacteria and leaves little impact on the environment.

Additionally, anti-bacterial products like Purell use synthetic polymers known as Triclocarban and triclosan to kill off bacteria. Triclosan is known to promote the growth of resistant bacteria, including E. coli, and both pose environmental toxicity risks; after washing your hands or washing the dishes they can get into the waste water system. Because they do not break down or get filtered out during waste water treatment, up to 75 percent of the original amount gets into the Bay. Once in the environment, these products have been known to disrupt the health of marine life and other wildlife.

So Academy scientists went in search of an alternative product that does not contain the above 2 agents, and has recommended Vionex Antimicrobial Soap for our public programs. Commonly used in the medical, dental, and law enforcement industries, Vionex uses a different antimicrobial agent called PCMX, or parachlorometaxylenol, which is considered significantly less toxic to humans and other mammals that Triclocarban and Triclosan.

What you can do at home

Even if you are not handling reptiles daily like we are, you can take action to reduce exposure to toxic anti-microbials. Whenever possible avoid products that are labeled “anti-bacterial.” Products that are likely to be anti-bacterial are most hand-sanitizers, hand wipes, cleaning products, and dishwasher detergent. If you must use hand-sanitizers, consider natural ones such as Hand-Sanz (found at Whole Food or Bristol Farms).

This week's local science event pick focuses on health care reform.

The idea for Kaiser was developed by Dr. Sidney Garfield way back in 1933. He established a prepayment health plan for 5000 workers building the Los Angeles Aqueduct in the Mojave Desert. Workers paid about a nickel a day to receive full medical care from Dr. Garfield. He emphasized prevention and early treatment to prevent more serious problems later.

Fast forward to today, the same issues of prevention to keep down costs are still being discussed today. Certainly, HMOs are not without criticism, but it is certainly a compelling story to trace the development of the modern system from a place of preventative care. Plus, it will be a relief to have a healthcare discussion without all the yelling.

Tom Debley is the author of The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care, the theme of his talk will be "The Long Quest for Health Care Reform: A Bay Area Doctor's Belief in Health Care as a Right." He will trace the story of Dr. Garfield's life because so much less is known about him than his co-founder, Henry J. Kaiser.

The Long Quest for Health Care Reform: A Bay Area Doctor's Belief in Health Care as a Right

When: Tuesday, August 25^th 2009

Where: Commonwealth Club, 595 Market Street 2nd Floor

Cost: $8 members, $15 non-members, Tickets

This radio story tries to cram a lot into five minutes, so if you don't find what you need here, put a comment on the blog, below and I'll see if I can't provide a lead to more information.

Transcranial magnetic stimulation interested me, in part, because of how non-invasive it is. Dr. Bret Schneider, who offers TMS from his private practice in Portola Valley, was one of several experts to suggest that TMS machines might one day be available for home use. Of course, that's a long way off. TMS is expensive: about $5,000 for an initial round of treatment. It's still much easier and cheaper to simply pop a pill each morning. And researchers are still working out how effective it can be.

Studies show that TMS brings a remission in depression to about a third of patients to try it. Another third experience some improvement, and a final third are unaffected. Dr. Schneider says he sees much better success rates on patients who combine TMS with antidepressant drugs (TMS without drugs, he says, is like "trying to drive a car with no gas.") Finally, the FDA approval covers only one TMS machine on the market, Neurostar, although some physicians use other techniques, off-label.

You can find links to the abstracts of clinical studies performed on TMS and depression through a search at pubmed.com. This meta-analysis compares 30 double-blind studies, covering a total of 1164 patients (606 received TMS, 558 received sham treatments).

But TMS is just one in a class of "brain stimulation" depression treatments — an important fact that didn't make it into the story. Others include vagus nerve stimulation, deep brain stimulation and, of course, electroshock convulsive therapy — which is offered here in the Bay Area at the UCSF Langley Porter Psychiatric Institute to severely depressed patients (as well as, less commonly, people suffering from manic depression and schizophrenia).

Quest TV will cover TMS and other depression treatments in greater depth later this season, so stay tuned. For a sneak peak at some of what you'll find on the show, check out Stanford scientist Karl Deisseroth's groundbreaking work using light-sensitive proteins to stimulate neural circuits — work that could someday help treat not just depression, but other brain diseases as well.

Listen to the Depression Advancements radio report online or check out the slideshow below of Dr. Bret Schneider, a consulting assistant professor at Stanford University and a practicing psychiatrist in Portola Valley, discussing depression and the brain.

Bring it on! A healthy dose of epicatechin, serotonin, caffeine, theobromine, phenylethylamine, and polyphenols

As seen in our QUEST story, "The Sweet Science of Chocolate," UCSF’s Mary Engler conducted a clinical trial that showed that a plant-based flavonoid, epicatechin, helped to promote healthy blood flow in healthy patients.

Other researchers in the late ‘90’s, such as Adam Drenowski at the University of Washington, found that chocolate helps trigger the release of endorphins, while Daniele Piomelli of UC Irvine, conducted research on cannabinoids found in chocolate.

And recent research suggested that chocolate could even be good for your memory. There are other compounds present in chocolate which may have beneficial effects on your mind and body, such as serotonin, caffeine, theobromine, phenylethylamine, and polyphenols. Who knows what future chocolate research may yield, but in the meantime– no joke here– you might even be pumping chocolate-based fuels into your gas tank!

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Hi everybody. I want to let the QUEST community know that over at KQED’s Health Dialogues, we just launched a new project, called Healthy Ideas: Californians Weigh In on Health Care Reform.

In his 100th day press briefing a few days ago, President Obama reiterated his desire to enact health care reform by the end of 2009. The President has also put out a call to all Americans to submit our ideas on just how to do that. So, Health Dialogues decided that we’d let Washington know what Californians think.

Is the cost of new medical technologies worth the potential health benefits? What can we do to eliminate health disparities across socioeconomic backgrounds? Should everyone be required to purchase health insurance?

Healthy Ideas is a conversation among academics, health care professionals, policy think tanks and the general public about what kind of health care reform California wants and needs. During the next two months, you can join the dialogue by reading our authors’ weekly posts, rating them and contributing your own thoughts and questions. At the end of the project, on July 1, we’ll summarize your ideas and deliver them to California’s representatives in Washington, as well as the Obama Administration, Senate Finance Committee Chairman Max Baucus and Senate Committee on Health, Education, Labor and Pensions Chairman Edward Kennedy.

To contribute your thoughts and let Washington know what kind of health care reform you want, join the dialogue at Healthy Ideas: Californians Weigh In on Health Care Reform.

Thanks!
Nick Vidinsky
Producer, Health Dialogues

The swine flu virus. Credit: C. S. Goldsmith and A. Balish, CDC.

As this story is being produced, the reports on swine flu are changing hourly. Cases are popping up closer and closer to home, and the CDC is updating several times a day on the spread of the virus, and plans to fight it.

The $64,000 question is how worried we should be.

Swine flu is largely untreatable: The two effective antiviral drugs, Tamiflu and Relenza, must be taken within 48 hours of infection to stop the spread of the virus.

That leaves a vaccine. Vaccines are relatively straightforward to create, but they take time. If swine flu becomes a deadly pandemic (meaning it's not only widespread — a pandemic – but more lethal than it appears to be so far) the demand for vaccines would likely far outpace supply. According to Art Reingold, at UC Berkeley's School of Public Health, it could take years for doses to reach everyone in the world who's vulnerable to the disease. Here in the US, we have very few vaccine producing facilities, which means we'd be competing with other countries' priorities to treat their own citizens.

Our story focuses on what could, one day, be the answer to pandemics like this one: a universal vaccine. Scientists like Harvard Medical School's Wayne Marasco believe that, in just a few years, we might be able to inoculate ourselves against nearly all influenza viruses – like a tetanus shot, against the flu. Universal vaccines will come too late for our current swine flu pandemic. But they may well be our response to pandemics of the future.

Listen to the Swine Flu and You radio report online.

The swine flu virus, up close (and colorized!)
Credit: C. S. Goldsmith and A. Balish, CDC

Swine Flu has been blanketing the news as of late. On April 29th, the Centers for Disease Control and Prevention (CDC) reported the first US fatality occurring in Texas. The CDC has determined that this swine influenza A(H1N1) virus is contagious and spreading from human to human. Yet at this time, they do not know how easily the virus spreads between people. At our museum, we have taken this very seriously and staff has been asked to stay home if symptoms arise.

CDC is recommending that those who come down with flu-like symptoms stay home from work in order to decrease the rate of infection. The Swine Flu is a viral infection rather than a bacterial infection, which makes it harder to treat. Much of the care for viruses is preventive; viruses are hard to treat after they have entered a living host.

Many people do not know the difference between a viral infection and a bacterial one and consider them interchangeable. Yet they are quite different. Viruses are sub-microscopic particles ranging in size from 20 to 300 nanometers (about 1000 times smaller than the width of a human hair). Viruses must have a living host to function. They remain dormant until they infect a living cell. Within a cell, they then change the genetic material of the cell to replicate the virus. AIDS and Influenza are both created by this process of taking over the normal function of a cell in order to replicate viral cells.

Bacteria do not take over cells. Bacteria are much larger than viruses, usually 10 to 100 times bigger than a virus. Their shapes include curved rods, spheres, rods and spirals. They are known as intercellular organisms because they live between cells. All viruses are harmful to the host because they alter cells, but bacteria can be beneficial (like the species that live in our guts and help us digest our food).

Harmful bacteria in the body create infections like Strep throat or Small Pox. Bacteria can grow and reproduce in both living and non-living environments. Antibiotics are used to treat harmful bacterial growth and infection in the body. Antibiotics; however, are ineffectual against treating viruses.

Because the Swine Flu is a virally spread disease, it is even more important to practice prevention. The CDC sees this disease being spread like a common flu – mainly from person to person through coughing or sneezing by people with influenza. People can also become infected by touching something with flu viruses on it and then touching their mouth or nose. Taking simple precautions like washing your hands and covering your mouth when sneezing is effective prevention. Working in a museum,we take this extra seriously considering how often we come in contact with lots of people and their germs. Many of my co-workers, myself included, have hand sanitizer at our desks, wash our hands often, and carry tissues. It is a simple way to combat an evasive illness.

For more about how to protect yourself from swine flu, check out this podcast from the CDC.

More than 20 million gallons of raw sewage spilled into California waterways last year, according to the state Department of Water Resources Control Board. That's not counting the partially treated sewage that makes its way into our water from overflows and sewer system malfunctions.

Many big sewer pipes are old, and many of the sewage treatment plants are antiquated. But the biggest problem faced by sewer systems in California is the tiny pipe called the lateral.

That's the pipe that runs from your home to the street, the small pipes under all of our homes that end up joining the bigger sewer pipes. When those pipes develop cracks, water leaks into them.

Storm water itself would not overwhelm a sewage system, because it's designed to be a closed system. Storm water is not supposed to BE in sewer pipes. So in one way, it shouldn't even matter what the weather is like – storm water shouldn't really mix with sewage at all.

But during a rainstorm, water seeps into your broken lateral pipe, and all your neighbors' pipes, and that rainwater mixes with sewage in the sewer pipes, and the volume of water/sewage can actually build up far beyond the capacity of the sewer pipe. And in the same way, thousands and thousands of gallons of water mixed in with the sewage can swamp a treatment plant during a rainstorm.

That's the number one concern of sewage treatment plants now. And the sewer districts need your help.

Those laterals are owned by homeowners. They're on private land, so the district can't just go in there and tear them up to replace or fix them.

However, most sewer districts offer a service where they will inspect your laterals to check for leaks, and many have started programs where the district will help pay the cost of repairing or replacing those pipes.

Sewer systems are run by local municipalities. Most communities have a local sewer district, and officials at the district can help you inspect and fix your lateral pipes.

Listen to the Sewage Spills Increasing radio report online.