It’s fair to say that vaccines haven’t had the best few years in terms of PR. The “anti-vax” movement of parents suspicious about potential side effects of childhood vaccines has grown in strength, despite numerous studies proving their fears to be foundless. Certain high-profile diseases, such as HIV, have repeatedly proven resistant to traditional vaccine approaches. Meanwhile, vaccines suffer somewhat from their own incredible success - with many of the diseases that once caused rampant child mortality now under control or eradicated, one might think that the tool has maxed out its potential.

But two talks on Wednesday at the University of Chicago suggested that the age of vaccines is far from over. A revolution in the scientific approach to creating vaccines has begun to yield promising new strategies for controlling previously stubborn diseases, such as meningococcus and MRSA. Those advances have also made vaccines safer than ever, eliminating even the small risk inherent in the vaccines used early in the 20th century. As scientists move on to tackling diseases of adolescence, adulthood and developing countries, the ability of vaccines to change the world is only growing, said Rino Rappuoli, global head of vaccines research at Novartis Vaccines and Diagnostics.

“Most people say the last century of vaccines has been very positive: they eliminated polio, they eliminated diptheria and tetanus - what are you going to now, are you out of a job?,” said Rappuoli, who delivered the 2010 George & Marie Andros Lecture.  “But I believe, in the 21st century, vaccines are going to be as important, and maybe more important, than they were in the 20th century.”

Until the late 1970’s, Rappuoli said, the strategy for creating new vaccines was largely the same as the approach developed by Louis Pasteur nearly one hundred years prior: Isolate, Inactivate, Inject. Pasteur learned that exposing a person to a non-toxic version of a disease-causing bacterium or virus sensitized their immune system, such that subsequent exposures to the true pathogen were fought off. That strategy led to vaccines for smallpox, measles, diptheria, mumps, polio and many other diseases that were once a scourge upon young children.

Nevertheless, several diseases remained unpreventable with this traditional vaccine approach, frustrating the field. Then, like many other scientific areas, new hope arrived in the form of genomics, which made a new form of vaccine research possible, Rappuoli said. With genomics, scientists developed reverse vaccinology, the process of sequencing a bacterial or viral genome to find components of the pathogen that are promising as “protective antigens” in a vaccine. Rappuoli discussed the first success of this method - the creation of a vaccine for meningococcus, which was given to all children under the age of 18 in the UK in 2000.

“The genome approach and the biology approach combine together and very frequently can bring you to a new, potential vaccine,” Rappuoli said. “These things were not possible before the genome. It would have taken one scientist a lifetime to develop.”

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Eric Goren and Eric Whitaker at Bloomberg Health & America Briefing (photo by John Zich)

If there’s anything clear about health care reform, it’s that it’s unclear. Over the last 15 months, what has mostly been heard has been the two loudest sides, as political supporters and enemies of the health care policy changes under debate in Washington state their views frequently, at maximum volume. But the landmark reform legislation signed by President Obama in late March is expected to cause ripples in many worlds, both in the health care industry and beyond. The rules for doctors, patients, hospitals and medical schools will certainly change, but so too will the effects be felt in the financial sector, the 2010 elections and the technology industry. As such, the health care reform bill is kind of an amorphous entity, one that takes on totally different shapes depending on one’s professional perspective, political beliefs, and educational background.

Getting a read on all the ramifications of reform is an ambitious project, and the Health & America Briefing, organized by the Bloomberg news organization and the University of Chicago Medical Center on Tuesday, was suitably epic in its scope. Drawing upon dozens of experts from all corners of the country and all sectors of the economy, the event at the downtown Gleacher Center employed interviews and panel discussions to try to circumscribe the enormous changes the health care reforms are expected to cause. Some voiced optimism, some voiced concern, and the entire chorus only agreed on one thing: no one can predict the ultimate impact of what some called the most significant legislation of the last 50 years.

The most optimistic view was presented, logically, by one of the health care reform bill’s lead architects. Ezekiel Emanuel, special advisor on health policy in the Obama administration, led off the conference in a one-on-one chat with Bloomberg News’ Washington editor, Al Hunt, and called the bill “the most complex piece of social legislation America has ever tried.” Emanuel, while slightly less strident than his younger brother, White House Chief of Staff Rahm Emanuel, was still demonstrative in his defense of the bill, which he said would still cause sweeping improvements despite the necessary compromises it required to pass through a divided Congress.

Reaching beyond the insurance extensions that have gotten most of the ink, Emanuel pointed to several measures he thinks will dramatically restructure American medicine: an independent federal cost-control commission, improvements in health care technology, and added incentives for doctors to practice primary care. The hope, Emanuel said, is that the health care system can learn from small successes in improving care and bring those lessons to a wider population.

“You see pockets almost everywhere in the country with fantastic practices, and the issue…is scaling them,” Emanuel said. “I think that over the next five years may be our biggest project, is can we scale the good things that the health care system does: the efficient things, the high quality things.”

One place where Emanuel allowed a modicum of defeat was in the arena of end-of-life care: the massive expenditures accrued by medical interventions in terminal patients. While more than a quarter of Medicare dollars (and 10 percent of health care costs overall) are spent on end-of-life care, “no one is satisfied by it,” Emanuel said. Efforts to change how that process is handled by doctors and patients were demonized during the legislative debate as “death panels.”

“We have to do better,” Emanuel lamented. “It was a sad loss for the entire country.”

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flickr photo by fourstuarts

Last week was Earth Day, and panels, celebrations and events were held all across the University of Chicago campus. On the Medical Center side of campus, I attended a talk that wasn’t technically a part of the Earth Day blitz, but which nevertheless offered an elegant environmental solution applying the latest genetic tools to a farming trick almost as old as agriculture itself.

For thousands of years, farmers have employed crop rotation to keep their soil from being depleted of essential nutrients, particularly nitrogen. One group of plants long known to be particularly useful for this function are the legumes, such as peanuts, alfalfa, blue bonnets (pictured at right), or soybeans. As Sharon Long, professor of biological sciences at Stanford University explained in a lecture last week, the nitrogen-fixing talent of legumes lies in a strange partnership between the plants and bacteria - a symbiotic relationship that essentially creates tumors on the plant’s roots.

This fascinating symbiosis is the focus of Long’s research, which she presented in the 5th annual Margot and Robert Haselkorn Visiting Lectureship. Robert Haselkorn, a professor of biochemistry and genetics at the University of Chicago, studies bacteria with the ability to fix nitrogen - the process of converting nitrogen into bioavailable ammonia. So Long was a logical invite, as she has dedicated her work to decoding the genes and signals that allow legumes to be nature’s soil saviors.

The environmental aspect comes in with how most modern farms replenish the nitrogen in their soil: fertilizer. To create artificial fertilizer requires extreme heat, which is typically generated with fossil fuels. Besides gobbling up a dwindling natural resource (3-5 percent of natural gas goes to fertilizer manufacture), the process also makes fertilizer prices sensitive to fluctuations in fossil fuel prices. That can lead to food shortages, Long said, as the price of fertilizer becomes too much for farmers in poorer countries to purchase and use, leading to nutrient-depleted soil.

However, legumes offer a potential natural answer to that problem, Long said. When particular species of bacteria infect the plants, they form “root nodules” - tumorous growths that enable the bacteria to harness the plant’s photosynthetic energy for the fixation of nitrogen.

“Nitrogen fixation cannot be carried out by any eukaryote; only bacteria can,” Long said. “It’s not an accident that so many legumes have big, fat, whopping, protein-rich seeds. It’s because for legumes, nitrogen is not a problem, and that’s due to this symbiosis.”

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Dr. Tanguy Seiwert at the 15th Annual Phase II Symposium (photo by David Christopher)

Phase II clinical trials are the clutch moments of translational science, the place where the star medical advances are separated from the disappointing pretenders. Backed by years of promising laboratory findings and a Phase I trial to assess toxicity, a Phase II trial is the first chance for researchers to see whether a new drug or treatment will fly in the real world by showing effectiveness in the patients for which it was intended. Though the number of subjects typically remain in the dozens or low hundreds, a promising result can send the treatment onward to larger trials and (hopefully) eventual approval and acceptance, while a lackluster performance usually sends researchers back to the drawing board.

That tipping point tension was the backdrop for the 15th annual symposium for the University of  Chicago Phase II Consortium, a national group of 11 centers working together to recruit patients for cancer clinical trials. Because the specifications for eligible study subjects are often very narrow, casting a wide net for patients allows treatments to be tested faster - and if the trial is successful, to reach approval faster, said Walter Stadler, professor of medicine at the University of Chicago Medical Center and director of the network. Friday’s symposium allowed for a progress report, updating the consortium participants on clinical trials already underway or in the application stage, so that clinicians are aware of trials potentially available to their patients.

The symposium is also a chance to compare notes on how to best design a clinical trial so that a treatment’s effectiveness can best be determined. With speakers from the University of Chicago Medical Center, the University of Michigan, the University of Maryland, and the MD Anderson Cancer Center at the University of Texas, it was a lightning-round survey of what cancer trials look like in 2010 and how the field is changing as personalized medicine inches toward becoming reality. Here are some of the themes I pulled from the symposium - from an outside perspective, these topics seemed to be the big stories going forward in modern clinical trials.

Biomarkers are a Big Deal

Clinical trials, by their very nature, must homogenize a patient population, combining people with different subtypes and stages of disease into the large pools necessary to analyze with statistics. But it is becoming increasingly accepted that most cancers are actually made up of several different diseases with different causes. Furthermore, each of these cancer types will respond differently to a particular treatment. Complicated, yes, but uncovering which treatments are best for each cancer subtype will pave the road to more effective, personalized cancer care.

Those answers may already be hidden in the data of a clinical trial, if researchers can figure out why specific patients respond better to an experimental treatment than others. The best way to do this - for now - is to collect tons of “biomarkers” about each patient - blood samples, genetic information, tumor biopsies, and even clinical measurements. As such, nearly all of the trials described at the symposium included plans to preserve biomarkers from patients that can be used for further study. Michael Maitland, assistant professor of medicine at UCMC, even talked about using potentially harmful drug side effects, such as hyperglycemia and hypertension, as rapid feedback biomarkers to assist in finding the appropriate dose of drug to give each patient.

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Bill Gates walks across the University of Chicago campus April 20, 2010. (Photo by Jason Smith)

A College Dropout Returns to Campus

The per capita income of Hyde Park experienced a brief spike on Tuesday as Microsoft founder/billionaire philanthropist Bill Gates paid a campus visit as part of his three-day college tour. After meeting with students and professors - including a walk-and-chat with Kevin White, pictured at left - Gates spoke and answered questions in a building named for another ultra-wealthy benefactor, the Rockefeller Chapel.

As Gates’ first college tour since resigning from Microsoft to focus full-time on his Bill & Melinda Gates Foundation, the focus was less on technology and more on the humble task of solving the world’s problems. With only a limited amount of time to speak, Gates focused on two priority areas for his foundation: child mortality and education. On the former point, Gates highlighted the vast differences between the wealthy world and the poor world in childhood death rates, with less than one percent of children dying before the age of 5 in rich countries while the death rate for young children remains around 20 percent in the third world. Vaccines are a big part of that change, Gates argued, which is why his foundation recently sunk another $10 billion into vaccination efforts around the world.

Interestingly, Gates said he once worried whether reducing infant mortality in developing countries could lead to more problems in terms of overpopulation and resource scarcity. But in fact, Gates said, studies have found that better health leads to smaller families, as parents choose to have fewer children when the chances of them living to adulthood increases.

You can find more coverage of Gates’ visit at the University of Chicago News Office.

A Year of Swine Flu

Hard to believe it was only one year ago that the world first learned to be afraid of the collection of letters and numbers known as H1N1. As a newspaper reporter at the time, I recall being impressed by the speed of the outbreak - not the virus outbreak, mind you, but the outbreak of media hysteria over the virus. For sure, there was reason to be alarmed about the novel H1N1 influenza, especially in the early days when the epidemiology was sketchy at best and seemed full of dire warning signs. But the leap from “new mysterious flu strain” to “1918 Pandemic Redux!!!” happened almost overnight, and spread far more quickly than the actual virus. I found myself writing “calm down, everybody” articles almost from the time I was put on the story, as the flu experts I interviewed balanced their concerns with a healthy dose of scientific skepticism.

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Organ transplantation has existed in the Western world for more than five decades now, and over that time, a lot of kinks had to be worked out. Medical questions about how best to perform such procedures and protect the health of the recipient and donor were paramount, and the technique of organ transplant has advanced in leaps and bounds. But there were also logistical and ethical challenges surrounding transplants that the medical world needed to resolve: Where should the organs come from? Who gets them first? How can the best interests of the donor be protected? Should people be allowed to travel to foreign countries to receive transplants?

The United States and Europe have had 56 years to formulate clear policies to answer such questions. For example, in the U.S., transplant centers are allowed to perform no more than 5 percent of organ transplants on foreign nationals, to discourage “transplant tourism.” But in China, the history of organ transplantation is much shorter, and the availability of transplants has far outpaced consideration of the ethical issues surrounding the procedure. That created an almost law-less transplant environment in China in the 2000’s, with 600 different centers offering organ transplants under minimal oversight by the country’s Ministry of Health. Inevitably, that regulatory void produced practices frowned upon by Western countries, with much of the organ supply coming from executed prisoners, rampant medical tourism, and a thriving black market for living donors.

But China’s health care leaders have set out to reform the country’s transplant practices. For good reason too; with more than 100 million people carrying the hepatitis B virus (one-third of the world’s prevalence), liver transplants will be a critical piece of the country’s health care arsenal. So China has turned to international transplant experts to help them clean up and legitimize the field.

Michael Millis, professor of surgery and medical director of transplantation services at the University of Chicago Medical Center, is one of those experts. Wednesday, he spoke at the MacLean Center for Clinical Medical Ethics weekly seminar about his advisory role in China, working with the Ministry of Health and the Peking Union Medical College - a hospital in Beijing founded, like the University of Chicago, by John D. Rockefeller. Millis said his role in advising China’s transplant community was not to scold them for practices considered unethical in our country, but to help move them away from such practices by improving and modernizing the donation process.

“All current donors are shot in the head,” Millis said. “My goal has been to develop a different system so that that system [of prisoner organ donation] goes away…but we also recognize that for a number of reasons, we need to find a different source of organs to allow that to occur, in reality.”

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An African Pygmy Kingfisher (Ispidina picta) from the Malawi expedition. (photo by Jason Weckstein)

The scenario played out last spring when “swine flu” suddenly became a household name. As public health agencies sprung emergency policies into place, scientists set about tracing the new H1N1 virus back to its source, following it from person to person and eventually to the animals where it originated. Understanding how the virus’ genes mutated in pigs could help scientists determine how it jumped to humans, and give clues as to the most effective ways to fight the disease. But in the time it took to reconstruct the origins of swine flu, thousands and thousands of people were were newly infected with the virus.

Fortunately, last year’s novel H1N1 virus ended up fizzling out into a run-of-the-mill flu - still deadly in a small percentage of people, but not the runaway killer it threatened to be in its earliest days. But we might not be so lucky with the next disease to jump from animals to humans, so monitoring potential threats before they crossover is a scientific priority. While the genetic sequences of more and more organisms are cataloged every day, the viruses, bacteria and parasites those organisms living inside those animals have barely been characterized.

That knowledge gap is the target of the Emerging Pathogens Project, a collaboration between scientists at the University of Chicago and the Field Museum announced Tuesday morning at the museum’s very cool DNA Discovery Center. Blending the centuries-old practice of gathering animal specimens on field expeditions and the bleeding-edge technology of large-scale genomics, the project hopes to give scientists advance warning and knowledge about tomorrow’s epidemics.

“We plan to treat each one of these animals as an ecosystem in and of itself,” said Shannon Hackett, head of the bird division at the Field Museum and co-leader of the project. “We’re really interested in what lives in and on these organisms.”

Those animal ecosystems were collected during an expedition last fall in the African country of Malawi, a trip that brought back roughly 1,100 bird and mammal specimens. A sampling of those (pictured above) were on display at the announcement of the project; just one shelf from the tens of thousands that store critters of all types in the museum’s vast collection facilities. In categorizing those specimens, the museum has moved increasingly to genetic analysis, but the Emerging Pathogens Project brings those efforts to a much larger scale.

That’s possible thanks to the genomics infrastructure established by Kevin White, director of the University’s Institute of Genomics and Systems Biology and Hackett’s leadership partner in the Emerging Pathogens Project. Having previously launched massive projects to study genetic regulation and the genetic makeup of tumors, White said there was still time to take on another scientific challenge. Gesturing at the DNA laboratory that was the backdrop for Tuesday’s event, White aid that the high-throughput sequencing technology now available could do an amount of work equivalent to several million of such labs.

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Here in the Upper Midwest, the first sustained period of spring sunshine draws everyone outdoors to stare at that big orange circle in the sky we haven’t seen in months. But as good as it feels to bask in the sun after a long winter of cold rain and snow, that enthusiasm must be tempered with an awareness of sunlight’s ability to harm. Not to be a killjoy, but skin cancer rates have steadily climbed over the last 20 years in the United States, and while many of those cancers are easily treated, several thousand a year are fatal. The good news is that skin cancers are also easy to prevent with simple measures such as wearing sunscreen, protective clothing or avoiding the peak hours for harmful ultraviolet rays.

The medical field of dermatology is progressing rapidly in finding new ways of treating skin cancer, from creams to photodynamic therapy to surgery. Hospital-based dermatologists have the advantage of seeing patients in a collaborative environment, where patients with rare or special circumstances can be treated by doctors from several different disciplines. At the University of Chicago Medical Center, Dr. Maria Tsoukas, assistant professor of medicine and dermatologist, is working with oncologists to provide skin cancer prevention and treatment in vulnerable patients with weakened immune systems due to chemotherapy. In the videos below, Tsoukas talks about that effort, while also offering general tips for skin cancer prevention, summarizing how skin cancer is diagnosed and treated in the clinic, and discussing current frontiers of research in the field.

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Typically, when a clinical trial is stopped early, it’s bad news. The drug being tested may show unexpected side effects too harmful to continue, the trial may fall short of its patient recruitment goals, or the early results may reveal too marginal a benefit to make the study worth the cost and time. But good news can also bring a clinical trial to a premature halt. One recent example is the ACCOMPLISH trial - a study of combination drug therapies for hypertension that was called short after three years basically for being too successful.

The lengthy acronym ACCOMPLISH stands for Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension. In short, the trial was designed to find the best two-drug combination for people with high blood pressure to reduce the frequency of strokes and heart attacks in such patients. The trial compared a previously-established combination of a diuretic and a drug called an ACE inhibitor to a new combination: ACE inhibitor plus calcium-channel blocker. Both two-drug combos were effective at reducing patients blood pressure, but the new combination (benazepril + amlodipine) won out on reducing cardiovascular events, decreasing the numbers of deaths, hospital visits and other serious incidents by 20 percent.

That result was so promising that the study’s data safety monitoring board - an independent panel of scientists who act as a kind of clinical trial lifeguard team - brought the study to its early end. In essence, the results were so positive for the new treatment combination that it would be unethical to continue treating patients with the older combination. Those positive results, announced in 2008 and published in the New England Journal of Medicine, established a new standard treatment for hypertensive patients.

But hypertension was only one of the targets that the ACCOMPLISH trial was designed to study. High blood pressure doesn’t always appear in isolation, sometimes it is accompanied by other diseases as bad or worse for the patient. Because of the trial’s very large size - over 11,000 patients - it was possible to break out some subgroups that had both hypertension and another disease to test the two drug combinations in their effect on that secondary condition.

In comes George Bakris, a professor of medicine and director of the hypertensive diseases unit at the University of Chicago Medical Center. Bakris, an expert in kidney disease, was one of the researchers who designed the ACCOMPLISH trial - and just as importantly, helped seek out the funding (which eventually came from the drug company Novartis) to make it possible. As such, Bakris was able to incorporate a sub-trial within the larger study to look at the effect of these drug combinations on chronic kidney disease, which affects more than 15 percent of Americans.

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Taxation With Neural Representation

Hopefully, all of you reading remembered that yesterday was that least enjoyable of holidays, the deadline to file taxes. If you didn’t remember, um, sorry. The act of filling out and paying taxes is known anecdotally to produce feelings of nausea, panic, and in some cases, language deficits. But is there any scientific evidence for an actual effect of taxation upon physiology?

Actually, there is! In 2007, University of Oregon scientists in the field of neuroeconomics, a relatively young discipline devoted to studying how financial decisions are encoded by brain activity, published in Science an experiment on how our brains react to taxation vs. donation. Using fMRI to take live images of neural activity, William Harbaugh and colleagues gave subjects $100 and ran them through trials where they either had the choice of donating money to a food bank or were “taxed” in the form of a mandatory donation. People reported that they were 10 percent more satisfied with the voluntary donation compared to the mandatory donation - not a big surprise. But the brain also reflected these different reactions; even though the money went to the same place (the food bank), a voluntary donation more strongly activated brain areas usually associated with reward such as the striatum, nucleus accumbens, and caudate nucleus.

I wrote about the study when it came out for the Chicago Tribune, but focused mostly on the “warm glow” effect of altruism as a potential motivator for the seemingly self-injurious process of donating money. But one could also turn it around the other way and say that the mandatory donation, or taxation, was significantly less rewarding, both in subject’s lower self-reported satisfaction and reduced brain activity. It’s likely that the aversive experience of taxation was even under-measured by this study, where subjects knew where those mandatory taxations were going: to a food bank, hardly a politically controversial cause. Presumably, if money was merely taken away from subjects’ accounts without a subsequent bump in the food bank’s accounts, the response would have been even more negative.

Checking Harbaugh’s site (where you can watch a video of the 3rd James Bond explaining this study), it doesn’t appear that any followup studies have been published as of yet that could better illustrate the brain’s response to taxation. The lessons for real life are also unclear; presumably it would make us all feel better to make voluntary donations rather than have to fill out tax forms every April, but that seems to rely a bit too much on the honor system to keep government services funded. Perhaps the IRS can borrow a portion of the study’s findings and blunt the pain of taxes just a bit by being more clear about where taxes are going - an educated taxpayer may find the experience at least marginally less miserable.

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The hunt for human origins typically takes the form of fieldwork, with teams of paleontologists scouring the earth for the fossil that will add to the story of how our strange species came to be. That search has taken scientists from Africa to Siberia, adding a pelvic bone fragment here and a skull pan here to build a mosaic depiction of human divergence from other primates. But even as the fossil data accumulates - occasionally bringing more controversy than clarity - scientists are uncovering missing chapters of human origin in less glamorous, albeit cleaner, setting of the laboratory.

Call it genetic anthropology, if you will - the search for DNA changes that set humans and chimpanzees onto different paths with the very different outcomes of zookeeper and zoo resident. A fine example of this practice was on display Tuesday at the weekly Institute for Genomics and Systems Biology lecture, given by Duke University’s Gregory Wray at the invitation of University of Chicago students.

Wray’s specialty lies in computational analysis of genes and gene regulation, with studies that produce graphically appealing representations of the genetic differences between humans and other primates. Taking inspiration from geneticist Mary Claire King, who has long argued that humans are the product of relatively subtle changes in gene regulation, Wray applied his complex calculations to look for small genetic differences that could account for actual physical and behavioral traits.

One difference between chimps and humans that you don’t need a Ph.D. to observe is head size - the human skull, and the brain inside of it, is 2-3 times the size of the chimpanzee skull. All of those fossil findings can be loosely organized into a 2 million-year progression toward larger head size, with the occasional detour - neanderthals, for instance, have a larger head-to-body ratio than modern humans. Evolving a bigger head and brain is no small feat either; though the brain is only about 2 percent of total body mass, it eats up about 20 percent of an organism’s calories, which means growing a bigger brain requires diverting energy away from other parts of the body. Those facts were the basis of an anthropological theory called the Expensive Tissue Hypothesis, which gave Wray a clue for where he might find molecular cues important in both brain evolution and human origins.

“If you’re going to study trait evolution, if you’re going to go fishing, you might as well go for the big kahuna,” Wray said. “What’s more interesting as a trait than the evolution of the human brain?”

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It’s easy to grasp the medical miracle of the organ transplant, where a kidney or heart is passed from one person to another to restore the life of the recipient. Stem cell transplants are a little more abstract in concept, with the life-saving exchange happening via blood donation and infusion rather than the drama of dual surgeries. But the effects upon patients who receive a stem cell transplant are no less transformative, providing them with a new future free from leukemia, myeloma and other bone marrow cancers and the health issues and unpleasant treatments those conditions entail.

As such, it made sense to organize an opportunity for stem cell transplant patients to share that experience with each other, just as recipients of other types of transplants have their own events. The 2nd annual Celebration of Life - a reunion of patients, donors, family members and medical staff - was held this past weekend at the University of Chicago Medical Center, drawing more than 200 people to hear and share stories of the procedure’s success. Held in the atrium of the Duchossois Center for Advanced Medicine, a beautiful spring day appropriately bathed the attendees in sunlight as they talked about the new beginning offered by the treatment.

While patients and their families mingled at the event, we pulled some aside to hear the stories of life before and after stem cell transplant. In the video below, you can view several of those stories, from patients who had their transplant in recent months to patients who received a stem cell transplant more than 15 years ago. We also heard from Koen van Besien, director of the stem cell transplant program at the Medical Center, about why he is “humbled” to see so many patients living healthy lives after the procedure.

A common thread throughout the event was the ever-widening window for people to be eligible for stem cell transplant. By coincidence, van Besien and Lucy Godley have a commentary in this week’s issue of the Journal of the American Medical Association, describing the advances that have allowed doctors to treat more patients with stem cell transplant. For people who are unable to receive autologous transplants from their own blood, the search for compatible donors has been a major obstacle for the procedure. But as the JAMA commentary describes, innovation in the immunological testing of potential donors, preservation of umbilical cord blood, and drugs that enable the use of partially-matched donors are giving more and more patients access to the treatment. As Andrew Artz says in the video below, the hope is that the procedure will become so widely available that future reunions will need to take place in Soldier Field.

For more on stem cell transplants, see our Dr. FAQ videos with Dr. Godley posted last week.

Implantable pacemakers and defibrillators have been a staple of cardiology for decades. Offering round-the-clock protection against heart attacks and other issues, it’s not hyperbole to say that the devices have been a lifesaver for hundreds of thousands of people. But the majority of these implantable devices are still placed predominantly in older patients with heart conditions, with the average age of recipients consistently in the high 60’s in clinical trials. Because of the finite lifetime of an internal cardoverter defibrillator (ICD) or pacemaker and the difficulties associated with removing or replacing those devices, many doctors prefer to avoid those options in younger patients.

“That’s crazy,” said Martin Burke, director of the heart rhythm center at the University of Chicago Medical Center. “You have more to gain from a defibrillator if it saves your life when you’re 50 rather than when you’re 80.”

But some of the concerns over implantable defibrillators are legit. Classic ICDs and pacemakers require the electrical leads that deliver the shock to be placed inside the heart, where any infection can be a serious complication. The sensory system that tells the defibrillator to fire sometimes overreacts to benign changes in heart rhythm, causing unnecessary shocks. Flexible materials must also be used due to the hostile environment inside the heart - “It’s a 98.6 degree, dynamic environment that pumps like a piston 60 to 100 times a minute; it’s a miracle they last 15-20 years in my mind,” said Burke, who is a specialist at removing ICDs as well as implanting them.

So Burke has been part of a lengthy effort to improve the technology of ICDs, with a new device - the subcutaneous-ICD, or S-ICD - that finally reached the clinical trial stage this year. Last month, Burke performed the first S-ICD implantation in the United States upon 38-year-old Brooke Bergeron, who suffered a heart attack last year while giving birth to her fourth child.

The subcutaneous ICD changes the location of the leads from inside the heart to just beneath the skin over the sternum. If an infection should occur in that location, it would be less dangerous, and removing the leads would be a less difficult process. While the added distance from the heart means a more powerful shock is delivered by the S-ICD (about 2.5 times stronger than traditional ICDs), the power is still well within a safe range, Burke said. And patients should experience fewer of those shocks, thanks to an improved monitor system that measures more complex heart rhythm characteristics to separate out dangerous cardiac events from false positives.

“We’ve been shocking people like this for 40 years, that’s no different. The big change is the position of the electrodes under the skin and the sensor,” Burke said. read more

Another species added to the library of sequenced genomes: the zebra finch. Published in Nature and explained in the New York Times, the finchonome could provide answers about the development of language and - most intriguingly - the epigenetic influence of language upon gene expression. Previous studies have shown that gene expression changes in finches that are singing or listening to birdsong, and the Nature study discovers that those expressed proteins, in turn, have effects upon other genes. This cascade effect is very large - the act of singing alone changes the expression of more than 800 genes! Our very own Daniel Margoliash studies birdsong learning in zebra finches, and is no doubt excited to have the entire genome to play with in his research.

Earlier this week, scientists in Russia and the US plugged a hole in the periodic table with the discovery of element 117, a super-heavy element which flashed into existence for a total of 78 milliseconds. The element currently bears the placeholder name of ununseptium - fancy Latin for element #117 - so the fun part now comes in naming the particle. Recent element naming has gotten creative, with names like Copernicium, Promethium, and the rather presumptuous Nobelium, so everyone’s got an idea for #117: see the naming suggestions on twitter for a funny read. My personal submission evokes the element’s super-heaviness: Sabbathium.

Daniel Levitin reviews Nature editor Philip Ball’s new book, The Music Instinct: How Music Works and Why We Can’t Do Without It, and nails a succinct answer for the question in the title:

The secret to composing a likeable song is to balance predictability and surprise. Because most music has a beat and is based on repetition, we know when the next musical event is likely to happen, but we don’t always know what it will be. Our brains are working to predict what will come next. The skillful composer rewards our expectations often enough to keep us interested, but violates those expectations the rest of the time in interesting ways.

Cool news from the other side of campus: the University of Chicago Oriental Institute has uncovered an 8,000-year-old city in Syria, one of the oldest civilizations ever discovered. Called Tell Zeidan, the site is expected to yield decades of data about what life was like in the 5,000s and 4,000s BC - Oriental Institute director Gil Stein told the New York Times, “I figure I’m going to be working there till I retire.” It’s enough to make a biologist jealous.

I am pro-stem cell research, of course, but am still slightly creeped out by the anthropomorphic stem cells in this children’s book, Super Stemmys: Doris and the Super Cells, which has drawn mixed reviews from scientists according to, er, The Scientist.

More cool things happening at Argonne that I barely understand: a green way for making the decidedly un-green-sounding chemical propylene oxide (money quote: “This is basically a holy grail reaction.”) and a venus fly-trap for radioactive waste, gamely tackled by Ted Gregory of the Chicago Tribune.

With good timing for Masters week, Jonah Lehrer talks to University of Chicago associate professor of psychology Sian Beilock about her studies on clutch performance in golfers.

Daniel Sulmasy is used to wearing many different figurative outfits, from the white coat he wears as a physician at the University of Chicago Medical Center to the brown robe he dons after work as a Franciscan friar. Now, Sulmasy will have another important role in his wardrobe as a member of President Obama’s Commission for the Study of Bioethical Issues. The 12-member committee was formed by Obama last fall to replace the Bush Administration’s Presidential Council on Bioethics, and will advise the president on forthcoming issues in science and medicine.

“This is quite an honor and a pleasant surprise,” Sulmasy said of the appointment. “I testified in 2006 to a previous presidential ethics council, but I never expected to become a member of such a group.”

Sulmasy, the associate director of the McLean Center for Clinical Medical Ethics, becomes the latest University faculty member to moonlight as ethical advisor to a president. The Medical Center’s Leon Kass and Janet Rowley both played prominent roles on the panel assembled by President George W. Bush, that most famously informed his decision to limit federal funding on stem cell research. On Obama’s panel, announced today, Sulmasy’s unique background as doctor and friar stands out among a panel made up of scientists, doctors, lawyers, and Muhammad Ali’s wife (an advocate for Parkinson’s disease). With experience in both religious and medical spheres, and an accomplished ethics background, Sulmasy should be a valuable voice for a panel that will have to wrestle with the difficult questions orbiting scientific advances in genomics, biotechnology, stem cell research and health care in the coming years.

One issue that may immediately be put before the panel is Sulmasy’s area of expertise: end-of-life care. The decision-making process between terminally-ill patients and their doctors was distorted through the political funhouse mirror during the health care reform debate into the fictitious concept of “death panels,” but that polarized discussion only obscured a legitimately important medical topic. Many of Sulmasy’s over 140 published journal articles deal with this very topic, some studying how well patients are informed of their options when their prognosis is poor and some considering the ethical boundaries for doctors between withdrawing care for a dying patient and assisting that patient in ending their life.

Wrestling with such a difficult topic requires an ethicist’s strong stomach for navigating the uncomfortable - best characterized by the title of a 1998 Sulmasy paper: “Killing and allowing to die: another look.” Discussing how doctors can best help their patients exert control over their own death requires blunt language; in a 2001 position paper for the American College of Physicians, Sulmasy (with co-author Lois Snyder) wrote that “Our societal emphasis on ‘cure’ and the medical emphasis on intervention have sometimes been a the expense of end-of-life care.” With studies showing that the vast majority of a person’s health care expenditures are made in the last year of their life, these are decisions that stretch beyond medicine into financial, ethical and spiritual zones.

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