BP has denied there are any health hazards to which cleanup workers get exposed and claims to have taken measurements of the air quality to prove it. But, but those measurements have yet to appear in public. Mr Guidry, knowledgeable about air quality issues, brought respirators to the commercial fisherman who were employed by BP for the cleanup, but they were all informed that BP would fire anyone caught using a respirator. Guidry claims that this experience goes all the way back to the Exxon Valdez oil spill, when respirators were not allowed to be used so that the company limited its liability; the use of respirators is an indication that the oil company believes there is an environmental problem with air quality and, as such, exposes them to the liability for respiratory ailments, a situation that could lead to long-term legal problems for the company. BP has stated that nothing is wrong with the air quality in the cleanup areas. If so, what made the workers ill a few weeks ago? Guidry claims it was exposure to toxins in the air. As it turns out, EPA (Environmental Protection Agency), the Federal agency responsible for monitoring air quality has no jurisdiction for air quality over the water, but would have jurisdiction once the air moves onto land. It appears that the Coast Guard and MMS have jurisdiction over air quality issues in the water and so far these organizations have not made any decisions about air quality or cleanup worker safety. Measurements of air quality seem to be limited to those provided by BP. Mr Guidry reported that when he did work in cleaning up oil refineries, all workers had protective clothing and boots, as well as respirators as part of the normal routine worker protection. He has claimed that the lack of such protection exists solely so that BP limits its liability.

It would seem that The Occupational Safety and Health Administration (OSHA), a regulatory branch of our Federal Government, should have jurisdiction over environmental standards facing Gulf workers, since one could extrapolate work on the Gulf oil spill as as constituting a “workplace.” And, OSHA has standards for worker protection, which includes the need for respirators when adequate air quality conditions are not met. Under OSHA rules, respirators are supposed to be provided by the company. But, so far the respirators that have been showing up, though banned for use by BP, have all been provided by individuals, or in one case by the NRDC (Natural Resources Defense Council).

Beginning today, the Institute of Medicine, National Academy of Sciences, is sponsoring a two-day workshop in New Orleans, LA, to discuss environmental health issues that face workers and residents in the region, related to the oil spill and the cleanup operation. You can watch a webcast of the meeting and even submit questions by going here. To view this properly, you will need Microsoft’s Silverlight which you can get here. The government of the United States needs to step in and take control of the environmental issues that are now apparent in many locations of this oil spill. Everyone in the region smells “oil.” Those workers closest to the source where the oil comes to the surface of the ocean must experience the most serious air quality problems. Why isn’t BP releasing measurements from these regions? Already we see in BP a company with a long history of safety violations, with little interest in responding to them, followed by subsequent disasters, followed in turn by minor fines which they treat as the cost of doing business. And, all of this takes place in a country that doesn’t matter to them, because corporate headquarters are in Great Britain. So far, our government has basically rewarded BP for their unresponsive attitude towards our safety regulations, and, their behavior in the Gulf oil spill is simply an example of continuity with their long-established corporate traditions, going as far back as when the company was Anglo-Persian, then Anglo-Iranian, at which time every drop of oil that fed the entire British economy, including fuel for ships, cars and lawnmowers, came from Iran, while the people in Iran got little in return and were treated as impoverished workers. BP would like to treat the people of America as they did the people of Iran and will continue to do so unless the people of America finally grasp the deficiencies in this arrangement.

There is straight line continuity in the BP we see operating in the Gulf today and the BP that felt it had exclusive rights to all Iranian oil, without adequate compensation to the Iranian people some seventy years ago. BP as a company should only survive so that its resources can be used to fund the study and cleanup of the Gulf oil spill, followed by company profits that will be funneled into the development of alternative energy sources. In other words, forcing the company to live up to their ads which talk about bp meaning “beyond petroleum.” What is yet to be established is whether BP will stand for “beyond prosecution.” We have plenty of safety standards that we could impose tomorrow should we choose to do so. Wouldn’t this be a great opportunity for Obama and his administration to finally take the wheel of this out of control vehicle we call BP?

RFM

Red Knot Shorebird

Perhaps we need another century or two to understand the species of the world and their inter-dependencies before we make judgments about who should go and who should stay: say goodbye to one and you may have to do the same for a seemingly diverse group of animals for reasons that are highly counter-intuitive. It’s foolish of course to even suggest that we are in a position to make decisions about species survival, because we aren’t knowingly making those judgments, even though events, such as species extinction, are very likely occurring on a regular basis as a result of human interventionism. But, species extinctions are taking place without our knowledge of the cause or even, in most cases, an understanding of the species involved. We keep track of big animals, like lions, tigers, elephants and other large mammals and, though  the future for them is not looking particularly bright, we are completely ignorant about animals a step or two below on the evolutionary ladder–like the now extinct, Gastric-Brooding Frog. Who said goodbye to that species? But, here’s one to ponder for the short-term: are you kidding me?–shorebirds and horseshoe crabs? This survival dynamic may play itself out over the next few years.

The interconnectedness of nature almost dictates that you don’t lose single species, that in in losing one, some other species or fauna will also be put into harm’s way:  the loss of one species may precipitate the loss of one or more others, largely because we are unaware of the biological forces that unite them. I don’t know who else we lost or which other species might have been changed when the Gastric-Brooding Frog disappeared, but it didn’t disappear without impacting other species. Of that we can be certain. But, what connection for example does the continued vitality of the horseshoe crab, Limulus polyphemus, an ancient marine arthropod, have with survival of the Red Knot bird, a migratory shore bird that makes an annual stopover in the region in which the horseshoe crab breeds? The Limulus is virtually unchanged since it first appeared in the Paleozoic, 570-248 million years ago. Though most people have barely heard of the Limulus, anyone who studies vision is well versed with this species, as its compound eye was first used by H.K. Hartline to reveal fundamental mechanisms of visual physiology, for which he went on to win a Nobel Prize in 1967 for his pioneering work. Horseshoe crabs are abundant on the shoreline of Woods Hole Massachusetts, where Hartline did much of his early work. One of Hartline’s students, Robert Barlow, went on to show that the male Limulus uses its eyes to search aggressively for females and looks for the outlines of the carapace as a visual cue for finding a suitable female, at a time when the animals come into the shoreline for laying and fertilizing their eggs, an activity that usually takes place at night. But, who would ever have thought that the seasonal breeding of this ancient marine species, which takes place big time in Delaware Bay on the East coast, would have a dramatic impact on the survival of the Red Knot bird, a migratory shorebird that flies 20,000 miles each year, from South America to the Arctic, where it breeds, and then flies back again. Surely the biologists got this one wrong!

The Red Knot arrives in Delaware Bay just at the time the Limulus has come near the shore for breeding and egg laying. Eggs are laid by the female in the sand and then fertilized externally by the male or males that surround her. It is the nourishment derived from feeding on the newly released Limulus eggs that provides a critically needed source of food for the Red Knot to regain its stamina and prepare for resuming its long journey North.  Once the Red Knots arrive at the Delaware shore, they only have about two weeks to get sufficient nourishment, rebuild their wing muscles and store fat for the flight ahead to their Arctic breeding grounds, where they lay their own eggs and raise their young over the short summer of the region. If  insufficient Limulus eggs are available, the Red Knot does not seem to have a plan B and may be ill-equipped to finish the long journey to the Arctic. In some regions where Red Knots used to breed in the Arctic, they have not been seen in recent years and insufficient Limulus egg nourishment has been regarded as the main deficiency in their failed migratory outcome. In preparation for the long flight from South America (Tierra del Fuego, in Chile/Argentina) the bird’s digestive system shuts down, such that the intermediate stop, to feed on Limulus eggs, provides the bird with a very digestible meal, rich in proteins–apparently the ideal food for building up muscle and fat for an animal with a reduced capacity digestive system. Despite the aggressive feeding of the Red Knot on Limulus eggs, the horseshoe crab population in the region was stable into the 1990s, when fishing with Limulus bait became popular.

The shortage of Limulus eggs seems to reflect an overly aggressive harvesting of animals, particularly gravid females used by fisherman as bait for catching eels and conch (marine snails): this has led to a significant decline in the number of Limulus eggs laid on the shoreline, down to perhaps 2/3 of previous estimates and the magnitude of this decline has been implicated in the reduced numbers of Red Knot birds making it to their Arctic breeding grounds. Indeed, it was the alarmingly fast reduction in the Red Knot population, by about 70%, that led to the discovery of their dependence on Limulus eggs in Delaware Bay.  The decline in Limulus breeding and egg-laying seems to be the tipping point that could wipe out the Red Knot and could do so very quickly if a better balance isn’t restored.   There is now a two-year moratorium on using Limulus for fishing bait in the region and researchers are busy trying to find artificial bait substitutes that could be used in place of the real thing. An excellent video about this species interdependency was shown recently on PBS and can be seen here.

How long this interconnectedness between a marine animal that is roughly 350 million years old and a bird, whose evolutionary record goes back 150 million years, is not a matter that can be resolved through the fossil record. At some point, the Red Knot’s migratory flight to Delaware Bay was initiated to be well-timed to the breeding season of the Limulus.  This synchrony could be seriously interrupted further by global climate change which might affect one or the other of these tightly timed mechanisms. Some biologists believe the Red Knot could be extinct within five years. At some point, you reach a bird density wherein birds can’t find one another to mate.

Limulus polyphemus

The fishing industry is not the only survival challenge that Limulus faces. The blood of  Limulus has been used for many years because of its unusual properties. Limulus blood is blue because it uses a copper protein as an oxygen carrier. But, of more importance is the fact that Limulus blood clots whenever it comes into contact with endotoxins. Extracts of Limulus blood have been used for decades to test for bacterial contamination. One quart of Limulus blood is valued at about $15,000. Currently, the FDA insists that all intravenously administered drugs should be exposed to a Limulus blood amebocyte lysate as a test for endotoxins. This is a significant improvement over the prior process of injecting a rabbit with the substance and then waiting to see if the animal gets sick and develops a fever!  The discovery of Limulus amebocyte lysate also took place at Woods Hole, through the observations of scientist Fred Bang. This insight and its technological development has reduced the endotoxin analysis test from days to about 45 minutes. Instead of killing the horseshoe crabs and then bleeding them, the pharmaceutical industry harvests blood from live animals, who are then returned to their native habitat. Thus, some former fisherman, who used them for bait, now collect them for blood letting in a laboratory environment and then release them to the same location. Last year, 300,000 horseshoe crabs were bled and then released; about 13% do not survive this blood-letting procedure, which extracts about 2/3 of their blood.

The counter-intuitive interconnectedness of the Red Knot and the horseshoe crab could only be revealed by extensive field studies that involved capturing, tagging and measuring birds along the pathway of their extensive, almost incomprehensible, migratory flight pattern. These are dedicated scientists who share a passion for this bird and its preservation. Why a bird would exist under the harsh conditions of the Tierra del Fuego, near the Strait of Magellan, then fly to the even harsher climate of the Arctic for breeding and the early rearing of their young, before flying off again on another 10,000 mile trip, is well beyond our capacity to comprehend. Perhaps it got started before tectonic plates rearranged the land masses. The migratory pattern of North America by non-indigenous Homo sapiens was primarily East to West, which is a little easier to understand. In contrast to the rational, the Red Knot flight plan is not one that any of us would recommend to serve as the basis for a committed, routine lifestyle, unless it was one we recommended to our Republican friends. I can imagine Rush Limbaugh feeding on Limulus eggs in search of a new high. Let us hope that the Red Knot survives and the current iteration of the Republican Party goes the way of the Dodo bird as its major flight plan glides it  into extinction. There are many signs that such a glide pattern is already underway. We will undoubtedly hear more about each species in the coming years.

RFM

On the front section of Times Science, an article by Tara Parker-Pope, describes “What you need to know in the first year” in which she points out that for starters 32 million, presently uninsured Americans, will eventually be covered under this law, such that 94% of legal residents not covered by Medicare will get insurance, up from what has been estimated at 83%. While only a gain of 11%, there are lots of people that will have to be brought in under this new plan. The extended coverage will not kick in until 2014. This bill cannot help but have an enormous social impact on our country, as we have been the harbingers of nothing less that a disastrous healthcare system–a true nightmare for far too many of our citizens. Shouldn’t that issue be part of our national security?  Some of the most important changes for individuals will kick in this June, while others will be delayed until the end of this year. Look for the nuts and bolts of these changes to be elaborated by the Health and Human Services at a website devoted to healthcare, but the Parker-Pope Q&A section handles some specific issues. In June of this year, denial of coverage by pre-existing conditions should be eliminated. If you currently lack insurance, there will be several different options, depending on your age, financial status and the duration during which you have not been insured.
The Times has gotten pretty slick at providing multimedia graphics to explain and help clarify the issue and with a healthcare bill that has more than 2000 pages, everyone will need a period of accommodation before the impact of the bill can be truly appreciated. If you go to the Times Science Website and click on the Multimedia section in the middle column, it will take you to a brief summary of the options available if you are currently  insured or uninsured. The site also explains what you can expect to pay in taxes, given your income level, when the plan is fully implemented.
One of the horror stories during the build-up to the healthcare legislation was that of a woman who had a previous Cesarean section for child delivery; she was subsequently told that C-section was a prior condition and that she couldn’t be insured unless she was “sterilized.” When she went public with her story, the use of the word “sterilized” served as a key motivating factor for rallying against the gender inequity rules of health insurance companies and some of you may be surprised about the extent of gender prejudice in our healthcare system. Denise Grady describes how the new healthcare bill will “lower the cost of being a woman.” Here, here!
I remember attending a meeting in Boston about a decade ago when I was invited to tell the sad story of the University of Minnesota Medical School under the banner of “How Not to Reform a Medical School, held under the auspices of the AAUP (American Association of University Professors). It was there that I listened to a physician in the Boston area describe an interaction with one of  his patients who had a headache and insisted on having an MRI exam. The physician suggested that she should have some other procedures done first and the patient retorted that he (the doctor) knew that she needed an MRI, but he wouldn’t give her what she needed because he worked for the insurance company and the money for the procedure would come out of his pocket.  It was at that moment that the physician realized his profession had been drafted into the wrong side of the healthcare war: the doctor, who sounded like a well-intentioned, selfless physician was now viewed by at least one of his patients as a corporate shill.

Historically, physicians made it hard on themselves by aligning their position on healthcare largely through the policies of the AMA, who repeatedly fought against the attempts to bring a unified system of healthcare to American citizens. Physicians tend to be Republican, whereas you would have thought intuitively, they should all be Democrats and believe in public policies that make us, all of us, healthier with better access to doctors.  Of course, there are some good, radical physicians who have helped push the issue of a single payer plan and we must be grateful for their voice, just as we should  be grateful to the California Nurses Association for pushing the same agenda. Perhaps someday we will get there–health insurance without health insurance companies. But we have to get through the current bill first before launching the better healthcare system that remains within our sights. The trouble is, we have a history of finding a fix, and no matter how imperfect, sticking with it until the mud flaps come off.

There continues to be something of a sham within medical schools, which have “ethics” programs that you might think should consider our present system of healthcare to fall within their purview. But most “ethics” programs at medical schools deserve to be expressed in quotes because they were really put their to deal with issues like “animal rights activism,” “organ transplant” and  “organ donor” issues and “death and dying” procedures. Only recently have I heard a few ethics members speak out against our disastrous healthcare system and even then it seemed like they were coming late to the healthcare party. So, almost any description of change in our healthcare system would be incomplete without comments on whether this new bill can help heal the badly fractured relationship between a doctor and his/her patient. In that regard, physician Pauline Chen describes an experience she went through with an uninsured patient and how she herself hopes that the new healthcare bill will offer at least the possibility of repairing what has become “a crippled, even broken, relationship between patients and doctors.” I would say to Dr. Chen, don’t hold your breath. As long as we have insurance companies dictating the treatments and drugs that will be given to a patient under their insurance plan and as long as a profit margin must be squeezed out of patient service denial, the doctor will still appear to be the insurance company shill who is denying service and appearing to do so while enhancing his own profit margin. At one time, doctors were in a position of control over the course that a unified healthcare plan might take. But they turned down the opportunity to be the master and instead became the slave of the healthcare industry. Now they are lightly regarded as a source of unbiased expertise on the healthcare debate. Nurses are a much better source of information. After all, they have been underpaid from the get-go.

Yet, we all have hope. Many of us have good physicians, whose passion for medicine is admirably high. My doctor for example donated an extensive period of his time to go to Haiti and treat patients and organizations such as “Doctors Without Borders,” continue to inspire hope that medicine and humanity are really one and the same. But such a unified concept cannot exist when corporate forces are in the way and the money-mad CEO is making the decisions. Many physicians have found their journey hopeless. I have noted in the past,  that for many months, AMWAY, the sales company, had a converted MD as their “employee of the month.” A more decent healthcare delivery system might  slow the rate of such defections, but we must recognize that part of the gigantic profit levels of the for-profit insurance companies, come off the backs of doctors, some of whom labor with huge debts and modest incomes.

Finally, in the same section of the Times, Abigail Zuber, MD reviews a book written by Lionel Shriver entitled “So Much for That.” It’s a story about a middle-class family, whose bread-winner comes down with the dreaded malignant mesothelioma–the asbestos-related cancer of the lining of the lungs. The symptoms of the cancer are generally very subtle, so by the time the diagnosis can be made, treatment is almost entirely palliative. Ms. Shriver details how the treatment causes other symptoms and during the course of therapy, retirement dreams are shattered and financial resources are drained. Shep, the husband-father with the disease is forced to keep working despite his decaying health, to keep his insurance active. Other health-related entanglements in the story reveal what a disastrous health care system we have imposed on our citizens, all for the sake of corporate profit and the unfettered free market system whose chief objective is to create disastrous levels of poverty that society then has to worry about. How about a Superfund from corporate profits to compensate for the widespread poverty the system has created?

RFM

Vision rules! We are overwhelmingly visual animals, with a visual brain that developed so much power, we eventually learned how to read and through that medium, we began to change the world we live in. Except for hurricanes, volcanoes, tornadoes and the coming global climate change and mass species extinction, we learned to rule the world and turn the tables on the remaining species that had previously hoped to dine on us. Vision controls our brain, even though it tells lies about the visible world around us, through mechanisms such color-constancy, Mach Bands for enhancing edges, contrast gain, chromatic adaption and movement distortion to name just a few deceptive tactics of our visual apparatus. The brain is a plastic organ, waiting to change and develop according to the experiences we present to it. The “lies” are actually generated by the retina’s commitment to improve our edge detection, recognizes boundaries and colors and detect the movement and project the estimated arrival times of moving objects. From stationary retinal inputs, the cortex begins to build larger regions of visual field receptivity. From small circular receptive fields, larger regions of light sensitivity are constructed that are made of lines of different orientation covering a larger retinal region and these respond preferentially to movement in one direction, as well as prefer information from one eye over the other in an organized set of repeated columns. All of the processing that takes place within the visual cortex, with multiple parallel streams of Lego block construction, still represents early coding for some of our most important visually related events.
Brain imaging studies have revealed that a “letterbox” region lies, on the left side of the brain, near the occipito-temporal border that is associated with the identification of letters of the alphabet and words we have learned. It’s estimated that the human word capacity is somewhere between 50,000 and 100,000 words accomplished when we are adults, through the repetitive, daily act of reading and challenging our brain with new words and their meaning. Written language has fundamentally changed the world and contributed substantially to the growth in intellect and the recognition that reading and writing are fundamental to progress. In the hundred years between the 20th and the 21st century, the percentage of people who are literate has increased dramatically and will continue to grow, given the essential entree it provides into advanced cultures.
Outside of the visual cortex per se, in the medial temporal inferior  lobes, close to the hippocampus that plays a big role in laying down memories that are eventually stored in the cerebral cortex, memories of the declarative type, available to our verbal recall, researchers have determined the encoding properties of single brain cells which turn out to display surprisingly specialized and unique properties. In the less than 1% of epileptics that do not respond to the litany of antileptic medications, removing the localized offending tissue is the only way to reduce or eliminate seizure activity. But since the legendary patient H.M., neurosurgeons carefully explore an epileptic focus with recording electrodes to make sure they don’t remove essential structures committed to the patient’s memory. At the cellular level, no two brains are wired alike, so one has to be careful and record from the cells near the lesion and avoid removing brain tissue that has stored or can store part of the human engram. These studies, which often require hours with a patient’s brain exposed and recording electrodes inserted into brain structures to explore single cell properties near the epileptogenic site, have revealed surprising properties of human neurons that contain memory information about people. One such cell recently described (Quiroga et al., Invariant visual representation by single neurons in the human brain, Nature, 435,1102-1107,2005) in a patient was the “Jennifer Aniston Cell.” This cell responded to images of Jennifer Aniston very distinctly; it did not require her face in any particular position or special clothing. An image of Jennifer Aniston in any position or posture fired the cell vigorously, whereas other similar images of famous people did not.  Interestingly, when the image of Jennifer Aniston was coupled with Brad Pitt, the cell was silent. Not only did the cell respond to an image of Jennifer Aniston, but it responded as well to the auditory or written form of her name. Was this then the long lost grandmother cell we had been searching for during the last 50 years? If you destroyed that single cell, would the patient lose all memory of Jennifer Aniston? Naturally, it was unethical to do something like that, but the authors did feel that their results, with included 993 units, with about 14% of cells committed to human identities (Halle Berry was also popular, as was Bill Clinton, the Beatles and cartoons from The Simpsons and Michael Jordan); to qualify as a human identity cell the cellular response to the picture had to equal to the mean plus five standard deviations of the baseline, with a least two spikes in the post-stimulus time interval.  Repetition is the means we have for forming strong, long-term memories. So perhaps all of us have Jennifer Aniston, Halle Berry and Bill Clinton cells. Since the study was done in 2005, the experimenters did not have a chance to look for Obama cells, but by now they are probably there, perhaps in all of us, maybe even more strongly integrated into the brains of tea baggers. The authors argue that their findings favor the interpretation that the cells from which they recorded are in fact, the missing grandmother cells that were postulated to exist, but have never really been found until now.  The  obvious question that comes up is whether there is more than one representation of Jennifer Aniston? And if one Jennifer Aniston cell is knocked out, will another one quickly takes its place through the methods of laying down a new long-term memory from the background neural engram already active in the brain? One of the most riveting of all issues related to brain function involves the question about the grandmother cell, or in this case the Jennifer Aniston cell. The fact that such a cell exists, when the theory to which I ascribed for many years held that Jennifer Aniston was represented by an overlapping population of cells, so that her identity was determined by a network, not a single, cell has been seemingly shattered by this report. Thus we must now acknowledge the likely fact that we store images of people we know or have seen enough times and encode the representation of these individuals into the discharge properties of a single cell. That cell is so sophisticated that it responds to Jennifer Aniston independent of position, expression, hair style, clothing or facial expression. But, do we have one or many Jennifer Aniston cells in our brain and can those cells be recalled for updating to new folks, once we lose interest in Jennifer Aniston? Of greater relevance is the question about who or what is it that reads the Jennifer Aniston cell to report it to our consciousness? Is the Jennifer Aniston cell one cell removed from our conscious identity? Is consciousness the readout of our cortex, with specialized Jennifer Aniston cells making the task more simplified? Stay tuned! There’s a notable human issue residing in these discoveries. Recordings from awake humans during surgical exploration for epilepsy-related surgery is about the only way we can get at this question and the results of Quiroga et al., have come down pretty hard in favor of us having brains with grandmother cells! But what if we find the same cells in the Chimpanzee? Will that give us pause? Do Chimps care about Jennifer Aniston if they see her on TV enough times? Do we also need language, both written and verbal to even form a Jennifer Aniston cell? All these questions remain in the future, but we can no longer deny the grandmother cells of our present and future brain.

RFM

But we know of many diseases that generally don’t lend themselves well to a magic bullet drug and among these are the hereditary diseases of which hundreds if not thousands are known today. Modern molecular biological analysis has led to the molecular identity of many hereditary diseases where the defective gene and its normal function are understood. One of the genetic disorders that commands attention is congenital blindness, a condition where children are born with defective vision and remain blind or nearly so for the rest of their life. Leber’s Congenital Amaurosis is one form of congenital blindness that may be caused by mutations in any one of 13 different genes; in about 6% of these cases, the defective gene resides in a layer of cells in back of the retina called the Retina Pigment Epithelium (RPE). The defective gene is known as RPE65; its normal mode of action is critical to maintain vision because visual pigments that have been bleached by light, and converted from a molecular configuration known as 11-cis retinal to all-trans retinal, are transported to the RPE where the enzyme “reisomerizes” the Vitamin A derivative back to the 11-cis form. The first clue to understanding these patients was a demonstration that they had very low levels of 11-cis retinal implying a defect in the regeneration of the pigment that is vital for the visual process and the defect pointed to a deficiency of the isomerase or RPE65.

The dream of every molecular biologist is to find a way to replace a defective gene and restore the health of the individual. As it turns out, a similar genetic defect to Leber’s  is found in some Golden Retriever dogs and several years ago a group at the University of Pennsylvania showed that a single injection of a modified adenovirus, that had been genetically manipulated to carry the missing gene and modified so that it would only enter RPE cells (the essence of the trick),  injected into one eye of a now famous dog named “Lancelot” resulted in a rapid restoration of his vision, which has remained normal for several years.   Two years ago, this same technique was applied to a few patients with equally good results, although the success of the procedure proved to be age-related. The longer this disease progresses without therapy, the retina undergoes a chronic degenerative change so that recovery of vision is much better the younger the patient at the time of the injection. Last month, the Lancet published a more comprehensive study of 12 patients followed for a period of up to 2 years after a single injection with ages ranging  from 8 to 44. This was the most extensive population yet tested. For each patient, the worst  of their two eyes were injected with a single application of the modified adenovirus (had to be modified over that of the dog because humans have different receptors on their RPE cells). The New York Times picked up on this story and their article provides access to a video where you can see the visual testing of a patient before and after the viral treatment.
Despite the age differences among the patients, all of them improved very dramatically with a single injection, which after two years was still sustaining and improving their visual capacity. There is some evidence that their vision continues to improve, perhaps because some learning and synaptic readjustment is taking place, though it is not clear whether this would be a brain or retina mechanism. It is fair to say that the achievements generated by the U Penn group are astounding: children normally condemned to live a life of blindness have now been given a cure by replacing their defective gene. So far only one eye of each patient has been treated and one wonders when the second untreated eye will also be injected, though one is certain that it was eventually take place.
Gene replacement therapy has now been proven in cases of Leber’s Congenital Amaurosis. The defective RPE65 gene was replaced by incorporating the normal human gene into a modified virus which was then injected underneath the retina. The virus was programmed to so that it only entered the RPE cells. In all cases, it led to dramatic improvements in vision with an average increase in visual sensitivity of 100,000 times over their pre-injection state. From the dog Lancelot to the 15 patients who have received injections so far, gene replacement has worked and patients previously condemned to blindness can now see and lead fairly normal lives. The earlier you get to the patient with this disorder, the better the outcome, though even older patients got significant improvement. The era of molecular medicine for treating blindness has begun: this is its first historic success. Now on to those patients with Leber’s Congenital Amaurosis whose defective gene is something other than RPE65! There are 12 other genes whose defects give a similar clinical picture. For them, it will take a different virus and a different gene, but with the principal established with the RPE65 patients, there is no reason to think that all patients with Leber’s Congenital Amaurosis can be effectively cured by gene replacement techniques!

This is a great moment for molecular gene replacement therapy. The achievement in treating one form of Leber’s  underscores the value of basic science research, which discovered all the key proteins, receptors and enzymes that are required for the visual pigment cycle. It was basic science that led to the concepts and tools needed to address this form of blindness and eventually all forms of hereditary diseases will be treated in a similar way. Each one of these hereditary diseases will require its own special tuning and it may not always be through an optimally tuned virus, but perhaps some other kind of vector such as a minicell. Today, science can shout from the rooftops!

RFM

The Baucus bill that was in the Senate finance committee emerged without any Republican support, turning Obama’s  position of insisting on bipartisan support, into a non-entity: this will be a Democratic bill and we can win the public support option in two ways. First, floor amendments to the Baucus bill will bring up the public option plan, though it is currently unclear whether the Senate will vote their version of the healthcare plan with that component in it. But, this is up to the Democrats and the pressure on conservative Democrats who do not favor the public option plan, will be to face the prospects of not getting a decent bill passed at a time when the Democratic Party controls all three branches of government. Though the planned healthcare bill will not go into force until 2014, a failure to achieve a decent healthcare bill could doom the prospects for Democrats’ re-election bids on any one of a number of legislative failures. Passing a bill in which the public becomes increasingly aware that it favors the for-profit insurance companies, as analysis trickles in over the next few years,  could be the single greatest element of destruction for the Democratic Party in the election of 2010. All Democratic Senators are aware of this dilemma and we should continue to remind those conservative Democrats that the NYT/CBS polling data favors a solution with the public option plan as a major component.

The second pathway to insure the public option is through the House, where several bills have already come out of committees that have a public option plan. Nancy Pelosi insists that a healthcare reform bill that lacks the public plan cannot pass the House because of pressure by progressive democrats and union support.  By increasing our pressure on Democrats who are wavering on this issue (again, we are unlikely to see any Republican votes in the House, unless we apply pressure and keep the poll numbers pointing in the direction of the public plan as an essential element to healthcare reform), a strongly endorsed healthcare plan coming out of the House with the public option intact, will force acceptance of that component in the House/Senate conference meeting–the Senate will not be able to avoid it. So the margin of victory in the House now becomes an important component of our reform prospects.  Now is the time to write to your Senators and House legislators, to keep the pressure and drive the issue into a state of redundant acceptance. I believe that the public option plan is more achievable now than at any other time in the last few months. We may have passed through the dimly lit tunnel of the goons into a brighter light of new hope for decent healthcare reform. The lobbying against the public option is running out of gas and it’s time to energize our legislators and force our news media to talk about the new polling data and explore the ethical failure of our current healthcare system. For the past two months, opponents of healthcare overhaul have outspent those supporting the bill, but that tide has now shifted, with more advertising money spent on support of the legislation, even though we don’t yet have a specific bill to fight over. One can almost predict that the Senate/House conference committee  will be the site at which the public option succeeds or fails and, if so, no conference in history will be in the public spotlight more than that one. Energize yourself–the battle for healthcare supremacy is about to begin!

RFM

It was always clear that the Kennedy’s were a special family, even though they were not without controversy, including Ted’s accident at Chappaquiddick which probably sealed Ted’s fate as a Presidential candidate. Father Joseph had created a huge base of wealth through his dealings in the stock market, liquor distribution and as a Hollywood movie mogul. As a result,  his children didn’t have to worry about financial security; they all seemed liberated and energetic to pursue interests that didn’t require the generation of substantial  independent wealth. Their patriarch, Joseph Kennedy, had once considered running for the Presidency himself, but dashed those prospects when he supported appeasement with Germany as Hitler’s war machine was building up (Joseph was then ambassador to England). Nevertheless, what Joseph Kennedy instilled in his children was a zeal for public life and a passion for not losing elections.

Both John Kennedy as President and Robert Kennedy as a Presidential candidate, were cut down before we could sample any sense of their legacy. I always felt that Robert’s preparation to run for the Presidency, while serving as a Senator from New York (he couldn’t vote for himself when running for Senator from New York because he hadn’t yet completed his New York residency requirement on election day), was one of the transforming experiences he passed on to his younger brother Teddy. As Robert began to think about his Presidential candidacy, he increasingly identified with the poor and the unseen of America. Poor migrant farm workers, blacks and the impoverished in America began to identify with him as a compassionate politician, while he began to visibly grasp the huge disparity between wealth and poverty in America. Neither John Kennedy nor Joseph Kennedy probably knew that atrocious living conditions still existed in the America of the 1960s. Yet, while these elements were important in shaping Robert and were passed on to Ted Kennedy, nothing shaped Robert’s views on America like the Bay of Pigs invasion and the Cuban Missile Crisis. Both of those experiences taught Robert to mistrust the CIA and the Joint Chiefs of Staff, as they were always opting for the most militant response to international challenges. John regretted that he had ever given the go-ahead to the Bay of Pigs invasion and did so only when the military guaranteed an easy quick victory with the elimination of Castro as the big prize.  When Russian missiles were discovered in Cuba, the CIA and the Joint Chiefs wanted to bomb the sites and, as Attorney General to his brother, Robert said that bombing by American planes would make the Kennedy administration look like they were perpetrating an aggressive  Pearl Harbor act on a small country. It was Robert Kennedy who persuaded his brother to use a naval  blockade against Cuba rather than bombing. But after John’s assassination, Robert split with Johnson and he began to have reservations about Johnson’s escalation of the war in Vietnam. Robert eventually sided with the anti-war movement and identified his brief Presidential candidacy with their cause. His election would almost surely have cut the war in Vietnam short without the additional bombing that Nixon and Kissinger did in North Vietnam, Cambodia and Laos. Ted Kennedy adopted these same views as he grew with his brother while serving in the Senate.

I can remember an experience Robert Kennedy had when he visited the Mississippi delta region and observed black share croppers, enslaved in conditions of abject poverty that had changed little from the civil war. He visited with families living in rickety shacks where children showed signs of nutritional deficiency, with bloated stomachs and lethargic reactions. When Kennedy came out of the shack where he had visited with such a child, he was asked by reporter Daniel Shore (this scene has been rebroadcast on the PBS American Experience series) what his impressions were and Robert basically said  that a country that spends as much money as we do on arms should be able to do much better in addressing the kind of poverty that he had just witnessed. That was perhaps the first and last time I ever heard a Presidential  candidate express a linkage between excessive spending on arms, while neglecting obscene poverty at home. We can only wonder what Robert Kennedy might have achieved had he been elected President in 1968: perhaps he might have prevented Reaganomics and Reaganism or at least diminished their impact on our culture. Perhaps Reagan would never have been elected, for it was the vacuum of the Vietnam War and Johnson’s resignation that opened the door for America’s conservative re-alignment.  I am sure that before Robert was shot in 1968, immediately after he  secured an essential political victory in California, he had imparted his views and his passion to young Senator Edward Kennedy about what he had seen and how he felt about the impoverished and disadvantaged in America. Those constituents eventually resonated deeply with Ted Kennedy who was, on many occasions, one of the few Senators that championed causes for the poor and minorities in this country. They could not have had a better spokesman. Teddy was joined by Paul Wellstone from Minnesota who might have challenged Ted for visibility in the liberal progressive mode, but he too, like the older Kennedy brothers, was cut down by an airplane crash while campaigning for re-election in Minnesota. That event led to six forgettable years of Republican Norm Coleman and his rubber stamp voting record for GW Bush.

Although Ted Kennedy also aspired to the Presidency, his failed attempt to unseat Jimmy Carter for his second term in the 1980 election, led to his personal conviction that he could never get elected President and, for that reason, he began to focus on becoming a legislator. Thus, the linkage was broken in the Kennedy family for sequential Presidential aspirations, and, with the absence of such enticements looming in front of him, Ted Kennedy committed himself to highly visible legislative priorities as he evolved into one of the greatest legislative rocks in the history of the Senate. While Ted Kennedy did not prevent the right-wing tilt towards Reaganism, he fought major battles against the trend and among them, he led the charge to prevent Robert Bork from becoming a Supreme Court justice, as he staked out the epicenter of liberal defiance against the conservative Republicanism that eventually  brought us GW Bush and his atrocious policies. While Kennedy didn’t prevent the arrival of Reaganism, he certainly softened some of its blows.

Ted Kennedy was among the most articulate Senators in opposing the war in Iraq and his tongue lashing of Secretary of Defense Donald Rumsfeld during a Senate hearing is classic of  Kennedy hyperbole and chutzpa. He was a great orator, and a vital force in the Senate for liberal causes, as he displayed a sensitivity to issues of humanity that endeared him to broad sectors of our society. The best thing the Senate can do in honoring one of the greatest to ever emerge from that body, is to pass a bill that will do justice to  one of Kennedy’s passions for the country–a healthcare bill that gives decent medical care to all Americans.   Ted Kennedy himself seems irreplaceable, but a healthcare bill that seals his legacy as the last of the Kennedy brothers to serve America, might also serve as a galvanizing endorsement for decent Americans to start  stitching our country back together again. Or, doesn’t anyone remember what a good country is supposed to look like?

RFM

But, nearly twenty years later,  when the Federal Government began to reduce Medicare payments in the 1980s, triggered by concerns over rapidly escalating costs, income for all physicians from this source of reimbursement declined;  compensation for reduced income from the government triggered  a more labor-intensive solution of seeing more patients each day and reducing physican time spent with each patient. A decline in the length of hospital stays was also part of this new economy. Beginning in the 1980s, but greatly accelerated in the 1990s, physicians were hired into academic programs whose function was to see as many patients per hour as they could, such that these “academic positions” allowed little time for research and evolved into such a demanding workload that they began to emulate the taxing conditions experienced by private practice physicians working in an HMO, rather than the academic physicians that they hoped to become; the process is complete: they are now indistinguishable from a doctor working in a private practice clinic.  The very foundation of an academic clinical physician began to erode in order to compensate for lost revenue from the government. As one of my clinical  colleagues once said, “I no longer feel like I’m in a medical school.

The drive for more income into departments for their programmatic needs, and to help elevate faculty salaries, continued unabated, such that the new emerging model of the American  medical school demanded more outside revenue to feed itself.  But, as if to answer a clarion call, an additional source of income began to emerge in the form of drug companies that seemed to find their mother lode in producing new drugs and advertising them as innovative cures or much better replacements for the older drugs, some of which were introduced just a few years earlier by the same company. Expensive advertising for drugs, something not allowed in other industrialized countries, began to sell patients on the benefits of newly generated pharmaceutical agents, and the patients who listened and saw theses ads on their television sets would insist that their physicians prescribe these new medications that seemed to offer a fresh version of medical paradise. The results of these efforts, along with favorable reimbursement rules for prescription benefits through Medicare and Medicaid, produced huge profit margins for drug companies and, as their profits soared, so too did their political and institutional influence. As basic science began to provide new insights into the biological basis of disease,  the pharmaceutical industry quickly fell into line by developing new drugs based on these findings. But, not all of the drugs were new. Some were developed years earlier, but found new applications in the emerging revelations of unraveling the molecular soup of human diseases. Old age is now viewed by the pharmaceutical industry as a disease and many of them have a drug for every symptom.

Before any new drug can be approved by the FDA for use by patients and prescribed by doctors, it must go through a clinical trial to determine its safety and efficacy. As the wealth of the drug companies increased, they began to permeate academic medicine in ways that, for many years, ran beneath the public radar screen. By subsidizing the salary of physicians, and sponsoring research in academic medical centers, drug companies learned that their products were taken more seriously if the clinical trials that led to FDA approval took place in an academic medical environment. Moreover, a prestigious academic physician who was willing to promote the new drug was also a highly prized token of  predictive success. For this reason, clinical trials increasingly took place within academic medical centers and the results of these studies often appeared in important journals, with prestigious authorship that in reality, reflected a new, but more  subtle way of marketing drugs. Today, there are untold numbers, presumably in the thousands, of clinical trials that are ongoing in academic medical centers across the country. But many drugs are prescribed today for uses other than those for which original approval was based on clinical trials. This process known as “off label” usage means that a single drug could be prescribed for uses other than those for which it was originally approved. Slowly, this unfortunate marriage between drug companies and academic medicine has increasingly diminished the image of our academic medical centers as entities dedicated exclusively to the public good.

Reports on clinical trials supported by the drug companies often emerge from academic centers, and  minimize the dangers of the drug while paying more attention to the benefits. This practice is a two-way street: Marcia Angell, writing in the NYRB (January 15, 2009) says “a recent survey found that about two thirds of academic medical centers have equity interest in companies that sponsor research within the same institution. At the department level in medical schools, two thirds of them received income from drug companies and three fifths received personal income.” The drug companies have embedded themselves into the very fabric of our medical schools, both private and public, and this marriage is beginning to capture the attention of a wary public, particularly since we are increasingly committed to reducing healthcare costs while simultaneously  increasing health care coverage. Our research medical centers across the country seem to be emulating the Federal  government under GW Bush, with a dramatic increase in centralized authority and the increasing relegation of faculty to the status of a ” hired hand” rather than an integrated faculty member, those that were once the epicenter of our medical schools and universities. The decline of faculty status is not unique to medical schools however, but is a trend that has permeated the entire university. Faculty created universities, but today they are run by administrators who often have extravagant salaries compared to their faculty counterparts, unless you are one of the “elite” faculty that draws extravagant payments from drug companies.

Academic standards eroded further however when drug companies began using academicians’ names for papers not written by the individual faculty member through a ploy labeled as  “ghostwriting.” This insidious process, which appears to be widespread in academic medical centers, is initiated by drug companies who hire writing firms to write articles about their products and then invite academic physicians who agree to have their name on the paper. Many years ago, I once questioned whether a student should receive his Ph.D. when he admitted that he had not read one of the references quoted in his thesis. Now, we have a different ethical challenge–an academic clinician signing onto a paper promoting a drug the he/she neither wrote nor perhaps even read.  So, what are we to make of a curriculum vitae (CV)  with this kind of ethical challenge residing in our academic halls?  In my opinion, these physicians should be fired and their names should be printed in a public place: they are destroying the prestige of academic medicine and dragging all of us down through a new form of corrupt behavior, all designed to curry favor with the drug companies and promote their interests. It is not difficult to fire tenured faculty–it happens all the time. You just have to identify the right cause and a doctor agreeing to have authorship on an article unseen, for financial gains, should meet the criteria to cross the threshold of a tenure violation. Such behavior is inconsistent with our traditional academic standards and it diminishes the sense of public trust that we should be promoting.

Years ago, professional societies that met to promote the dissemination of science and research studies in clinical and basic science medicine foresaw problems emerging with conflict of interest issues between researchers and their source of funding. If the researcher had formed a commercial relationship with a company and was reporting on research that would benefit the company coiffures, other meeting attendees should know about these relationships.  These societies, several of which I belong to, demanded that scientists report all conflicts of interest in the abstracts they submit for review and the papers and talks they present at scientific meetings. Over the years, I have watched in horror as the list of conflicts has become increasingly large and, in many cases, it tends to shroud the presentation in a state dubious credibility about the validity of the research and the impartiality of the authors. I do not pay attention to posters or talks that have a complex list of conflicts of interest, yet it seems that the numbers grow each year. I have also observed posters at meetings where the methods were not divulged because they were “proprietary.” This is completely unacceptable in a scientific society, where free access and open communication is the essence of our work and the substance of our interactions. Without free exchange of information it is not science, but pseudoscience. To have international scientific meetings tolerate this abuse of scientific exchange is unacceptable and those professional societies who tolerate this kind of intellectual fraud will surely succumb to an accelerated rate of ossification on a timeline much smaller than a geological time scale. Finally, journals and scientific societies are beginning to understand the depth of the flaws that they have allowed to creep into their meetings and publications. Some medical schools such as Duke, prohibit ghostwriting articles and demand that faculty keep track of their contributions to scientific work and publications. But, while academic institutions are beginning to formulate new policies about ghostwriting, the incestuous nature of the permeation of the pharmaceutical industry into our medical schools continues, though the depth of penetration remains largely unknown to the public. That is part of the problem: suspicions about flawed ethics create deep antagonism to the  institution and evolve into diminished capacity for them to attract and retain the faculty and students they depend on for their success. The road they travel can only go one way–down. But, admitting to identifiable conflicts of interest is only part of the problem.

The need for damage control doesn’t stop with ghostwriting or conflict of interest statements. It also goes into the ethics of drug promotion done in such a way that it borders on criminal behavior and, under some circumstances, results in new applications for drugs for which they are not approved and could be dangerous.  Again from Marcia Angell’s article in the NYRB:

“Or consider Dr. Alan F. Schatzberg, chair of Stanford’s psychiatry department and president-elect of the American Psychiatric Association. Senator Grassley [Grassly (Iowa) has been working on this general issue of ethical propriety in academic medicine]  found that Schatzberg controlled more than $6 million worth of stock in Corcept Therapeutics, a company he cofounded that is testing mifepristone—the abortion drug otherwise known as RU-486—as a treatment for psychotic depression. At the same time, Schatzberg was the principal investigator on a National Institute of Mental Health grant that included research on mifepristone for this use and he was coauthor of three papers on the subject. In a statement released in late June, Stanford professed to see nothing amiss in this arrangement, although a month later, the university’s counsel announced that it was temporarily replacing Schatzberg as principal investigator “to eliminate any misunderstanding.” This clear conflict of interest in owning stock in a company that will benefit from your research efforts is not unique to academic medicine, but it still serves to shatter the image of medical research objectivity.

A more famous case is perhaps that of Dr. Charles B. Nemeroff, then chair of Emory University’s department of psychiatry. He served as the principal investigator on a large NIH grant to study several drugs made by GlaxoSmithKline. Federal regulations required that he report any income over $10,000, together with an explanation of the conflict of interest. But Senator Grassly obtained records from the drug company and declared that Nemeroff failed to disclose approximately $500,000 he received from GlaxoSMithKline for giving many talks promoting the drugs. Emory university did their own investigation and found numerous violations of their own policies which included the under reporting of financial gains from the drug giant.

When drug companies sponsor research within university medical schools, they insist on tight control and intimate involvement in all phases of the project. And because they also have tight control over publications of the results, they can manipulate the manuscript to maximize the benefits and minimize the problem areas. Before the 1980s, drug companies would typically leave the studies entirely to the faculty of the institution, but now employees of the sponsoring institution often design the experiments, perform the analysis, write up the results which come out in print with the faculty’s name on the paper, making the faculty look like simple hired hands–a faculty member whose name is on the paper may have done next to nothing to generate and report the results.  This drug culture in our medical schools is generating a plethora of seemingly new, miracle drugs we have on the market, and the advertising gimmicks that we see today, where normal behavior is turned into a treatable disease, like excessive urination caused by prostatism. The result of this manipulation of the drug studies through the intrusion of these drug companies into our medical schools, results in reporting clinical trials that unavoidably favor and endorse the product.

Again quoting from Marcia Angell’s article in NYRB  “In view of this control and the conflicts of interest that permeate the enterprise, it is not surprising that industry-sponsored trials published in medical journals consistently favor sponsors’ drugs—largely because negative results are not published, positive results are repeatedly published in slightly different forms, and a positive spin is put on even negative results. A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies were published.  But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome. It is not unusual for a published paper to shift the focus from the drug’s intended effect to a secondary effect that seems more favorable.” Today, we have undoubtedly expanded the drugs available for prescription without knowing whether they have a valid application, or whether they are any better than a placebo. Clinical trials are so often distorted, without significant attention paid to side effects, some of which can be dangerous or fatal, that the true benefit of the drug cannot be stated with certainty. Faulty investments in the companies whose drugs they are researching, hidden payments for promotional activities, promotion of biased positive outcomes for clinical trials, ghostwriting articles with information about which faculty have no direct knowledge, all contribute to the tarnished image of our medical schools. Today every medical school is required to have a program in medical ethics. It is about time that these programs began to speak out about the ethics of the unholy alliance between the pharmaceutical industry and academic medicine. The result of this incestuous behavior is elevated healthcare costs through over prescribed drugs given to patients, often treating diseases that are not truly a disease. And the wealth and influence of these drug companies makes it difficult to sanitize their removal from our medical schools: but they are not yet in the DNA of these institutions. It will take some bleach though to get the stain out and the bleach needs to find ways to reduce costs and protect physician’s salaries from drastic erosion. If they all got paid a salary, this problem could be brought under control.  The universities need to stand up and assert themselves into fixing a problem that is badly in need of repair.

RFM

Almost discounted out of hand in many of the HuffPo articles on health, is evidence-based science and medicine: for many articles, the assumption is that traditional medicine  got it all wrong, or is covering up the truth in a kind of CIA-like conspiracy, probably involving the drug companies. A common theme on HuffPo is that vaccination causes autism; an example of an article promoting this view (though by no means the only one) was written by comedian/actor Jim Carrey, wherein he promotes the now disproven relationship between vaccination and autism. The Institute of Medicine of the National Academy of Sciences (NAS) reviewed the issue of vaccinations (mostly the MMR vaccine for measles-mumps and rubella) and autism very thoroughly in 2001 and 2004, with a separate 2001 study on the vaccine carrier thimerosal; this work strongly endorsed prior conclusions that no causal relationship existed between vaccination or the carrier thimerosal and autism. Another good summary, in addition to the NAS publications, about the lack of a relationship between vaccination and autism can be found here. Nevertheless, all recommended children’s vaccines are now available in thimerosal-free delivery systems [thimerosal is an organic mercury compound that is metabolized to ethylmercury and thiosalicylate; it was used beginning in the 1930s to protect vaccines from bacterial infection, but,  largely because of consumer complaints, it was removed from all required children's vaccines]. In February of this year, the U.S. Court of Claims (the “people’s Court”) ruled on an autism case by stating: “The evidence is weak, contradictory and unpersuasive,” concluded Special Master Denise Vowell. “Sadly, the petitioners in this litigation have been the victims of bad science conducted to support litigation rather than to advance medical and scientific understanding” of autism. In addition to the courts, The American Academy of Pediatrics, the Center for Disease Control (CDC), the World Health Organization (WHO), and the Institute of Medicine in the National Academy of Sciences (NAS) all agree that there is no demonstrable relationship between autism and vaccines. Does anyone believe that any or all of these organizations would form a conspiracy of obfuscation about vaccinations that would eventually have to come out if at all true? Vaccinations have been one of the great hallmarks of life-expectancy advancement throughout the world and if something is wrong with the procedure or its actions, these organizations would be the first to reveal it, not the last–it’s called evidence-based medicine and institutional self-survival.

So, why are people still pursuing the vaccine-autism connection? Although these aforementioned studies were thorough and disproved a relationship between vaccination and autism, the devastating nature of autism and the fact that there is no cure or recognized treatment available, means that parents with autistic children fall easy prey to extravagant claims and conspiracy theories that remain, despite all the evidence to the contrary, for a relationship between vaccination and autism. There are still physicians out there who continue to promote the vaccination connection, without heeding the extensive analysis that says otherwise. One outcome of the NAS studies was to call for a dramatic increase in funding for autism, as the lack of a robust research program has limited good, rational  theories from gaining foothold within the community of autistic victims and their families. In 2006, the Interagency Autism Coordinating Committee (IACC) was formed as a national government advisory panel to propose research strategies for ASD (ASD is the entire spectrum of autistic diseases and includes the milder form of autism known as Asperger’s).  Their home page can be viewed at this site; their recently released national plan for addressing ASD can be viewed at this website. The IACC is seeking input from the public, as the incidence of ASD has increased more than tenfold over the past decade. The main conclusion with respect to autism and thimerosal, is that the latter has been removed from children’s vaccines years ago (and earlier in other countries) but, tragically,  the rates of autism continue to rise at an alarming rate and no one knows why.

Many of the medical articles that appear in HuffPo use reasoning that reminds one of the ideological bias that is used to promote Creationism–they can’t let it go, no matter what the evidence or the arguments, despite the fact that evolution is not a theory, but an established fact. Indeed we probably know more about evolution than we do about the structure of the atom. At one level, all science is a theory, including I might add, the structure of the atom, for which our current level of uncertainty still awaits detection of important subatomic constituents, like the Higgs boson, before a better account of atomic structure can be accepted (and the dark matter of the universe perhaps partially resolved).  But, for devout Creationists, it would not be possible to prove that evolution, through natural selection, really did get humans to where they are today.  Medicine, like Creationism or Intelligent Design (two peas in the same pod), has always had its fringe deniers, those for whom a more intuitive grasp of illness and its causes leads to self-illumination on new theories and cures for medical diseases, while raising doubts about commonly accepted and proven explanations for them. America is still wild and her people still generate wild ideas. We are regularly inundated with a mistrust of science, such that it is not difficult to find diversionary support for just about any claims made under the banner of science and evidence-based medicine, the hallmark of which are concepts derived from reproducible observations.

Recent breakthroughs in the genetics of risk factors related to ASD increasingly support a genetic predisposition for autism and many investigators now refer to ASD as a heritable neuropsychiatric or neurodevelopmental disorder. Common genes suspected in ASD include those that form “cell-adhesion” molecules that are important in the development of the nervous system. It is the location and timing of appearance of such molecules that serve to guide neurons to make their complex and often distant connections with other regions of the brain. Abnormalities in cell-adhesion molecules can prevent normal brain connections from getting made, or generate neuronal connections that are abnormal. Although this work remains at a very early stage of recognition, the genetic data in so far suggests heritable risk factors, not a simple Mendelian form of transmission, so the question then becomes given the risk factors that are heritable, what other factors are required to trigger the onset of ASD? While preliminary, the new genetic data does serve to bring ASD into a much more contemporary focus, similar to what now exists for schizophrenia and bipolar disorders (the most current theory for schizophrenia and bipolar disorder is a deficiency in glutamate neurotransmission in the brain, mediated by NMDA receptors, causing “NMDA receptor hypofunction”). Shizophrenia also has heritable risk factors, some of which relate to NMDA receptor function. Science does best when it has an animal model to work with and the identification of risk factor genes will help focus work on how these genes work and how abnormalities in gene function can be corrected. Going down the autism-vaccination road has been a huge diversionary trip that could have been avoided in most countries other than America. The current theory that schizophrenia is related to hypofunction of synaptic glutamate receptors (NMDA receptors) required the combination of a single observation on humans with the disorder (low levels of D-serine in their cerebrospinal fluid), extensive basic science knowledge of glutamate receptors and animal models manipulated such that they show characteristics similar to those seen in schizophrenic patients, aided by a little extrapolation from mice and rats to humans.  An early clue was the drugs which tended to make people somewhat schizophrenic, such as “Angel Dust” (PCP) or MK-801, turned out to be antagonists to NMDA receptors. Despite this new direction for research into schizophrenia,  there is no cure for this disease, and the causal factors remain more than that of a single deficiency, with a likely genetic contribution for at least some forms of schizophrenia.

As contemporary medical doubters demonstrate a deep mistrust of modern medicine, they often follow a pattern of behavior that puts their own children at risk of serious illness, or worse, by denying them proven public health safety measures, such as vaccination. Furthermore, significant numbers of unvaccinated children create a public health hazard, escalating risk for every child, and unvaccinated adult in the community. But, in America, you can only wonder how many wild theories get started because so many of our citizens lack access to medical care? It’s one thing to decry fringe medical ideas, but quite another to acknowledge their origins as a result of limited access to modern medical procedures. Do these strange articles in the HuffPo, reflect the uninsured trying to access medical cures in the absence of a decent health care plan? Don’t physicians have a historic blame component for creating our current system of high profits for some and complete lack of health care for others? The NAS has estimated that more than 18,000 people die in America every year because they do not have access to health care and many experts believe this is an underestimate. Celebrated cases of these hard reality stories are now abundant in the news, but somehow Americans seem numb to this broken system that we call health care. Maybe that’s what the HuffPo articles reflect.

The confident state of ignorance displayed by the misinformed reminds me of the Civil War surgeons working on the wounded and carrying out one amputation after another in relatively quick succession. In those days, medicine in America was still mired in its primitive colonial practices, including that of blood-letting. The surgeons, who knew very little about aseptic techniques at the time, kept blood-stained aprons on through multiple operations, unaware that they served as a primary source of bacterial infestation which they passed on to their patients: disease-causing bacteria were unknown at the time, but the advantages of aseptic surgical practices were widely appreciated and applied in European medical centers at the time. The result of these barbaric colonial practices during the Civil War was to help generate the most costly war in our history in terms of human lives lost, yet the majority of soldiers that died, did so under the care of a physician many of whome died from the aseptic conditions of the surgical environment. Not until the American medical revolution began at Harvard University and later helped to establish the gold standard for American medical schools at Johns Hopkins University in the late 19th century, did American medicine begin to slowly extricate itself from the colonial practices that led to the medical disaster of the Civil War. Unfortunately, not everyone, including many of those writing on health issues at the HuffPo, got on board that train that led to the fusion of science and medicine. There are still people out there who need to get a ticket.

Other fringe ideas that have appeared in the HuffPo, include the concept that cancers are all caused by fungus infections created by the use of antibiotics. At times, it seems that because the “journal of medical pseudoscience” doesn’t yet exist, the HuffPo has substituted its website to feature bizarre articles on health, until the hoped-for journal gets underway. The result of these utterly strange articles on health and medicine, is to cast something of a pall on the objectivity of the entire HuffPo, and like a cancer, with or without fungus, the more articles you read on quack medicine and bizarre therapies from people with “star” names, such as Don Imus and Jim Carrey, the more you wonder about the objectivity of other articles on more political issues, for which the blog is well respected, or at least read. The progressives I know and respect also have a healthy understanding for the importance of science and the critical role that the concept of reproducibility has had on the advancement of our culture, technology and medicine. Without science, the industrial revolution would have us choking in its fumes, with a shortened lifespan and a higher level of shared human misery. So detracting from evidence-based medicine principals and promoting fringe medical ideas through publicly well-known figures doesn’t really help anyone and promoting diversionary ideas certainly doesn’t advance the drive to find the cause for our major health problems of today. Autism is almost surely a disorder that involves heritable, developmental mechanisms of the human nervous system and these kinds of issues are among the most challenging that we face, primarily because we are still in a period of flourishing new discoveries about development of the brain and the neurochemical and environmental mechanisms that determine brain connectivity and normal development. At least a few more Nobel Prizes will be awarded before we understand human brain development and its relationship to human diseases such as autism. Confounding issues like this, is the very real possibility that man-made chemical contamination of the environment could be responsible some of the developmentally related disorders that we see so much of in our society today. In that sense, the idea that something like a vaccination that could trigger an autoimmune response is perfectly rational, but it’s one that has been disproven. Time to move on.

To give another example of the quackery found on HuffPo, you can check out the article by Kim Evans entitled “Swine Flu: Protect Yourself and Loved Ones.” In this incredulous article, Evans suggests that cleansing your bowel with enemas is the way to get rid of excess bacteria and protect yourself from the flu. She even goes so far to say that those who went through the 1918 flu epidemic using enemas had better survival outcomes than those who received the vaccine. This is especially interesting when you consider that vaccines were not developed for the 1918 flu epidemic and that the disease was transmitted by aerosol. Is there anyone at HuffPost who vets these articles or should this article cast a pall on the HuffPo in general? Information is valuable, but misinformation out of ignorance is inexcusable. Fortunately, others have responded to the bogus medical ideas frequently found in  the HuffPost and the Science-Based Medicine site has articles challenging the HuffPo quackery written by Steven Novella and David Gorski. It seems that HuffPo is increasingly known for its misinformation on medical issues and personal health. This is not to say however that American medicine gets a completely free pass for its performance on issues of health care. Physicians in general, but especially those belonging to the AMA, must be given a big lion’s share of the health insurance crisis we find ourselves in today. From the get-go, going all the way back to FDR’s administration, the AMA was successful in fending off national health insurance plans, by labeling them “socialized medicine,” a term still used as a rallying cry to the doubting Republicans. Harry Truman had hoped to make a national health insurance plan the signature of his domestic program, but with the rising tide of anticommunism (which he himself helped put in motion), the label of “socialized medicine” killed the program, which only resurfaced in the form of Medicare and Medicaid, nearly twenty years later. Had physicians endorsed a national health insurance plan out of their commitment to the social good, they would be better off financially today, than many of them are, especially those living under the medical tyranny of for-profit health insurance companies. That’s why some doctors consider an MBA to be an essential, secondary degree. The profits in medicine these days are made at the top, while there is a modern form of enslavement at the bottom, where many doctors and nurses work.  If you want to get rich as a medical doctor, you still stand a chance by going into surgery and practicing in a southern state.

RFM

I.F. Stone

This past June 18th was the 20th anniversary of the death I.F. Stone (1907-1989), muckraker extraordinaire.  In recognition of the date, Amy Goodman interviewed D.D. Guttenplan on Democracy Now radio: he is the author of  “American Radical: The Life and Times of I.F. Stone.” If you wanted to nominate any single writer for journalistic integrity, in my book, I.F. Stone would be the gold standard. I first encountered I.F. Stone in the 1960s, when I discovered his little publication gem the “I.F. Stone’s Weekly.” I promptly subscribed and continued my subscription for several years until he folded the publication in 1971. In that year, I remember receiving an envelope in the mail, with a note signed by I.F. Stone thanking me for my subscription and giving me a cash refund, which conformed to the penny, what he had calculated to be the value of the remaining  portion  of my subscription. It must have taken him some effort to personally write notes like that, since his Weekly had grown to a readership of 70,000 and was basically a one man operation. For a relatively small   fee, you could subscribe to Stone’s weekly publication and learn things about our government and international events that you would not hear about from any other source, or if you did, it would often be the case that the source you heard it from would have been jostled into pursuing a story because of hearing about it first from Stone. There was really no one like him. Unfortunately for us, Stone lived before his truly needed time, as we find ourselves desperate for someone of his caliber today in the face of corporate-controlled news centers, all for reasons that he never would have imagined during the prime of his journalism career. Insider journalists considered Stone to be one of their key sources in tracing down stories, but also setting the journalistic agenda and the once high standards of news reporting.  But,  It wasn’t always flashy and never came in the form of a single sound bite.  It was Stone’s  belief that governments lie, but in doing so, they leave behind the damning evidence in their own publications–a clear paper trail–it’s up to you to find it.  In the case of the U.S. Government, government documents from many different sources could be scrutinized for the nuggets of information that would disprove what the government was trying to put out as the reasons for its actions. His advice was to begin reading government documents backwards, going to the index first.

I.F. Stone's Weekly

I have commented on how we created a false enemy to keep our military complex intact at the end of WW II, create U.S. hegemony over the rest of the world and began marching down the road of a series of major Folly Compounding misadventures, with a philosophy of “military empire” that still grips our government and a sizable portion  of our economy.  That misstep took place because Truman was a hardliner on foreign policy and unraveled many of the plans and ideas that FDR had expressed for the post-war recovery period, particularly with respect to Russia. That shift in policy towards a hard line position made it inevitable, that when the French lost the battle at Dien Bien Phu in 1954, and had to abandon their colonial ambitions in Vietnam, we would step in to replace the French, using an anticommunist rhetoric, initially claiming that the Vietcong got their funding and military support  from the Russians and Chinese. Our national propaganda was to adopt the “domino theory” to fend off the advancing wave of communism. If South Vietnam fell to the communists, all of Southeast Asia would be lost. One of the earliest challenges to this idea was brought to national attention by I.F. Stone. He scoured through government documents related to captured weapons and, using the hard data in those documents, showed that the majority of Vietcong weapons that had been captured in South Vietnam, were manufactured in the U.S. and other Western countries, meaning that they were obtained from the South Vietnamese that we were training and equipping at the time. The Vietcong got their weapons from the South Vietnamese, not Russia or China. Because of that kind of evidence, Johnson had to invent the Gulf of Tonkin episode (which never took place) and blame the North Vietnamese for interfering with U.S. policies, using that fictitious event to escalate the war in South Vietnam. I.F. Stone was a major force in getting the anti-Vietnam War protesters focused on some of the important lies that the U.S. government was using to start and keep us in that disastrous war. I always had the feeling that by reading Stone’s weekly publication, I was a member of the “most informed club.” It was that simple. It was like his Weekly came with a prepaid veracity stamp on it. If his weekly was still published, it might amount to the only print publication available in which hard-nosed, independent news reporting was available to us.

Through his weekly publication and other sources, Stone lived through and wrote about the depression, WW II, the birth of Israel, the Cold War, Zionism, McCarthyism, the Cuban Missile crisis, the Vietnam War, Civil Rights and multiple presidencies. He was a prescient force on almost everything he wrote about. Stone  was blacklisted from television as a commentator for asking questions that were too tough when he participated in one of the first episodes of “Meet the Press.” A single episode that got him thrown off and removed from television is described by D.D.  Guttenplan on Amy Goodman’s show, from which I quote below:

” And on this particular morning, the person he was battling with was a guy called Dr. Morris Fishbein. Now, in the ’40s, Morris Fishbein was the most famous doctor in America. He was the editor of The Journal of the American Medical Association, and he was the person that the medical and pharmaceutical industries put up to oppose socialized medicine, or national health or a national health insurance. He was the person who coined the phrase “socialized medicine” as a means of discrediting national health insurance [Truman supported a National Health Insurance Act].

Fishbein had described the proposals for national health insurance as a step on the road to communism. And so, Stone said to him, “Dr. Fishbein, given that President Truman has already spoken out in favor of national health insurance, do you think that that makes him a dangerous communist or just a deluded fellow traveler?” You know, and it’s familiar, isn’t it? And—” Stone was blacklisted for 18 years from television for his remarks and interview with Fishbein.”

I. F. Stone was a Jeffersonian Marxist. By that one means that he believed in Jefferson’s statement that he would rather live in a society without government but with a free press than live in a society in which there was a government but no free press. Thank about that–a Marxist state with a free press. That’s never been tried before and is probably possible only within a subset of our current population–a rather small subset. Stone believed in common social goals and aspirations. He loved the FDR period and contributed writings to promote the implementation of the New Deal (he wrote a book for FDR explaining how the courts were denying the New Deal legislation to go through and criticizing them for it, though he was not in favor of stacking the court, as FDR tried to do). Izzy Stone applauded the New Deal era in which the pursuit of social justice had become a political objective and he would have spoken out vociferously against the erosion of those ideals through Reaganomics and beyond. He was also a visionary who saw conflicts in terms of their human, social impact and not the geopolitical forces that created them. He visited the Middle East right after WW II and was in favor of a home for the displaced European Jews, but he believed that the best possible solution for the region was a state in which governance was shared between the Palestinians and the Jews. Where would we be today in the Middle East  if that formula had been implemented?

I.F. Stone has a website where you can read and download one of his Weekly publications. His biography, written by D.D. Guttenplan has moved to the top of my long reading list. In a 2000 poll of journalists, when asked what were the top 100 most influential publications of the 20th Century, I.F. Stone’s Weekly was ranked 16th. Not bad for a publication that he basically put out himself. Last year, the Nieman Foundation at Harvard University announced plans to award an annual “I.F. Stone Medal for Journalistic Independence,” designed to stimulate a resurgence of independent journalism, something desperately lacking in our nation. I don’t think blogging alone can get it done.
RFM