There are many different stakeholders in fixing the runaway costs of the U.S. health care system, including patients, doctors, hospitals, and the federal government. Another interested party, heavily involved in recent debates over health care reform, is the health insurance industry. As the Patient Protection and Affordable Care Act rolls out in the coming years, insurance companies will need to adapt to many new rules and regulations on matters such as pre-existing conditions and insurance exchanges. But they also have their own ideas about how to reduce health care costs, focusing on two key components of PPACA: health disparities and quality improvement.

Aetna is the third largest insurance provider in the United States, providing medical insurance for more than 17 million people. The Aetna Foundation, their charity and grant-dispensing arm, is focused on promoting wellness, health, and access to high-quality health care. Addressing those goals will also make progress in reducing health disparities, said Anne Beal, president of the Aetna Foundation, in her presentation to the MacLean Center for Clinical Medical Ethics. The strategy she outlined showed how parties who have sometimes been at odds in the health care reform debate can find common ground for the benefit of patients.

Beal, formerly a faculty researcher at Massachusetts General Hospital and the co-author of a best-selling parenting book, made a case for health equity to the seminar series, which this year is themed “Health Disparities: Local, National, Global.” Beal presented now-familiar statistics about higher rates of infant mortality, diabetes, and more in minority communities, but added a new voice to the mix - the words of Martin Luther King, spoken in Chicago in 1966: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

But aside from social justice, there’s also a bottom-line argument to be made for reducing health disparities, Beal said. If you think of disparities as a form of inefficiency in the health care system, billions of dollars could be saved by narrowing those gaps.

“When you talk about health disparities, it is an important opportunity for us to really try to bend the cost curve,” Beal said. “Giving people the right care at the right time and preventing disease is an amazing way for us to really rein back a lot of these health care costs.”

Ensuring that people receive appropriate care falls under the domain of quality improvement (QI), the idea that health outcomes can benefit from fewer mistakes and more efficient delivery of care. Beal admitted that quality improvement was just one of many possible causes of health disparities, but argued that QI was a way to improve care for all patients and reduce health disparities at the same time - a win-win situation, if done right. Simple interventions such as making sure patients receive the right hemodialysis dose or even basic vaccination programs can help overall population health while narrowing the gap between white populations and minorities.

“This is not to say we shouldn’t do special interventions and targeted population efforts and things like that, but we need to stick to the basics,” Beal said. “If you can’t look at a population of children and say that they’re 100 percent vaccinated against measles, then any other intervention you do is just trying to put a band-aid on a bad situation. I would argue that we really need to focus on high quality care as the first step for addressing population health in communities of color.”

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Like the rest of campus, the MacLean Center for Clinical Medical Ethics seminar series is on spring break, resuming in early April with a talk from provocative economist Richard Epstein. So now’s a good chance to get caught up on the previous quarter’s seminars, covering topics under the umbrella of health disparities from the biological factors of breast cancer to the relationship between crime and public health to some of the exciting projects from the Urban Health Initiative. Hopefully, the ScienceLife coverage has kept interested readers informed about the valuable contents of this unique seminar series, but if you prefer a more visual experience, the MacLean Center website has posted several of the lectures in video form. Here’s a recap of the Winter Quarter sessions that are currently available for viewing.

Eliminating Global Disparities in Breast Cancer - Olufunmilayo Olopade Jim Fackenthal, University of Chicago

Unfortunately, Dr. Olopade was unable to deliver her talk due to a last-minute conflict, but Jim Fackenthal, research associate assistant professor in her laboratory, was able to provide emergency relief. The disparity in the survival rates of white women and black women in the United States with breast cancer remains wide, and while some of this gap can be explained by socioeconomic factors, biology also plays a role. Fackenthal talks about the evidence for more aggressive and harder to treat forms of breast cancer in women of West African origin here and abroad. The group’s research projects span from laboratory experiments on genetics and epigenetics to blood testing and screening in Nigeria.

Births to Arab-American Women Before and After 9/11: Evidence of Stress Effects - Diane Lauderdale, University of Chicago

The terrorist attacks of September 11, 2001 were stressful for all Americans, but possibly most challenging for Arab-Americans who experienced discrimination in the wake of the events. Lauderdale, a professor of epidemiology, wanted to look at whether one could measure a negative health impact of this discrete period of stress, choosing premature or underweight births as a health outcome potentially sensitive to discrimination. It wasn’t an easy task, as Lauderdale and her collaborators first had to develop an algorithm to find names in California’s birth registry that are likely of Arab origin. But the results of the study were striking, as Lauderdale was able to measure a spike in babies born underweight to Arab-American mothers in the months after 9/11, without any significant changes among other ethnicities.

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Cells are often described as factories, a metaphor that adequately describes the swarm of specialized tasks constantly underway in each of the human body’s 100 trillion cells. The factory floor of the cell is so busy and complex that scientists are still discovering new machinery responsible for important jobs, with no clear end in sight. The neurons of the brain have been especially difficult to analyze given their role as communicators, ceaselessly sending and receiving chemical messages called neurotransmitters. Many different proteins are needed to release these signals, and when just one is missing, it can cause disaster.

The CLC family is a group of ion channel proteins known by such disasters. When these channels are missing or not working properly, motor disorders such as myotonia can result, suggesting how important their normal function is to the nervous system. Through the use of genetically-modified mice, where the gene for a single protein can be switched off, scientists can determine what a protein’s job is in the cell’s factory. But the process requires working methodically backwards, analyzing the big problems caused by a defective factory and retracing the steps back to where the target protein should have been working.

Yesterday in Nature Neuroscience, the laboratory of Deborah Nelson, professor of neurobiology, pharmacology and cell physiology, reported on one such investigation of a CLC family member. CLC-3 has not been tied as of yet to any human disease, but when it is deleted in mice, there’s no missing the consequences. Without CLC-3, the hippocampus, a region of the brain involved in learning and memory, slowly degenerates over the first months of a mouse’s life until it has completely vanished by the end of their first year. The retinas of the eye also degenerate in CLC-3 knockout mice, causing blindness during their first month of life. What could CLC-3, a humble ion channel that allows chloride ions to pass through its gate when activated, be doing in normal circumstances to avert such neurological catastrophe?

Vladimir Riazanski and Ludmila Deriy, research associates in Nelson’s laboratory, started with a clue about where CLC-3 lives in the cells of the hippocampus. Before they are released, neurotransmitters must be concentrated into packages called synaptic vesicles, sort of like a car being filled up at a gas station. A 2001 study of CLC-3 found that the protein is located on these synaptic vesicles in hippocampal neurons, suggesting a role for the ion channel in this packaging process. Experiments recording electrical activity from hippocampal regions of CLC-3 knockout and normal mice indicated that something was wrong with the transmission of GABA, the inhibitory neurotransmitter, when CLC-3 went missing.

So Riazanski and his collaborators zeroed in on the process of filling vesicles with GABA in the neurons of the hippocampus. By isolating those extremely small vesicles (on the scale of nanometers), the researchers could look very closely at what CLC-3 is doing to package GABA. The vesicles lacking the ion channel acidified more slowly, researchers discovered - a logical result of losing a channel that allows for the influx of acidifying chloride ions. But without acidification, the GABA vesicles can not be filled as efficiently, leaving vesicles with lower amounts of GABA or no GABA at all. It’s as though the gas station inside GABA neurons is missing its attendants - there’s plenty of fuel, but nobody around to properly fill up the vesicles.

Without sufficient inhibitory GABA being released, surrounding neurons can become over-excited to the point of death, Nelson said, which may explain the hippocampal and retinal damage seen in knockout mice.

“This is the first study to show any effect of CLC-3 on inhibitory transmission,” Nelson said. “It’s this loss of GABA transmission that probably contributes to the imbalance between excitatory and inhibitory signals within the mouse hippocampus, and eventually gives rise to excitotoxicity and cellular loss.”

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In a famous 1999 study, 700 physicians were given a simple case-study task. Each watched a video of a patient-actor describing chest pain and were given basic test results for that patient. Each doctor was then asked whether they would recommend the patient for cardiac catheterization, an additional diagnostic procedure. The patient cases varied in terms of type of chest pain, stress test results, and heart history, influencing the physician’s eventual decision. But when all of those clinical factors were controlled for, two other factors remained: race and sex. With everything else equal, black patients and female patients were 40 percent less likely to be recommended for catheterization; black, female patients were 60 percent less likely to be sent to advanced care.

“People assume that when physicians take the Hippocratic oath that somehow there is a miraculous, magic process that makes us free from any inherent stereotypes or biases that we may have had through our whole lives,” said Monica Peek, assistant professor of medicine in her MacLean Center for Clinical Medical Ethics seminar. “We want to be good physicians and give good care and be unbiased in our assumptions. But there’s not really any magic that happens just because you get a medical degree.”

Many studies of the health effects of discrimination focus on the world outside the doctor’s office, where the cumulative effects of sexism and racism negatively affect clinical measures such as hypertension and cardiovascular disease. Less attention is paid to discrimination within the healthcare system, Peek said, the often subconscious biases that physicians and other caregivers may use to make snap judgments about patients. Discrimination in this setting might directly affect preventative measures such as vaccination or screening, lower adherence to prescribed medications, and decrease patient satisfaction.

One way to combat discrimination within healthcare is to elevate the patient’s role in their treatment, creating a patient-centered and shared decision-making model. Research suggests that when the patient is an active participant in their care rather than a passive recipient of doctor’s orders, measures of trust, understanding, and satisfaction improve - and chronic disease measures such as glucose levels and blood pressure are better controlled. But for many African-Americans, shared decision-making in a healthcare setting is a foreign concept.

A 2008 focus group study led by Peek found that many African-American patients wanted to be involved in the decision-making process with their doctor, but many told stories that showed a less than equal relationship:

• “We make decisions together and she gives me what I’m suppose to take and she knows what I’m suppose to take.”
• “She told me I need to go to the dermatologist … Now the lady up there at the check out desk. I told her that I didn’t want to go.”
• “See, when the doctor tells me what to do, then I can make up my mind whether or not to do [it].”

“Basically African-Americans…wanted shared decision-making as much as their non-hispanic white counterparts when we adjusted for class and education - and maybe a little more so,” Peek said.

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When health disparities in urban populations are discussed at the University of Chicago Medical Center, it’s not an abstract, far-away concept. Only a few blocks west and south of the hospital campus are some of the poorest neighborhoods in Chicago, where nearly every health statistic one finds is shocking. Pick any measure - diabetes, heart disease, obesity, infant mortality, or violence - and the numbers in some South Side neighborhoods are closer to those found in developing countries than they are to more affluent North Side neighborhoods mere miles away. The problem is exacerbated by a decline in health services on the South Side of Chicago, from losing more than 2,000 hospital beds in the last decade to a sparse density of grocery stores and exercise facilities.

In response to this health crisis, the Medical Center launched the Urban Health Initiative to execute a multi-faceted campaign of patient care, education, and research. But an important first step in fixing the health disparities on the South Side of Chicago is measurement, obtaining updated and accurate statistics on the healthcare needs of the region and cataloging the resources already available. At the MacLean Center for Clinical Medical Ethics seminar series earlier last week, associate professor of obstetrics/gynecology and medicine Stacy Lindau updated the progress of the UHI’s measurement arm, the South Side Health and Vitality Studies.

The first aim of the SSHVS is to build a map - not of transportation routes, but of neighborhood assets. Recently, organizations such as the World Health Organization and the Robert Wood Johnson Foundation have started to define an area’s health system as “intersectoral,” stretching beyond direct medical care to other aspects of the community that impact the population’s health. For the last two years, the Community Asset Mapping project of the SSHVS has sent out college and high school volunteers to measure assets such as grocery stores, gyms, daycare centers, government services, churches, and more on the South Side of Chicago. The fruits of those efforts are twofold: both a resource for the community and a baseline for UHI research on improving the broader infrastructure of the region, Lindau said.

“Has anyone ever described anywhere all the components of an intersectoral health system and how they’re working together? Has it ever been empirically evaluated or studied? The answer is no,” Lindau said. “But where are we starting to this? Here on the South Side of Chicago, where we’re mapping every single built asset in the primary service area of the University of Chicago…and trying to understand: if everybody’s in the health system, then what’s everybody’s role?”

So far, 11 of the 34 community areas that make up Chicago’s South Side have been mapped, and the information is already proving its value as the “highest-quality asset list for this region,” Lindau said. Compared to the most recent commercially-available resource guide, the mapping project found 4o percent more assets…and found that 30 percent of the resources listed in the commercial guide were no longer in existence. Unlike that flawed information, the mapping project’s data is available for free through a customizable map program on southsidehealth.org (one of many website domains the program has wisely snapped up for community outreach purposes) that allows visitors to search by asset-type and location for 16 different categories. Lindau also hopes to someday incorporate the information into electronic medical records, so that patients can take home a printout of their nearby health resources after a doctor’s appointment.

“You can’t do this on Yelp or Google,” Lindau said. “You can’t map places by disease or by need. I think we have something really special here.”

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“If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made.” - Allan Rechtschaffen.

We spend approximately one-third of our lives asleep, and yet there is still much to learn about why. Modern sleep research only began less than a century ago, when Nathaniel Kleitman founded the world’s first sleep laboratory at the University of Chicago in 1925. Since then, many of the mysteries of sleep have been uncovered by UChicago researchers, including the discovery of REM sleep by Kleitman and Eugene Aserinsky in 1953, and the characterization of the first sleep disorder, narcolepsy, by Rechtschaffen and Gerry Vogel in the early 1960’s.

But in the last two decades, the study of sleep has shifted from how it works and doesn’t work to the serious consequences when sleep is lacking. Locally, the hub of this new wave of sleep research is Eve Van Cauter, who has linked insufficient or irregular sleep to a long list of chronic diseases including diabetes, obesity, and heart disease. Earlier this week, Van Cauter was doubly honored in receiving the Frederick H. Rawson Professorship and headlining the christening of the new University of Chicago Sleep, Metabolism, and Health Center (SMAHC, pronounced “Smack”). Sleep scientists from UChicago, Northwestern University, and Harvard University gathered to discuss the latest evidence on just how important sufficient sleep is for good health. The consensus message was frightening: From infancy to the golden years, the failure to get a good night’s sleep can cause a wide variety of problems - and may be a major contributor to today’s most worrisome health trends.

The importance of sleep starts with birth, said David Gozal in his talk, and maybe even before due to epigenetic imprinting during the mother’s pregnancy. Gozal reviewed his paper from last month on the elevated risk of obesity in children with shorter and less consistent sleep patterns, but also presented even newer findings, including altered expression of metabolic genes in children who snore and mouse studies that found frequently-disrupted sleep can cause animals to ingest more food and retain more fat tissue. Meanwhile, more and more studies are finding that young children are not getting nearly as much sleep as recommended.

“Sleep curtailment is not only a problem of our adult society, but clearly has pervasively infiltrated to infants and young toddlers,” Gozal said.

The effect of poor sleep upon children may go beyond metabolic issues such as obesity and diabetes, proposed neurobiologist Daniel Margoliash. In both humans and birds, Margoliash’s laboratory has found evidence that sleep helps the brain consolidate information learned during the day into memory. As young birds sleep after a day of practicing their distinctive song, the brain recreates its activity patterns from those earlier performances, presumably part of the process of making that newly learned skill permanent. For schoolchildren, the lesson is clear: lose out on sleep, and you could be losing what you were taught during the preceding day.

Later in life, the problems associated with insufficient sleep only appear to grow worse. In older adults, chronic insomnia has been linked to cognitive decline, perturbations in hormones associated with hunger, and insulin sensitivity, said Northwestern’s Phyllis Zee. Women with polycystic ovary syndrome, a condition marked by infertility, hormonal dysregulation, obesity, and diabetes, are more than 8 times more likely to suffer from obstructive sleep apnea, said David Ehrmann. And the medical effects of poor sleep can literally appear overnight - Vineet Arora’s study of poor sleep in noisy hospital wards found an average blood pressure increase of 6.2 mmHg for every hour of sleep lost. read more

The future of medicine, we are told time and time again, is genetic and personalized. Someday, physicians will call up the genetic code of a patient and determine their genetic risks and which treatments will work most effectively with the fewest side effects. That information can be organized into individual, unique medical plans for each patient, helping them avoid disease as much as possible and treat quickly and directly when illness does occur. Though completely personalized medicine remains years, if not decades, away, the first few glimpses of this future have arisen in recent years with gene tests that help inform decisions about blood thinners and cancer drugs.

But for all the talk of genetic medicine improving patient care, an important question lingers: what will it cost? The soaring costs of health care in the United States have been at least partially driven by the steep price tags attached to medical innovations. New drugs and tests tend to be expensive when they reach the market, and it remains to be seen whether the clinical advantages of personalized medicine will outweigh its potential costs.

To put this balance to the test, a team of University of Chicago researchers used one of the earliest successes of genetic medicine: monogenic neonatal diabetes. As profiled before on ScienceLife, some children who are born with a form of diabetes caused by a genetic mutation can be switched from daily injected insulin to a pill, with dramatic improvements to their quality of life and disease control. At last summer’s Celebrating the Miracles conference, the families of children who had successfully “transitioned” off of insulin spoke emotionally about how the switch had changed their lives for the better. But for all the heart-warming anecdotes, the financial benefits of testing for neonatal diabetes have not yet been assessed.

“Despite all the talk and the fact we have now sequenced the human genome, there are very few studies showing an actual benefit of all these tests,” said Siri Atma Greeley, instructor of pediatrics and first author of the study. “We have to prove to people that it can make a measurable and appreciable difference in dollars and cents.”

To test the cost-effectiveness of genetic testing in neonatal diabetes, Greeley and colleagues (many from the Kovler Diabetes Center) built a simulation of the costs and quality of life effects associated with the disease over 30 years. Beyond the daily costs of insulin and blood-sugar tests, children with diabetes are at risk of several complications, including blindness, stroke, and heart disease, that can further increase medical spending and decrease quality of life. But testing for the two most common genetic mutations in neonatal diabetes has costs too - roughly $2,800 at 2009 prices - and not every child tested will have a mutation that allows for switching from insulin to sulfonylurea pills. Children who develop diabetes before the age of 6 months have a high chance of testing positive for one of the mutations, but only 1-2% of children diagnosed between 6 months and 1 year old may have this form of monogenic diabetes.

Still, when the researchers ran the numbers, genetic testing clearly proved its worth. Alongside the health benefits one would expect to result from genetic testing of all children diagnosed with diabetes before the age of 6 months, the model also revealed dramatic financial savings over not performing the tests. By 10 years after testing, the average cost savings was over $12,000; by 30 years, the savings figure had climbed over $30,000. The results add a strong financial argument to the medical case for genetic testing of all infants with diabetes.

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Eodromaeus, or "Dawn Runner" (Copyright Todd Marshall)

While ScienceLife was away at the Science Online 2011 meeting two weeks ago, our friends in the University of Chicago News Office tried to sneak a dinosaur story past us. Eodromaeus, the “dawn runner,” is the latest edition to the dinosaur discovery menagerie of Paul Sereno, professor of organismal biology and anatomy, discovered in the fossil dig site of Argentina known as the “Valley of the Moon.” While only four feet tall and roughly 10-15 pounds, Eodromaeus was (as Chicago Tribune great Bill Mullen puts it) a “nasty looking little critter,” a carnivorous predecessor to the T. Rex in a time (230 million years ago) when dinosaurs were not yet the dominant lifeform on the scene. [You can watch a cool time-lapse movie of the reconstruction of Eodromaeus here, as well as an interview with Sereno about the discovery and its significance for the rise of dinosaurs.]

As the excellent fossil blogger Brian Switek describes at the Smithsonian’s Dinosaur Tracking site, the discovery of Eodromaeus rearranges scientific theories about the early days of dinosaurs. A previous discovery of Sereno’s team in the same area, Eoraptor or “dawn plunderer,” was once thought to be an ancestor of the larger meat-eating dinosaurs that came later. But comparing the teeth of Eoraptor and its neighbor Eodromaeus suggests that the former was actually an omnivore ancestor of the more benevolent sauropods, with Eodromaeus near at the top of the T. Rex family tree.

“We’re looking at the dawn of the dinosaur era where the fork in the road is still very narrow in the divergence of plant eaters from meat eaters,” Sereno told the Tribune. “That is why Eoraptor and Eodromaeus look so much alike.”

But as in Hollywood, your 15 minutes of fame are very short in the world of dinosaurs. In the mere two weeks since Eodromaeus was unveiled, another thunder lizard has stolen the spotlight: the hilarious-looking Linhenykus, the “one-fingered” dinosaur. Seriously, imagine trying not to laugh as one of these ran towards you (bear in mind that they were also small enough to “s[t]and comfortably in the palm of your hand.”). As Switek points out at Dinosaur Tracking, a current theory goes that Linhenykus, and other dinosaurs with one pronounced digit, may have used their comedically short arms to dig for ants and termites.

Nabokov’s Hobby

The research of lepidopterist Vladimir Nabokov never quite got the credit it deserved while he was alive and working as curator of butterflies at Harvard’s Museum of Comparative Zoology. Perhaps it was his outlandish ideas, about butterflies migrating from Asia through Siberia and Alaska and down to South America. Or perhaps it was because he was better known as the experimental novelist responsible for Lolita, Pale Fire, and other books. Catching and studying butterflies was a lifelong hobby for the Russian-born Nabokov, but despite publishing at least one manuscript (pdf, found via Carl Zimmer’s twitter) on the evolution of a group of species known as Polyommatus blues, he was largely ignored by the scientific community as an amateur.

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The late December quiet has given way to a post-holiday flurry of exciting research news, most of which I can’t tell you about until next week. But in the meantime, here’s our first weekly roundup for 2011 of the most interesting science and medical news around the web.

Tears for Fears

Scientists have discovered a multitude of ways by which animals communicate through chemical signals, such as those in the urine that dogs use to mark their territory and the path left by ants to guide their compatriots to food sources. But whether such pheromone signals exist in humans has been much more controversial. Martha McClintock, professor of psychology at the University of Chicago, has published many papers showing evidence for communicative signals in human sweat that can influence menstrual cycling, mood, and brain function in other people. But the behavioral effects of human chemical signals have so far been small, producing nowhere near the sensational effects that marketers of “pheromone” perfumes claim on less than reputable websites.

But another mediator of chemical communication in humans may have been traced this week, in a paper published by Science on the ability of women’s tears to affect sexual interest in males. The Israeli study used a hilarious method of collecting their experimental substance, sitting women down in front of sad movies and catching their tears in test tubes (”We obtained negative-emotion tears from 2 donor women who watched sad movies in isolation,” the authors right in scientist-ese). The fluid was then placed under the nose of male subjects, who viewed pictures of women’s faces and rated their attractiveness. As described by Ed Yong at Not Exactly Rocket Science, the males’ sexual interest decreased when exposed to the tears, as compared to being exposed to a control of saline. Differences in brain activity and testosterone levels were also detected while men sniffed the tears of sadness.

Consulted by the New York Times, McClintock said the study “really broadens the possibilities of where signals are coming from,” but expressed skepticism that the tears’ effect would be restricted to sexual behavior. “I have no doubt that it affected sexuality as they report, but I would be very surprised if it doesn’t turn out to affect other emotions in other contexts. Maybe it’s affecting some deeper, more fundamental psychological process that drives the effect that they’re reporting,” she told the newspaper. Other critics have asked whether the chemical signal lies in the tears themselves, or are collected by the tear from the skin as they roll down a subject’s cheeks. The nature of the chemical still remains to be found, but the evidence suggests another entry in the previously hidden chemical vocabulary of humans.

Fraudulent Science, Human Cost

Last year, the infamous 1998 Lancet paper purporting to show a link between the measles, mumps, rubella vaccine and childhood autism was finally retracted after years of criticism for biased selection of subjects and unethical behavior. But the research, led by Andrew Wakefield, went beyond scientific mistakes to fraudulent falsification of data, a new report from the British Medical Journal released this week discovered. Investigative reporter Brian Deer found that Wakefield, who was being receiving payments from a lawyer seeking to file a lawsuit against vaccine manufacturers before he started the study, changed the timeline of autistic symptoms appearing in patients to make it look more like vaccines were the cause. The article is a rigorous and thorough deconstruction of a scientific fraud that has had concrete consequences for children around the world - in the  12 years since the article was published, measles cases have spiked in England and America as vaccination rates have dropped, and other vaccination-sensitive diseases such as whooping cough have also made a resurgence.

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ScienceLife ran 219 posts in 2010, and choosing the best of them is as hard as picking a favorite gene.  So here’s a month-by-month scan of a busy year at the University of Chicago Medical Center, full of exciting discoveries in the laboratory and the clinic. The impact of some of this research is already being felt by patients receiving improved, evidence-based medical care. For other studies, the clinical benefit may be years in the future, and may take unpredictable forms. As a closing message for 2010, we’ll re-quote the recently departed Eugene Goldwasser, whose laboratory research isolating and purifying the hormone erythropoietin has helped millions of people worldwide.

“It is a particularly impressive example of how basic research can pay a dividend that could not be anticipated at the start,” Goldwasser wrote about his life’s work, “and it is a pity that the lesson still has not been learned by those who control public funding of science.”

January: Tong Chuan-He looked at how cancer may result from cells who don’t want to grow up. Scientists studied how sleep affects the language learning skills of starlings (with painstakingly acquired video of the experiment!). Richard Jones combined two laboratory staples - Western blots and DNA micro-arrays - to develop a new method for studying protein networks. While physicians such as Tammy Utset treat patients with lupus, UChicago scientists are looking for the genetic origins of the autoimmune disorder.

February: Many Medical Center employees returned from volunteering with relief efforts in Haiti, and we filmed video interviews with Rex Haydon, Tiffany Cupp, Richard Cook, and Dima Awad on their experiences. Most of the human genome is “junk” between protein-encoding regions, but Marcelo Nobrega developed a way to find important regulatory elements in that genetic sea. Like birds, human learning can be affected by sleep, and Leila Kheirandish-Gozal reported on the impact of obstructive sleep apnea upon learning in children. Can a single protein in the brain create behaviors associated with drug addiction in rats?

March: Everyone knows air travel is stressful, but did you know that eastbound flights cause stronger cortisol changes than westbound trips? The laboratory of Milan Mrksich found a way to direct stem cells to form fat or bone by shaping them into stars or flowers, a brilliant example of bioengineering. Computational neuroscientists discovered how touch is like vision in the brain, knowledge that could be used to someday re-engineer Luke Skywalker’s robot hand. Dartmouth president and Partners in Health co-founder Jim Yong Kim visited to talk about a new, needed area of research: health care delivery.

April: Researchers at the Field Museum and the University of Chicago teamed up for the Emerging Pathogens Project, an effort to find new viruses in animals before they jump to humans. Cardiologist Martin Burke tested out a new type of internal defibrillator device that can go under the skin, instead of into the heart (the clinical trial, reported in May, was a success). In a lecture to the MacLean Center of Clinical Medical Ethics, transplant surgeon J. Michael Millis described his efforts to bring American organ transplant practices to China.

May: A trial testing the erectile dysfunction drug Viagra for a rare, untreatable lung disease failed, but pulmonologist Imre Noth found a silver lining. Lauren Sallan and Michael Coates uncovered evidence of a previously unappreciated mass extinction event 360 million years ago that changed the path of life on Earth. Researchers from the University of Chicago and around the world presented science at the frontier of biotechnology at the annual BIO conference.

June: In a study that is literally the size of an entire country, epidemiologist Habibul Ahsan measured the toll of a tragic, accidental exposure of millions to arsenic in Bangladesh. Putting a gene from fireflies into the pancreas of mice isn’t mad science, it’s an imaging tool that will help study cures for diabetes. Epigenetics, the modifications that turn genes on and off, took off in 2010, and cardiologists Stephen Archer and Jalees Rehman linked one epigenetic factor to pulmonary artery hypertension.

July: Scientists don’t often get to see the fruits of their research in the flesh, but the Celebrating the Miracles gathering of diabetic children weaned off injected insulin thanks to genetic research was a moving exception (video of the event can also be viewed). Another hot topic in science and medicine this year was the use of computational analysis to sift through rapidly accumulating data, topics explored by Gary An and Andrey Rzhetsky. Or you can build a computer model of a brain network to study the dynamics of epilepsy, like neurologist Wim van Drongelen.

August: Air pollution is a problem indoors as well as outdoors in developing countries where dung and firewood are used to cook food - a problem being tackled in a project led by Sola Olopade. A study of the hormonal changes induced by a stressful test revealed a surprising protective effect of marriage and long relationships. Microbiologist Olaf Schneewind’s laboratory developed two new strategies against MRSA, the most-wanted cause of hospital-acquired infections.

September: To study multiple sclerosis, neurologist Brian Popko’ s laboratory developed a new mouse model that can replicate the disease, then spontaneously recover. Meanwhile, a new drug to treat MS, originally isolated from fungus found in wasps, was approved by the FDA and is being studied for broader uses at the Medical Center. The micro-organisms that live in humans were analyzed as part of a “microbiome” study looking at the protective effects of breast-feeding against a intestinal disease.

October: Common wisdom on quitting smoking says to stay away from cigarette-associated cues, but research from psychiatrist Harriet de Wit’s laboratory revealed that abstinence could make craving even worse. A study of how getting a good night’s rest affects dieting results suggested that “sleeping off the pounds” isn’t merely a fantasy. Graduate student Daniel Matute solved a 100-year-old riddle about how quickly new species become reproductively incompatible with each other.

November: In perhaps our favorite study of the year, geneticist George Perry found a way to acquire the genomic information of endangered species from…poop. The evolutionary biologist Leigh Van Valen passed away, but his Lewis Caroll-inspired Red Queen Hypothesis lives on. Sometimes statistics don’t tell the whole truth, as in the curious case of the aspirin paradox - why the cardio-protective drug may actually predict worse outcomes after heart attack.

December: Evolution textbooks may need a rewrite after geneticist Manyuan Long’s laboratory discovered that new genes can be just as essential as old genes. A study by neurobiologist Nicholas Hatsopoulos proved that the only thing better than a thought-controlled device is a thought-controlled device equipped with a robot arm. Ripped from the headlines: microbiologist Jack Miller weighed in on the hype over arsenic-based bacteria, and ethicist/physician/friar Daniel Sulmasy discussed the Presidential Bioethics Commission’s report on synthetic biology.

All told, it was a great year of science and medicine. Let’s do it again in 2011! Regular posting will resume Jan. 3rd. Happy Holidays.

(photo by Lloyd DeGrane)

Here in Chicago, we’re entering the second of our two seasons: transitioning from “Construction” into “Winter.” The rampant highway repair that happens during warm weather months is largely due to the stresses of the cold weather months, which leave our roads cracked and potholed. But perhaps we’ll be saved from all that misery if a team of Dutch researchers are successful in their efforts to create biologically self-healing concrete. The process embeds calcite-precipitating bacteria into concrete paste, so that when cracks occur, the microorganisms can secrete a mineral that will fill those fractures. It’s a cool example of biology-inspired engineering, and was mentioned as part of the New York Times’ interesting “What’s Next in Science?” feature this week.

Two exciting studies from the other side of the University of Chicago campus came out in this week. In the first, Chuan He in the Department of Chemistry helped characterize the activity of “the most exciting protein family now in biology,” a DNA repair protein called AlkB. In charge of demethylating DNA, AlkB has the power to re-activate silenced genes, a valuable epigenetic function that could someday be harnessed to treat diabetes, obesity, and cancer. The study also utilizes a delightful science word to describe one of the protein’s intermediate states: “zwitterionic,” when an object has a neutral charge, but acts positive or negative when interacting with other objects.

In another study, University of Chicago psychologist Susan Levine found that a child’s early exposure to mathematics can influence later success in the subject. Researchers videotaped interactions between parents and their children when they were between the ages of 14 and 30 months, counting how many “number words” were used by the parents. When the children were given a simple math test at the end of the experiment, those that heard more about math from their parents tended to perform better.

Today and tomorrow, the MacLean Center for Clinical Medical Ethics will hold its 22nd annual conference, a two-day festival of ethical lectures and discussion. Today’s session will expand upon the local, national, and global health disparities theme of the center’s weekly seminar series, while the second day takes a broader approach with topics such as pediatric ethics, palliative care, transplant medicine, and a session dedicated to the memory of faculty member Stephen Toulmin. The schedule is available here (pdf), and we’ll have coverage of the conference next week.

ScienceLife is very excited to have gotten in during the very brief window that registration for Science Online 2011 was open this week. The “unconference,” held in North Carolina in January brings together a dream team of science bloggers for open discussions and workshops on the growing field of internet science journalism. Expect to hear more about it.

The past few decades have brought astounding progress in fighting the scourge of infectious disease in developing countries. It’s remarkable to think that a disease such as smallpox, which killed 50 million people a year only 50 years ago, has been successfully eradicated from the world. Similarly, polio has been stamped down to only rare outbreaks, and great strides have been made against HIV/AIDS and tuberculosis in poor countries.

But the fight against infectious disease is only half the battle in global health. In fact, it’s less than half, said Abdallah Daar of the University of Toronto in his Nov. 3 talk for the MacLean Center for Clinical Medical Ethics Seminar Series. More people in the developing world die from chronic, non-communicable diseases like diabetes and cancer than from infectious disease, nutritional deficiencies, or inherited conditions combined. While chronic diseases dominate health care in the United States and Europe, efforts to fight those disease in poorer countries have lagged far behind the funding for infectious disease.

“About 60 million people die each year, and people imagine that a lot of people in the developing world die from infectious diseases. Well, it’s not so,” said Daar, the Senior Scientist and Director of Ethics and Commercialization at the University of Toronto’s McLaughlin-Rotman Centre for Global Health. “Chronic disease…is an area that has been totally neglected in the developing world.”

To fill in this considerable gap, Daar’s group has helped coordinate new initiatives with the Canadian government and research agencies around the world. The Global Alliance for Chronic Disease, which brings together six scientific funding bodies from the US, Canada, China, India, England, and Australia, was created to address the priorities laid out by Daar and colleagues in a 2007 editorial. “Inaction is costing millions of premature deaths throughout the world,” they wrote.

The effort plans to go after worldwide chronic disease on several fronts, from modifying risk factors such as diet, exercise and smoking to advocating for healthier government policy and health systems to working with businesses to deliver cheaper, more effective care to underserved populations.

“We know how to treat hypertension in one person. We know how to treat hypertension in a classroom. But how do you treat hypertension in a whole country? We don’t know how to do that,” Daar said. “We need to learn how to take evidence and how to scale it up and interact with policymakers and get them to buy in. So if you do a screening program, and it’s very successful and you save many lives, how do you get the policymakers to say yes, we’ll do this on a national scale and save even more lives?”

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As discussed previously on ScienceLife, the microbiome is the ecosystem of billions of bacterial organisms living inside our bodies, influencing us in as-yet-undetermined ways. Most efforts to study the microbiome thus far have focused on how gut bacteria affect digestion and disease, but a paper this week in PNAS reveals a surprising new power for those microorganisms: the ability to shape sexual preference. Okay, so far it’s only been observed in fruit flies, but as Ed Yong at Discover Magazine’s Not Exactly Rocket Science explains, it’s still a remarkable example of how a change in diet can alter an organism’s behavior in unforeseen ways.

The relationship between science and films, Carl Zimmer writes in this week’s Nature, has largely been a one-way street. Science gives Hollywood the technology to make pictures move, talk, and appear to throw things at you (in the case of the recent 3D boom), but returns the favor by portraying scientists as mad, geeky, or both. Zimmer’s column was inspired by hosting the recent Imagine Science Film Festival, a New York event that showcases short films with scientific inspiration. And while Zimmer is skeptical about the use of Hollywood film to promote science - Citizen Kane “would not have been a masterpiece if Orson Welles had kept asking himself ‘Does this make journalism accessible to a broader audience?’,” Zimmer writes - he comes slightly around after seeing films portraying the sensory phenomenon of synaesthesia and the comedic adventures of a Norwegian cryonics laboratory.

Bad news: a new projection by former University of Chicago faculty member Nicholas Christakis predicts that 42 percent of Americans will be obese by the year 2050. Good news: the obesity rate will plateau at that ghastly figure; as the authors write, “While not great, this is a much more optimistic estimate than 100%.” As our own Elbert Huang calculated last year, that plateau will still mean billions more in health care costs to treat chronic diseases associated with obesity, such as diabetes and heart disease.

The health care reform measures passed last year, should they survive the new Republican-led House, put a greater emphasis on primary care and preventive medicine. But the question of who will provide that primary care remains unanswered, as Joanna Broder wrote in the Chicago Tribune this week. Broder leads her article with Pritzker School of Medicine graduate Nina Vergari Rogers, currently working at the Chicago Family Health Center as part of the University of Chicago Medical Center’s REACH program. Doctors enrolled in REACH can receive $40,000 a year toward their medical school loans - a serious incentive, given that the lower salaries paid to primary care physicians mean their expenses exceed their earnings for the first 3-5 years after residency.

Two months ago, ScienceLife wrote about a very special scientific conference, focused less on data and graphs than on the real human effects when a scientific breakthrough is successfully translated to the clinic. Called Celebrating the Miracles, the conference brought together families with diabetic children whose lives had been changed by the discovery that their disease could be treated with a simple pill instead of frequent injections of insulin. The word “miracle” is tossed around a lot, but talking to the parents of these children and the scientists and physicians who study and treat diabetes was a really moving experience about the power of science to change lives.

At the conference, each family had the opportunity to record a video message about their child’s “transition” from insulin to pills. Those stories, alongside interviews with the physicians and scientists from the Kovler Diabetes Center who treated the children and spoke at the conference, were assembled into the following video. Enjoy:

A diagnosis of diabetes brings with it a plethora of lifestyle changes. Patients must switch up their diet and exercise habits, take on a new routine of daily medications and injections, and keep an eye on their blood sugar. But another potential change under the cloud of diabetes is even more personal: the diabetic’s sex life. With diabetes rates on the rise, and the lifespan of those with diabetes gradually lengthening, it would be informative for doctors to know how often their older, diabetic patients are having intimate moments and whether the disease impacts their sexual health.

In an article published last week in the journal Diabetes Care, a team led by Stacy Tessler Lindau at the University of Chicago Medical Center shed light on the previously hidden sex lives of elderly diabetics. With a dataset of interviews with older adults - in fact, the same dataset used for the medication disparities study ScienceLife wrote about last week - the researchers were able to analyze the sexual health and un-health of people with diagnosed and undiagnosed diabetes. The results found that diabetes doesn’t take as big a bite out of a person’s sex life as might be expected - though all is not entirely well.

“Patients and doctors need to know that most middle age and older adults with partners are still sexually active despite their diabetes,” said Lindau, an associate professor of obstetrics and gynecology. “However, many people with diabetes have sexual problems that are not being addressed.”

When it comes to elderly diabetics who are married or living with a partner, the numbers on who remains sexually active are in line with the general population. Broken down by gender, the same sexual gap appears with diabetics as well - diabetic men between the age 0f 57 and 85 are more than twice as likely to be sexually active as diabetic women of the same age. A similar imbalance was seen for the discussion of sexual issues with a physician: 46.8 percent of men said they had talked with a doctor about the topic, compared to only 18.8 percent of women.

“Failure to recognize and address sexual issues among middle-age and older adults with diabetes may impair quality of life and adaptation to the disease,” said Marshall Chin, senior author of the study and professor of medicine. “Sexual problems are common in patients with diabetes, and many patients are not discussing these issues with their physicians.”

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