Nature Outlook: Leukaemia

editing

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.

leukemia

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.

Controversy over cervical cancer vaccine

writing

(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.”

FDA says cold medicine is not for children under 6

writing

(This article was #18 in Discover Magazine’s top 100 stories of 2007.)

In October, Food and Drug Administration (FDA) advisers recommended against the use of most nonprescription cold and cough medicines for children under age 6, citing the lack of evidence of safety or efficacy in this age group. Prior to the announcement, most manufacturers had already voluntarily restricted sales of medicines formulated for children less than 2 years old.

The FDA review of the medications began after a report by the Centers for Disease Control in January found that, between 2004 and 2005, more than 1,500 children under the age of 2 had wound up in emergency rooms after taking over-the-counter cough and cold medicines. In another development that prompted the review, Baltimore city officials filed a citizen petition with the FDA in March, noting that the remedies do not help children under 6 years of age and may in fact harm them.

There are roughly 800 ­products on the market containing antihistamines, decongestants, anticough agents, and other chemicals intended to treat colds and coughs in children. Like many pediatric medicines, they have been tested only in adults and are simply packaged to deliver smaller doses to children.

In September, the FDA also required that, by November 2007, drug companies stop making unapproved prescription drugs containing the narcotic cough suppressant hydrocodone for use by children younger than 6. Manufacture of all other unapproved hydrocodone products must halt by December 31.

FDA approves vaccine for cervical cancer

writing

(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.”

Big issues from a small child

writing

(This Opinion column ran on Nature’s news site on January 8, 2007. You can read the original post here.)

How far can a parent go in managing the life of their disabled child? Perhaps too far.

Shock. Even revulsion. These were the main reactions provoked by news stories about Ashley, a nine-year-old disabled girl who has been surgically and hormonally altered by her parents to forever stay the size of a small child. Is such treatment acceptable, asked the world’s press. On instinct, my immediate reaction was “no”.Ashley2006

But instinct isn’t always a good judge of sensitive ethical issues. So I learned more about the situation. The shock has now subsided. But my answer to the question of acceptability is still “no”, albeit for different reasons.

Keeping a child small to help her parents care for her is an untested medical solution to a societal problem — and one that could set a dangerous precedent.