Cooking indoors over firewood and dung is a tough habit to break for billions of poor people around the world. But Sola Olopade, MD, professor of medicine and family medicine, found a way. He wanted to stop women from hunching for hours over open fires inside their houses, cooking with babies strapped to their backs. The air in such houses quickly becomes filled with toxins, and the women and children have a host of bad health consequences.

“It’s the most unclean combustion you can get,” Olopade said in his seminar earlier this month at the MacLean Center for Clinical Medical Ethics. “The women and children have coughs, headaches, runny noses, chest tightness.”

Those are just the health problems he could measure. “I wonder what kind of cognitive dysfunction people develop in spaces where the carbon monoxide is so high.”

Unfortunately, the billions of poor people who cook their daily meals over firewood and dung have few other options. Without electricity, Olopade said, “energy poverty drives people to use whatever they can get their hands on.” But Olopade was determined to see whether education and a little technology could make it less dangerous for people to breathe inside their houses.

Olopade, who is clinical director of the University of Chicago Global Health Initiative, went to two small villages in his native Nigeria, ready to distribute energy-efficient ceramic stoves. He believed the simple stoves could make an enormous improvement in the community’s health. His team measured the air quality inside 100 homes, and found heavy metals, carbon monoxide, and particulate matter more than twenty times the World Health Organization acceptable standards. The researchers also educated the community about the dangers of exposure to smoke from using firewood to cook indoors and the benefit of using the new stoves, handing out brochures about cooking in their native dialect.

“I told them without medical jargon that this was killing people,” Olopade said.

Three months after giving the stoves to the families in the villages, Olopade returned. He took the same air quality measurements, repeated the survey of symptoms and saw a remarkable improvement. Carbon monoxide and particulate matter levels were dramatically lower, much closer to the WHO standards.

“People were very happy with the stoves. They’re very simple. They’re lined with ceramic which retains a lot of heat and promotes more complete combustion of the firewood or biomass fuel,” Olopade explained.

The women were burning the same fuel - cow dung, agricultural waste, and firewood - but the stoves had kept most of the pollutants from pouring into the homes. With this small change, “you can really improve the indoor environment,” Olopade said.

The health benefits were drastic. Before the intervention, many of the children and most of the mothers suffered from dry cough, runny noses, burning eyes, breathing difficulties, chest tightness, headaches and dizziness. All of these health problems plummeted after they started cooking on the clean stoves.

“Just by engaging the community in partnership, educating them on the dangers of exposure to toxic fumes and giving people efficient stoves, without changing their lives much, the change in symptoms is dramatic,” Olopade concluded.

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Last week, we brought you exclusive video from the rehearsal space of Turnover Time, the band of Medical Center employees formed to raise money for David Song’s relief efforts with Medical Aid for Children in Latin America. The band’s big debut took place at the Lend an Ear fundraiser Saturday night at the University of Chicago International House, and by all accounts, it was a roaring success. The event raised nearly $25,000 for the annual trips led by Song to the Dominican Republic to reconstruct ears and repair cleft palates, with an additional $17,000 donated via the MACLA website (where you can still make a donation). In exchange for their philanthropy, the standing-room-only crowd at the fundraiser was treated to two sets of music from Turnover Time, excerpts of which appear below. Enjoy the tunes!

Turnover Time is Shahab Akhter (drums), John Alverdy (keys), James Anderson (vocals), Kevin Johnson (vocals), Jeff Matthews (guitar), Joan Matthews (bass), Jono Matthews (guitar), Sarah Pae (vocals), Nikki Phillips (vocals).

Since late September, ScienceLife has been posting near-weekly recaps of the annual Maclean Center for Clinical Medical Ethics seminar series. The topic for this academic year, “Health Disparities: Local, National, Global” (pdf), has brought together an all-star cast of physicians, biologists, economists, social scientists and other experts to present research on some of the biggest challenges facing health care in the United States and around the world. Most of the sessions have been videotaped, and the first batch of those videos recently went live on the MacLean Center website. Here’s a digest of the first seven seminars available to watch and the ScienceLife posts that briefly summarized the discussions. The videos have also been added to each post.

Rick Kittles (UIC) - “Race, Biomedical Research, and the Politics of Trust”

Rebuilding Trust, Moving Beyond Race

Kathleen Cagney (UChicago) - “The Neighborhood Context of Health Disparities”

Urban Crime and the Waistline

Robert Sampson (Harvard) - “The Social Reproduction of Health Disparities: Lessons from the Chicago Neighborhood Project”

The Invisible Hand of the Neighborhood

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When you think of a medical instrument, you usually think of a scalpel or forceps. But nine employees of the Medical Center are also proficient in instruments of a musical nature, and are putting those side talents to use for a good cause this weekend.

For the last 11 years, plastic surgeon David Song has led a team of University of Chicago Medical Center employees to the Dominican Republic for two weeks of charity care. Working with Medical Aid for Children in Latin America (MACLA), the team of surgeons, anesthesiologists, nurses, and residents focuses on ear reconstruction, cleft palate surgery, and burn treatment for disfigured residents of Hispaniola (including Haitians and Dominicans) who might otherwise face a life of discrimination and pain.

“A lot of children in the Dominican Republic are born without ears, and they’re ostracized from the community,” said Song, professor and vice chairman of surgery. “Shamanism and voodoo are still practiced in some of these villages near the Haitian border, and a lot of these villagers feel that these children with congenital deformities are really possessed by a demon. They see us as exorcists, when simply it’s reconstructive surgery, and we’re able to reintegrate them back into the village and have them be accepted by their families as normal human beings. That’s really touching for us.”

This Saturday’s “Lend an Ear” fundraiser (pdf), to be held at the International House on the University of Chicago campus, will feature a different type of philanthropy: the debut of the Medical Center band Turnover Time. Named for the medical jargon of the time between procedures in the operating room, the nine members of Turnover Time include surgeons, anesthesiologists, techs, medical students, and residents with serious musical chops. In the video below, you can watch them rehearsing some of the songs from their Saturday setlist, including Coldplay’s “Clocks,” the gospel tune “Oh Happy Day,” and Bonnie Raitt’s “Angel from Montgomery.”

“I knew they were talented, but they blew me away,” Song said of viewing of a Turnover Time rehearsal earlier this month. “It’s an expressive way for them to directly affect our philanthropy and our efforts across the globe and the Western Hemisphere. They’ll have a great time, raise money for a great cause, and it brings the entire Medical Center community together.”

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.

Fangs You Very Much, Evolution

Where did the snake get its fangs? It sounds like the lead-in to a Rudyard Kipling Just So stories, but it’s a legitimate evolutionary biology question about one of nature’s deadliest weapons, one that goes back 20 million years ago to the oldest snakes in the fossil record. But even those ancient snakes had fangs similar to the poisonous snakes of today, with a hollow tube running through the tooth to inject venom into some poor prey like a hypodermic needle. How snakes (and other venomous reptiles) evolved such an elegantly dangerous mechanism was a mystery, until a new study published this week by University of Chicago’s Jonathan Mitchell and colleagues.

To study the evolution of snake fangs, Mitchell and his team were forced to go to a non-snake reptile - the mysterious Uatchitodon, a roughly 200 million year old reptile known only by its teeth. But in this case, the teeth were what the scientists cared about, and they compared the dental fossils from Uatchitodons found in Virginia, North Carolina, and Arizona. Interestingly, the teeth of older specimens appeared to show a kind of proto-fang, with a “canal” running down the outside of the tooth for the delivery of venom. This style of venom delivery is more similar to the modern-day Gila monster, the authors wrote, which “chews” its venom into its victims (shudder).

Later Uatchitodon teeth display a new form more similar to modern snakes, with the once-external groove now hidden inside the tooth. “This fossil really suggests that you can’t get hollow fangs any other way,” says co-author Wolfgang Wüstertold Nature News. Indeed, modern snakes even demonstrate a fast-forward highlight reel of this evolution, with grooved “replacement fangs” that give way to the mature, tubular model. It’s also a demonstration of the kind of transitional, evolutionary process that intelligent design supporters absolutely hate, demonstrating that the highly successful fang mechanism didn’t just appear out of nowhere, but through a series of intermediate steps that were also functional in their own right.

Another Bridge to China

The effort to help Wuhan University revise their medical school curriculum, described here yesterday, is not the only current collaboration between the University of Chicago Medical Center and Chinese hospitals. Last month, a delegation from Comer Children’s Hospital and the Department of Pediatrics visited Shanghai, where they signed an agreement establishing an educational, clinical, and research collaboration with Shanghai Children’s Medical Center (SCMC).

The relationship between the two pediatric hospitals sprouted from a training program started by Donald Liu, professor of surgery at Comer, who has taught minimally invasive techniques to surgical fellows from the Shanghai hospital for the last 10 years. For a disease called gastroschisis, where an infant is born with their bowels on the outside of their body, Liu’s instruction helped SCMC improve survival rates from 30 percent to 95 percent in 10 years. The success of that informal program and a successful visit from SCMC leadership to Chicago last year inspired the expanded collaboration, which will begin next year.

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Sarah-Anne Schumann with the first community health clerkship students.

Facing rising medical costs and shortages of physicians in rural and urban areas, a government calls for health care reform. Experts warn that more primary care and family medicine physicians are needed to meet the surging demand for first-line treatment, chronic disease management, and the promotion of prevention. In response, medical schools look for ways to adjust their programs to prepare new doctors for careers in family medicine and community health.

It’s a familiar story for Americans, but the same drama is playing out half the world away in China. With their population soaring past the 1.3 billion mark, the community health crisis is on an even larger scale than the one here in the United States. But in many ways, the country is farther away from a solution, with a national medical curriculum that heavily prioritizes inpatient care and specialization. In response, the Chinese government recently issued a mandate redirecting schools to start producing more front-line doctors.

But it’s no simple matter to create a new curriculum from scratch, and the University of Chicago Medical Center is helping one Chinese medical school with that process. Wuhan University, a school in the central Chinese province of Hubei, is working with Renslow Sherer, professor of medicine, and other faculty to revise their curriculum over five years. A key part of that collaboration - the creation of a family medicine department - recently reached a landmark in October as the first six Wuhan medical students began a one-month community health rotation designed by Wuhan and Chicago doctors.

Sarah-Anne Schumann and Mari Egan, assistant professors of family medicine, have spearheaded Wuhan’s construction of a new family medicine program, visiting the country three times between them in the last year. As leaders of the family medicine and community health programs at the University of Chicago’s Pritzker School of Medicine, both are experienced in creating partnerships between a hospital and the surrounding neighborhoods. But despite Wuhan’s original plan to import their Pritzker program wholesale to China, it became quickly apparent during the visits that a custom-fitting was necessary.

“We were constantly saying ‘You can’t create a community clerkship for the South Side of Chicago in China,’” Schumann said. “You have to look at what your patients need and design the clerkship around that. They needed to take ownership and make it work for their students.”

The pricelist at a community health center.

The main challenge was connecting the Wuhan medical school with the community health centers in the city, which are actually very impressive facilities, Schumann and Egan said. Care for chronic diseases such as diabetes or asthma, rehabilitation medicine, traditional Chinese medicine, and specialized care are all available at the centers, and doctors and nurses do home visits for those who can’t make it into the clinic. Physicians use electronic medical records to keep track of patients, statistics about blood pressure and glucose levels are posted on the wall, and a “menu” of procedures is prominently displayed in the front (pictured at right).

“You walk into the health center, and it’s like McDonald’s - there’s a neon sign that’s rotating, and it has all the treatments and how much they cost,” Schumann said.

But until now, students from Wuhan University did not have an opportunity to experience medical care in this environment. Nearly all of their patient encounters took place in the hospital, and the community health education amounted to hearing lectures about the neighborhood clinics without ever visiting them. That format is similar to what was commonly seen in American medical schools until the relatively recent push for more hands-on community health experience, Egan said.

“Until about 40 years ago in the United States, most of medical education was taught in the hospital, and we needed to learn how to teach students in the outpatient community setting,” Egan said. “Now we’re starting to do the same thing in China.”

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Anyone who dares make predictions about the future of the U.S. health care system in 2010 is standing on shaky ground. With the passing of the Patent Protection and Affordable Care Act (PPACA)- the legislative product of the health care reform debate - everyone knows that the rules are about to change in this country, but nobody is quite sure how. The changes included in the act will not be fully phased in until 2014, and the complicated business of determining exactly how those changes are implemented is currently underway in the bureaucratic halls of Washington. Throw in the Republican gains in this month’s election - won at least in part on promises to repeal aspects of PPACA - and uncertainty is rampant about the most important overhaul to American health care since the creation of Medicare.

That foggy vision of the future dominated discussion on the opening day of the 22nd Dorothy J. MacLean Fellows Conference, this year’s edition of the MacLean Center for Clinical Medical Ethics annual event. Though the topic of Friday’s sessions was nominally health disparities on the local, national, and global stages, the discussion was magnetically drawn again and again to PPACA, which was designed in part to narrow notorious health care gaps in the United States.  The physicians, ethicists, and social scientists at the conference unsurprisingly agreed that it was imperative that those disparities be reduced, but less consensus was reached on whether PPACA would be the magic bullet to do so.

On its face, the legislation makes several sweeping moves that would appear to directly confront health disparities in America. No PPACA component is more significant for underserved populations than the expansion of medical coverage for the country’s 47 million people without insurance, the majority of whom are minorities, said A. Eugene Washington, the dean of the David Geffen School of Medicine at UCLA. The other major aims of the bill, improving quality and reducing cost, may produce more mixed results for disparity reduction, as new payment measures based on outcome, rather than volume, could push health care providers to avoid communities with poor health at baseline. Much relies upon how the broad goals of the bill are truly implemented by federal and state agencies, he said.

“The legislation is really a framework, and it’s going to get shaped,” Washington said.

The (mostly) pessimistic view of that shaping process was provided by Harold Pollack, professor of social service administration at the University of Chicago. Pollack said the legislation, as written, is the most important AIDS and drug addiction policy ever passed in the United States and that expanded coverage will help address some disparities. But he was also critical of the slow roll-out of policies because it makes them contingent upon “bipartisan goodwill,” a scarce resource lately in Washington.

“We’re in for a wild ride, and it’s going to be a wild ride in a time of fiscal crisis and political gridlock in the short run, when the most difficult implementation challenges in our health care system will have to be resolved,” Pollack said.

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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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Designing a trial for the treatment of cancer is hard. Designing a trial to prevent cancer is even harder. In a typical population, such a small percentage of people will naturally contract a particular type of cancer that to test the ability of an intervention to reduce that number may require tens of thousands of subjects to be followed for decades. That’s not a cheap, or easy, study to run.

But in a population where the risk for a particular cancer is elevated, a prevention study might be both possible and immediately helpful. One such situation is found in the unfortunate case of Bangladesh, where charity efforts in the 1970’s to provide pathogen-free sources of drinking water accidentally exposed 40-70 million people to water tainted with arsenic. The disease epidemiology of that long-term exposure was recently characterized by Habibul Ahsan, director of the Center for Cancer Epidemiology and Prevention at the University of Chicago Medical Center, whose HEALS study found increased mortality and cancer in a study of more than 20,000 people.

In addition to characterizing what has been called “the largest mass poisoning of a population in history,” Ahsan has also been leading a study to try and offset some of its damage. The Bangladesh Vitamin E and Selenium Trial, or BEST, is testing two inexpensive nutritional supplements for their ability to prevent the non-melanoma skin cancer (NMSC) that commonly develops in people exposed to high levels of arsenic. The study, which recently received a $10 million renewal from the National Institutes of Health, has a twofold purpose, Ahsan explained.

“In the short term as well as unfortunately the long term, these people will be at an increased risk for arsenic-related cancers,” Ahsan said. “What we can do on the biomedical side, beyond solving the arsenic-contaminated water problem, is to identify low-cost, pharmacological or dietary/nutritional interventions. Something we can provide to these people that is feasible for millions of people at risk to take and reduce their future risk of these cancers.”

Like Ahsan’s HEALS project, the BEST study is massive in scope. In the first five years of the trial, roughly 7,000 Bangladeshi subjects were recruited and sorted into one of four groups, each required to take one pill a day for 6 years. Depending on the group, each subject will take a daily dose of vitamin E, selenium, vitamin E and selenium, or a control pill, with researchers tracking the amount of skin cancer, mortality, and other adverse events that develop by the end of the study.

Even at that size, the trial is smaller than it would be in a less vulnerable population. Because of the increased risk for NMSC among Bangladeshis exposed for decades to arsenic, a chemoprevention trial can operate with fewer subjects, Ahsan said. The infrastructure built by Ahsan’s team in Bangladesh (with collaborators at Columbia, Dartmouth, and the University of North Carolina) also saves money and ensures high compliance rates. More than 300 staff members have been hired to visit each subject on a daily basis to make sure they take their pill and to observe any side effects or illnesses.

“That’s something that’s impossible to do here,” Ahsan said. “It’s an expensive trial, but it’s a fraction of the cost had we conducted this trial here in the United States.”

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It’s well established that environment can influence a person’s weight as much as their genes or their behavior. For people growing up in inner city environments where fast food restaurants and liquor stores far outnumber grocery stores with fresh food options, it’s a struggle to piece together healthy meals on a consistent basis. But beyond “food deserts,” can a person’s neighborhood also influence their weight and their health in more subtle ways? Could less tangible factors such as crime rates and community networks contribute to the health disparities of race and socioeconomic status?

University of Chicago researcher Kathleen Cagney and Christopher Browning of Ohio State University set out to answer those intriguing questions by merging enormous data sets of health information and crime rates. The results of that study, presented by Cagney on October 6 at the MacLean Center Seminar Series, suggested that a person’s social surroundings - and the local police blotter - can exert a great influence on their health and fitness.

Cagney and Browning started with the Dallas Heart Study, a survey of thousands of residents of the Texas city on parameters relevant to cardiovascular heath. Focusing on one measure - body mass index, or BMI - the researchers then plotted the data against changes in local crime rate from police data for each patient, focusing in particular on short-term “crime spikes.” The hypothesis was that an increase in crime nearby the person’s home could produce stress and discourage outdoor activity, leading to less exercise, increased consumption of unhealthy “comfort food,” and activation of the hormonal “fight-or-flight” response.

“If something changes dramatically in your environment or in your community, you can imagine that your life behaviors and patterns would change in concert with that,” Cagney said.

After controlling for several other factors (a necessity for so broad a research question), Cagney said a significant effect of crime spikes on BMI was found for one group: women. Females from neighborhoods that had experienced the largest increase in crime over the past six months experienced a rise in BMI, equivalent to roughly a 2.7-pound weight gain for a typical 130-pound person. The weight of men in the study was found to be slightly sensitive to the overall crime rate in their neighborhood, but not the short-term dynamics of crime spikes, Cagney said.

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When long-hidden information about U.S. syphilis experiments on Guatemalan prisoners in the 1940’s surfaced last week, the shocking case contained echoes of the infamous Tuskegee study. Conducted from 1932 to 1972, the Tuskegee syphilis experiment followed African-American sharecroppers with the disease, and gained notoriety for withholding antibiotic treatment from the men in order to study the disease’s “natural progression.” The damage left by this unethical research persists to this day as an example frequently cited by minority communities distrustful of medical research.

“Most folks in the black community who know very little about research know about the Tuskegee study,” said Rick Kittles, in his Sept. 29 MacLean Center seminar “Race, Biomedical Research, and the Politics of Trust.” “It’s as if it was imprinted in our genes. There’s no Sunday morning breakfast discussion about it, but we know about it. We know something bad happened. We know that we were exploited. It has some serious implications still today.”

Indeed, the shadow of Tuskegee looms large over modern efforts to reduce the growing health disparities in the United States between Caucasian and minority populations, said Kittles, an associate professor at the University of Illinois School of Medicine. Many factors contribute to health gaps on parameters such as obesity, diabetes, and cancer: genes, socioeconomic status, environment, behavioral and cultural practices, and discrimination. But attempts to study any of these factors in the hope of reducing disparities must face the troubled history of research on the undeserved. As researchers find new ways to improve health, from advanced genetic medicine to improving access to fresh food with weekend farmers markets, community involvement is essential for such measures to close the disparity gap instead of further widening the distance between haves and have-nots.

“As this new technology and information is emerging - new treatments and intervention that could hopefully eliminate disparities - if [the community] is not involved, they’re not going to accept it. You have to bring them into the mix,” Kittles said.

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This week’s biggest science news would have to be the discovery of Gliese 581g, a planet 20 light years away from Earth that appears to have the capacity to support life. The coverage brought the delightful term “Goldilocks Zone” to public awareness - signifying a planet that is the correct distance from its sun to have liquid water on its surface. This is the kind of science news story that produces shockwaves of misinformation and misleading over-hype across the media world, with a small piece of mathematical data converted into definitive proof that aliens will be showing up any day now. But even the reliable science news sources appeared to be pretty pumped about this - “scientists have found the most earth-like planet” is probably the safest (but still exciting!) way to spin the story. Still, if you want to appear smart to your friends in weekend discussions of exoplanets and the potential for alien life, read Phil Plait’s take at his blog Bad Astronomy, which underlines both the caveats and the hidden gems (one day = one year on the Gilese 581g!) of the discovery.

Last year, UChicago researchers were the proud (?) recipients of an Ig Nobel Prize, given out annually by the Annals of Improbable Research. The winner, a woman’s undergarment that can be converted into a gas mask, recently went into production - available in B and C cups and “original red,” according to one of the inventors. But alas, our tenure as an Ig Nobel-winning institution ended yesterday, as the 2010 crop of winners was announced. This year’s esteemed honorees are, as always, a motley crew of bizarre science, covering everything from the sexual habits of fruit bats to the development of a tool to collect snot samples from whale blowholes. But I think my personal favorite, at first glance, is research from Keele University in England finding that swearing increases pain tolerance. Maybe it’s not as socially acceptable as eating a chocolate chip to reduce pain, but it’ll do in a pinch.

The new issue of the Medical Center’s print magazine, Medicine on the Midway (known informally around the office as “MoM”), came out this week, and you can flip through its pages electronically thanks to some really nifty software. The cover story this month focuses on neurology at the Medical Center, and features stories familiar to ScienceLife readers on Parkinson’s disease and epilepsy. There’s also great writing about the Medical Center’s efforts in Haiti written by Cheryl Reed, who spent a week with our volunteers and filmed the Field Hospital Haiti movie, and a perspective by Dr. Kris Alden, an orthopedic surgeon who was part of the first Medical Center team sent to Haiti. The publications team has also started running periodic updates between print issues of the magazine, so give it a bookmark if you’re hungry for more medical news from the University of Chicago.

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Many people take pride in never missing a day of work, and fighting through what they perceive as a minor illness to put in a full shift at the office. But what if your office is a hospital ward? Doctors who show up for work sick run the risk of spreading their illness to patients, further complicating their health issues. But with the tight schedules and long hours of the hospital, there’s even more pressure to get out of bed and fight through your sniffles (or worse).

Medical residents, physicians in their first few years out of medical school, have the tightest schedules and longest hours of all, and a study by University of Chicago and Massachusetts General Hospital researchers found that population to be especially guilty of “presenteeism.” In the wake of last year’s H1N1 flu epidemic, concerns about this bad habit have grown, and Vineet Arora, Anupam Jena and colleagues surveyed residents from 12 medical centers. In a study published in the Journal of the American Medical Association, they found that 60 percent of residents surveyed showed up to work sick at least once in the academic year 2008-09.

“Hospitals need to build systems and create a workplace culture that enables all caregivers, not just residents, to feel comfortable calling in sick,” Arora said of the results. “Their colleagues and their patients will thank them.”

See coverage at CNN, Scientific American, and AP.

Elsewhere…

How many species bear your name? If your name is Robert F. Inger, the answer is more than 50, ranging from Calamalaria ingeri to Ingerna charlesdarwini. That’s the kind of list you rack up when you’ve spent seven decades studying amphibians and reptiles in Borneo, Thailand, Malaysia, India, and China. Last week, Inger - a graduate of the University of Chicago and curator emeritus at the Field Museum in Chicago - celebrated his 90th birthday, and his colleagues put together a website to celebrate the occasion.

The official opening of the University of Chicago Center in Beijing was celebrated this week, a space designed to foster collaboration between our faculty and Chinese researchers and experts. As this feature describes, many such partnerships are already underway, including the AIDS education efforts of professor of medicine Renslow Sherer and fossil-hunting projects by paleontologist Paul Sereno. By a stroke of luck, ScienceLife will write about another Sino-UofC research collaboration next week - stay tuned!

Our contribution to President Obama’s Commission for the Study of Bioethical Issues, physician/bioethicist/friar Daniel Sulmasy, was profiled in the Chicago Tribune.

Another genetic sequencing race, this time between…Mars and Hershey’s? The Snickers maker struck the first blow with Wednesday’s online public domain publication of the Cacao Genome Database, while a group funded by Hershey’s hopes to publish their sequence in a journal soon. The competition is both delicious and beneficial, experts said, and may someday yield more efficient cocoa famring as well as chocolate that is both healthier and better-tasting. Yes, please.

Since the middle of the 20th century, fighting air pollution has been a primary goal of the growing environmental movement in the United States and around the world. Encounters with smog and toxic gases inspired waves of public anger and protest that led to Clean Air Acts being passed in several countries and a steady progression toward tighter standards. But most of these efforts have concentrated on pollutants in the air outside the home produced by factories, automobiles, and other industrial sources. Meanwhile, another source of air pollution closer to home has gone unnoticed, even as it causes potentially millions of death in the developing world.

The main cause of indoor air pollution, explains Sola Olopade, professor of medicine at the University of Chicago Medical Center, is the burning of biomass for cooking food. In impoverished areas without access to electricity, people resort to using firewood, agricultural residue, and even cow dung as fuel for their kitchen stoves. In structures with poor ventilation, the burning of these items can create a high concentration of toxic fumes with serious health effects for those exposed.

“The problem is when you use firewood to cook, the smoke from it contains a lot of polluted dust that is carcinogenic and can also lead to airway damage and infection,” said Olopade, who is also clinical director of the University of Chicago Global Health Initiative. “When you look at it globally, there are about 3 billion people, mostly women and children, who are exposed to indoor pollution from using firewood to cook.”

The World Health Organization estimates that indoor air pollution is responsible for roughly 1.6 million deaths each year, from acute lower respiratory infections, chronic obstructive pulmonary disease, lung cancer, and other diseases. Half of those deaths are children, and nearly a third are children under the age of five, Olopade said.

“To put it in the right context, indoor pollution from biomass contributes to about 2.6 percent of the global burden of disease, actually kills more people every year than HIV and maybe even malaria, and yet nobody knows about it,” Olopade said. “So if we can accomplish bringing sensitivity or attention to this problem, and use it to influence policy and help people who are poor and would otherwise have no opportunity to have more efficient stoves, I think we will be very delighted.”

Just such an effort is currently underway thanks to a grant awarded to Olopade by the CHEST Foundation, an organization of American pulmonologists. Olopade has traveled back to his birth country of Nigeria to launch an effort against indoor air pollution in three rural communities named Eruwa, Igo-Ora, and Abanla. While doing a previous study on asthma in Nigeria, Olopade said he found that an overwhelming number of asthmatic children experienced high concentrations of toxic fumes at home.

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