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

By Dianna Douglas

The Affordable Care Act is nearly one and a half years old, but the complexity of its reforms and their gradual roll-out have made it difficult to grade. Different disciplines are still parsing the legislation, attempting to figure out how it will change the future of their field. Experts in the field of Family Planning and Contraceptive Research has been puzzling over an enormous and perhaps unanswerable question: How will health care reform affect the reproductive lives of women and girls?

That was the primary question at the section’s spring conference, “Reproductive Justice and Health Care Reform: the Impact of Reform on the Reproductive Health of Underserved Women and Youth.” The phrase “reproductive justice” connotes the activism to give women and girls of all races and incomes the access to the same choices and education for controlling their reproduction. Panelists argued that some aspects of the bill, particularly the expansion of insurance coverage, would benefit this cause. But there were also warnings about the political resistance, exemplified by Representative John Boehner’s statement that he doesn’t think reproductive health care services are the business of the federal government: “How can you spend hundreds of millions of dollars on contraceptives? How does that stimulate the economy?” he asked in 2009.

Speakers at the conference, which was co-sponsored by UChicago’s Center for the Study of Race, Politics and Culture, posed many unanswered questions about how the Affordable Care Act will affect women and girls in America. Some expressed hope that it could close the gap between black and white and rich and poor in all areas of maternal health, unintended pregnancy, intimate partner violence, and infant mortality.

But Harold Pollack, PhD, professor at the School of Social Service Administration, gave both sides of the story. He argued that the Affordable Care Act is not only health care policy, but it is the defining document of America’s public policy on reproductive health care.

“Near-universal health insurance coverage will reduce disparities in health,” Pollack said. One of the goals of the Affordable Care Act, passed by Congress and enacted by President Obama in 2010, was to stop people from skimping on health care when they couldn’t afford it. If enacted properly, the health care plan would extend reproductive health care to millions of women.

Under the law, Pollack said, insurers can no longer require a referral to see an obstetrician or gynecologist, and must offer women direct access to these specialists. They are required to pay for some preventative services, like screenings for breast and cervical cancers and sexually transmitted infections. Insurers are required to pay for certain vaccines for women. They have to pay for preventive care for children and adolescents, including screenings for pregnancy. And, insurers may be required to pay for contraception and other family planning services.

All of these requirements were designed to improve women’s health across income levels, but basic access to physicians is the key. “When you visit a doctor because your knee hurts, the truth is that she probably won’t do very much for your knee. But you’ll get your blood pressure taken. She’ll ask you about your diet. And she’ll recommend you for other screenings and lifestyle adjustments,” he said. Oregon recently found that poor people with health insurance were healthier than poor people without it.

Pollack’s keynote address was not uniformly cheerful, however. “The bill is vulnerable, and reform is a risk,” he said. The politics around health care reform have become poisonous, he said, and some of the best public policies in the bill are the most under attack.

Pollack lamented that the great benefits of health care reform won’t be enacted for a few years, during which time public opinion on health care reform could sour more dramatically. “Backloading was the sin of this bill,” Pollack said. It takes time for reforms to embed in society, he said and the legal challenges to the bill may stop the process before it can begin.

To keep the Affordable Care Act on track and make the reforms sustainable, Pollack suggested that the people who support the bill should put a human face on it. “Americans are deeply ambivalent about sexuality and reproductive health,” he said. “But even people who disagree with abortion are uncomfortable with making a poor woman carry a baby to term after a rape or if the pregnancy will seriously damage her health.”  The more human and less theoretical the reforms can become, the more likely they are to survive the next few years of budget cutting.

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The treatment of cancer is growing more and more specialized, as researchers and pharmaceutical companies test strategies designed to attack very specific types of tumors. A success of this approach received an avalanche of publicity this past week at the American Society for Clinical Oncology meeting in Chicago - two new drugs that target mutations associated with some forms of melanoma. But the history of cancer treatment is marked by many happy accidents, and two papers published shortly before the ASCO meeting revealed a potential new bit of cancer-fighting serendipity. In this case, a drug class used for decades to treat hypertension and heart disease may play a previously-unanticipated role in improving the outcome of patients with breast cancer by interfering with the more general phenomenon of stress.

Beta blockers are a group of drugs named for their inhibition of the beta-adrenergic receptors, where the hormone known as adrenaline or epinephrine binds and activates the sympathetic nervous system. Drugs that block these receptors can lower a patient’s heart rate and blood pressure, making them valuable tools for fighting cardiovascular disease. Those effects would seemingly have little to do with treating cancer. But animal and tissue culture studies have suggested a role for beta-adrenergic receptors in promoting tumor growth and metastasis, and human data implicating lifestyle factors such as social stress and obesity in cancer outcomes have also suggested a role for the sympathetic nervous system.

Those were enough clues for two groups of researchers to test whether beta-blockers affected the usual course of breast cancer. Using retrospective data on thousands of patients from the United States or Ireland, the two groups compared patients who were taking beta-blockers (for reasons unrelated to cancer) and women who were not on the drugs. While retrospective studies aren’t always the best way to measure the effect of an intervention - due to an inability to control what data was collected, which beta blocker was used, how much of the drug was given, etc. - it was a fast way to see whether promising signs were apparent in a large population.

In spite of these limitations, both studies (published in late May in the Journal of Clinical Oncology) found favorable effects of beta blockers in breast cancer patients. In the United States study, led by former Medical Center fellow Amal Melhem-Bertrandt and co-authored by professor of medicine Suzanne Conzen, women with triple-negative breast cancer who were on beta-blockers during their cancer treatment exhibited a longer relapse-free survival, despite no dramatic differences in initial tumor response to chemotherapy. The effect on patient’s cancer-free survival was particularly notable, since triple-negative breast cancer is a form of the disease especially prone to relapse and death.

“It seems to be particularly affecting those tumor cells that are left behind after chemotherapy and surgery, those that grow back  after the initial therapy and return as recurrences,” Conzen said. “It suggests that the beta-adrenergic pathway has something important to do with tumor growth and the stress responsiveness of the tumor cells themselves.”

The study using breast cancer data from Ireland found benefits of beta-blockers using slightly different measures. Women who were on beta-blockers were initially diagnosed with less severe tumor types and displayed significantly lower breast-cancer related mortality than the no-drug controls, the authors reported. Intriguingly, they also determined that one type of beta blocker, propranolol, produced these protective effects while a more specific version, called atenolol, did not show an effect.

The authors of an editorial appearing alongside the two articles were convinced enough to call for “proof-of-concept” trials to more carefully test the value of beta blockers in treating breast cancer. But Conzen said the star of the show was not necessarily the drugs themselves, but the identification of a stress response pathway with an impact upon cancer outcomes. With professor of psychology Martha McClintock, Conzen’s laboratory is studying the relationship between stress and breast cancer in animal models, and the new studies add an intriguing piece to that puzzle.

“It fits our hypothesis that a patient’s chronically heightened stress responsiveness resulting from exposure to unrelenting stressors is associated with increased breast cancer growth,” Conzen said. “We think that the new beta-blocker results reflect the beneficial effect of antagonizing part of this pathway.”

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There are few biological functions that we take for granted more than gait, the intricate symphony of motion that happens almost automatically when we walk or run. Gait is programmed deep into the nervous system of animals, an activity so robust that it is maintained even when large segments of brain are removed. Those crude, early experiments suggested that the machinery for gait was somehow packed into the spinal cord. But scientists are still mapping the networks of neurons - called central pattern generators - that give fish, mice, and men the ability to propel themselves forward at slow or fast speed.

For the past 5 years, the laboratory of Kamal Sharma, associate professor of neurobiology at the University of Chicago, has been looking at one key component of this gait machinery: the V2a interneuron. Interneurons are the go-betweens of the spinal cord, coordinating the message between the motor and sensory systems. In animals with a gait that alternates left and right feet as they walk or run, interneurons are a likely candidate for coordinating this action - suppressing the left limb as the right moves forward, and vice versa. So after a paper identified the developmental background of the V2a interneurons, Sharma and postdoctoral researcher Steven Crone began studying whether these cells were in fact an important component of the gait system.

The quickest way to determine a cell type’s importance is to remove it, and that’s just what Crone did in a 2009 paper - genetically inserting a toxin that kills V2a interneurons. Other than appearing smaller than their wild-type peers, the mice without the neurons seem to be fairly normal. When placed on treadmills running at a slow speed, the modified mice alternate left and right paws just as the normal mice did. But when the treadmill was sped up, a difference was revealed - where normal mice continued alternating left and right at a faster pace, mice lacking V2a interneurons broke out into a “gallop,” moving left and right limbs together.

That result suggested that the system controlling gait at slow speeds may differ from the gait system when an animal is traveling at faster speed. That dynamic has been seen in other animals, such as the zebrafish, where different spinal cord interneurons are active when swimming at high speed compared to low speed.

“The question is when you are walking slow versus when you are walking fast, do you use the same neurons that are firing at different speeds, or are you actually recruiting more neurons?,” Sharma said.

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The Darwin/Chicago conference in Ida Noyes, October 2009

I’ve recently stumbled across two veritable smorgasbords of video content from events covered right here on ScienceLife. The first, the Darwin/Chicago conference that took place last October, had already yielded some video lecture bounty, but I’m pleased to report that the rest of the conference (with the exception of the opening night’s session) has been posted on the official website. I highly recommend:

Peter & Rosemary Grant - Whose accents are as delightful as their Galapagos Islands research, made famous by Jonathan Weiner’s The Beak of the Finch.

Eric Lander - The first author on the Nature paper that published the human genome and now a prominent scientific advisor to President Obama, Lander bridged Darwin and early genetics with our modern genomic era, while offering a primer on what can reasonably be expected from personalized medicine.

Richard Burkhardt - Darwin is known as the father of evolutionary biology, but the University of Illinois’ Burkhardt gave a convincing argument that he was also instrumental in establishing the field of animal behavior and behavioral ecology.

Eugenie Scott - The cultural/historical half of the conference was equally fascinating, including this talk by the executive director of the National Center for Science Education debunking Darwin myths (including his “deathbed confession”) propagated by creationists.

Michael Ruse - The funniest talk at a Darwin conference may sound like a backhanded compliment, but Ruse’s irreverent refutation of 2009’s trend of “Darwin was Wrong” articles is full of chuckles, while making a convincing argument for Darwin as skilled aggregator and communicator.

Hopi Hoekstra - Where many of the weekend’s lectures took the 30,000-foot view of Darwin and evolutionary biology, Harvard’s Hoekstra presented an elegant case study of evolution in motion with her field study of beach mice and coat color.

There’s also a long list of one-on-one interviews with the conference participants that I haven’t waded into yet.

The second treasure trove of science videos, linked in passing yesterday, is the library of lectures from last year’s MacLean Center for Clinical Medical Ethics seminar series. Some of the most interesting conversations in science and medicine take place over ethical questions, an assertion this series proved again and again. On the blog, we covered transplant ethics in China, the disclosure of HIV test results in India, relief efforts in Indonesia and Haiti, the bright side of spiraling health care costs, the involvement of doctors in Guantanamo Bay interrogations, and the general challenges of global health programs at American medical centers.

Now, you can go beyond our analysis with videos of the actual lectures, made available by the University of Chicago’s Global Health Initiative. Despite the lure of free lunch, I couldn’t make it to all the lectures, so I look forward to catching up in advance of this year’s series starting next month (pdf schedule).

Occasionally, drugs produce beneficial mysteries - effects that are useful to physicians despite being largely unexplained. Levodopa (L-dopa), the most commonly-used treatment for the symptoms of Parkinson’s disease, is meant to replace dopamine, the neurotransmitter lost as the disease progresses to its most severe stages. Clinicians recognize that the benefical effect builds up slowly over weeks despite the same dose of medication. In addition, after a patient’s L-dopa is stopped, the relief of a patient’s motor symptoms can persist partially for weeks, long past the time it takes to clear the drug entirely from one’s system. Though this effect has a name - the “long duration response,” or LDR - nobody’s quite sure what causes it, though physicians are happy to put it to use in patients.

Adding to the mystery is the fact that animal models of Parkinson’s disease, usually involving chemical brain lesions, have consistently failed to replicate the long duration response. But in a bit of serendipity, a University of Chicago laboratory studying the role of dopamine in the learning of motor skills may have unintentionally found the LDR in a mouse. Published this month in the Annals of Neurology, the finding could dramatically shift both the theory and treatment of Parkinson’s.

Jeff Beeler, a postdoctoral researcher in the laboratory of Xiaoxi Zhuang, associate professor of neurobiology, wanted to study a difficult problem: how can one untangle motor performance from motor learning? The deficits seen with Parkinson’s disease, such as muscle tremors and akinesia (the inability to initiate movement), implicate dopamine as an important part of the brain’s motor control. But is it simply that one needs dopamine to move, or do you need dopamine to learn how to move? It’s a hard question to experimentally test, Beeler said.

“If you can’t perform something, in a sense you can’t learn it,” Beeler said. “On the other hand, if you can’t learn it you can’t perform it. It’s a chicken and egg thing.”

So Beeler began working with a unique mouse strain, called aphakia mice, with a naturally-occurring genetic mutation. The mice were first known for being blind (aphakia means the loss of the lens of the eye), but were later found to have a severe, 90 percent depletion of dopamine neurons - similar to the loss seen in advanced Parkinson’s patients. But strangely, these mice exhibit only very subtle motor deficits.

“It’s a good model of particular aspects of Parkinson’s disease,” said Un Jung Kang, professor of neurology and director of the University of Chicago Movement Disorders Center and another author of the paper. “The simple way of saying it is that this is a model of very mild Parkinson’s disease that reflects a lot of endogenous compensation. They basically have a very minor deficit in terms of motor performance.”

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

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

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

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

Biomarkers are a Big Deal

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

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

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

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

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

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

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

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Stem cells are a little like teenagers, full of potential but not sure what they’re going to be when they grow up. It’s that uncertain destiny that makes stem cells so exciting to scientists and physicians, who hope to someday use them for everything from spinal cord repair to organ regeneration. But corralling the uncertain power of stem cells requires learning how to push them toward a desired fate, convincing them to become bone cells or liver cells or neurons. Most laboratories have figured out ways to accomplish this goal with chemicals, exposing stem cells to growth factors and other signals that lead it down a particular developmental path. But there may be another way to play guidance counselor to an indecisive stem cell - changing its physical shape.

This process, called cell patterning, is a primary research focus of Milan Mrksich, professor of chemistry at the University of Chicago. On the surface, cell patterning sounds like a mix of science fiction and Play-Doh art: cells are grown on a plate stamped with a special mold that forces the cells to form a particular shape chosen by the researcher. Those shapes can be as simple as circles or squares of various sizes or as complex as flowers, stars, and pentagons. And far from being mere aesthetic lab trickery, this shape-shifting can have dramatic biological effects upon the cell, its underlying skeleton, and even the expression of particular genes.

In a paper published in PNAS earlier this month, Kristopher Kilian, a postdoctoral fellow in Mrksich’s laboratory, applied the cell patterning technique to a particular type of stem cells. Mesenchymal stem cells, harvested from bone marrow, are the slightly less ambitious cousins of the more-hyped pluripotent embryonic stem cells that can change into virtually any cell type. As multipotent cells, MSCs are generally restricted to one of three career paths: fat cells called adipocytes, bone cells called osteoblasts, or cartilage cells called chondrocytes. But despite being limited, those outcomes are potentially very useful therapeutically should scientists learn how to reliably control the differentiation of these cells.

So Kilian, with colleagues Branmir Bugarija and Bruce Lahn, tested out cell patterning on his supply of MSCs. The first experiments confirmed that size and aspect ratio mattered: when given larger or wider areas to grow, the stem cells preferred to become bone cells instead of fat cells. Kilian then kept the size of the stamp constant, but altered the shape, forcing the cells into either a “flower” with curved edges (top row above) or a “star” with sharp edges (bottom row). Both cell shapes were then grown in the same media - a “cocktail” of signals promoting fat cell or bone cell growth, and fates were chosen.

The results? “Flowers make fat and stars make bone,” Kilian summarized. “The view is that, when you introduce the cocktail, the cells are driven one of two ways…the geometry dictates which path the cell goes toward.”

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  Banda Aceh before the 2004 tsunami

A populace is devastated by natural disaster, without access to medical care for trauma and infectious disease. Physicians and nurses from around the world rush to help, but good intentions are handicapped by logistical challenges - a lack of diagnostic technology, operating room facilities, and clean environments where the severely injured can recover. To alleviate the medical crisis, the U.S. Navy sends one of its two massive floating hospitals, which sits offshore and starts providing advanced medical care for survivors of the disaster with the help of volunteers from non-governmental organizations in a unique military/civilian partnership.

That, in a nutshell, is the current situation in Port-au-Prince, Haiti. But, according to Matthew Wynia, assistant professor of infectious disease at the University of Chicago Medical Center, it could also describe the situation five years ago in Banda Aceh, Indonesia, in the weeks after a deadly tsunami killed as many as 170,000 people in the country. In the rush to provide critically-needed medical resources to the region, strange bedfellows were made between the U.S. Navy and Project HOPE, an international health care organization that provides medical care to developing countries. As part of that effort, roughly 100 physicians and nurses from around the world worked from the USNS Mercy, a Navy hospital ship, to treat the wounded of Banda Aceh - a mission that set the mold for efforts such as the current use of the USNS Comfort to treat survivors of the Haiti earthquake.

Wynia, also director of the Institute for Ethics at the American Medical Association, spoke about that experience Wednesday as part of the MacLean Center for Clinical Medical Ethics weekly lecture series. In light of current events, the talk was particularly interesting - though the Medical Center teams in Haiti are not working from the USNS Comfort, they will be receiving patients discharged from the ship to clear space so that more people can receive operations and care. Usefully, Wynia recapped his experience with candor, addressing the ethical issues that faced medical volunteers working alongside the U.S. military administering care to a nation wary of American intentions.

At the end of 2004, when the tsunami struck Indonesia, public opinion of the heavily Muslim country about the United States was precariously low: only 15 percent positive, Wynia said. What’s more, the country had been in the midst of a civil war before the disaster, and neither side particularly welcomed a naval ship nearly the size of an aircraft carrier floating only 2 miles off shore. As a result, the ship was only allowed to be in Indonesian waters for 90 days following the tsunami, and given the time it takes to sail a gigantic ship from San Diego to Indonesia, it didn’t arrive until a month after the disaster.

By that point, as with the current situation in Haiti, many of the severe trauma victims had already undergone surgery or succumbed to their injuries, Wynia said. As such, despite the fact that the USNS Mercy was equipped to serve as a floating trauma center for severe war injuries, the medical team only saw 300 operating room cases during their 60 days off Banda Aceh. On a ship equipped with 1000 hospital beds (though as Wynia pointed out, half of them were upper bunks unsuited for severely-ill patients), only 170 inpatient admissions were made. Much of the care supplied by the physicians and nurses was either diagnostic (using the state-of-the-art CT scanner on board) or primary care - providing dental care, eyeglasses, and prescriptions for management of chronic disease.

The USNS Mercy alongside the USS Abraham Lincoln

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Photo by Justin Kern

For this week betwixt holidays, I will be tinkering with the blog’s design and taking care of assorted other housekeeping tasks. So if the site is experiencing technical difficulties when you visit this week, never fear - barring WordPress catastrophe, we’ll be back with new posts in the new year.

Provided the site remains readable as I remodel, enjoy these highlights from 2009, the blog’s best year ever (Editor’s note: also the blog’s first year ever).

The beautiful photo at left of the University of Chicago in winter is by Justin Kern, a graduate student here who has more excellent photography around the city at The Windy Pixel.

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5) The Passion of Francis Collins (July 12): President Obama’s choice for director of the National Institutes of Health seemed simple on its face, but generated a firestorm of controversy from scientists such as Jerry Coyne and Steven Pinker. Blog founder Jeremy Manier, who interviewed Collins multiple times for the Chicago Tribune, shared his thoughts on the controversy and debated with Coyne in the comments.

4) Lilly’s Law: A Diabetes Registry for Illinois (August 18): When Lilly Jaffe was 6 years old, University of Chicago doctors discovered that her diabetes was caused by a rare genetic mutation that could be treated with pills instead of insulin injections. The publicity around Lilly’s story, including a Chicago Tribune story by the late Peter Gorner, eventually led to the creation this year of a statewide registry for children with juvenile diabetes, which researchers hope will lead to improved diabetes treatment and research.

3) Shaving Your Head for Science (September 28): Pediatric oncologist Samuel Volchenboum’s grant from the St. Baldrick’s Foundation for research on the genetic signatures of neuroblastoma carried an unusual prerequisite - a public head-shaving. Before and after pictures included.

2) Darwin/Chicago 2009 - The Digest (November 2): A busy year of celebrations for Charles Darwin’s 200th anniversary reached the doorstep of the University of Chicago on Halloween weekend. I was there all weekend updating the blog from talks by the world’s leading experts on evolution’s past, present and future.

1) Foundational Research: Our (Ig) Nobel Prize (October 7): The Medical Center may not have pulled down any Nobels this year, but the Annals of Improbable Research saw fit to recognize work done here to invent a bra that can double as a gas mask in case of emergency. Director of Communications John Easton told the story of this, er, uplifting project.

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We spend a lot of time on ScienceLife talking about human disease and intricate biological research, so it’s important to take a break every once in a while and stir the inner 8-year-old in all of us with one glorious word: DINOSAURS!

Woah! That fine illustration by artist Jorge Gonzalez depicts three Triassic carnivores, the uppermost of which is Tawa hallae, a new species described last week in the journal Science as a sort of uniter-not-divider of early dinosaurs. Appearances to the contrary, Tawa hallae did not fly in from outer space to invade the Earth 215 million years ago, but the unusual features revealed by a complete fossil found in New Mexico in 2006 have prompted reconsideration of the dinosaur evolutionary tree and theories about how far early dinosaurs traveled across the super-continent of Pangea.

The University of Chicago can claim several A-list paleontologists, such as Paul Sereno and Neil Shubin, on faculty, but our representative on the Tawa hallae paper showcases the importance of educating future stars of the field - Nathan Smith, a graduate student in the evolutionary biology program and a research associate at Chicago’s Field Museum. Smith was involved in the dig, at New Mexico’s famous Ghost Ranch, that uncovered a nearly complete Tawa skeleton and bones from six other members of the species, as well as the analysis of the skeleton, which places it as a relative of several species formerly thought to be weird cousins of dinosaur evolution.

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After a long layoff due to conference congestion, here’s a new installment of Linkage, our semi-regular round-up of science news from around the world and web.

The “Speech Gene” Gains a Function

One of the more intriguing genes discovered since the flood of genetic sequences began to arrive at the beginning of this decade is FOXP2. Encoding for a humble transcription factor (sort of a DNA light switch), FOXP2 nevertheless gained lofty status when it was found in the late 1990’s to be associated with human language - one of the most complex behaviors of all. Previously associated with speech and language disorders in humans, FOXP2 gained steam when a team of scientists (including University of Chicago professor of human genetics Molly Przeworski) compared our FOXP2 with our close primate relatives and found only two amino acids different between the human and chimpanzee versions of the gene. With only 715 amino acids total in the FOXP2 protein, that small difference suggests a recent evolution event, which that research group estimated at roughly 100,000 years ago - right around the time that “modern humans” appeared on the scene. This has led some to conclude that this fortuitous small change in the FOXP2 gene is one of the key moments in our evolutionary history that separated man from beast.

But what exactly does FOXP2 do, and how could such a minute change mean the difference between chimpanzee grunts and Shakespeare? One way to answer that question is to put the human version of the FOXP2 gene into another animal, an experiment that was published earlier this year by a very large team of German researchers. That mouse didn’t suddenly start reciting soliloquies, but it did show differences in “ultrasonic vocalizations,” as well as cellular changes in a part of the brain associated with movement - which makes sense given that FOXP2 is thought to mediate motions related to speaking. Still, changing just one gene to the “human version” in an animal and leaving all the other mouse genes intact would presumably limit the impact of the human FOXP2 gene in changing the mouse brain. (Jerry Coyne wrote about the media reaction to this paper here)

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Calculating the carbon footprint of everything from U2 world tours to pet dogs and cats to presidential inaugurations has become a favorite pastime of the media, a measuring stick by which to label an entity’s environmental damage. But somehow in all of the footprint calculations, everyone forgot to run the greenhouse gas numbers on one of the biggest pieces of the American economy: health care. The U.S. health care sector, from hospitals to nursing homes to doctor’s and dentist’s clinics to pharmaceutical companies and insurance, makes up 16 percent of the country’s gross domestic product. And while many hospitals have launched efforts to help decrease their waste and energy appetites, nobody had taken the time to calculate the industry’s total carbon toll.

That is, until today, when University of Chicago researchers Jeanette Chung and David Meltzer published a letter in the Journal of the American Medical Association that measures the health care sector’s carbon footprint. By running the economic data about how health care spends its resources through a model, created at Carnegie-Mellon University’s Green Design Institute, that estimates the emissions of various greenhouse gases. Chung said she was surprised that nobody had run these numbers on health care effect, but thought it might have to do with the other priorities of the industry of late.

“In this country, the primary focus is on issues surrounding patient safety, health care quality, and cost containment at this current point in time. The health care sector, in general, may be a bit slower than other sectors to put this on their radar screen,” said Chung, a Research Associate in the Section of Hospital Medicine. “But given the focus on health care policy and environmental policy, it might be interesting - if not wise - to start accounting for environmental externalities in health care.”

In Chung and Meltzer’s analysis, health care accounted for 8% of the country’s total emission of carbon dioxide, methane, nitrous oxide and chlorofluorocarbons. That sounds pretty good - health care’s slice of the carbon pie only half the size of its slice of the economic pie - but Chung and Meltzer emphasize that such a huge contribution makes health care a ripe target for environmental improvement.

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Darwin/Chicago 2009 was a bit like two conferences in one. In the movie theater of Ida Noyes Hall, evolutionary biologists sorted through the hard details of how evolution happens beneath wide-screen Powerpoint slides. Three floors above, in a long room with hand-painted walls, historians and philosophers of science synthesized decades of reading and scholarship into half-hour lessons. One session gazed forward at future promise, one session made sure the previous steps and missteps weren’t forgotten. After two days of running back and forth from one theater to the other, I felt I got a three-dimensional portrait of Charles Darwin and his elegant theory - the decades of thoughts, influences and experiences that went into the writing of On the Origin of Species, the multitude of new and exciting examples still being found that prove the truth of evolution.

Because my dispatches from the conference turned into two very long posts, here’s a menu to jump to the highlights of the conference.

Thursday

The conference kicked off in the Gothic setting of Rockefeller Chapel with a trio of talks (Richard Lewontin, Ronald Numbers, Marc Hauser) that set the tone for a gathering that would approach Darwin and his work from every possible angle.

Friday

Pietro Corsi reminded the room that Darwin (and Jean-Baptiste Lamarck) weren’t the only scientists pondering evolution in the 19th century.

The finches that bear Darwin’s name remain one of the best species for studying rapid natural selection in nature, as Peter and Rosemary Grant explained.

Robert Richards got provocative with his argument that Darwin believed in a purpose behind evolution when he was crafting his famous theory.

Famous fossil hunter Paul Sereno outlined his proposal for a common language of morphology while the second-oldest bird ever discovered lay beside him.

The University of Chicago’s Jerry Coyne threw down the gauntlet on the debate over how species have formed over Earth’s history.

Eric Lander, one of the leaders of the Human Genome Project, primed the audience on how that data and the sequences of other organisms have changed assumptions about genetics.

Perhaps Darwin’s most lasting metaphor, the Tree of Life has been dramatically altered by the flood of genetic data, and Philip Ward explained how that has changed biologists’ knowledge of how species are related.

Saturday

Thomas Schoener kicked us off with a discussion of how evolution and ecology are finally working together…and David Jablonski made a similar pitch for cooperation between evolutionary biologists and paleontologists.

The study of animal behavior helped Darwin craft his theory, but it took more than a century for it to gain steam as a scientific discipline, said Richard Burkhardt.

Neil Shubin used his discovery of Tiktaalik - and the ensuing lab experiments on the genetics of limb structure - to illustrate how evolution can build a bridge between two very different kinds of science.

To answer the question of whether being a “Darwinist” still has meaning in the modern world, Michael Ruse gave an inspiring and very funny explanation of how Darwin’s hypothesis was built to last.

How the oldfield mouse has adapted to beach living made for a perfect cap to the weekend, the research of Hopi Hoekstra an delightfully simple demonstration of natural selection at work.

Elsewhere

I was quite impressed with the instantaneous insight PZ Myers of Pharyngula posted all weekend from the front row of the conference; it was like reading over the shoulder of a truly excellent note-taker.

Skip Evans, of The Panda’s Thumb blog, was on hand representing Wisconsin Citizens for Science and photographing evolutionary biology superstars with his stuffed penguin, Flightless Frank.

As if conference organizer Robert Richards wasn’t busy enough, he also gave radio interviews to WMFT and WGN (the latter with science historian Ronald Numbers).

Jerry Coyne has posted some pictures from the conference to his blog, Why Evolution is True.

Finally: the entire conference was videotaped, and the organizers hope to have it online soon. Rest assured, when they are accessible, I’ll point you to them from here.