Mash Season 9 Episode 16: The Red/White Blues

Alternate, in case that link has issues:

(Both are gorilla but 2 separate uploads)

Start at 7:11 to play; if you have time, watch until the end as a health note finishes the episode. (Each episode is only about 23-25 minutes long) In this episode Springtime has come in Korea which means malaria. Unfortunately not everyone can take the medicine…for reasons you’ll have to see.

Still slightly confused about the outcome of the video? A medication that reacts poorly to people and communities of African and Mediterranean decent? Primaquine was created in 1946, it was tested during WWII on volunteers, soldiers, and prisoners of war. It was seen early on that those who were African-American had a hemolytic reaction to the medication, (though it was also noted there there were a few cases of Caucasion reactions also). After that doctors were given the warning not to use Primaquine or only in sparing amounts in those of African decent. It became a ‘race warning’, later by the time of the Korean war those who had Mediterranean background were included and recently those in the Middle East (Iraq and Iran) have been added to the list…. But is it a race issue? In fact it is not, what the Primaquine is reacting to is an allele called Glucose-6-Phosphate Dehydrogenase. Those with the allele have a hemolytic reaction when they use Primaquine. To make it very clear…. EVERYONE has the ability to have this allele. So why does it appear to create a race affect visually in those that have a shared community background for lineage or decent? Those who read my previous post may know where this is going…. that’s right! Cross-Protection! James V. Neel explains it in his article Are Genetic Factors Involved in Racial and Ethnic Differences in Late-Life Health?

‘The sickling alleles and the G-6-PD deficiency alleles are representatives of balanced polymorphisms. Homozygosity for the hemoglobin S allele is usually inconsistent with reproduction because the homozygotes usually die in childhood. Homozygosity for a G-6-PD deficiency allele (or hemizygosity in the case of a male) by no means confers the handicap of sickle cell anemia but must still be regarded as impairing the fitness of the homozygote. But in both cases, the alleles have a positive side, conferring resistance to malaria, and the frequency of the allele in a population is determined by a balance between positive and negative selective forces.’

Translation? Environment, environment, environment! This allele provides a protection against Malaria. So those in a community that have the allele and Malaria in their environment will see an upsurge of the allele in procreated generations because those without the allele may not to survive as well without the added protection. Non-alleles will be less likely to procreate a new generation when dead from the extra benefit of protection.  When more members of a community, line of decent, or group heritage have an allele it can make it appear that their ‘race’ may be more or less susceptible then others to things, when in fact this is a result of environment messing with allele spikes. Nor does it matter that the allele itself may be what causes a separate disease or condition. Its protection might be an unintentional side effect of the primary disease or condition or a protection mechanism against other diseases wiping out the primary disease or condition. So the appearance that Primaquine is not advised in certain ‘races’ is deceptive. The health label has since been changed to read that it is not advised in those with the Glucose-6-Phosphate Dehydrogenase allele else wise hemolytic shock may occur or those with similar conditions. For a long time though it was treated as a race issue from the naked eye when in truth the culprit was microscopic…. but universal.

Additional Readings…

How Diseases Keep You Healthy

The doctor comes into the exam room and looks at you with that stern but sympathetic look; his hands hold your test results and you feel the worst must be coming.

“I’m sorry Mrs. Smith, your test results came back you have Phenylketnonuria, more commonly known as PKU. With proper diet the effects on your neurological system can be controlled. (Then he grins) On a brighter note it protects you from miscarriages so you and the mister don’t have to worry about that family line!”

“I’m sorry Mr. Greenspan, your son Samuel has Tay-Sachs. As lipids begin to build and store in your sons brain and nervous tissue, he will become blind, deaf, and eventually be unable to swallow. (Then he grins) On a brighter note because you and your wife are both carriers of the gene you are both well protected against Tuberculosis!”

“Mr. Humanitarian, I’m sorry to say your breathing problems are due to Cystic Fibrosis, or CF. You will probably experience more repeated lung infections during your life which may lead to severe lung damage. (Then he grins) but your upcoming mission to Africa don’t you worry about those Cholera outbreaks, while you may catch it like other people you CF will protect you from it it killing you! Have a fun trip!”

All of these sound like horrible jokes; yet there is research that shows different allele mutations that occur in populations lead to immune protection against other diseases and conditions. In fact there is a strange effect that occurs that may even explain why some diseases are prone to certain groups or communities and not others. Factors that are related not only to the diseases themselves but the environment that they interact in also.  In a 2008 article by Dr. Pardis Sabeti entitled Natural Selection: Uncovering Mechanisms of Evolutionary Adaptation to Infectious Disease, he shows the relation between sickle-cell anemia and its resistance to Malaria. As those that have sickle-cell escape death from Malaria those without  the condition die off. This causes an increase in sickle-cell in the surviving group, because those without could not fight the Malaria. The population left with only a members that most likely carry sickle-cell now has a disease or condition that can be attributed to their group whereas it might not another where Malaria is not prevalent in the other groups environment weeding out non-sickle cell members.

This can also be shown in why Tay-Sachs is a condition that is normally associated with Jewish populations versus other groups and communities. In Jewish History living in ghetto like conditions was not something that singularly arose during WWII. Those conditions had occurred before, yet if for this post one wants to focus on just WWII the point still can be driven across. Crowded living conditions with bad air is a perfect breeding ground for Tuberculosis (TB). The mutation that causes Tay-Sachs has a built in defense against TB. As those in the ghettos who did not have Tay-Sachs to defend their health against TB outbreaks died, the remaining Jewish survivors were more likely to have Tay-Sachs as a result of its ability to side step the TB. Other communities or groups that did not have both conditions present in their enviroment would not have the build up of Tay-Sachs in their genetic community. This leads to Tay-Sachs associations more with people of Jewish heritage then perhaps other groups.

Some of the reasons for cross-disease protection are a result of the specific way a mutated allele may affect the surface of a blood cell to how it changes the way ones body performs a specific function i.e. an organ or its ability to breakdown specific chemical. Why some of these diseases though are more prevalent in some groups versus others though does bring into the wonders of its protection from other diseases causes an increase of its occurrence in certain populations. Remembering outside factors that contribute to a disease being carried on to future generations while non-carriers die out should be an important thought when focusing on the how and a why one person or group has/gets something while others seem to breeze through unaffected.

Two webpages at this moment discuss in small detail these occurrences, I will find some journal articles that also detail this and tag them on later. To get started though is this interests you:

Dr. Sabeti’s article from Nature Education can be found at:

PBS also has a quick comment page on a few conditions that provide protection from other, it can be found at: