01 Février 2012

FN: 7

Le remède contre le paludisme

OR

How to (not) get malaria

More or less everyone knows that malaria is a parasitic infection that is transmitted by mosquitoes and is endemic to most if not all tropical areas. Americans primarily know it as one of those “hot country diseases” that people going on cruises and tropical vacations have to worry about but which you can otherwise ignore[1]. So we do

And how.

Forget AIDS. Forget the Black Plague. Forget every war humanity has ever engaged in. They’re nothing. If you want the identity of the most proficient killer of mankind since we first decided to leave the safety of the trees and hunt the savannahs of East Africa, it’s malaria. Hands down, no contest[2]. WWII killed 40 – 60 million people, depending on whose numbers you use. That’s bad. The Spanish Influenza killed maybe 80 – 100 million. That’s worse. The Black Plague killed maybe 100 – 150 million. That’s terrible.

But malaria still wins.

The problem isn’t so much one of intensity as it is one of persistence. Malaria infects about 200 million per year, and “only” kills 500,000 – 1,000,000 of them. That’s nowhere close to the 60 – 90% death rate caused by the Black Plague, but it actually makes malaria more dangerous to humanity in the long run. Highly virulent diseases burn themselves out when they kill all the potential victims, but malaria just keeps on keeping on, killing its pathetic 500,000 people a year, every year.

By the way…what’s 500,000 times two thousand years[3]?

Which brings me to the point of today’s post: if you want to serve in the Peace Corps in West Africa, you have to take an anti-malarial prophylaxis[4]. Right now, there are 3 to choose from: mefloquine (cheap, you take it once per week, the major side effect is weird dreams), doxycycline (very cheap, you take it daily, the major side effect is serious nausea if you forget to take it with food), and malarone (very expensive -but getting less so-, also taken daily, fewer side effects than either mefloquine or doxycycline). I tried to take mefloquine, but it made me perpetually dizzy and gave me awful headaches, so now I take doxy.

Boy, does it suck. Or at least it sucks for me.

Every morning, you have to think about taking it when you wake up. But you can’t take it at once, because if you do, you’ll immediately see your breakfast again – and maybe last night’s dinner as well. And you can’t include it in your morning routine (poo, shower, brush teeth, take doxy) for the same reason. So you have to wait.

And pray to your dear and fluffy Lord that you don’t forget.

After breakfast, the problem becomes one of timing. Ideally, you take it right at noon, along with a nice big lunch. But what happens if you have a meeting? Or if you’re on public transport? Or if you’re just not feeling so hot? You know you can’t take it without food, so if you can’t take it with lunch you fudge it just a bit and decide you’ll take with dinner.

Then you pray to your dear and fluffy Lord that you don’t forget.

When dinner time rolls around, you’re usually wrapping your day up. You’re not thinking “oh yeah…I need to do that thing I do every day that I couldn’t do this morning”. Even worse, oftentimes you can’t remember if you even took the damn thing this morning or not. I know I sound like a damn old man, complaining about his daily pills, but I see why geriatrics use those little pill sets with one box for each day of the week: it’s damn hard to remember if you took the effing thing or not. So sometimes, you forget to take the damn thing at all.

And then you pray to your dear and fluffy Lord that you can do better tomorrow.

Because as hard as double dosing is on your liver, it’s not nearly as hard as malaria[5], right?

Right.

 

 

[1] Except for star-crossed characters on shows like House and Grey’s Anatomy when the writers are hard up for interesting new diseases with mysterious and obscure (potential) symptoms.

[2] In terms of absolute numbers. If you want percentage of populations destroyed, smallpox wins with 90% of the population of the Americas in a bit less than 100 years. But the absolute number there was probably no more than 80 – 100 million, and malaria will go on killing for centuries while smallpox is extinct, so malaria still wins.

[3] Malaria actually has a pretty consistent death rate for a disease. Yes, populations used to be a lot lower, but modern medicine has done a lot for victims too. Basically, malaria used to kill a much higher percentage of a much smaller population across a much wider geographic area, and so its death rate is assumed to have been more or less constant since at least Roman times. That’s kind of scary, when you think about it.

[4] Or they send you home. And not unreasonably, in my humble opinion.

[5] On the other hand, doxycycline is actually an antibiotic that is used as the treatment of choice for certain diseases. So if I somehow manage to contract e. coli, Lyme disease, Rocky Mountain Spotted Fever, yersina pestis (the infectious agent for bubonic plague), chlamydia, or erlichosis, I’m set. Yay? Oh, and it could also help me out with my Shigella, COPD, rheumatoid arthritis (KSO…check it out!), sarcoidosis, multiple sclerosis, Marfan’s syndrome, and elephantiasis transmission problems. Hooray for off-label use…