Archive for July, 2009

Stem Cell Gamble?

July 7, 2009

The Obama administration issued new NIH guidelines for Human Stem Cell research after scientists had complained about restrictive and extensive consenting proposed for fertilized egg donation.  The head of the NIH, Dr. Raynard Kington, said researchers would be able to use federal funds for some stem cell lines that were previously banned under Bush administration rules.

Many scientific groups welcomed the new rules as a step in the right direction, away from politically-driven policy and toward science-based policy.  The rules permit federally funded research on surplus fertilized eggs from in vitro fertilization clinics, embryos that would have been destroyed.

But some complain the new rules still fall short of “decisions based on facts, not ideology” as President Obama promised on March 9, 2009.

Continuing a ban on embryonic stem cell lines derived from other proven techniques “is a terrible disappointment,” says Stanford University School of Medicine stem cell researcher Dr. Irving Weissman.  He says transferring genetic material from a patient to egg, through somatic cell nuclear transfer (SCNT) has shown promise in many animals including primates, and the failure to include those cell lines for future research restricts important work.

Some who oppose human embryonic stem cell research say advances in adult stem cell research make ethical problems obsolete.  Not so fast, say Weissman and others.  So-called induced pluripotent stem (iPS) cells have caused cancer in lab animals, when genes used to reprogram the cells continue to be active.

The International Society for Stem Cell Research is urging the NIH to allow federal funding for both iPS and SCNT-derived human embryonic stem cells.  The California Institute for Regenerative Medicine says it is also working with the NIH to include broader sources of stem cells, consistent with ethical and professional standards.

“The NIH is gambling,” says Weissman, that adult stem cells and IVF-derived stem cells will be enough.  He says discouraging ethical scientific research on human stem cell sources continues a policy dictated by polls not by science.

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The Flu to Come

July 5, 2009

“For the moment, H1N1 (influenza) is causing the same kind of disease as the regular seasonal flu,” says UC Berkeley School of Public Health professor of epidemiology Dr. Arthur Reingold.  Reingold is a wiry and wry researcher who also advises the World Health Organization on vaccine policy.  We spoke in his living room only hours after he returned from the Cote d’Ivoire.  He also studies AIDS prevention in Africa and Latin America and teaches at UC San Francisco Medical School.

I had asked his opinion on two new studies published in Science on the H1N1 swine flu virus that continued to cause cases and even deaths during the summer.  “True, it’s not the usual flu season in North America, but this is not a usual virus.  It’s new, and there is very little natural immunity to it,” Reingold explained, squinting for effect behind wire-rimmed glasses.  He added there is some evidence of partial immunity among adults older than about 57, presumably who’d been exposed to a similar virus decades ago.

The new studies in Science, one from the US Centers for Disease Control and Prevention, one from the Netherlands, offered details about the molecular structure of the new virus.  In research on ferrets, whose lungs are infected with influenza very much like human lungs, the studies suggest H1N1 may penetrate deeper into lungs and bind more strongly with lung cells than with nose cells “potentially with more severe clinical consequences,” said Dutch researcher Ron Fouchier.  Both studies found the ferrets became sicker with H1N1, and the infections penetrated the gastrointestinal tract.

However, the two studies differed on how infectious the virus may be.  CDC researchers used virus samples from California, Texas and Mexico, where it was first identified, and found the new virus was not as transmissible as ordinary seasonal flu.  The Dutch researchers said their sample, from a patient in Rotterdam, was just as infectious as regular flu.

The new virus, technically called 2009 A(H1N1), may have already mutated in Europe to a slightly more infectious form.  This diabolical evolutionary trick of influenza viruses is called resortment, an ability to recombine genes.  It is why epidemiologists including Reingold are wary of H1N1.  No one knows what it’s going to become.

It is flu season now in the Southern Hemisphere, where cooler temperatures favor the survival of influenza viruses outside the body.  H1N1 resortment is almost certainly going on right now in the bodies of people infected with multiple influenza strains.  This combining genes of various viruses happens randomly, until a particularly strong variant emerges and stabilizes.

“It is worth paying attention to what’s going on in the rest of the world,” says Reingold.  He says whatever virus variant becomes dominant, is the one we’ll have to deal with in the Northern Hemisphere in a few months.

How about a vaccine?  115 million doses of seasonal flu vaccine are normally distributed each year in the US.  A swine flu vaccine would be in addition to that one.  A new swine flu vaccine is now ready for clinical trials, and if all goes well, could be available by November.  But Reingold is cautious.  “It may take two doses per person,” that’s 600 million doses to cover everyone in the United States, he says, and it’s unlikely there will be more than 60 million available.  Some countries, such as Switzerland, likely will have enough for their entire populations.

The good news is not everyone will have to be vaccinated to stop the spread of the virus.  “Herd immunity” is the idea that transmission can be stopped if even a fraction of a population is immunized.  How many people will need to be vaccinated, will depend on how infectious H1N1 becomes.  Even if it is no more infectious than regular seasonal flu, Reingold predicts “we still won’t have nearly enough vaccine this Fall.”

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What Price Satisfaction?

July 1, 2009

“Insane,” she said, her blue eyes reddened with tears, “I can’t believe what I did.”

She’s a trim, blonde 54-year old woman with three children and a heavy burden of dissatisfaction with her looks.  I told her I think she looks a lot like Meg Ryan, with her bangs and pigtail bobbing.  She would, except for the gnarled, puffed and reddened lips and a bright scar across her left cheek.  She had mutilated herself in an attempt at inexpensive beauty.

We agree to call her Mary.  She makes a living in public and wants anonymity.  She confessed she’s always had “issues with self-image” and that’s what drove her to a plastic surgeon a few months ago.  That turned out well, she said, but “It cost over a thousand dollars, and I couldn’t justify the expense of more injections of silicone.  So I went to the internet and bought a bottle of silicone for ten dollars and injected it into myself.”  It was contaminated.

It is difficult to look at the picture of her face taken four days later.  “People thought I was the victim of domestic violence,” she said, adding “I assured them I was not, but it’s embarrassing to talk about.  It’s my worst nightmare.”

She is in the comfortable office of TriValley Plastic Surgery in Dublin, California.  Dr. Steven Williams, an athletic-looking Yale Medical School graduate and new father of a baby boy, gently probed his gloved index finger around Mary’s inflamed face.  “You may need several corrective surgeries, we’ll do the best we can.”   His voice seemed to reassure a very nervous patient.  “Will this scar?” she asked pointing to her gashed cheek.  “We can make the scar very small but you might notice some scarring.”  She attempted a smile.

“We have a practice that’s becoming known for repairing such problems.  We’ve noticed an uptick in people trying to do things like this at home and having problems and having to come in and see us,” says Williams.  He says he thinks it may be the economy and the notion, encouraged by advertising, that plastic surgery is somehow “foolproof.”

In the operating room in his office suite, a monitor beeped tracking Mary’s heart rate as it hovered around 90.  She’s awake with local anesthetic as Dr. Williams moves quickly around her head and neck with blue cloth drapes.  “We don’t know exactly what this material is, but it is actively causing serious problems for her,” Williams selects a small scalpel.  “It’s not something you can just draw out,” he explains, “You actually have to go in surgically and cut it out.”  He repeatedly asks Mary if she feels any pain, she answers no, but under the surgical drapes her feet wag in some discomfort.

“She’ll have some residual scarring, we simply can’t avoid that,” says Williams.  Mary may have more profound scars that will not be visible.  “It’s taken this to realize I should have been satisfied with what I had,” she says and takes a deep breath.

An hour and a half later, Mary left the office and headed home.  She looked at me, seemingly pleading for understanding, “I hope speaking out might help someone avoid doing what I have done.”

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