Archive for the ‘Health’ Category

Failures are stepping stones to…

June 14, 2010

Research. In this very interesting article in BioMed Central, Gregory Petsko writes about three phases of drug testing during the development of newer drugs. The first phase is for the assessment of toxicity of the drug to humans and is tested on healthy population. The second phase is for assessing how well the drug works with patients with the disease. The third phase tests are for assessing the effectiveness of the drug in comparison to what is available at the moment in the market.

Apparently, 19 out of 20 drug trails fail. And, most of them fail at phase two. And, the interesting point that Petsko makes is:

My main point is that the Phase II failures represent an enormous, untapped resource for the biomedical sciences – a resource that could go a long way towards solving the problem of low productivity, in terms of cures, that plagues both industry and academic medicine.

You see, the Phase II failures have all passed Phase I, so they have been shown to be safe in humans. They failed for efficacy. They failed because they did not effectively treat the disease they were intended to treat, even though they showed biological activity in assays and model systems. There are hundreds of them – perhaps more than a thousand. I don’t know the number because drug companies bury those failures. They don’t want to release a lot of information about the molecules in question because, among other things, they fear that will give their competitors too much of an insight into what they are working on. But here’s the question I would like you – and them – to ponder. What if those drugs were not tried on the right disease?

We now know that many quite different diseases share common pathways and processes in the cell. Cancer is a disease of abnormal cell survival; in Alzheimer’s disease the survival pathways have failed. Alzheimer’s patients have significantly lower risk of many cancers. What if the cure for Alzheimer’s disease is sitting on some drug company’s shelf, as a potential cancer drug that failed in Phase II? (A biotech company called Link Medicines is currently testing one such failure to find out.) Gaucher disease and Parkinson’s disease both involve lysosomal damage and display aggregates of a protein called alpha-synuclein; Gaucher carriers are at elevated risk for Parkinson’s. What if a drug intended to cure Gaucher disease, one that failed in Phase II, is actually a treatment for Parkinson’s? (Another biotech company, Amicus Therapeutics, is beginning to investigate that possibility.) Recent studies show that people diagnosed with psoriasis are at greater risk of developing heart disease; in fact, in patients with severe psoriasis who are younger than 50 years old, the risk is comparable to that seen in diabetes. How many Phase II-failed psoriasis drugs have ever been tested in heart disease clinical trials?

A very interesting piece!

PS: While you are at it, these two pieces on mammalian pheremones are interesting too:

On the scent of sexual attraction

Darcin: a male pheromone that stimulates female memory and sexual attraction to an individual male’s odour

A few interesting pieces from BMC

April 15, 2010

[1] A personal view on autism — you can either watch the video or read the edited transcript.

[2] When and whether to model — in molecular biology

[3] When it comes to scientific publishing, bigger is better?

Are pilot programmes the way to go?

January 5, 2010

Atul Gawande, in his latest piece, says yes:

According to the Congressional Budget Office, the bill makes no significant long-term cost reductions. Even Democrats have become nervous. For many, the hope of reform was to re-form the health-care system. If nothing is done, the United States is on track to spend an unimaginable ten trillion dollars more on health care in the next decade than it currently spends, hobbling government, growth, and employment. Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here’s the interesting thing—history suggests otherwise.At the start of the twentieth century, another indispensable but unmanageably costly sector was strangling the country: agriculture. In 1900, more than forty per cent of a family’s income went to paying for food. At the same time, farming was hugely labor-intensive, tying up almost half the American workforce. We were, partly as a result, still a poor nation. Only by improving the productivity of farming could we raise our standard of living and emerge as an industrial power. We had to reduce food costs, so that families could spend money on other goods, and resources could flow to other economic sectors. And we had to make farming less labor-dependent, so that more of the population could enter non-farming occupations and support economic growth and development.

America’s agricultural crisis gave rise to deep national frustration. The inefficiency of farms meant low crop yields, high prices, limited choice, and uneven quality. The agricultural system was fragmented and disorganized, and ignored evidence showing how things could be done better. Shallow plowing, no crop rotation, inadequate seedbeds, and other habits sustained by lore and tradition resulted in poor production and soil exhaustion. And lack of coördination led to local shortages of many crops and overproduction of others.

You might think that the invisible hand of market competition would have solved these problems, that the prospect of higher income from improved practices would have encouraged change. But laissez-faire had not worked. Farmers relied so much on human muscle because it was cheap and didn’t require the long-term investment that animal power and machinery did. The fact that land, too, was cheap encouraged extensive, almost careless cultivation. When the soil became exhausted, farmers simply moved; most tracts of farmland were occupied for five years or less. Those who didn’t move tended to be tenant farmers, who paid rent to their landlords in either cash or crops, which also discouraged long-term investment. And there was a deep-seated fear of risk and the uncertainties of change; many farmers dismissed new ideas as “book farming.”

Things were no better elsewhere in the world. For industrializing nations in the first half of the twentieth century, food was the fundamental problem. The desire for a once-and-for-all fix led Communist governments to take over and run vast “scientific” farms and collectives. We know what that led to: widespread famines and tens of millions of deaths.

The United States did not seek a grand solution. Private farms remained, along with the considerable advantages of individual initiative. Still, government was enlisted to help millions of farmers change the way they worked. The approach succeeded almost shockingly well. The resulting abundance of goods in our grocery stores and the leaps in our standard of living became the greatest argument for America around the world. And, as the agricultural historian Roy V. Scott recounted, four decades ago, in his remarkable study “The Reluctant Farmer,” it all started with a pilot program

As always, a must read piece.

What have we found out about the influenza A (H1N1) 2009 pandemic virus?

September 19, 2009

S J Turner et al, explain here! A good piece.

Swine flu facts

August 14, 2009

A nice piece in the Hindu today.

Influenza: all you ever wanted to know about!

June 16, 2009

A couple of articles from Journal of Biology:
[1] Q&A: What do we know about influenza and what can we do about it?, P C Doherty and S J Turner.
[2] Influenza: one or two more questions, M Robertson.

Sometimes more is not better

June 2, 2009

Atul Gawande gives one instance when it isn’t:

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

As usual, a must-read piece!

Morning miscellany: Madras madness and upma puranam

February 20, 2009

Vikram Raghavan at Law and other things is upset:

Almost 100 years older than the Supreme Court itself, the Madras High Court has been a grand symbol of our country’s commitment to justice and the rule of law. As a school boy and law student, I walked through those magnificent Indo-Sarcenic hallways of the High Court that reek with history, grandeur, and tradition. Having spent formative years as a legal intern there, the court is an indelible part of my legal imagination. It has greatly influenced my pride in what I’ve always considered to be the learned and noble legal profession and, indeed, in my conception of what is just, what is fair, and what is proper. Yesterday’s violent incidents shake those long-held beliefs to the core.

The fact that Vikram is upset is also made palpable by his unconscious use of the word “reek” while referring to the history, grandeur and tradition of Madras High Court.

In the other story this morning, this post of Arun Giridhar makes me crave for the Samba ravai upma (and, the fact that I showed up at the class at 8 in the morning without breakfast does not help me either):

On a very unscientific level, I had suspected once that upma made with fine semolina was digested more quickly (and consequently felt less filling) than upma made with coarse cracked wheat. It is nice to learn that there is a scientific basis for that hypothesis.

Time for a breakfast of vada if not upma, I guess!

What is paleofantasy?

January 20, 2009

Even though not quite in the same league as the ideas discussed, this post, touched a cord with me since I also face so many of my close relatives and friends who believe that all the ills and diseases that we face today were either absent in an earlier “golden” Indian era or were completely treatable and curable by the local doctors and physicians of that period!

As an evolutionary biologist, I was filled with enthusiasm at first over the idea of a modern mismatch between everyday life and our evolutionary past. But a closer look reveals that not all evolutionary ideas are created equal; even for Darwinians, the devil is in the details. The notion that there was a time of perfect adaptation, from which we’ve now deviated, is a caricature of the way evolution works.

Take a look!

On some matters maternal

January 14, 2009

Jill Lepore in The New Yorker on breast-feeding, pumps, the politics of pump promotion and many other things besides:

There are some new rules governing what used to be called “mother’s milk,” or “breast milk,” including one about what to call it when it’s no longer in a mother’s breast. A term, then, nomenclatural: “expressed human milk” is milk that has been pressed, squeezed, or sucked out of a woman’s breast by hand or by machine and stored in a bottle or, for freezing, in a plastic bag secured with a twist tie. Matters, regulatory: Can a woman carry containers of her own milk on an airplane? Before the summer of 2007, not more than three ounces, because the Transportation Security Administration classed human milk with shampoo, toothpaste, and Gatorade, until a Minneapolis woman heading home after a business trip was reduced to tears when a security guard at LaGuardia poured a two-day supply of her milk into a garbage bin. Dr. Ruth Lawrence, of the breast-feeding committee of the American Academy of Pediatrics, promptly told the press, “She needs every drop of that precious golden fluid for her baby”; lactivists, who often stage “nurse-ins,” sent petitions; and the T.S.A. eventually reclassified human milk as “liquid medication.” Can a woman sell her milk on eBay? It has been done, and, so far, with no more consequence than the opprobrium of the blogosphere, at least until the F.D.A. decides to tackle this one. The Centers for Disease Control and Prevention, however, does provide a fact sheet on “What to Do If an Infant or Child Is Mistakenly Fed Another Woman’s Expressed Breast Milk,” which can happen at day-care centers where fridges are full of bags of milk, labelled in smudgeable ink. (The C.D.C. advises that a switch “should be treated just as if an accidental exposure to other bodily fluids had occurred.”) During a nine-hour exam, can a woman take a break to express the milk uncomfortably filling her breasts? No, because the Americans with Disabilities Act does not consider lactation to be a disability. Can a human-milk bank pay a woman for her milk? (Milk banks provide hospitals with pasteurized human milk.) No, because doing so would violate the ethical standards of the Human Milk Banking Association of North America. If a nursing woman drinks to excess—some alcohol flows from the bloodstream into the mammary glands—can she be charged with child abuse? Hasn’t happened yet, but there’s been talk. Meanwhile, women who are worried can test a few drops with a product called milkscreen; if the alcohol level is too high, you’re supposed to wait and test again, but the temptation is: pump and dump.

A must, must read!