Nature Outlook: Leukaemia

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The leukaemia Outlook is out!

I spent much of April and May working on this special magazine supplement on leukemia for Nature. I came up with the article list, commissioned and edited the articles, worked with the art department on the photos, graphics and cover, and oversaw the production. And I wrote the editorial introducing the contents (below.) You can see the supplement on Nature’s website here.

Of all of the cancers that can wage war on the body, leukaemia — the general term for cancers of the blood — has a reputation for being among the least malevolent.

Most solid cancers are riddled with dozens of mutations, making it impossible to know which mutation set a cell on the wrong path, or which one to target. Leukaemia seems simpler: one type of the disease, chronic myeloid leukaemia (CML), can be traced to a single gene fusion (page S4). Scientists were able to develop a drug, imatinib, that exploits the errant gene, increasing the five-year survival for CML to more than 95%. Most children with acute lymphoblastic leukaemia (ALL) also survive

As we show in this Outlook, however, these headline statistics belie the reality for many patients.

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A new high-tech, grassroots effort to fight breast cancer

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I wrote this article for Slate’s Tech blog, Future Tense, after hearing about it from Joanna Rudnick, my close friend and one of the leaders of the project. You can see the article, which ran June 25, 2013 on Slate’s website here.

By now you’ve probably heard that, thanks to the Supreme Court, no one, and certainly not Myriad Genetics, can patent human genes. This decision was sensible and long overdue, but the celebrations have been short-lived. Because what you may not have heard is that Myriad still owns all of the information it has collected since the mid-1990s on the breast cancer genes—and it has no intention of releasing any of it.

Myriad’s interpretations of mutations are out there, but scattered in a million pieces—in the reports it has sent out to women, or, more often, to the clinical centers where they were tested. But a new volunteer grass-roots effort, led by a few women with a family history of breast cancer, is trying to Free the Data so that scientists everywhere can analyze it and help women make informed choices about their breast-cancer risk. In collaboration with the University of California-San Francisco, the nonprofit advocacy group Genetic Alliance, and a biotech company InVitae, these women are hoping to collect even a tiny fraction of the million or so reports Myriad has sent out over the past 17 years.

Read the full article on Slate.

Controversy over cervical cancer vaccine

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(This article was #26 in Discover Magazine’s top 100 stories of 2007.)

This past year, several countries and at least 24 states in the United States introduced laws to mandate vaccination against cervical cancer for preteen girls. Although the vaccine was initially hailed as a breakthrough, urgent proposals to make it mandatory quickly triggered a backlash. “In the long term,” says Susan Wood, a former director of the FDA Office of Women’s Health, “the rush to get this mandated immediately has done more harm to the issue.”

The FDA approved Merck’s Gardasil vaccine in 2006, after clinical trials showed that it protects against four strains of human papillomavirus (HPV), which together cause about 70 percent of cervical cancers and 90 percent of genital warts. HPV is the most common sexually transmitted virus among Americans (and cervical cancer is the second most common cancer in women worldwide). Because the vaccine doesn’t reverse existing exposure, the CDC recommends it be administered before the age of sexual activity—specifically to girls ages 11 to 12. As for women who already have HPV, two separate studies published in May in the New England Journal of Medicine reported that the vaccine’s effectiveness in preventing cervical lesions dropped to 20 percent or less.

Some conservative groups oppose targeting preteens, arguing that because the virus is sexually transmitted, the vaccine will encourage promiscuity. Meanwhile, bioethicists who are skeptical about compulsory vaccination laws note that all other mandated vaccines protect against diseases easily transmitted in schools. “In my opinion, there’s not a compelling ethical reason [to mandate],” says Richard Zimmerman, professor of family medicine at the University of Pittsburgh. “The ethics is the opposite: to strongly recommend, but not to mandate.”

Held to ransom

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(This Opinion column ran on Nature’s news site on March 26, 2007. You can download a pdf of the original post.)

A pharma giant’s decision to withhold new drugs from Thailand will only hurt patients, says Apoorva Mandavilli.

Is there ever a good enough reason to deny life-saving medicines to an entire country’s citizens? I say no. But it seems pharmaceutical giant Abbott begs to differ.

The Chicago-based company decided on 14 March not to introduce in Thailand any of its seven new drugs — including an antibiotic, an important AIDS drug called Kaletra and medicines to treat blood clots, kidney disease and high blood pressure. Without this crucial registration, the drugs cannot be imported to or sold in that country.

It seems to me that Abbott is, in effect, holding millions of Thais’ lives hostage to force their government to respect its patents. This is good business?

The price of drugs varies from place to place.

What’s shocking to me is that the company is making no bones about the fact that its decision is retaliation against Thailand’s decision in January to issue ‘compulsary licenses’ allowing some locals to import or make cheap copies of Abbott’s new version of Kaletra. “This matter is about intellectual property and the integrity of the patent system,” Abbott spokeswoman Melissa Brotz said in a statement.

Lofty words, but I’m reminded more of a schoolyard fight.

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FDA approves vaccine for cervical cancer

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(This article was #27 in Discover Magazine’s top 100 stories of 2006.)

The cervical cancer vaccine—the second vaccine after the hepatitis B vaccine to target a sexually transmitted disease—debuted this year. In June the Food and Drug Administration approved the vaccine, distributed under the brand name Gardasil, for girls and women ages 9 to 26. The European Union and Australia have also approved the vaccine, and a similar product to be manufactured by GlaxoSmithKline is in the works.

The vaccines work by inducing antibodies to the human papillomavirus, or HPV, which can cause genital warts and cervical cancer. In large clinical trials, the vaccines were more than 99 percent effective in preventing HPV infection. Like most vaccines, however, they are most effective among people who have not yet been exposed to the virus. An American government advisory panel therefore recommended that Gardasil be given routinely to 11- and 12-year-old girls—and in some cases to girls as young as 9.

Every year cervical cancer kills more than 230,000 women worldwide, about 80 percent of them in developing countries. In the United States, the disease claims the lives of roughly 4,000 women each year. Based on a mathematical model, GlaxoSmithKline claims that immunizing every 12-year-old girl with the vaccine would reduce U.S. cases and deaths from cervical cancer by 70 percent. But some conservative groups have opposed the vaccine, saying it might promote sexual activity.

Poor countries also face a more practical obstacle. The full course of the vaccine—three shots over a six-month period—costs about $360. “The biggest issue will be price,” says John Schiller, a senior investigator at the National Cancer Institute, who did some of the early work that led to the vaccine’s development. “It’s the most expensive vaccine we have.”

Low-fat diet a bust?

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(This article was #53 in Discover Magazine’s top 100 stories of 2006.)

The largest-ever experimental study examining whether a low-fat diet can prevent cancer and heart disease brought discouraging results. After following 48,835 postmenopausal women for eight years, scientists concluded that cutting fat from the diet doesn’t significantly reduce the incidence of breast or colorectal cancer, heart disease, or stroke. Results of the $415 million trial, part of the National Institutes of Health’s Women’s Health Initiative, were reported in three papers in the Journal of the American Medical Association.

Revised ideas about the role of fat in disease could help explain the murky data, notes Michael Thun, who heads epidemiological research for the American Cancer Society. For example, women in the study cut their total fat intake rather than specifically targeting saturated fats and trans fats, which are now known to contribute to heart disease risk. Cancer researchers are also starting to focus more on risks from obesity. “The evidence base has become very strong that it’s being fat rather than eating fat that’s associated with risk,” Thun says.

He and others plan to follow the women for an additional five years for more information. Meanwhile, the best advice from experts is to eat less saturated and trans fats and more fruits and vegetables.

ArtMedicine: Science diagnoses art

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(This article appeared on Medscape in February 2001.)

The bulge in the left breast is large and distinct. The nipple and areola appear swollen and the skin nearby looks dimpled–puckered. It takes Dr. James Stark exactly 2 seconds to make his diagnosis.

“That woman’s got breast cancer,” Stark whispers to his wife as they stand in Florence’s Church of San Lorenzo. He has just diagnosed the subject of Michelangelo’s 500-year-old sculpture called Night.

Over the years, art historians have suggested that the breast is malformed because Michelangelo was unfamiliar with female anatomy, or that it is the result of a sculpting error. But until June 1999–when Stark visited the chapel–no one had diagnosed the prominent lump.

“I’ve been . . . [diagnosing breast cancer] for 25 years. I looked at the breast for 2 seconds and I just knew,” says Stark, medical director of the Cancer Treatment Centers of America and associate professor of medicine at the Eastern Virginia Medical School. For the next 1 1/2 years, Stark and Jonathan Nelson–a scholar in Renaissance art and a visiting professor at the Florentine campuses of New York University and Syracuse University–thoroughly investigated Stark’s theory. Skeptical at first, Nelson has since become convinced that Michelangelo knew the woman had a fatal disease.

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