By Dianna Douglas

Imagine your doctor says he plans to increase your oral medication to control your diabetes. You do not like taking pills. Should you:
A. Not rock the boat with your doctor and agree to take the increased dosage?
B. Agree, but keep taking the same number of pills?
C. Try to discuss another option with your doctor?

Monica Peek, MD, assistant professor of internal medicine at the University of Chicago, believes the best answer for long-term health and happiness is C. But she knows that low-income African Americans with diabetes will often, for a variety of reasons, agree with the doctor and then ignore the advice. Peek has spent hours leading classes with patients from this vulnerable group. They role-play talking to their doctor, critique each other as they practice, and give a debriefing on whether they could ever truly feel comfortable taking an active approach with a physician.

The classes are part of a new program to chip away at the disparities in diabetes among low-income African Americans. The gap is huge. The prevalence of diabetes on the South Side is 19.3 percent, compared with an average prevalence in Chicago of about 7 percent. African American neighborhoods in Chicago have five times the rate of diabetes-related leg amputations as primarily white neighborhoods do.

Three years ago, about 40 people at the University of Chicago Medical Center with expertise in nutrition, cultural tailoring, communication, quality improvement, and even community organizing launched an effort to close this gap. They were prepared to tackle multiple factors that exacerbate diabetes outcomes on the South Side. Among them are unhealthy eating habits, limited safe places to exercise, food insecurity and less access to health care.

Their first move was to get out of the hospital.

The group created teams at six community health clinics to focus on improving diabetes care. They led patients on field trips to local grocery stores to practice making smart food choices. The physicians were constantly on the radio, at health fairs, in churches and high school gymnasiums, educating South Siders about diabetes. Still, the Medical Center team ran into challenges from all sides.

“The economic factors of people choosing between food and medications don’t account for all of the disparities,” Peek said. “There is racial and cultural baggage that creeps into clinical encounters between doctors and poor African American patients.” As an example of this long history of bias, Peek cites a famous 1999 study from Georgetown University in which cardiologists were found to offer better care to men over women who complained of heart problems, and to white patients over black patients.

“People who have had bad interactions with the health care system may delay treatment until their condition is dire,” Peek said. Some say they are afraid of being experimented on, that they don’t trust doctors to do right by them, or that they dislike the perceived power imbalance of being in a doctor’s office.

Peek said she was surprised to learn how some low-income African Americans view the doctor-patient relationship. A woman told her that she gets agitated when she goes to a doctor’s office and hears, “What brings you here today?” — she thinks the doctor is saying, “Why are you sitting in front of me when I’m so busy?” read more

As another year comes to a close we’d like to look back at the fascinating research breakthroughs and inspiring patient stories from 2011. ScienceLife ran 168 posts this year, and while we wish we could highlight all of them, here are a handful of our favorites from each month.

January

Patrick Wilson found out that the H1N1 virus could end up helping us fight all types of flu. Stephen Pruett-Jones studied how some male birds mimic the sounds of predators to pick up the ladies (with an audio clip). We interviewed David Gozal about his study on the link between childhood obesity and lack of sleep, and took a look at NCAA regulations mandating sickle cell testing for athletes.

February

Harold Pollack gave a lecture on why violent crime in urban, minority communities should be considered a public health epidemic. Siri Atma Greeley studied the actual medical benefit of widespread genetic testing. Stacy Lindau wanted to know why so few women get help for sexual problems after surviving cancer. We talked to Bana Jabri about the causes of celiac disease, and Sliman Bensmaïa showed us how the brain processes the basic elements of touch very much like it handles visual information.

March

Sola Olopade educated women in Nigeria about using clean-burning stoves to prevent indoor pollution. Stefano Allesina and Jonathan Levine looked at how rock-paper-scissors helps explain evolution. Joshua Miller went to Yellowstone Park to see what stories the ghostly bones of animals can tell, and Scott Eggener questioned the wisdom of indiscriminate prostate cancer screening.

Photo by Gerald Waddell

Andrea King studied the wide range of responses to drinking alcohol, and why it can be fun for some people and a bummer for others. Cheryl Reed took a ride in a helicopter with our UCAN nurses. Kamal Sharma looked at the genes that control animals’ gait, and Ningqi Hou studied how urban environments can dictate how much exercise people get.

May

Daniel McGehee looked at the long-term effects of nicotine on the brain. Habibul Ahsan went to Bangladesh to study the health impacts of accidental exposure to arsenic in drinking water. The brain’s overlooked supporting cells got their due at a conference on neuroscience, and we remembered a landmark discovery about a once popular drug taken during pregnancy that we now know can cause cancer.

June

As we headed into summer, Diana Lauderdale used Google to track MRSA. We learned about an extraordinary transplant where a man received a new heart, liver AND kidney. Daniel Geynisman gave us the rundown on whether or not cell phones are killing us (they’re not, as long as you don’t use them in the car), and some UChicago undergrads studied what happens to gorillas on the birth control pill.

July

We spoke to Donald Jensen and Andrew Aronsohn about the new outlook for patients with hepatitis C. Igor Schneider made a time machine to find the genetic switch for limb development. Farr Curlin led a study about the benefits of addressing spiritual needs alongside medical care, and Adam Cifu looked at the phenomenon of scientific study reversals.

August

Stefano Allesina dug into the long, shady history of nepotism in academia in Italy. John Schneider talked about his work addressing sexual health and stigma in India. Michael Becker discovered a new treatment for the Royal Disease, and we had the rare chance to name check a Spiderman villain in a post.

September

Martha McClintock and Suzanne Conzen studied the connection between social isolation, stress and breast cancer. Gallego Romero traveled to India to search for the origins of lactose intolerance. Stephanie Dulawa developed a mouse model for OCD, and Paul Vezina looked at a different kind of obsession, compulsive gambling.

October

Arshiya Baig started a pilot project to help people learn about life with diabetes through pictures. Manyuan Long found that some of the youngest genes are in the brain. Jens Ludwig and Stacy Lindau published a landmark study about the connection between neighborhood poverty and health, and Issam Awad studied a rare brain disease that soon could be treated with a drug instead of surgery.

November

Cathy Pfister and Tim Wootton figured out how to use seashells to track climate change over the years. Lianne Kurina found a link between loneliness and sleep quality. Shantanu Nundy, Monica Peek and Marshall Chin developed a program to send text message reminders to people with diabetes, and Pan Chen looked at the links between childhood abuse and aggressive behavior in adults.

December

Inbal Ben-Ami Bartal, Jean Decety and Peggy Mason discovered that rats can show empathy for their fellow rats in distress. Maciej Lesniak performed a scary but amazing brain surgery on a patient who was awake. Cathryn Nagler searched for the source of food allergies within our bodies, while Stafano Guandalini uncovered the challenges in educating doctors about one of those allergies, celiac disease.

Whew. Hope you were able to click through at least a few of those. We look forward to another great year of research in 2012. We’re taking a break next week, but we’ll be back on January 5. Happy holidays!

If you are an avid reader of food packaging materials or a parent of an elementary school student, you might get the feeling that food allergies are on the rise. Statistics back up this notion, with the CDC reporting an 18 percent increase [pdf] in child food allergies between 1997 or 2007. That puts current estimates of food allergy prevalence at 4 percent for children and 2 percent for adults, with allergies to peanuts (3.3 million Americans) and shellfish (6.9 million) leading the way.

The factors driving this surge remain a scientific mystery, and answers are even more scarce when it comes to treating or preventing dangerous allergic reactions. Currently, the only way to prevent anaphylaxis caused by a food allergy is avoidance, a strategy that can be very cumbersome for parents raising small children who cannot be exposed to basic food groups. Dave and Denise Bunning faced this challenge with their two children, both of whom were allergic to milk and eggs, leading to “several emergency room visits before the age of 5,” Dave Bunning said. Those experiences inspired the family’s philanthropy for research into the science of food allergies, which included this year’s founding of the Bunning Food Allergy Professorship at the University of Chicago Medical Center.

At the official naming ceremony for the new position, the inaugural Bunning Food Allergy Professor Cathryn Nagler presented her latest research to a large crowd including the Bunning family themselves. Nagler’s intriguing theory about food allergies looks within, at the bacterial universes that exist inside the human body. In parallel with other laboratories on campus looking at the impact of the human “microbiome” upon diseases such as inflammatory bowel disease and diabetes, Nagler is focused on the trillions of bacterial tenants that occupy each of our bodies.

“It’s becoming clear that we are outnumbered,” Nagler said. “There are 10 trillion human cells encoding 20,000 genes [in an individual], but 100 trillion bacterial cells encoding an estimated 2 to 20 million genes. So there are as many E. coli in each of our digestive tracts as there are people on Earth…and that’s not even one of the more popular species.”

All those bacteria, sometimes called the “commensal microbiota” to distinguish them from disease-causing pathogens, could play the environment role in the genes + environment recipe for food allergies. Many of the trappings of modern life, including high-fat diets, antibiotic treatments, and the use of baby formula instead of breastfeeding, can affect the census of our bacterial inhabitants. In food allergies, where the immune system mistakenly treats innocuous dietary proteins as harmful invaders, these microbiota changes might tip the balance towards over-sensitivity to components of peanuts or shrimp.

“An increase in disease prevalence in 10 to 15 years’ time can’t be explained by genetics, so there’s got to be other factors that are driving this increase in disease prevalence,” Nagler said. “All of these environmental variables lead to alterations of the commensal microbiota, which in genetically susceptible individuals could drive allergic responses to food and other antigens.”

To study this model, Nagler’s laboratory gave a long-term treatment of antibiotics to lab mice, finding that this prolonged exposure did indeed trigger an allergic response to peanuts. Using genetic identification methods, her group compared the gut microbiomes of mice treated with antibiotics versus mice who did not receive the drugs, finding several differences in the bacterial populations colonizing their digestive system. One bacterial family, called Clostridia, were reduced in the mice treated with antibiotics, while another was increased — suggesting that reducing or decreasing different species of bacteria might affect the chances of developing food allergy.

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By Matt Wood

Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine. When a person who has celiac disease consumes gluten, a protein found in wheat, rye and barley, the individual’s immune system responds by attacking the small intestine and inhibiting the absorption of important nutrients into the body. At least 1% of Americans, or nearly 3 million people, have celiac, but 97% of them are undiagnosed.

The University of Chicago Celiac Disease Center is an international center of excellence providing comprehensive patient and professional education, expert diagnosis and treatment for both children and adults, groundbreaking bench and clinical research, and active leadership in advocacy efforts. Their goal is finding a cure for celiac disease by 2026. We spoke to Dr. Stefano Guandalini, medical director of the Celiac Disease Center, about this unique, comprehensive research and treatment approach. We also discussed the link between celiac and diabetes, and asked pediatric dietitian Lara Field from Comer Children’s Hospital how people with both diseases manage their diets. Lara also discussed how children with celiac disease can learn to go gluten-free.

The ability to drink animal milk into adulthood is something that most of us take for granted.  But lactose tolerance is a genetic marvel, an exclusive human trait facilitated by a genetic mutation that only appeared in the last 10,000 years. In fact, the persistent production of the enzyme lactase (which digests lactose) has been so useful to humans, it has evolved several times in different populations around the world. The mutation that allows for lactose tolerance in people of European origin is different from the mutation observed in African or Saudi Arabian populations - an example of what is called “convergent evolution.”

One corner of the world where lactose tolerance has not been well studied is India. Cattle have a long history in India, both as an agricultural animal and a figure of worship. In fact, India has grown to become the world’s largest producer of milk, using both cattle and water buffalo as dairy animals. Cheese, yogurt, and cream-based curries are a staple of the Indian diet, and many Indian citizens consider themselves lactose tolerant. But other than a few small studies, nobody had looked at whether Indians have their own unique mutation - or whether they were even as tolerant of dairy as commonly thought.

“India is fantastic because it’s really, really diverse culturally and geographically,” said Irene Gallego Romero, a post-doctoral researcher in the University of Chicago Department of Human Genetics. “They have a history of milk consumption, but nobody had looked at whether they were actually lactose tolerant or not.”

Gallego Romero’s research, conducted while a graduate student at the University of Cambridge and recently published in Molecular Biology and Evolution, allowed her to do more fieldwork than a genetics project typically allows. To collect samples, Romero went on two separate trips to India in 2008, spending two months each time traveling the country and asking for saliva samples from remote populations to assemble a truly countrywide data set. Along the way, there were some unforeseen technical obstacles to collecting samples from inhabitants of rural Indian villages: “It’s really hard to get 2 milliliters of saliva from toothless men,” Gallego Romero said.

The final tally included almost 2,300 individuals from 105 different tribes and castes, five different language families, 22 of 28 states, and even one group from Nepal. Romero and a team of researchers from the United Kingdom, Estonia, India, and the United States then zeroed in on the chromosomal region where most of the previously-detected lactose tolerance mutations are located. To the authors’ surprise, what they found there was not a new India-specific mutation, but a familiar genetic pattern - a single switch from C to T, characteristic of the common European mutation.

“We thought they would have a different mutation, because they’ve had cattle for a long time and they’ve been drinking milk,” Gallego Romero said. “But it was all European, except for a couple mutations that we haven’t proven yet do anything. We were very shocked by that, it was interesting.”

The finding suggests that the most common lactose tolerance mutation made a two-way migration out of the Middle East less than 10,000 years ago. While the mutation spread across Europe, another explorer must have brought the mutation eastward to India - likely traveling along the coast of the Persian Gulf where other pockets of the same mutation have been found, Gallego Romero said. Once the ability to take nourishment from milk in adulthood met the pastoralist cattle-herding cultures of northwest India, it made for the perfect evolutionary mix.

“All you need is a few people,” Gallego Romero said. “It’s not disadvantageous if you’re not drinking milk, it’s just sitting there, so it’s going to drift like anything else that’s neutral and then it’s going to hit some advantageous population and spread,” Gallego Romero said. “So then you have to ask the important question: Who decided to start drinking milk from a cow the first time?”

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The future of genetic medicine comes in many flavors, from the discovery of the rare mutations responsible for uncommon diseases to the cataloging of variants that may be responsible for common diseases such as high blood pressure and diabetes. A segment from last night’s ABC 7 Chicago news focused on both aspects of this potential, jumping from a young man in Utah with Miller Syndrome to the 1200 Patient Project of the Medical Center’s Mark Ratain and Peter O’Donnell. Results from the project, currently underway, could help physicians customize medical treatments for individual patients, maximizing effectiveness while reducing side effects. As the segment says, if we really are heading toward a future where every patient has their genetic code read as routinely as they receive a doctor’s check-up, such research will be essential for unleashing the power of genetic medicine.

When the media hypes the healthy effects of drinking red wine in moderation, they’re talking about resveratrol, the chemical responsible for wine’s benefits. Scientists have long tested whether isolating that chemical can turn it into a super-pill for good health and long life without the alcoholic “side effects” of its normal route, with mixed results. But a new study featured in the New York Times this morning finds an intriguing benefit of a resveratrol derivative called SRT-1720. Obese mice given the experimental drug lived 30 percent longer - as long as control mice - rather than expiring earlier from obesity-related diseases such as fatty liver and diabetes. As the article states, such a drug may represent “more a moral hazard than an incentive to good health,” seen by some as a way of avoiding the consequences of excess. But with trials of the drug in humans still in their earlier stages, the ethical discussions will have to wait on the science.

Since our piece remembering famed bio-statistician Paul Meier ran last week, two more fine obituaries of the UChicago professor emeritus have appeared. Read the Chicago Tribune take to learn what instrument Meier learned to play at the Old Town School of Folk Music, and the New York Times version for the context of how Meier changed randomization in clinical trials forever.

Living shoulder to shoulder (or even closer, on the subway) in an urban environment feels like a particularly modern phenomenon. But as friend of the blog Tim de Chant explains in his guest blog at Scientific American, human societies have concentrated themselves since even the prehistoric hunter-gatherer days. For more of Tim’s great writing on the science of population density, visit his Per Square Mile blog.

Stress can have all sorts of negative effects on your health, but what about the stress of your spouse or partner? Not Exactly Rocket Science looks at a study in finches that suggests a high-strung life mate could actually shorten your life.

Teaching with Treadmills

Inside the Biological Sciences Learning Center on the Medical Center campus is a laboratory that looks more like a gymnasium. Six state-of-the-art treadmills and six futuristic exercise bikes sit around the room, each connected to a computer alongside modified oxygen masks and suction cup sensors. Instead of dissecting frogs or mixing chemicals, students show up to lab sections in shorts and running shoes, prepared to sweat for science. In Mark Osadjan’s “Metabolism and Exercise” course, part of a two-quarter Exercise and Nutrition sequence, there’s no sitting on the sidelines.

Since joining the University of Chicago as a senior lecturer in 2003, Osadjan has designed courses that teach undergraduates about biology by connecting with what most college students care about: keeping fit, and sex. As part of the UChicago core curriculum, every undergraduate must fulfill a biology requirement, even if their interests lie in political science, music theory, or philosophy. With his “Metabolism and Exercise” and “The Biology of Gender” courses, Osadjan has met these science-shy students halfway, filtering instruction on evolution, physiology, and genetics through their own personal hobbies and interests. The efforts have been such a success that Osadjan’s courses fill up soon after registration is opened.

Today, Osadjan was announced as one of this year’s recipients of the Quantrell Award for Excellence in Undergraduate Teaching, an esteemed UChicago honor that goes back to 1938. Last week I met with Mark to talk about his award and his career path, from a graduate student studying Antarctic fish to an instructor of graduate-level science to his current position, teaching predominantly undergraduate non-biology majors.

“It’s always a trick to figure out how to teach with enough enthusiasm, such that it spills over to the students,” Osadjan said. “It’s our challenge not only to teach these students a certain number of facts, but to show them why those facts are important, relevant, and worth thinking about throughout life.”

You can read more about Osadjan and the other Quantrell winners in the award package at The University of Chicago news site.

Elsewhere…

Most college students spend their summers traveling the country or working an internship, but 20-year-old Rachel Garneau had other plans: donating a kidney. On Tuesday morning, Garneau came to the Medical Center and made the rare gift of an altruistic kidney donation, triggering a kidney swap chain that helped patients in need of the organ in New York and Madison. Neil Steinberg at the Chicago Sun-Times followed the story before and during the surgery, and got some great play-by-play commentary from Yolanda Becker, professor of surgery and director of the kidney and pancreas program.  For instance: “‘The pancreas is the bitch of the abdomen,” she confided.’”

Are clinical trials handicapped by their own success? A new analysis from Anup Malani and Tomas Philipson of the University of Chicago Law School finds that trial enrollment for a given disease plummets when a treatment is found to be effective, using AIDS clinical trials after the approval of anti-retroviral therapy to illustrate the point. Richard Schilsky, professor and section chief of hematology/oncology at the Medical Center, agreed with the findings at Nature News: “There are so many options that patients are not flocking to get into clinical trials like they used to.”

Read how turtles move to warm areas to bask - even in their own eggs as embryos. Adorable photos and interesting commentary (are they determining their own sex?) at Not Exactly Rocket Science.

That news about the World Health Organization adding cell phones to their list of possible carcinogens? Here’s an article from Cancer Research UK to reassure your fears. Another reassuring fact: it was placed by the WHO into the same risk category [pdf] as coffee, dry cleaning, and pickled vegetables.

Can jazz musicians tell the difference between another musician improvising or following composed music? A new study finds the answer, and a ScienceNOW article gives you the chance to test yourself.

Did you know UChicago evolutionary biologist Neil Shubin does a regular science news roundup on local newsmagazine show Chicago Tonight called Scientific Chicago? Well he does, and the latest edition discussed a story familiar to readers of the blog: the mass extinction 360 million years ago that ended “The Age of Fishes.” Watch the video here.

It’s a challenge to watch TV for any length of time these days without coming across a commercial for drinks like Gatorade and Red Bull, beverages usually marketed with adrenalized advertisements featuring athletes and daredevil feats. Though these commercials always feature adults, the tone and pacing is clearly aimed at a younger audience more susceptible to quick-cut, extreme-sports salesmanship. The message appears to be connecting, as a 2003 study found that more than half of adolescents use sports drinks and nearly half used energy drinks. Simultaneously, such beverages are becoming more and more accessible to kids, as some schools removing soda from their vending machines for health reasons are replacing them with sports drinks.

But are their dangers for kids ingesting sports or energy drinks? And how should parents treat their child’s consumption of these beverages? Guidance was provided this week in the journal Pediatrics by a panel of physicians co-led by Holly Benjamin, associate professor of pediatrics at the Medical Center. Their report is a stern warning, particularly on the effects of caffeine-packed energy drinks in young consumers and the casual use of sports drinks intended for replenishment after rigorous exercise. Here are the main take-home points from the report:

1) Sports Drinks ≠ Energy Drinks

A common misconception on the part of both parents and children is equating sports drinks such as Powerade with energy drinks such as Monster, despite their very different ingredients and purpose. While sports drinks purport to rehydrate and restore electrolytes after a long run or game of basketball, energy drinks are high-calorie and filled with stimulants such as caffeine, ginseng, and guarana. Despite these differences, adolescents often mix up the two beverages, expecting thirst-quenching and energy boosts from either one - a misconception encouraged by the  advertising for the various brands of drinks, the report concludes.

2) Boring is Still Best

Of the two types of drinks, sports drinks pose fewer health risks than the energy drink side of the aisle. But the claims made by sports drinks - to replenish electrolytes, provide muscle-repairing protein, and rehydration - are just as effectively, if not better, performed by plain old water and a balanced diet, the authors write. Sufficient amounts of the electrolytes sodium and potassium, which are important for brain and muscle activity, are provided by a healthy diet (the kind to be promoted by the new USDA “plate” on Thursday), and are only significantly depleted after lengthy or intense exercise. As such, “sports drinks offer little to no advantage over plain water,” the authors write. But they do offer a significant disadvantage compared to H20 - calories. Even the relatively low calories-per-serving of a sports drink (10 to 70 calories, the report says) can increase a child’s daily carbohydrate intake. In the absence of the exercise the drink is intended to offset, that could contribute to the risk of a child being overweight or obese.

3) A Dangerous Buzz

The calorie count of energy drinks is even higher - as high as 270 calories per serving, and often served in multiple-serving cans or bottles. But the even scarier figure cited by the report is the 500 milligrams of caffeine that some cans and bottles of energy drinks contain. To put that amount in perspective, it’s equivalent to roughly 14 cans of caffeinated soda! Energy drinks can also hide their stimulant content behind unusual ingredients other than caffeine. Each gram of guarana, which is included in drinks such as Rockstar and Power Trip, is equivalent to 40mg of caffeine.

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The benefits of measuring body mass index (BMI) are clear: a physician who knows a patient’s BMI is more likely to counsel her on lifestyle changes, and people are more likely to try diet and exercise on a doctor’s advice. But in the often-rushed environment of the clinic, even the quick calculations required to know a patient’s BMI can get lost in the shuffle.

Internal medicine residents at the Medical Center noticed that almost none of their patients had a BMI recorded on their charts, but many of their patients seemed overweight and obese.

“They initially wanted to improve obesity rates in patients,” said Vineet Arora, MD, who participates in teaching a quality improvement curriculum to residents and is senior author of a study. “But we needed something feasible. Recording and calculating most patients’ BMI was something they could change.”

Their quality improvement initiative and a study about it, published online in March in the American Journal of Medical Quality, grew out of the quality improvement education that all residents now receive at the University of Chicago.

Neda Laiteerapong, MD, was an internal medicine resident at the University of Chicago Medical Center when she decided that measuring BMI was vital to improving patient care. “We couldn’t even identify who was obese in our clinic. If you don’t identify it, you’re not going to treat it on a patient-by-patient basis,” she said.

Laiteerapong and nine of her fellow residents looked at the triage of patients in the clinic, and decided that they could easily make a few small changes to the vital signs that nurses record when a patient is checked in. “Most clinics weigh people, but they don’t measure height,” Laiteerapong said, noting that the combination of height and weight is usually only measured in children. She also said that asking a patient his height isn’t an accurate way to calculate BMI, since people often overestimate how tall they are.

The residents added rulers in the clinics, height and weight charts in the patient rooms, and a slot on the patient intake form for BMI. The nurses took the measurements, and the residents were responsible for calculating BMI. Within a month, the number of patients with a recorded BMI jumped from 4% to 80%.

Julie Oyler, MD, assistant professor of medicine and associate program director for the internal medicine residency, implemented the quality improvement curriculum for residents in 2006. “I would consider this a successful project,” she said. “Instead of complaining about poor practices in a clinic, the residents are getting experience changing and fixing the clinics.”

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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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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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The immune system is designed to protect the body against foreign invaders, neutralizing disease and infection. But organisms are all too happy to invite invasions several times a day through a seemingly innocuous act: eating. When food enters the digestive system, it has to be dealt with by the immune system just like everything else that finds its way into the body. Under normal circumstances, the immune defenses recognize that food is not a threat and lay down their arms. But in the case of food allergies or digestive disorders, certain types of food are treated as dangerous enemies, with unpleasant consequences for the person.

Celiac disease is one such disorder, where patients suffer painful symptoms after consuming gluten, a dietary protein found in wheat, barley, and rye. Rather than building up a tolerance to the protein that allows for untroubled digestion, the immune system treats gluten as a threat and activates its defensive weapons, including inflammatory factors that attack the lining of the small intestine. As a result, an innocent piece of bread for most people can be absolute misery for one of the 3 million Americans with celiac disease, causing abdominal pain, diarrhea, vomiting, and more serious chronic symptoms.

So far, the best treatment for celiac disease is plain old avoidance - a gluten-free diet to prevent digestive symptoms. Because the immune system is so complex, researchers have struggled to find the exact components responsible for the intolerance to gluten. But clues abound from patients treated at clinics such as the University of Chicago Celiac Disease Center, including unusually high levels of an immune factor called interleukin-15 in the patients’ intestines. That clue was the starting point for a new study published last week in Nature and led by Bana Jabri, associate professor of medicine at the Medical Center, that tracks down two triggers of celiac disease that may prove crucial to better treatments.

Interleukins are the messengers of the immune system, carrying signals that instruct the body’s defensive force to ramp up or stand down, depending on their context. In the gut, interleukin-15, or IL-15, was found by Jabri and colleagues to inhibit the activity of regulatory T cells, peacekeepers that block the immune response on targets that are considered non-threatening. After repeated exposure to gluten, most people build up a tolerance to the protein and are able to digest the nutrients in grains and breads without trouble. But for people with celiac disease, elevated IL-15 may interfere with this cease fire.

The researchers further tested their theory by engineering mice that over-expressed IL-15 in their digestive systems. When these mice were fed a protein found in eggs, another common food allergy trigger, the result was inflammation instead of tolerance - as is seen in celiac disease with gluten. Conversely, blocking IL-15 activity restored the normal response in the mice.

“We found that having elevated levels of IL-15 in the gut could initiate all the early stages of celiac disease in those who were genetically susceptible, and that blocking IL-15 could prevent the disease in our mouse model,” Jabri told John Easton.

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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.

Imagine There’s No Hunger

This post is going up around lunchtime, and you might be just now picturing what you’re going to eat. There are those healthy whole-wheat pasta leftovers in the fridge, but just down the street is a deli where you can purchase a giant Italian sub with hot peppers and cheese and a bag of chips on the side. Just the thought of that delicious sandwich is making your mouth salivate and your stomach grumble in anticipation. Wait, were we talking about you, or me?

The ability of people to make themselves hungry just by imagining food has always baffled psychologists, who would predict just the opposite response. Using imagination for habituation, the gradual diminishing of a stimuli’s power to provoke a response with repetition, is a classic tool of psychological treatment. For example, people with phobias are often instructed to repeatedly imagine the cause of their fear (spiders, heights, airplanes) until their emotional response subsides. By that theory, repeatedly imagining a delicious pizza should eventually make you less hungry for a slice, rather than increase craving.

But maybe people are just imagining the wrong thing, thought researchers from the business school at Carnegie-Mellon in this week’s Science. Instead of imagining the food before it is eaten, perhaps people could imagine actually eating that food to habituate themselves against its wily charms. Using a particularly seductive denizen of the office vending machine, M&M’s, the authors instructed their subjects to imagine eating 30 pieces of the candy in succession, like picturing the process of inserting 30 quarters into a vending machine. This tedious fantasy actually worked when the subjects were subsequently given a nice big bowl of M&Ms - subjects who imagined eating 30 pieces of candy ate less than subjects who only imagined a 3-piece snack, or no snack at all. The trick was found to be stimulus-specific, in that a session of imaginary M&M eating had no effect on subsequent eating of another snack; in this case, cheese cubes.

Aside from it’s dietary implications, the study is a pretty amazing demonstration of the power of imagination - “The difference between actual experience and mental representations of experience may be smaller than previously assumed,” the authors write. But it’s unlikely that anyone will incorporate this imagination trick into a get-thin quick diet plan, as you can’t sell a customer the ability to imagine eating unhealthy food, and therefore can’t hire Kirstie Alley to endorse it. But it is something we can all try for free, at home or at our office desk. So while I write the rest of this post, I’ll devote part of my mind to imagining the laborious consumption of that delicious Italian sub sandwich, rather than the sandwich in all it’s pre-eaten glory.

[H/T to the Wall Street Journal Health Blog for the article.]

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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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