The Experimental HIV Vaccine

The Wall Street Journal and The New York Times, two of the most puissant media outlets, informed us of the new experimental HIV Vaccine that inflamed the hopes of many.

“An experimental vaccine regimen has shown a modest ability to protect people exposed to the HIV virus, the first time an investigational HIV vaccine has been shown to have this effect. The results from the trial, which involved more than 16,000 adult participants in Thailand, indicated that the vaccine regimen lowered the rate of contracting HIV by 31% compared with those taking a placebo, according to the U.S. National Institute of Health, which helped fund the study” (Gautam Naik, WSJ).

Out of the 8,198 people who received a placebo drug, 74 became infected with HIV.
Out of the other 8,198 people who received the real vaccine, 51 got affected.

The numbers might not be impressive or compelling, but the difference suggests a statistical difference of 31%.
This really is a “piece of good news” and gives hope in the battle against HIV. Yet, why is it that the press does not cite the actual scientific article? I find this deeply flawed. The scientific method relies on methodological and well documented studies in a strictly controlled environment. A scientific article has to be peer reviewed and approved in order to be published. Evidence for none of this was provided in either of the newspapers. This makes me wonder if the study has been peer reviewed and published in a scientific journal. It makes me question the authenticity of the results and the validity and reliability of the whole experiment.

It is worth acknowledging the limitations that researchers face when attempting to experiment with people. When people’s lives are being affected, we cannot really apply the scientific method and conduct a true empirical experiment. There is a moral code that scientists ought to follow. We cannot divide the participants in two groups and infect one of them with HIV in order to test the vaccine. In this sense, it is impossible to have completely manipulated experimental setting. Still, scientists are trying to do the best they can and control the conditions of the experiment as much as possible. This is not the subject of my concerns. My concerns are that such experiments have a lot of limitations and possible alternative explanations that might explain the observed results. An experiment of this sort does not, by any means, imply a cause and effect relationship. My fear is that such data can be simply be interpreted the wrong way. If a pharmaceutical company sees opportunity for profit and starts to sell such vaccine, typing the warnings in small font, hidden in a corner, people might be in danger. A single wrong message from the powerful media empire can convince many that a successful vaccine has been found and scientists have the results to prove it. Yet, no one is quoting the scientific study.

In this particular case, the statistically significant results can be explained by a number of unmentioned reasons. Possibly, the participants, who took the experimental vaccine did not have as many (or any) sexual relationships. Perhaps, the people who had the placebo had unprotected sex with people who were infected, whereas most participants in the other group did not. These are only a few examples of alternative explanations for the results. However, we cannot know for sure if researchers have considered these, because the media is not providing the scientific information. Unsubstantiated by the scientific facts, such reports and statements could be very equivocal or even misleading.

Commercials tell us: “Ask your doctor about … Cymbalta, Ambien, Lunesta… Ask your doctor it it’s right for your”. The easiest thing for your doctor would be to give you the prescription you are looking for. That is probably why we are on the way of becoming an overmedicated nation, if we are not one already.

I encourage each and every one of you to be more skeptical. Ask the right questions and demand an answer. Beware the small font warnings hidden in the bottom. Whenever someone tells you a ‘fact’ and makes a promise, ask him/her to state her source. Know what is in the product that you are consuming, from the prescription drugs you’re taking, to the dinner you’re having.

The danger is found in drugs’ effect on GABA receptors.

Drugs like alcohol, barbiturates, and benzodiazepines all seems to affect the same target – the major inhibitory neurotransmitter GABA. Neurons containing GABA receptors are very common in the nervous system and their function is to inhibit other neurons. One such receptor that is affected by GABA is the GABAa receptor that contains chloride channels. When the receptor is excited, an influx of Cl ions takes place, increasing the negative charge on the inside – hyperpolarization – making initiation, or propagation of an action potential much more difficult. However, this GABAa receptor has not only a binding site for GABA, but two other binding sites as well. One is the sedative-hypnotic site, the other is the anxiety site. That’s why it is possible that both sedative-hypnotic drugs (alcohol and barbiturates) and antianxiety drugs (benzodiazepines) can bind to the same receptor, amplifying their effects. Sedative-hypnotic drugs (alcohol or barbiturates) have precisely this effect -making it hard for action potential to take place and, therefore, sedating the body and affecting bodily functions. Antianxiety drugs (benzodiazepines) enhance binding effects of GABA and so alcohol, or barbiturates will have an even stronger sedative effect, possibly leading to coma, or even death.

The threat of mixing drugs and alcohol is not just a myth, it is a deadly cocktail that you don’t want to be experimenting with.

Why is early adulthood often considered “the prime of life”?

Early adulthood is the developmental stage from about age 20 to age 35. It is generally considered the ‘prime of life’ as the young individual is emerging from adolescence with a well-established sense of Identity and can approach life with determination and self-esteem. Also, during this period, young adults are physically stronger and healthier that any of the other stages to follow. It is the time of pursuing one’s dreams and enjoying the comfort of cozy, meaningful and loving relationships.

When are the norms and peaks for height and weight for both men and women reached?

For females, maximum height is reached at about age 16, while males still undergo the process up until age 18. However, in some cases, skeletal growth may continue in people’s early 20s. Fat accumulation and muscle growth continue into the early 20s as well. It is then that males reach full upper-arm and shoulder size, while females reach their full hip and breast size. This developmental stage can be identified with one’s growing physical strength that reaches its peak around the age of 30. Physical endurance, strength and stamina are the norm in this stage. In addition, all of the body systems (digestive, respiratory, sexual-reproductive, circulatory) function at their optimal levels.

What are senescence and organ reserves?

Generally speaking, senescence is a hallmark through adulthood. It is a state of physical decline (that usually starts around the 30s) where the body gradually loses its strength and efficiency with age. Senescence goes hand in hand and can be partly explained with the decline of organ reserve with age. Organ reserve stands for the extra capacity each organ has to withstand the critical moments of prolonged, or extreme stress. With advancing age, organ reserve gradually declines.

What is infertility and what are some of the new technologies for dealing with it?

Infertility explains the lack of successful pregnancy after at least one year of regular intercourse without any contraception. There are many personal, social and also environmental factors that may stand behind it. Fortunately, Assistive Reproductive Technology is widely used nowadays, using numerous artificial methods to achieve or facilitate pregnancy. Some of these methods are:

In-vitro Fertilization (IVF) – a medically developed technique in which the egg cell is being fertilized outside of the woman’s body. This method has proven to be very efficient for couples suffering infertility when other attempts  of achieving conception have tailed. The in-vitro fertilization requires removing the ova from the woman’s ovaries. Then, when put in a fluid, the egg is being fertilized by the sperm. Finally, the zygote is put back in the woman’s uterus so that pregnancy is established. Still being an expensive procedure, in-vitro fertilization is usually performed after other attempts to get pregnant have failed.

Intracytoplasmic Sperm Injection (ICSI) – a procedure that is very effective in cases when male infertility implies low or very low sperm count. In this method a single sperm is taken and injected directly in the middle of the egg cell with the help of a micro needle.

What is body mass index (BMI)?

Body mass index is the ratio between one’s weight and height (using the Metric measures). It is supposed to be very accurate for both men and women and is claimed to be a reliable indicator for one’s general condition and fitness.

Personally I think that as accurate as it may be for the general population MBI calculation is not always reliable criterion. For example, it does not consider variables such as body and bone structure, levels of physical activity, etc.

What are some major health problems in young adulthood?

Encountering the numerous social pressures of adult life and trying to deal with emotional problems, young adults often suffer clinical depression, drug and alcohol abuse. Eating disorders are particularly common among females. Also, young adulthood is, typically, the onset stage for many psychological disorders (some of them being very severe, like Schizophrenia). Many of the Personality disorders become clearly expressed in early adulthood as well. Still, health problems are not really common among young adults. However, violence (especially among males) is a major cause for injuries and even death.

What are the most common types of eating disorders?

Anorexia Nervosa is generally described as ‘self-starvation’. Usually, the person who is suffering Anorexia is voluntarily eating too little and/or exercising too much. The victims hold a distorted image of themselves, always seeing their bodies as ‘unattractive’ and ‘fat’ and deny the problems of not eating. Most often, victims refuse to maintain body weight of at least 85% of what is considered to be normal for their age. Anorexia Nervosa is a very serious condition and between 5% and 20% of its victims die because of it. The severity of the disease caused it to be characterized in the DMS-IV as one of the eating disorders.

Bulimia Nervosa is yet another eating disorder described in the DSM-IV. Once again, victims have a distorted self-image and are overly preoccupied with the way their body looks. The disorder is characterized by episodes of bingeing and then purging (induced vomiting or use of laxatives). In order to meet the criteria for the disorder, these episodes should occur at least once a week for three months.

Both Anorexia and Bulimia Nervosa are seen more often among females, although there have been a slight percent of male victims.

Body Dysmorphic Disorder is more common among males. It is characterized by the preoccupation with working out, gaining muscle mass and reducing body fat. Once again, victims have an unrealistic body image and tend to abuse steroids.

Why is male violence during young adulthood such a problem?

Unfortunately, male violence appears to be very common in Early Adulthood, taking a lot of victims. It is a serious problem, because it is among the major causes of death and serious injuries that does not allow young adults to enjoy the healthy life of this developmental stage. The statistics showing that almost 1% of young adults in the United States (between ages 15 and 25) die violently is very disturbing. It is incredibly sad that the world loses people in the prime of their life to homicide, suicide or motorcycle accidents.

What is cognitive flexibility?

Cognitive flexibility is probably the main characteristic in young adults’ cognition. It explains their awareness of the fact that each and every problem has a number of possible solutions and that every individual has a personal opinion that may reflect only one side of an issue. This cognitive flexibility also stands for the better coping skills of young adults and their ability to contemplate different perspectives, opinions and analyze multiple possible solutions. It also explains creativity.

What are the effects of college on the young adults?

Psychologist and textbook writer Kathleen Berger explains a very important aspect of college life. After carefully explaining and considering anxiety and disidentification she is drawing the important conclusion – that hard work during the years spent in college results in deeper and more dialectical thought of reasoning. Dialectical thought is probably the most advance cognitive process which involves thinking about a thesis and antithesis. It also involves Hegel’s philosophical concept that each and every truth or idea has implanted within itself the exact opposite. Thus, young adults are capable of considering multiple choices and points of view, coming up with their own thesis, considering an antithesis and combining them in a synthesis. Ideally, all of these processes are being strengthened in college, as the person encounters many new fields of information, gets involved in hot debates in search of the ‘truth’, and may spend months or years in researching a single problem. Needless to say, college improves one’s reading and analytical skills.

What can be a central challenge of this time period?

According to psychologist Erik Erikson, the central developmental challenge in young adulthood is Intimacy vs. Isolation. Erikson explains that people in this stage desire to form meaningful relationships where they can love and be loved, sharing their personal life. However, this can happen after the person has emerged Adolescence with a secure sense of Self/ Identity. Otherwise, one is at risk of suffering isolation and loneliness. Not being able to answer the question “Who am I?” can easily explain why sharing and being committed to someone else is difficult.

Why is intimacy so important?

Intimacy is a physical, mental and emotional state of total sharing with another individual, where the relationship is strengthened by attachment and physical proximity. Intimacy is not only associated with physical attractiveness or sexuality, but also with platonic feelings of love and closeness. To a great extent, it is a ‘two-way-street’ and can truly be accomplished only of it is shared by the two people in the relationship.

Since relationships are so important, what are the gateways to friendship? What are exclusion criteria?

There are many qualities in a person that we consciously and/or unconsciously consider before establishing any sort of relationship with them. Often, proximity in appearance, physical attractiveness, social status, level of intelligence and moral values are among these qualities. Exclusion criteria are the person’s reasons for excluding certain people from their circle of friends and/or partners. These are strictly personal and therefore, may vary greatly from one individual, to another.

What are some gender differences in friendships?

The general differences that men and women have are easily transmitted in the friendships that they have. Women, in their friendships, tend to talk about their feelings, intimate relationships, problems in the family and with their loved ones, personal fears, wishes and difficulties. On the other hand, men tend to bond around a mutual hobby or interest that they have. Usually, that is sports, cars, politics or their work. From my personal observations, I dare say that it almost seems as if men work hard to avoid sharing. It is funny, how many men may seem scared if you confront them with a personal question, even if you are a friend. Many of my good friends are boys and I have noticed that they are able to confide better with a woman than with another man.

What are the benefits and drawbacks of co-habitation?

Living together with a significant other, without marriage can be viewed as a way to strengthen the relationship and help you really get to know each other. However, I was surprised to read about all the drawbacks that author Kathleen Berger points out. Obviously, research shows that co-habitations bring more stress and less financial satisfaction. Also, it appears that health problems, physical abuse and alcohol abuse are more common among co-habitants that among married people.

What are some of the contemporary changes in marriage?

The number of people who get married has dropped dramatically over the past century. Statistics show that almost a half of all births are to single mothers and in another 20%, the conception has taken place before the actual marriage. Less and less people in young adulthood tend to get married, as the average age is increasing. Shockingly, the divorce rate is 49% of the marriage rate. All of these contemporary changes really imply little faith in the marriage institution.

What is homogamy?

Homogamy exists in the relationship of two individuals when they share mutual values, goals, interests, socio-economic status, ethnical and social background and religion.

What is patriarchal terrorism and how does it relate to spouse abuse?

Spouse abuse as well as common couple violence appears to be very common in relationships. This is often explained with the huge amount of stress that people suffer every day. Sometimes, violence is just a part of one’s cultural or/and personal background which makes it a repeatable pattern. Patriarchal Terrorism stands for a type of spouse abuse where the husband (usually) is using violent methods to degrade, punish or isolate his wife, thus making her feel vulnerable and helpless. This, then, strengthens his sense of superiority.

What is generativity?

Generativity is an essential theme throughout adulthood (and also one Erikson’s developmental challenges in life). It stands for one’s desire to be active, effective and functioning at his/her peak. It is the motivation behind personal and professional accomplishments and pursuing goals.

What is “the social clock” ?

The concept of the ‘social clock’ explains the expectations that a society holds as to what roles should be appropriate for a particular developmental stage. These, however, may vary incredibly from one culture to another and is usually very hard to change, as it is already deeply implanted in the culture and the peoples’ historical background which had shaped them as a society. In many parts of the world it is well accepted that children as old as 10 should take care of their siblings or work in the fields, whereas such practice would be unacceptable or even punished by the law in the United States or most European countries. In the same way, in many societies, marriages among young adolescents are encouraged – a practice that might be illegal in other parts of the world.

Symptoms of Major Depression

Feelings of helplessness and hopelessness; sadness; loss of interest and pleasure (from food and/ or sex) – anhedonia; may be accompanied by significant weight loss or gain (sometimes hyperphagia); insomnia or hypersomnia (middle of the night awakening, early morning awakening); fatigue, general loss of energy; having hard time concentrating. People with depressive symptoms are indecisive, have low self-esteem; pessimism; disturbance of body rhythms; suicidal tendencies are common.

Evidence for genetic predisposition for Depression

Although the impact of genes varies, depending on the type of depression, there is a correlation. Depression tends to run in families. That is why adopted children, resembling their real parents’ genes may have depression in spite of living in a cheerful, lively atmosphere. One is at risk of depression if one has close relatives who have had severe early-onset depression, especially if that relative is a female. However, no single gene has been identified to have a strong link with that mood disorder. So, obviously, depression depends on a combination of genes and environmental factors.

Are males or females more vulnerable to depression? What is the role of hormones?

Depression is much more common in women, in all cultures. For sure, hormonal changes can trigger an episode of depression, but this correlation does not necessarily imply causation, as some women are more vulnerable than others. Still, the reason why women suffer depression more often is not clearly identified.

What is the role of traumatic experiences for episodes of depression?

Stress is a typical trigger for an episode of depression, as it causes the release of cortisol that prepares the body for action and, in the long run, exhausts the body. A lot of women experience postpartum depression, after giving birth and some of them enter a more serious, long lasting depressed condition. However, giving birth itself does not cause depression as many of the women have already suffered previous onsets. Thus, traumatic experiences may trigger an episode of major depression, but do not cause the disorder.

What are the patterns of hemispheric dominance with happy moods in normal people? How do they differ from patterns in depressed people?

Happy mood is generally related with increased activity in the left prefrontal cortex. Depressed people, however, have decreased activity in that area, whereas it is increased in the right prefrontal cortex. Also, many people who have had damage to the left hemisphere become seriously depressed. Fewer become depressed after damage to the right hemisphere. And sometimes, people with right hemisphere damage become manic.

What is Borna disease? What evidence links it to depression?

Borna disease was first noticed in European farm animals. It affects behavior, causing frantic activity or inactivity. In severe cases, the disease can be fatal. As many other viruses, Borna disease can be passed between humans and other species. However, the effect is different in humans. In an experiment/ survey, in all 12 cases of people with Borna disease, those same people had either major depression or bipolar disorder.

What are 3 groups of antidepressants? How does each of them exerts its effects?

Tricyclics prevent the presynaptic neuron from reabsorbing catecholamines or serotonin after they have been released. Thus, the neurotransmitters remain in the synaptic cleft longer, continuing to stimulate the postsynaptic cell. They inhibit the reuptake of NE and dopamine. However, tricyclic also block certain receptor which may lead to side effect.

Selective serotonin reuptake inhibitor (SSRIs) block the reuptake of serotonin by the presynaptic terminal (in a way, those are similar to tricyclics). SSRIs have little and only mild side effects. Still, sometimes, they may cause nervousness and, thus, are not recommended for people suffering anxiety.

Monoamine oxidase inhibitors (MAOIs) block the enzyme monoamine oxidase, which has the function to metabolize catacholamines and serotonin into an inactive form. O, when this enzyme I blocked, the amount of those neurotransmitters in the presynaptic terminal and the cleft increases. However, MAOIs tend to affect blood pressure, which can be very dangerous and, in general, are very dangerous in the long run, although they tend to work within a few days.

Why does Prozac/ fluoxetine preferred over tricyclics and the monoamine oxidase inhibitors?

It almost no side effects (sometimes mild nausea, headache, or nervousness, very rarely people react with having Serotonin fever). Also, there is almost no risk of over dosage. In addition, it takes only within 2 – 4 weeks to work and, in the short term, causes loss of weight, which is, generally desired by people.

What are atypical antidepressants? For whom are they used?

This is a miscallaneous group of drugs that have the antidepressant effect, but very little side effects. They are being prescribed to people who did not respond to the other drugs. Some atypical antidepressants are bupropion (inhibiting the reuptake of DA and sometime NE, but not 5HT), venlafaxin (mostly inhibit the reuptake of serotonin, and lightly of DA and NE).

How effective is St. John’s wort? Which class of antidepressants produces similar effect? What is one potential problem?

St. John’ wort is an herb that works like the selective serotonin reuptake inhibitors. However, it efficacy I not yet accurately determined, a different studies how different results (some suggest it is more effective that SSRIs, some claim it is equal to them, others that it is not effective at all). One potential dangerous side effect is that St. John’s wort increases the production of the liver enzyme that breaks don toxins, also medicines. Thus, it decreases the effectiveness of many medicines that may be vital. Another problem is, that it is cheaper that drugs and can be taken without prescription, which hides risk of inappropriate use and dosage.

Explain the problem of time course effects on neurotransmitters and depressive symptoms. What are some delayed effects of antidepressants?

Antidepressant drugs, in general, have delayed effects that limit the excitation of the postsynaptic cell, decreasing the sensitivity or the receptors on the postsynaptic cell. They also affect autoreceptors (the negative feedback receptors on the presynaptic terminals). Also, Prozac, for example, causes gain of weight hen used for a long time.

What neurotrophin is produced as a result of repeated use of antidepressants? In which brain areas is it produced?

Brain-derived neurotrophic factor is produced that aid the growth, survival and connections between the neurons. The cerebral cortex and the hippocampus.

How is electroconvulsive therapy (ECT) applied today? How is this an improvement over practices in the 1950s?

In the 1950, ECT was widely used without patients’ consent, being tried on many people in mental hospitals. Today, however, ECT is used only with informed consent for patients who do not respond to other antidepressant drugs. During ECT, the patient is under general anesthesia, with muscles being blocked. Thus, the process is not painful and the risk of injury is minimized. A common side effect is that the patient has a loss of memory for that particular time hen ECT has taken place.

For which two groups of patient is ECT most often used?

ECT is used with people ho do not respond to other antidepressant drugs and with people ho have severe depression and suicidal tendencies, who need fast results and betterments (may be the difference between life and death).

What are the advantages and disadvantages of ECT?

Advantage is that it is the most effective treatment available nowadays and gives very fast results. Some disadvantages are that it may cause prolonged convulsion that can be fatal. Also, ECT should be applied over long periods of time and, as people lose memory of that time, it may, eventually, cause amnesia. Often, the case is that, after ECT treatment, patients enter another episode of depression within 6 months.

What are the effects of ECT on neurotransmitter receptors? What newer treatment is similar to ECT?

ECT stimulates the production of additional dopamine (types D1 and D2 receptors) and decreases the number of norepinephrine receptors.

How does the onset of REM sleep differ in depressed people, compared in non-depressed? How may this be related to body temperature cycles?

People with mood disorders also suffer some disorder of the biological rhythms. Depressed people have troubles sleeping and people who have sleep problems are more likely to get depressed, so it is a two way street. After going to sleep, most non-depressed people enter REM sleep after about 80-90 minutes and the amount of REM sleep is increased in the second half of the night. Depressed people, however, enter REM phase of sleep after about 45 minutes after going to bed. Also, the have trouble staying asleep and feel drowsy the next day.

What change in sleeping schedules has been found to alleviate depression? How long do the benefits last?

Surprisingly, sleep deprivation improves the condition of depressed people, relieving the symptoms of the disorder. Yet, this is not a solution as sleep deprivation is dangerous in the long run. Both antidepressant drugs and sleep deprivation decrease the amount of REM sleep. So, there is something about that stage of sleep that may be a hidden cure for depression, but researchers are not certain yet.

The Eight Millennium Development Goals cont.

For many people The World AIDS Day is everyday

For some of us the World AIDS Day is on 1 December. For many, it is everyday. Since the Human Immunodeficiency Virus was first documented in 1981 it has claimed more than 20 million victims. Today, 40 million people are living with HIV/AIDS. 95% of these victims are peoples in developing countries, which only proves that socio-economic factors may catalyze the spreading of the virus. In the year 2005 only, 3 million people died from AIDS-related diseases. 14 000 more people are being infected by the virus every day and 6000 of them are younger than 25 years of age. Let us not forget, not even for a moment, that people having AIDS are not merely numbers extracted from the statistics, but people like us who had plans and goals, but now can only hope that they will not get a cold that may be mortal for their weakened immune system. Scientists have not yet developed effective cure for HIV/AIDS and existing medications are too expensive for many of the infected people. Not to mention, lack of education and medical prevention in developing countries often explains why people become infected so often and effective treatment can hardly take place before it is already too late.

Charles Saco from Kibera, Nairobi, used to be a teacher, but lost his job when it became clear that he was HIV-positive. People asked him “Charles – does your body shed scales? What sickness are you suffering from?” However, taking drugs saved Charles from the “death sentence” and now he is able to stand on his feet for hours, feeling stronger. The person who had plans for a teaching career is now happy that he found a job as a social worker – cleaning the rubbish in Kibera. Eventually, he even started working in an HIV clinic where he could help people who are suffering as he did.

The World Bank informs that HIV/AIDS is not only a health problem, but also a “developmental problem, threatening human welfare, socio-economic advances, productivity, social cohesion and even national security”. Obviously, it is important to put a price tag next to the lost lives and the lives to be saved. Talking prices, the United Nations estimated that between $40 and $70 billion additional assistance per year is going to be needed, if we are to ensure the help and medications infected patients in developing countries need.

Humanity is waking up to unite and work for achieving a better future for all of us. In the year 2000 the organization of the United Nations came up with “The eight Millennium Developmental Goals” to guide us in out actions in the near future. This blueprint has been agreed to by the world’s leading developmental institutions and all countries. The target date of this Brave Project is the year 2015.

The eight Millennium Development Goals are:

1. To eradicate extreme poverty and hunger.

2. To achieve universal primary education.

3. To promote gender equality and to empower women.

4. To reduce child mortality.

5. To improve maternal health.

6. To combat HIV/AIDS, malaria and other diseases.

7. To ensure environmental sustainability.

8. To develop a global partnership for development.

Kofi Annan, the Secretary-general of the United Nation, prompted people that “we must start now. And we must more than double global development assistance over the next few years. Nothing less will help us achieve the Goals.” Nine years have passed since the goals have been clearly formulated. However, does it happen that we ask ourselves “How much did we achieve?” and “Where will we be in 2015?” The 2005 report of the United Nations states that poverty is falling and progress has been made against hunger. Also, efforts have been made to make sure that children in sub-Saharan Africa, Southern Asia and Oceania are receiving “a high-quality education”. The report reads “the gender gap is closing” and “death rates in children under age 5 are dropping”. Yet another thing we have to be extremely proud of is that “some progress has been made in reducing maternal deaths in developing countries, but not in the countries where giving birth is most risky.” As to Goal 6 in the plan for development, it is stated that yet “there is no cure for AIDS, and prevention efforts must be intensified in every region of the world if the target is to be reached.” In ensuring environmental sustainability we did not have huge success, as “most countries have committed to the principles of sustainable development. But this has not resulted in sufficient progress to reverse the loss of the world’s environmental resources. Achieving the goal will require greater attention”. The mere fact that there is “The United Nations Millennium Declaration” is enough to show we have already developed some global partnership that we can feel proud of. Nine years have passed, and all we have are vague statements that have only one message – we need not lose all hope yet, someone, out there, is working on those issues; someone out there probably cares, so that humanity may eventually face 2015 with pride – we have achieved the Millennium Development Goals.

After all, we have six more years until the onset of the target-date and, we all know, anything may happen in six years. Setting highly challenging goals for oneself is, undoubtedly, motivating, but when the subject of consideration is millions of people all over the world we need to be a little more realistic, rather than romantically-ambitious. Are our good intentions just another paradox in our times?

Let us track our progress…

The effect of child abuse on the brain and the impact of stress hormones on emotional and cognitive development

Maltreatment, no matter whether it is abuse, neglect, abandonment or witnessing violent acts, can lead to enduring negative changes in the still developing brain of a child. Each time there is some sort of trauma, the brain suffers a particular change. So far, research have noted changes in the prefrontal cortex, the cerebellum and the limbic system (Wheeler T, 2006) It is important to point out that infancy and early childhood are times for rapid brain development and formation of dendritic connections. Of course, they continue to develop throughout adolescence an early adulthood, but are even more vulnerable earlier in life (Kalat J, 2003).

The prefrontal cortex is the most anterior part of the frontal lobe of the brain that is involved in critical thinking and judgment as well as any behavior that, in one way or another, depends on the context. Therefore, people with damaged prefrontal cortex often cannot modify their behavior and become inflexible in changing situations, which can make their reactions and behavior too impulsive and socially unacceptable (Kalat J, 2003). Damage to the prefrontal cortex can eventually result in many deficits such as not being able to regulate motivation and efforts as well as impaired short-term and long-term goal-directed behavior. In addition, damage and disruption of prefrontal cortex functions due to any type of abuse may lead to not being able to integrate positive emotions. Thus, the person is stuck in a negative stance of fear and anger, and cannot engage in experiencing positive emotions. Needless to say, this may lead to developing depression, antisocial or borderline personality disorders (Wheeler T, 2006).

The cerebellum is a large structure in the hindbrain that is mainly known for controlling movement, achieving balance and coordination (Kalat J, 2003). However, it also plays a role in attention and emotions, as well as in regulating the limbic system (Wheeler T, 2006). It is important to note that many people with psychiatric disturbances have certain abnormalities in the cerebellum (Wheeler T, 2006). This is probably so, because in cases of childhood abuse the cerebellum is extremely vulnerable to the stress hormones that are present in large amounts during stress, trauma or abuse. The changes that occur then can result in depression or hyperactivity, and inattention. Also, the cerebellum is considered to play a role in suppressing irritability. Therefore, abnormalities or damage to the cerebellum may cause chronic irritability and make the person seek external means, such as drugs, to deal with that (Wheeler T, 2006).

The limbic system is the forebrain area next to the brainstem that includes a number of interdependent structures under the cerebral cortex that deal with motivation and is critical for regulating emotions, sexual activity, eating, drinking, anxiety, and aggression (Kalat J, 2003). The hippocampus and the amygdala are essential parts of the limbic system, and are crucially important for controlling the emotional response to a particular situation. They also take part in memory formation and learning (Wheeler T, 2006). Prolonged and continuous exposure to stress hormones can cause serious damage to these parts of the limbic system and, thus, disrupt mood regulation, memory, and one’s way of interpreting the environment. Besides, damage to the limbic system can lead to epileptic seizures and abnormal EEGs that usually affect the temporal lobe of the left hemisphere. Usually, damage to the left hemisphere is associated with poor verbal development, but, more importantly, with aggression, self-destructive behavior and suicide (Wheeler T, 2006).

What is stress? Many things can be considered stressful for an individual, including insufficient nutrition, lack of rest, overstimulation, especially of the fear-related response system, not to mention abuse, neglect or witnessing violence or death (Gunnar & Vazquez, 2001). The prolonged exposure to stress and, therefore, the produced stress hormones in the body, can be very serious and especially harmful to the infants and young children (Gunnar & Vazquez, 2001). In fact, exposure to stress activates two body systems: the autonomic nervous system that prepares the body to react quickly to whatever stimuli in the environment; and the HPA-axis – the hypothalamus, pituitary and adrenal cortex.

The HPA-axis reacts more slowly, but is critically important in prolonged exposure to stressors (Kalat J, 2003). The activation of the hypothalamus stimulates the ‘master gland’ (the pituitary gland) to secrete adrenocorticotropic hormone (ACTH) that, in turn, stimulates the secretion of cortisol. Cortisol is generally regarded as ‘The’ stress hormone. It helps the body mobilize energy and respond to stress quickly, but has negative effects in the long run, since it enhances metabolism and elevates blood sugar levels (Kalat J, 2003). Other stress-related hormones are corticosteroids, corticotrophin release hormone (CRH), epinephrine, norepinephrine and others (Gunnar & Vazquez, 2001). Serotonin is also very important for the adequate coping with stress. Therefore, abnormal function of serotonin is associated with some depression and anxiety-related disorder, such as BPD.

Research has proven that elevated stress hormone levels can cause malfunctions in the amygdala and hippocampus (Gunnar & Vazquez, 2001). Severe or merely constant exposure to stress may lead to the shriveling of certain dendrites in the hippocampus, which can cause its degeneration and malfunction (memory loss and inability to control the release of other stress hormones) (Gunnar & Vazquez, 2001). As a matter of fact, shrunken hippocampus was found in autopsies of children who have experienced repeated abuse or in people who were suffering posttraumatic stress disorder. In addition, disruption of the HPA-axis that is also related to exposure to stress in early age is associated with depression, inattention, and poor memory (Gunnar & Vazquez, 2001). The hippocampus is a particularly vulnerable brain structure, especially during infancy and childhood, when it is still developing (Gunnar & Vazquez, 2001).

If too many stress hormones are being produced in the early stages of development, the developing brain may be permanently damaged, becoming incapable of initiating a normal stress response. It may either overproduce stress hormones, so that the person becomes hyper-vigilant, fearful and always on the alert, or it may underproduce stress hormones so that the person becomes “emotionally flat”, sad and angry (Berger, 2005). A study of Cicchetti & Rogosch (2001) identified a lot of “atypical cortisol regulation patterns” that are obvious among children that have been maltreated (Gunnar & Vazquez, 2001). Studies like this are evidence for the correlation between child maltreatment and the disrupted function of certain brain structures that cause inflexibility in behavior, such as depression, chronic stress, anxiety, aggression and many others that can often be associated with a number of illnesses and disorders, Borderline Personality Disorder among them.

Many of the brain abnormalities that have been studied in abused and neglected children are located in the left hemisphere. Very often, in children, victims of abuse, there were fewer dendritic connections between different areas in the left hemisphere (Gunnar & Vazquez, 2001). Children that had showed such abnormal results demonstrated self-destructive or aggressive behavior, as well as certain disturbances in behavior, thinking and physiology (higher blood pressure, heart rates temperature, hypervigilance) (Gunnar & Vazquez, 2001). Since these could all be characteristics of a borderline personality patient, the results give food for thought as to the relation between abuse in childhood and the development of the disorder.

Studies of neglected children found that their cortex was about 20 percent smaller than that of a control group of subjects (children) who have not suffered neglect (Gunnar & Vazquez, 2001).

Mothers who endanger the health and well being of their children are considered deviant, possibly, in almost all cultures in the world. Certainly, this is a sensitive and loaded topic that normally provokes strong societal response. The labeling of a deviant mother often involves the legislative system, child services and other governmental organizations. Beyond doubt, most people will agree it is absolutely deviant for an expectant mother to drink alcohol. However, is drinking during pregnancy a discussed issue in our society? Do we just assume that everyone is aware of the medical research on the negative effects of alcohol? Do we simply expect pregnant women to be responsible?

An adult’s decision making on behalf of a minor should serve the best interest of the child. The same should be true for a mother’s decisions that might affect her inborn baby. This is not a matter of personal choice anymore, as, inevitably, another life is to be affected.

Scientists explain, there are many poisonous substances – teratogens – that could be endangering the life of a fetus that is particularly vulnerable in this early stage of prenatal development. Alcohol is the most common teratogen (National Task Forces on Fetal Alcohol Syndrome and Fetal Alcohol Affects, 2002). Teratogenic exposure of alcohol may cause Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE).

The life of the inborn child that is ‘poisoned’ with the alcohol can be severely impaired by a debilitating disorder such as FAS. With this syndrome, the alcohol ingested during pregnancy affects the normal development of the baby. Facial features are particularly vulnerable to change, especially the situation and opening of the eyes, ears and the upper lip of the baby.

Even if the newborn looks unharmed, alcohol could have still affected the brain, and more specifically the Central Nervous System, causing hyperactivity, poor concentration, impaired spatial reasoning, and mental retardation (Streissguth & Conner, 2001). In addition, the child has a slow physical growth and relatively small stature, compared to peers. The poor coordination, mental retardation, poor reasoning and judgment could profoundly affect the life of the child, making even the simple daily activities an impossible burden. Even if the condition of the child is not severe, there are, certainly some differences.

Alcoholics’ children who have never had a drink on their own still show distinct brain patterns that can only be compared to those of alcoholic adults (Agarwal, 2001). Scientists warn that children affected by FAS are at much greater risk of psychiatric problems. Also, they are more likely to engage in criminal behavior. Statistics reveal that more than 50% of children with Fetal Alcohol Syndrome grow up to have trouble with the law. Many of the shocking homicide cases that have been covered in the press have involved a person, who was diagnosed with a Fetal Alcohol Syndrome.

On a macro level, it is shocking to learn how many people are affected directly, and how many more suffer the consequences around them. According to the US Department of Health and Human Services, 1 out of 500 children is “damaged” in certain degree because of the irresponsible alcohol consumption of the mother. Many of these children require special help and need to be included in specialized programs that yearly cost billions of dollars. Many of the children require special educations and face the Juvenile Justice System. By no means should this issue be underestimated, especially when data demonstrates a threatening growth of the rate of Fetal Alcohol Syndrome each year.

Scientist and physicians are not certain as to what amount of alcohol is dangerous. Some still advice pregnant women to have a glass of red whine, while others are strictly against such practice, saying: “No amount of alcohol is safe for the fetus.”

When a pregnant woman is drinking, do we have the right to intervene? Could we enforce our understanding and concern? As far as I know, there are no laws prohibiting ‘pregnant drinking’ although it does not sound to me like a bad idea. The irony is we try to protect young people from alcohol until the age of 21, but that is virtually  useless if we do not protect them prenatally.