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April 29, 2009

Lessons from 1918

Swine flu continued to make headlines today when the World Health Organization today raised the pandemic threat alert to level 5 (out of 6).

Many news reports have referred to the Spanish Flu, which killed approximately 50 million people worldwide. Starting off as a relatively mild infection in the spring of 1918, the virus proved much more deadly when it returned in the fall. According to a 2008 article, this increase in lethality could have been due to a relatively weak virus mutating to become a stronger one or a respiratory bug circulating in the fall that made patients sicker in the second infection wave (J Infect Dis. 198, 1427–1434; 2008).

It seems that US and British soldiers exposed to the 1918 flu virus in the early stages of the disease were more likely to be protected from or survive the second wave of illness than those not exposed to the first wave. Given this, the authors suggested that “if a mild first [flu] wave is documented, the benefits of cross-protection during future waves should be considered before implementing public health interventions designed to limit exposure.”

What does that mean for us today? No one knows whether this outbreak will stay as is, become milder, or become more deadly. Authorities still do not know the ratio of deaths or serious illness to mild cases, meaning they don’t even know if it is currently a ‘mild’ outbreak. But lessons from the past suggest that this story will stay with us for some time.

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Photo by Eneas

April 20, 2009

Tales of Brown Fat

Three new studies published in the April 9, 2009 issue of The New England Journal of Medicine show conclusive proof that adult humans do indeed have appreciable amounts of brown adipose tissue. Why is this important? For at least two reasons: 1) it puts to rest the issue that adult humans have this cell type (more on this below), and 2) if the numbers or the activity of these cells could be increased it could help in the fight against obesity.

So what exactly is brown adipose tissue? Well, when most people think of adipose tissue they think of white fat - the cell type that stores fat for future energy needs of the body (though experts think it is also useful for keeping fats away from other critical organs, like the liver and muscle, and preventing the excess fat from inhibiting their function). But brown fat has another purpose entirely - it burns fats and carbs to release heat, which in turn keeps the body warm. For animals that can shiver, like adult humans, it was believed that brown fat wasn't needed or if it was present it was a vestigial organ that wasn't important for normal physiology. These three studies show that cold temperatures induce the occurrence of this tissue and that it is indeed likely important for normal physiology. More importantly, though, the findings also suggest that because these cells are present they could be targeted to fight obesity, as mentioned above. Indeed, as one of the papers points out, if as little as 0.1% of a person's body weight is converted to brown adipose tissue it could account for ~20% of the adult body's daily energy expenditure.

But there is also an interesting background to these three studies, which all three papers cite and two explain a bit, but it might be interesting to spell out a little further here. The technique the three papers used to identify the brown fat is to give volunteers radiolabeled glucose ([18]F-fluorodeoxyglucose) followed by PET-CT scans. But this technique has been around for awhile. It was originally devised because it was noticed that tumors are quite energy intensive and thus more likely to take up this radiolabel more quickly than normal, healthy cells. Thus it was hoped the technique would allow advanced tumors and their metastases to be visualized. But around 2002-2004 a number of reports started to appear in the radiological literature pointing out that patients tested in this way showed several 'blobs' of staining in the supraclavicular area. Given what we know about the energy expenditure of brown fat, the authors of those earlier studies suggested that adult humans do indeed have appreciable levels of brown fat. But it wasn't until the new studies published this month that this staining was shown conclusively to be cold-inducible and, more importantly, upon biopsy that the cells are indeed brown adipose tissue, as characterized by histology and molecular marker analysis.

Time will only tell now if this cell type in adult humans can indeed be manipulated to keep us trim.

April 08, 2009

Get an editorial job at Nature Medicine!

For those of you who want to explore the possibility of a career in scientific publishing, we have TWO openings to join our team to cover maternity leaves.

You can find the details and requirements HERE.

And if this is not the right opportunity for you, share it with a friend.

We look forward to your application.

April 07, 2009

Nature Medicine is now on Twitter

In addition to our Spoonful of Medicine blog and our new Nature Medicine podcast, you can now also stay tuned in to our content using Twitter -- we're at NatureMedicine. We'll keep the posts coming and look forward to hearing from you!

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A uniquely generic problem

Last Tuesday, a US House of Representatives subcommittee held a hearing on the deals pharmaceutical companies strike with one another to delay generic drugs from reaching the market. In these deals, a company wishing to continue making a profit from its brand-name drug pays another firm to refrain from selling a generic version.

These deals undoubtedly hurt consumers’ pocketbooks. According to the House subcommittee hearing, such deals made between 1993 and 2008 have cost US consumers at least $12 billion annually. It’s no wonder the Obama administration wants to stop these deals. Democrats in Congress have recently introduced legislation in both the House and the Senate that would make such deals illegal.

I don’t think consumers should bear the brunt of funding the R&D of pharmaceutical companies. However, if profits from drug patents are curtailed, companies might have less cash to invest in riskier research that could lead to the development of new types of drugs. This, in turn, could reduce the number of drugs available to consumers. What do you think can be done to provide consumers with reasonably priced drugs and keep money flowing to R&D at the same time?

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Photo by klynslis


April 03, 2009

Restrictions... for the FDA?

Yesterday, the US House of Representatives passed a tobacco bill that would give the Food and Drug Administration (FDA) regulatory power over the tobacco industry. If the legislation passes in the Senate and is signed by President Barack Obama, the FDA would be able to regulate nicotine levels in cigarettes and impose restrictions on tobacco advertisements.

While nearly 1,000 public health groups support the bill, some experts say it does not go far enough. On his blog, Michael Siegel, a public health expert at Boston University, argues that the bill “permanently institutionalizes nicotine”, by prohibiting the FDA from removing the addictive ingredient from tobacco products. Although I agree with Siegel’s point that this restriction is worrying and “tie(s) the FDA’s hands”, I think that the FDA could still require nicotine levels to be lowered enough to reduce the addictive effect of cigarettes.

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Photo by waferboard