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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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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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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Following reports that Pope Benedict XVI stated that condoms increase the problem of HIV/AIDS, many government and public health officials condemned the Pope’s comments. The Development Minister in the Netherlands, for one, called them “extremely harmful”. In Paris, the Pope’s comments spurred a clash between those who agree with and those who oppose his view on condoms. And yesterday, about a dozen different pro-condom groups waited in St. Peter’s square for the Pope’s return to the Vatican.

While the responses to the Pope’s comment covered by the mainstream media were overwhelmingly negative, some government officials, including two deputies from France, defended the Pope. According to Jacques Remiller, deputy-mayor of Vienne, France, the media only partially reported the Pope’s words, which made the words lose their meaning. Remiller argued that while condoms are effective when used properly, they will not solve behavioral problems such as rape that can lead to the spread of HIV.

So what did the Pope really mean?

We might not find out, as it seems as though the Vatican might have retroactively softened the Pope’s words. News sources such as the Catholic News Service had reported the quote as follows: “One cannot overcome the problem with the distribution of condoms. On the contrary, they increase the problem.” However, according to the Catholic News Service, the version of the sentence published later by the Vatican translated as follows: “One cannot resolve the problem with the distribution of condoms. On the contrary, there is a risk of increasing the problem.”

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In an effort to explore the potential of personalized medicine, journalist David Duncan underwent hundreds of medical tests. He has now written a book, “Experimental Man: What One Man’s Body Reveals About His Future, Your Health and Our Toxic World”, describing his journey. From genetic tests aimed at uncovering his risks for over 37 diseases to detailed blood tests taken to help determine his chances of having a heart attack, it seems doctors tested and analyzed just about every part of Duncan’s body that they could.

One question Duncan asks in his book is whether, in the future, doctors will focus more on testing the healthy to try to keep them healthy, rather than treating those who are already ill. While doctors already do use family history and diagnostic tests to determine people’s risks for specific diseases, Duncan contemplates how new technologies and comprehensive genomic analyses might one day be routinely used to predict a broader range of illnesses.

However, even if advanced tests could provide a better pictur of our future health, with listed test prices of up to $40,000 much of the world’s population would likely not benefit from such tests. Costs aside, how much would a person want to know about his or her risk of future illnesses, especially about an untreatable illness? And is it possible to undergo one test too many?

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Hoping to prevent something along the lines of the birth of octoplets from happening in Georgia, state legislators proposed a bill that would cap the number of embryos created for any given round of in-vitro fertilization. The new rules would limit this to two embryos per cycle for a woman 39 years old or younger and three embryos for a woman above that age. In a press release, the president of Georgia Right to Life said the bill’s purpose is to “help reduce the attendant harm that could come to the mother and her children through the creation and implantation of more embryos than is medically recommended.”

In addition to limiting the number of embryos fertilized per cycle, an article in Slate.com explained how the bill, if passed, would give embryos legal rights, thus blocking certain types of stem cell research in the state. The Georgia legislation will probably not be voted on this year, but lawmakers there will likely reconsider the issue next year.

The proposed legislation does not take past IVF failures into account, unlike the joint guidelines previously issued by the Society for Assisted Reproductive Medicine and the American Society for Reproductive Medicine. So in addition to limiting biomedical research, the legislation would also promote an oversimplified approach to reproductive medicine that would likely harm more women than it would help. What do you think about the proposed bill?

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Senator Charles Grassley is not the only one working to reveal financial ties between doctors and pharmaceutical companies. In November, a group of more than 200 students and faculty at Harvard Medical School asked the administration to expand the school’s conflict-of-interest policies. Students had already convinced the school to require professors and lecturers to disclose relevant financial ties to pharmaceutical companies when discussing drugs in class. In November, the group asked that professors at the teaching hospitals and institutes affiliated with Harvard also disclose their ties to industry. Today, The New York Times reported that a 19-member committee organized by the school’s dean will meet to re-evaluate these policies on 5 March.

In addition to the students’ demands, Harvard is facing external sources of pressure. In 2008 The American Medical Student Association, which grades medical schools on how well they track and curtail industry interaction with faculty and students, gave Harvard an F. Unlike schools such as the University of Pittsburgh Medical Center and Mount Sinai School of Medicine, who received A’s, Harvard does not currently ban faculty from accepting personal gifts from pharmaceutical companies. We’ll have to wait to see if Harvard makes substantial policy changes and whether more medical schools follow suit.

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On 13 February, the pharmaceutical company GlaxoSmithKline promised to reduce prices of its patented medicines in 50 poor countries to no more than 25% of the cost in developed countries. Additionally, GSK CEO Andrew Witty committed to reinvesting 20% of profits made from sales in these poor countries toward developing infrastructure to supply health care to the underserved.

To propel the development and production of new treatments for neglected tropical diseases, Witty also proposed a voluntary ‘patent pool’. Through this pool, GSK would share “relevant small molecule compounds or processes patents” for such diseases with outside researchers. Richard Barker, director general of the Association of the British Pharmaceutical Industry, has been quoted saying GSK’s initiative will lead people to discuss “how much further industry can and should go” to improve public health worldwide. What do you think drug companies should do to support global public health?

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A boy who received human fetal stem cell injections developed benign tumors in his brain and spinal cord four years after the stem cell treatment began, researchers reported in PLoS Medicine last week. Doctors at an unrelated clinic in Russia had apparently used the stem cell injections to try to treat the boy for a rare genetic disease called ataxia telangiectasia. Upon examining the surgically removed spinal cord tumor, the scientists determined that the tumor arose from the stem cells of at least two donors. The tumor was composed of both female and male cells and the tumor cells had two normal copies of the gene that causes ataxia telangiectasia when mutated.

As the first documented case of human neural fetal stem cell injections leading to tumor growth, this story has captured media attention worldwide — spurring discussions on how the safety of stem cell therapies should be evaluated. A Scientific American blog noted that researchers don’t yet fully understand how to control the development of such stem cells in the brain, while a BBC story highlighted the need to regulate stem cell therapy centers. Many sources explained the boy’s condition may have facilitated tumor growth, but US News and World Report was among the few that noted the rarity of this side effect. As for the authors of the article, they recommended more research on stem cell therapy safety, but did not suggest halting stem cell research.

Photo from PLoS Medicine, doi:10.1371/journal.pmed.1000029.g002

Scientists are not the only ones conducting experiments these days: Governments around the world are experimenting with various ways to stimulate their sagging economies, including plans aimed at strengthening biomedical research. Here is a summary of budget-related headlines from the past week:

— The Norwegian government unveiled a NOK 20 billion ($2.84 billion) stimulus package that included around NOK 3 billion of support for biotechnology, designed to protect half of the country’s biotech companies from bankruptcy.

— The 2009 Canadian budget will invest millions into research infrastructure over the next two years. On the downside, Genome Canada, which funds large-scale genomics and proteomics research, will receive no new money this year. Moreover, the three government councils that provide grants to scientists (including the Canadian Institutes of Health Research) will see their collective budgets reduced by $113 million CAD ($91 million) over the next three years.

— The US House of Representatives passed an $825 billion stimulus bill, with $10 billion of that going to science facilities, research, and instrumentation. The Senate is currently debating the bill.

What do you think of the plans that have come out so far?

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