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![Permalink for '[This Week in Medicine] January 28–February 3, 2012'](/themes/lilina/web//media/mark_off.gif)
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At the end of 2011, China's urban population overtook its rural population for the first time. The National Bureau of Statistics reports that 51·3% of the country's 1·35 billion people now live in cities. For an economy at China's stage of development, this ratio is still low, possibly due to past constraints on free movement.
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In this week's Perspectives section, Hilary and Steven Rose describe the moving film Playing Against Time. This film describes the life and music of Barbara Thompson, a jazz saxophonist, and her efforts to continue with her music despite the diagnosis of Parkinson's disease in 1996, including her struggle to obtain care and treatment. The diagnosis of a neurological disorder, such as Parkinson's disease, multiple sclerosis, or motor neuron disease, is a devastating one. Not only is there no cure—treatment will at best delay progression—there is also the predicament of a continuing decline in health, functioning, and quality of life, and a long-term reliance on professionals within the health and social care system.
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In an episode of the science fiction series Star Trek: Deep Space Nine, a trio of capitalist aliens find themselves thrown back in time to 1947. They are overjoyed to discover human beings—including medical staff—smoking tobacco. “If they'll buy poison, they'll buy anything!” cackles one of the protagonists, smelling a profit.
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“Academic publishers have become the enemies of science.” So wrote Dr Mike Taylor, a scientist at the UK's University of Bristol. He, and many scientists like him, are angry that publishers are supporting the Research Works Act (RWA), a controversial Bill before the US Congress.
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Leaders from international agencies, including WHO and the World Bank, charities, and pharmaceutical companies, together with politicians from donor and recipient countries, will meet in London on Jan 30, 2012, to pledge increased support and collaboration for the control of neglected tropical diseases (NTDs). A London Declaration from this meeting will mark an expanded vision from WHO for the elimination of some NTDs and improved implementation of control efforts for other NTDs by 2020.
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Although adjuvant therapy for gastric cancer is known to improve prognosis, controversies remain about the choice of chemotherapeutic regimens, the use of radiation therapy, and the selection of patients who are likely to benefit from different therapies. Adjuvant therapy is used to eradicate potential micrometastases after curative surgery and, therefore, therapeutic strategies vary dependent on anticipated locoregional disease control after surgery, and by institution and country. It seems reasonable to apply adjuvant chemoradiotherapy, providing a combination of radiation therapy for local control and chemotherapy to achieve systemic control and radiosensitisation, to patients with less locoregional control; and systemic adjuvant chemotherapy to those with greater local control after surgery.
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Vitamin K antagonists have been successfully used for more than 50 years as oral anticoagulant drugs in patients at risk of venous or arterial thromboembolism. Because of a narrow therapeutic window and an unpredictable dose response, regular laboratory monitoring is mandatory. A strong association exists between the intensity of anticoagulation and adverse clinical events, with an increased thrombotic risk at an international normalised ratio (INR) of less than 2·0 and an enhanced risk of bleeding when the INR exceeds 4·0.
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Lysosomal storage disorders are a diverse group of more than 50 serious, progressive diseases. Until recently, treatment was symptomatic with the expected outcomes of great disability and premature death. Improvements in bone-marrow transplantation and development of recombinant enzyme replacement therapies for some of these disorders have raised the expectation that neonatal screening could enable early treatment before irreversible damage occurs. The greatly improved early outcomes of infants treated soon after birth following identification through the Taiwanese Pompe's disease screening programme add support to this contention, but long-term data are not yet available.
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Yaws—an infectious disease caused by Treponema pallidum subsp pertenue—affects children and adults in poor rural communities in tropical countries, causing disfiguring lesions of the skin and bones. The yaws elimination programme coordinated by WHO in the 1950s and 1960s screened more than 160 million people, treated more than 50 million people with intramuscular injections of benzathine benzylpenicillin, and reduced the prevalence of yaws by more than 95%; however, yaws was not eliminated. This disease is now re-emerging (largely unnoticed) in parts of Africa, southeast Asia, and the Pacific islands.
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We invite you to submit your best research in respiratory medicine for our annual respiratory theme issue, which will be published to coincide with the 2012 European Respiratory Society (ERS) conference in Vienna, Austria on Sept 1–5.
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Every 5 years in Britain, a gargantuan exercise in judging the performance of our research-based universities takes place. The Higher Education Funding Council of England (HEFCE), for example, will spend £1·6 billion in 2011–12 on research in English universities. (A friend of mine in Italy almost choked on his cappuccino when I told him this figure.) But how should HEFCE, and similar bodies in Wales, Scotland, and Northern Ireland, judge who gets what? In the past, institutions have competed in a Research Assessment Exercise.
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While the cause of nodding syndrome in Africa continues to perplex scientists, they are hoping to soon unravel one mystery: which treatments the disease might respond to. John Donnelly reports.
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The long-running dispute over patents for the BRCA1 and BRCA2 genes granted to Myriad Genetics may finally be laid to rest by the US Supreme Court. Sharmila Devi reports.
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Safety flags for Boehringer Ingelheim's antiblood clotting agent dabigatran serve as a reminder about the risks of rapidly adopting newly approved drugs. Asher Mullard reports.
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The Greek Government's austerity drive has inadvertently triggered problems with the country's drug supply, causing shortages of hundreds of medicines. Eva Karamanoli reports from Athens.
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The Wellcome Trust has a long track record of fostering science-art collaborations, but Playing Against Time must be one of the best. It focuses on the life and music of Barbara Thompson, one of Europe's finest jazz saxophonists, who in 1996 was diagnosed with Parkinson's disease. Since then she has continued composing and performing with the constant support of her partner, jazz/rock drummer Jon Hiseman. Film maker Mike Dibb describes Playing Against Time as “a film about Parkinson's disease seen through the prism of music”, and central to his film is Barbara and Jon's collaboration as wife and husband, patient and carer, saxophonist and drummer.
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To the world at large, the late Joseph Rotblat is known as the Polish-born, British-based, scientist who worked on the Manhattan Project to build the atomic bomb, and for the rest of his life campaigned for the abolition of nuclear weapons. He, and the unofficial federation of European, American, Soviet, and other scientists that he founded, known as Pugwash, were jointly awarded the Nobel Peace Prize in 1995. To physicians, Rotblat is also known as a physicist who specialised in understanding the effects on living tissue of radiation and radioactive fallout and in developing nuclear medicine, through his long-held professorship of physics at St Bartholomew's Hospital in London.
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[Perspectives] Ndola Prata: fighting for women's reproductive health
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“O that moral science were in as fair a way of improvement, that men would cease to be wolves to one another, and that human beings would at length learn what they now improperly call humanity!”Benjamin Franklin, 1780
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Multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis have become an important health problem in many countries of the WHO European region and currently threaten global efforts to control tuberculosis. The highest rates occur predominantly in eastern Europe; however, population movement means that drug-resistant tuberculosis is a priority public health issue for all European countries.
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Efforts to find the “real Shakespeare” are fraught with pitfalls. Although ample documentation exists about his business dealings, evidence of the man's inner psychological processes—unfiltered through plays or poetry—is non-existent. Attempts to address the private life of Shakespeare often result in the critic projecting his or her own preoccupations onto the Bard and his works. A case in point is Sigmund Freud's insistence that Hamlet represented Shakespeare's reaction to the death of his father.
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[Obituary] Robert Ader
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While WHO undergoes a wide-ranging reform sparked by a US$300 million budget shortfall, the agency is facing an exodus of qualified staff that is affecting its ability to work. The Executive Board is due to meet on Jan 16 to agree long-term principles and priorities for the organisation; it must ensure, in particular, that core functions are accorded the priority they merit. Oxfam is especially concerned that inadequate funding will severely diminish the WHO Essential Medicines Department, which for more than three decades has had an indispensable role in enabling developing countries to access affordable medicines.
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Andrew Ewer and colleagues (Aug 27, p 785) claim that their testing protocol has superior sensitivity to that advocated by de-Wahl Granelli and colleagues. This claim is incorrect for several reasons.
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The PulseOx study reports on oximetry as a screening test for critical and severe congenital heart disease. It concludes that oximetry adds value to existing screening. These results will inform decision makers about national screening recommendations.
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Although I agree that pulse oximetry is useful as an important vital sign monitor soon after birth, I have doubt in its value as a screening instrument for identifying congenital heart disease.
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Differences in results between de-Wahl Granelli and colleagues' study and ours are likely to have arisen because of antenatal screening and timing of pulse oximetry. Detection of critical congenital heart disease by antenatal ultrasound is very variable: we detected 50% of cases of critical congenital heart disease antenatally compared with only 3% in de-Wahl Granelli and colleagues' study. Detection rates of between 15% and 50% have been reported among UK health regions. We noted a lower incremental value of pulse oximetry than did de-Wahl Granelli and colleagues, almost certainly because many more cases were identified by antenatal screening in our study hospitals.
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Although of interest and hypothesis-generating, the MESA report by Michael Blaha and colleagues (Aug 20, p 684) is not a randomised trial and thus it is impossible to conclude that coronary artery calcification can be used to target patients who “derive the most and the least absolute benefit from statin therapy”.
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The paper by Michael Blaha and colleagues adds to the debate on cardiovascular risk assessment by suggesting that coronary artery calcium could (1) further risk-stratify individuals eligible for the JUPITER trial, (2) be useful to target subgroups of patients for prevention, and (3) be better than high-sensitivity C-reactive protein (hsCRP) alone. Such claims, however, can hardly be solely based on effect sizes for the association of coronary artery calcium with cardiovascular outcomes.
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Paul Ridker questions the ability of coronary artery calcium to identify appropriate patients for statin therapy. However, his implication that increased coronary artery calcium is a marker for poor response to statins is not supported by the available data.
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Intensive risk-factor control did not significantly reduce cardiovascular risk in people screened positive for diabetes in the ADDITION-Europe trial (July 9, p 156). Although the study might have been too small or too brief to show such an effect, the corollary is that absolute benefit is likely to be quite small. Were the benefit significant, it would have required screening of 1829 people, and treatment of 78 screen-positive ones, for 5·3 years to prevent one cardiovascular event.
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ADDITION-Europe is not a trial of screening for diabetes. We reviewed the evidence for screening and identified the key uncertainties: the effect of early treatment in the lead time after detection by screening and the harms associated with screening. ADDITION-Europe addressed the effect of early treatment. Inclusion of a no-screening control group in one centre enabled us to add to the growing evidence of minimal harms associated with screening. A diagnosis of diabetes certainly has adverse consequences, which are brought forward by screening.
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The need to establish quantitative and qualitative indices of scientific production by a researcher or institution is hotly debated. Worldwide, the impact factor and H-index are regarded as the best available. However, the question might arise: is an article written to be cited or to be read?
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Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet 2012; 379: 361–72—In this Seminar (Jan 28), an affiliation was missing for Sarah Garner. The affiliation should be “The Commonwealth Fund, New York, NY, USA”. This correction has been made to the online version as of Jan 27, 2012, and to the printed Seminar.
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The Correspondence letter by Eloi Marijon and others (Aug 20, p 662) chastises the drug regulation authorities in Europe for the slowness of their assessment processes in the approval of new antithrombotic drugs for use in atrial fibrillation. They claim that the ROCKET-AF and RE-LY studies have shown these new drugs to be superior to vitamin K antagonists. Marijon and colleagues then go on to extrapolate the claimed advantages to the European population with atrial fibrillation and calculate the number of strokes that might have been saved by earlier introduction of these drugs.
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We thank Sarah Bell and colleagues for reinforcing the point that approval processes should be optimised, in terms of delay, without decreasing the rigour of these processes.
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David Holmes's Profile (Oct 22, p 1455) quoted Steve Wesselingh, the dean of Monash University, Melbourne, VIC, Australia, as stating: “academic institutions have an enormous amount of expertise and knowledge, but rarely are they engaged in the process of health and social policy”. The inaugural Inter Academy Medical Panel (IAMP) Young Physician Leaders (YPL) programme held during the third World Health Summit in Berlin, Germany, attempted to address this deficit. IAMP sent out a global call for nominations for physicians aged 40 years or younger with demonstrated leadership skills in medicine or public health, and 22 participants were chosen, representing 18 countries—low-income, middle-income, and high-income—and diverse physician specialties.
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In your Editorial (Oct 1, p 1198), you rightly stress five reasons to ensure continued financing for the Global Fund as it undergoes necessary reforms. However, there is another compelling, often unremarked, reason to further support the Global Fund: the organisation accelerates the availability of better health products at better prices to developing countries, generating a global public good that maximises the value for money achieved by all global health donors.
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Adjuvant capecitabine plus oxaliplatin treatment after curative D2 gastrectomy should be considered as a treatment option for patients with operable gastric cancer.
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Our analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up.
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The combined overall proportion of infants carrying a mutation for lysosomal storage disorders was higher than expected. Neonatal screening for lysosomal storage disorders is likely to raise challenges for primary health-care providers. Furthermore, the high frequency of late-onset mutations makes lysosomal storage disorders a broad health problem beyond childhood.
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A single oral dose of azithromycin is non-inferior to benzathine benzylpenicillin and avoids the need for injection equipment and medically trained personnel. A change to the simpler azithromycin treatment regimen could enable yaws elimination through mass drug administration programmes.
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Cryoglobulins are immunoglobulins that precipitate in vitro at temperatures less than 37°C and produce organ damage through two main pathways: vascular sludging (hyperviscosity syndrome, mainly in type I cryoglobulinaemia) and immune-mediated mechanisms (principally vasculitis, in mixed cryoglobulinaemia). Cryoglobulinaemia is associated with many illnesses, which can be broadly grouped into infections, autoimmune disorders, and malignancies; the most common cause is infection with hepatitis C virus.
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Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven.
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Thalassaemia is one of the most common genetic diseases worldwide, with at least 60 000 severely affected individuals born every year. Individuals originating from tropical and subtropical regions are most at risk. Disorders of haemoglobin synthesis (thalassaemia) and structure (eg, sickle-cell disease) were among the first molecular diseases to be identified, and have been investigated and characterised in detail over the past 40 years. Nevertheless, treatment of thalassaemia is still largely dependent on supportive care with blood transfusion and iron chelation.
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In October, 2010, a 55-year-old woman was admitted to our department for investigation of recurrent ascites. She had a medical history of adult polycystic kidney disease with hepatic cysts. 9 months earlier, she had started peritoneal dialysis, which was changed to haemodialysis after 5 months because of poor catheter flows and underdialysis. Subsequently, she developed ascites which required frequent drainage. The fluid was borderline for transudate or exudate with no malignant cells and was initially attributed to peritoneal irritation from her dialysis catheter.
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Science
Locust Heaven | Natural Selection Caught in the Act | Potassium Permeation | Porous Membranes | Boxing in Peroxide | Centrosome Center Stage? | Magnetic Moon | Forest Diversification | A Good Judge of Distance | A Passive Optical Diode | Prion Problem | Antigen Polarity in B Cell Differentiation
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Applied Physics: Listening In by Nanoparticle | Structural Biology: A Fuzzy Fit | Immunology: Neutrophils Lend a Hand | Climate Science: Whence the Little Ice Age? | Psychology: Us vs. Them in Context | Microbiology: Full Sequence Ahead | Plant Sciences: A Cactus by Any Other Name
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Signature of Senescence | Embryonic Stem Cells for Eye Disease Appear Safe
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Author: Bruce Alberts
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In science news around the world this week, outbreaks of H5N1 continue in poultry in south and southeast Asia—and the human death toll mounts; the University of Tokyo plans to shift the start of its school year from April to autumn; researchers are looking for signs of life in the Tissint meteorites; the Natural History Museum in London is under fire for its scientific cooperation with an Israeli company that conducts research in the occupied West Bank; Marco Antônio Raupp will become Brazil's new minister of science, technology, and innovation; and NASA's twin moon orbiters were officially christened Ebb and Flow.
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Peerage of Science, an online social network founded by three Finnish ecologists, aims to provide journals with already-peer-reviewed manuscripts. And this week's numbers quantify NIH grant success rates and the number of bats that have died from white nose syndrome.
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This week's Newsmakers are Terence Tao of the University of California, Los Angeles (UCLA), and Jean Bourgain of the Institute for Advanced Study, winners of the Crafoord Prize in mathematics; Reinhard Genzel of the Max Planck Institute for Extraterrestrial Physics and Andrea Ghez of UCLA, who will claim the prize for astronomy; and Cristián Samper, who in August will become the president and CEO of the Wildlife Conservation Society.
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Amid a growing global controversy over the potential dangers of experiments involving the H5N1 avian influenza virus, a group of leading influenza researchers last week agreed to a 60-day moratorium on some sensitive flu studies.
Author: David Malakoff
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Science talked to Ron Fouchier of Erasmus MC in Rotterdam, the Netherlands, who carried out one of the two controversial H5N1 avian influenza studies that triggered the international debate.
Author: Martin Enserink
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As a result of widespread migration, rising inequality, and evolving sexual mores, China now holds the dubious title of the nation with the largest increase in reported syphilis cases in the penicillin era.
Author: Mara Hvistendahl
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Last week, astronomers gathered to work out a plan to combine data from radio telescopes worldwide and create, in effect, a dish the size of Earth that will be able to peer into our galaxy's heart.
Author: Daniel Clery
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A $500 million upgrade planned for early next decade would enable the Relativistic Heavy Ion Collider to answer a key puzzle about the proton itself—if RHIC doesn't fall victim to budget cuts.
Author: Adrian Cho
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Scientists hope the next generation of supercomputers will carry out a million trillion operations per second. But first they must change the way the machines are built and run.
Author: Robert F. Service
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Deep beneath the central United States, researchers find signs of buried faults that have triggered earthquakes in the past—and may still be kicking.
Author: Naomi Lubick
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The venerable Center for Advanced Study in the Behavioral Sciences has been trying to reinvent itself by applying behavioral science to 21st century problems.
Author: Greg Miller
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Authors: Ron A. M. Fouchier, Adolfo García-Sastre, Yoshihiro Kawaoka, Wendy S. Barclay, Nicole M. Bouvier, Ian H. Brown, Ilaria Capua, Hualan Chen, Richard W. Compans, Robert B. Couch, Nancy J. Cox, Peter C. Doherty, Ruben O. Donis, Heinz Feldmann, Yi Guan, Jaqueline Katz, H. D. Klenk, Gary Kobinger, Jinhua Liu, Xiufan Liu, Anice Lowen, Thomas C. Mettenleiter, Albert D. M. E. Osterhaus, Peter Palese, J. S. Malik Peiris, Daniel R. Perez, Jürgen A. Richt, Stacey Schultz-Cherry, John Steel, Kanta Subbarao, David E. Swayne, Toru Takimoto, Masato Tashiro, Jeffery K. Taubenberger, Paul G. Thomas, Ralph A. Tripp, Terrence M. Tumpey, Richard J. Webby, Robert G. Webster
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[Correction] Corrections and Clarifications
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Authors: Gerald Schwank, Schu-Fee Yang, Simon Restrepo, Konrad Basler
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Authors: Ortrud Wartlick, Peer Mumcu, Frank Jülicher, Marcos Gonzalez-Gaitan
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Author: William Joseph Rosenberg
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Author: Nuno C. Santos
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Drawing on their own primary research, Hunt and Lipo argue that Easter Island's population did not collapse from human exploitation of the environment.
Author: Robin Torrence
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Combining historical and ethnographic perspectives, Silverman explores the various ways in which researchers, practitioners, and activists have interpreted and responded to autism.
Author: Beth Ann Malow
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Science
A
listing of books received at
Science during the week ending 20 January 2012.
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We need a more nuanced debate on how prices and policies affect food security; neither high nor low prices are panaceas.
Authors: Johan Swinnen, Pasquamaria Squicciarini
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Science
The asymmetric distribution of antigen during B cell division affects the fate of B cells and their function.
Authors: Michael L. Dustin, Michael Meyer-Hermann
Nature (4968 unread)
Cell
(840 unread)Genes Development (386 unread)
Developmental Dynamics (811 unread)
Mech Dev (227 unread)
EMBO J (688 unread)
PNAS (6382 unread)
JCB (674 unread)
MCB (653 unread)
Genetics (553 unread)
Science News (1486 unread)
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