Our news internship

As described in the job listing earlier this month, Nature Medicine is currently accepting applications for its science writing internship.

The intern will be closely involved in the editorial process and write news articles and briefs. This is not a paper-pushing internship! The person selected for the position will be reporting stories and working on editorial content full-time, including the blog (https://blogs.nature.com/spoonful/).

Applicants should have completed one year in a graduate program in journalism or have equivalent work experience in journalism. Additionally, a strong understanding of biology and current issues in medicine is required. The six-month, paid internship will start in late May and be based in New York City.

The deadline for applications is 2 April 2012.

Please send an email to r.khamsi@us.nature.com with “Nature Medicine news internship” in the subject line and include 1) a cover letter, 2) your resume and 3) three published writing clips.

Autism reaches record high levels in the US

The US Centers for Disease Control and Prevention today reported that the number of children with autism spectrum disorders (ASD) has risen to an estimated 1 in 88 (1.1%), up from 1 in 110 (0.9%) according to agency estimates from two years previous. The prevalence figure is the highest since the CDC began its biennial nationwide survey of children ten years ago.

The survey released today assessed rates of autism in eight-year-olds at sites in fourteen states in 2008. The new US rate is on par with the 1% rate reported in the UK, and is significantly lower than the 2.6% prevalence observed in South Korea, according to reports from last September.

“Some of the increase is due to an increase in diagnosis, although how much is due to this is unknown,” Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, said in a press telebriefing today. In the last decade, doctors, parents and teachers have gotten better at recognizing symptoms of ASD. But “a large portion of the increase, some 50%, remains unexplained,” said Mark Roithmayr, president of Autism Speaks, a New York-based advocacy group. “We need more research into potential environmental causes.”

Roithmayr is not alone in his concern that environmental factors may be partly to blame for the rise in autism. As Nature reported in November, the steady increase in ASD prevalence has led epidemiologists at the CDC and elsewhere to launch multiple studies in the past five years that have gathered environmental, developmental and genetic information from large numbers of children in the hopes of pinpointing the driving factors behind the disease. Yet, despite a slew of genetic markers have been correlated to high rates of autism, their actual importance and how and why those genes are expressed remains a mystery. The harrowing history of false alarms, such as the discredited link between vaccines and autism, raises the bar for such studies.

Regardless of the cause, all the experts at today’s press conference agreed that earlier detection of ASD is critical. Today’s report shows that the average age of diagnosis continues to hover near four years old, nearly unchanged from recent years, meaning that although detection is getting better overall, services are not getting to children any earlier. And, as the University of Rochester’s Susan Hyman, chairperson of the autism subcommittee of the American Academy of Pediatrics, pointed out, “To meet the need presented by increasing ASD diagnoses, federal autism resources will need to expand.”

Photo courtesy of the US Centers for Disease Control and Prevention

As massive cancer databases come online, some still fret about target validation

Researchers today unveiled the two largest ever databases of information about cancer cells, which they say will help them and others test new chemotherapy treatments and speed them to the clinic.

Before today’s publication of these databases in Nature, the most sophisticated cancer cell-line library was the US National Cancer Institute’s NCI-60 panel, which is composed of 60 cancer cell lines that have been tested against thousands of potential drugs over the last twenty years. The new databases, compiled at the Dana Farber Cancer Institute and Massachusetts General Hospital, both in Boston, boast 479 and 507 cancer cell lines, respectively, and have information about a broader range of DNA and RNA mutations and drug responses than the NCI-60.

“You want as many cell types as possible in order to establish a spectrum of [cancer cell] behavior in response to a potential drug,” says John Weinstein, a computational biologist at MD Anderson Cancer Center in Houston, Texas. Weinstein, who was not involved with either project, says the breadth of the new collections will make it more likely that scientists will identify cell lines with mutations that match those found in tumors from specific patients. Having access to information about how those cell lines respond to different chemotherapy treatments will help physicians suggest the best drug options to their patients.

“This is going to enable us to realize the vision we have for personalized medicine,” says Levi Garraway, a molecular pharmacologist at the Dana Farber Cancer Institute and senior author of the first paper. And, he says, such extensive cancer cell line data will speed up the preclinical process because in the future it will allow drug companies to predict the effectiveness of experimental compounds, decreasing their reliance on slow and costly animal studies. “If you have robust genetic or molecular indicators, that can be sufficient,” he says. “You don’t necessarily need mouse models.”

But other scientists say cell-line data cannot replace testing in animal models. “Validation models are always necessary, whether it’s testing potential drugs in freshly isolated tumor cells, or using several genetically engineered mouse models to recapitulate the heterogeneity of human tumors,” says Lee Ellis of MD Anderson Cancer Center. In a commentary also published today in Nature, Ellis and cancer researcher Glenn Begley, formerly of the drug company Amgen in Thousand Oaks, California emphasize that cell line data is only the first step in bringing new treatments into the clinic. They point out that even large numbers of cell lines cannot predict how immune mechanisms and the tumor micro-environment will factor into a drug’s effectiveness.

They are not alone in their concerns about lax preclinical testing. An analysis last September in Nature Reviews Drug Discovery said that new drug targets fail to be reproduced in follow-up studies 65% of the time, meaning that many drugs are making it to the clinic without being adequately validated.

“Preclinical validation is expensive,” Ellis says, “but going to clinic is not only expensive, it puts patients at risk.”

Image courtesy of Dimarion via Shutterstock

Greater oversight needed for genomic tests, experts say

With an eye to advancing ‘personalized medicine’, clinicians have tried to predict who will respond to certain therapies using biomarkers gleaned from tests that probe genomics, proteomics and other branches of biomedicine. But according to a report from the US Institute of Medicine (IOM), such ‘omics-based’ tests require greater regulatory oversight and more transparent data-sharing before they should be allowed to move from the lab to the clinic.

“Nothing short of patient safety and public trust are at stake,” IOM committee chairman Gilbert Omenn, a computational biologist at the University of Michigan Medical School in Ann Arbor, said in a press conference this afternoon.

The report was commissioned by the US National Cancer Institute and the US Food and Drug Administration (FDA) after a genomic test developed by Anil Potti and his colleagues at Duke University in Durham, North Carolina proved to be worthless. The test, reported in and then retracted from Nature Medicine, supposedly assessed the molecular traits of a malignant tumor to determine which chemotherapy would be most effective; it also triggered a storm of lawsuits and resignations. The IOM was tasked with determining how such a faulty test ever got through the regulatory and institutional review board systems.

The centerpiece of today’s nearly 300-page report, called Evolution of Translational Omics, is the finding that institutional review boards are not adequately assessing clinical protocols for diagnostic tests and the FDA is not demanding sufficient evidence of safety and efficacy before allowing the tests to hit the market. The report cites six case-studies of commercially-available genomic and proteomic tests, including two faulty tests for ovarian cancer, Lab-Corp’s OvaSure and Correlogic’s OvaCheck, which were licensed and, in the case of OvaSure, even sold to patients before they were shown to be ineffective. “This is a wake-up call for people doing translational research,” Omenn said. “There’s a big incentive to get tests to patients, but it’s got to be done right.”

The report also calls for public disclosure of all data and algorithms from studies related to genomic tests being developed for clinical settings. “It’s very important to release data and computer code to address issues of reproducibility,” committee member Nathan Price, a biostatician at the Institute for Systems Biology in Seattle, told reporters at the press briefing. “When you start to compare across many different studies, your idea of whether the test is effective gets better.”

Photo courtesy of the Institute of Medicine

Top Canadian biomedical prize goes to antibody pioneer

The immunologist who revealed the structure and function of the crucial Fc region of antibodies was one of the researchers recognized today by the Toronto-based Gairdner Foundation for his contributions to biomedicine. Jeffrey Ravetch (pictured), along with six leading scientists in the fields of genetics, neurobiology and infectious diseases, has received one of the prestigious Gairdner awards, which have been called the ‘Canadian Nobels’. The awards come with a hefty C$100,000 ($101,000) cash prize for each winner.

Ravetch, now of Rockefeller University in New York, published a series of trailblazing immunology papers in the late 1980s and early 1990s showing that antibodies in the immune system possess a region called the Fc (or ‘fragment, crystallizable’) region. He found the Fc region is essential for initiating an inflammatory response and also that antibodies have both activating and inhibiting functions, a finding which overturned centuries of dogma about the regulation of the immune system. In subsequent years, he has gone on to show that the Fc region is part of a pathway that suppresses inflammation, publishing a  paper in Nature Medicine in 2000 that demonstrated Fc regions contribute to the effectiveness of tumor-destroying antibodies. “That paper was quite heretical at the time,” says Ravetch. Since then, engineering the Fc region has become a central concern for anyone designing antibodies as therapies for diseases such as breast cancer and lymphoma, and Ravetch’s work may also have applications for improving current antibody-based treatments for autoimmune disorders such as lupus and rheumatoid arthritis.

Such clinical advances are one reason that the Gairdner Foundation chose to honor Ravetch among its 2012 winners. “Dr. Ravetch changed the way we understand how antibodies work, leading to the design of new therapeutic approaches to autoimmunity and cancer,” says John Dirks, president and scientific director of the foundation.

Other International Award winners announced today include Rockefeller University’s Michael Young and his collaborators Jeffrey Hall and Michael Rosbash of Brandeis University, located just outside Boston, for their work on the genetic mechanisms of circadian clocks, and Thomas Jessell of Columbia University in New York for his research into the connections between sensory and motor neurons. Brian Greenwood of the London School of Hygiene and Tropical Medicine locked up the Gairdner Global Health Award for showing that the pneumococcal vaccine and insecticide-treated bed nets both greatly reduce mortality among children in Africa—and for his advocacy efforts to bring such prophylactics to the region.

On 25 October the Gairdner prizes will be formally awarded in Toronto. To read about last year’s winners, click here.

Photo courtesy of Jeffrey Ravetch

VIDEO: ‘Resting state’ brain scans give diagnosis by default

Brain scans that map differences in how brain regions communicate while people lie idle in the imaging machine are providing a possible new way to diagnose attention disorders. Michael Milham of the Child Mind Institute in New York talks about the work being done on so-called ‘resting state’ brain scans and explains how they are expanding the field of functional MRI.

For more, check out our news feature on the clinical utility of resting state fMRI from the March 2012 issue of Nature Medicine.

Circumcision cuts prostate cancer risk—but only a bit

Scientists have found more evidence for yet another health benefit of circumcision for young males. In addition to reducing the risk of urinary tract problems, penile cancer and sexually transmitted infections, doctors might now add lower rates of prostate cancer to the mix. In a study of nearly 3,400 men, researchers at the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle found that males who were circumcised before their first sexual encounter were somewhat less likely to develop prostate cancer in later life compared to uncircumcised men.

“The study provides even more reason for parents to opt for this ‘surgical vaccine’ to protect their baby boy from infections,” Brian Morris, a molecular biologist at the University of Sydney Medical School in Australia, who was not involved in the research, wrote in an email.

Over the past 60 years, a smattering of reports has appeared in the literature suggesting that male circumcision might protect against prostate cancer. But the largest of these papers, a study conducted more than 20 years ago in Southwest England, included only 161 men with prostate cancer and a comparable number of healthy controls. In contrast, in the latest report the authors compared 1,754 cases of prostate cancer in men aged 35 to 74 and 1,645 age-matched controls. Using this much larger cohort, the researchers showed that men circumcised before they first had sexual intercourse had a 18% reduced risk of developing aggressive prostate cancer and a 12% lower risk for less aggressive forms of the disease. The benefit of circumcision was found in both African Americans and Caucasians, although the effect was greater in the former group.

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Fluke’s testimony highlights broad uses of birth control, but pain applications go beyond ovarian cysts

The Affordable Care Act contraceptive coverage currently being debated in the US Congress could allow institutions that provide health insurance to opt-out of covering birth control pills for religious or moral reasons. Such policies have, in the past, raised difficulties for women prescribed the drugs for noncontraceptive uses, such as the treatment of pain from ovarian cysts. On 23 February, a law student at Georgetown University named Sandra Fluke testified before the US House Committee on Oversight and Government Reform that when insurance coverage doesn’t cover contraceptives, it can deny women such a friend of Fluke’s with polycystic ovarian syndrome access to birth control prescribed to treat the condition. And although such treatments do not cure the underlying causes of such conditions—oral contraceptives do not shrink ovarian cysts—there is accumulating evidence that they can be used as analgesics, allowing women to avoid invasive surgeries to remove abnormal tissue from the uterus or ovaries. The debate over limiting coverage by private insurance for contraceptives raises the question of whether denying access will cause real, physical pain to women in the US.

Prescription for pain from ovarian cysts is just one of many noncontraceptive uses of popular combination hormonal birth control pills such as Yaz, Orthocept and Ortho Novum, which prevent pregnancy by suppressing ovulation or blocking proliferation of the endometrial lining of the uterus, deterring implantation of an egg. “Birth control is also a widely prescribed treatment for pain from endometriosis and fibroid tumors in the uterus,” says Joyce King, a nurse at Emory University in Atlanta who studies the benefits of contraceptives.

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Chimeras: bloodthirsty myth or genetic revolution?

NEW YORK — Chimeras, part one species and part another, have a long and violent history in the world of art and religion. But the way society views the mythical creatures is changing, thanks in part to the advent of genetic engineering.

“If you look back at depictions of chimeras, it is clear that there have been changes in our relationship with the animal within us, whether we fear it or try to harness its power,” Robert Klitzman, a psychiatrist and bioethicist at Columbia University in New York, told Nature Medicine.

At a lecture here this week at the Solomon R. Guggenheim Museum, Klitzman argued that art reflects our changing attitudes toward the differences between humans and animals, a line which is increasingly being blurred by genetic technologies such as the creation of chimeric mice and monkeys for research.

Klitzman’s survey of artistic representations of chimeras began in ancient Egypt, when the duality of the gods was their most terrifying trait. For example, Anubis, god of the afterlife, had the head of a conniving jackal and the body of a man, and Sekhmet, the warrior goddess who carried out heavenly punishments on earth bore the head of a lion. By the time of the Greeks, the most famous chimera, the murderous sphinx, had evolved to have the haunches of a lion, the wings of an eagle, the tail of a serpent and the head of a woman.

But attitudes have changed, Klitzman said, and “modern artists like Magritte, Picasso, and Dali saw animalistic traits as integral and powerful parts of their identities.” Their paintings reflected this, featuring powerfully self-aware chimeras that appeared to gain strength and poise from their animal traits rather than becoming blood-thirsty beings, banished like their predecessors in art and myth. In this way, early twentieth-century art signaled the beginning of a greater modern acceptance of the line between human and animal, a feeling which has only grown with the advent of modern genome manipulation.

“To some extent, we still fear chimeras,” said Klitzman, author of the new book Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing. “But it’s also becoming clear that there is a lot to be gained—longer, healthier, more productive lives—from genetic engineering.” How we decide to adjust our beliefs and morals as a society faced with new biological possibilities, he noted, could ultimately determine how future generations view chimeras and where they draw the line between man and beast.

Photo courtesy of Shutterstock


 

Update: More evidence that bone marrow swaps could improve organ transplant options

Drug-free kidney transplants could one day be an option even for people without immune-matched donors, according to a pair of papers published today.

In January, I wrote a news feature about an experimental protocol to help recipients of kidney transplants avoid having to take immunosuppressive drug therapy for life. The approach, investigated for more than a decade by doctors in Massachusetts and California, involves giving bone marrow or just a subset of marrow-derived stem cells from the same people who donate the kidneys in an effort to induce tolerance to the foreign organ.

In one of the two papers published today, the same California team reports in the American Journal of Transplantation that 11 of 16 people who underwent the procedure since 2005 with tissue-matched siblings as donors achieved long-term normal kidney function and successfully weaned off their immunosupressants, and a twelfth study subject is now in the process of tapering the drug regimen. In unpublished results, the Massachusetts group has achieved similar success in seven of ten people who were only half matches with their donors. Both groups, however, have not always seen levels of donor immune cells sustained over the long haul—and this means that the risk of organ rejection can return.

But other research groups that have incorporated the drug cyclophosphamide, a chemotherapy medication used to treat lymphoma, have seen more lasting effects. For example, the second paper published today from a team led by Suzanne Ildstad, director of the University of Louisville’s Institute for Cellular Therapeutics in Kentucky, and Joseph Leventhal, a kidney transplant surgeon at the Northwestern Memorial Hospital in Chicago, describes a way to boost the level of donor immune cells in the recipient for the long term—so much that it completely takes over the recipients’ native bone marrow.

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