Don’t rush your vaccines

writing

(This Opinion column ran in Nature’s news site on May 17, 2007. You can read the original post here.)

The ethical debate about a vaccine for a sexually transmitted disease has been premature, says Apoorva Mandavilli; we don’t even know how well it works.

Here’s a good lesson: before you start pushing for a controversial vaccine to be made compulsory, best wait for the research — and I mean all the research — to come up with results.

For more than a year, we’ve been hearing that there is a vaccine that is 100% safe and effective in protecting young girls and women from the deadly viruses that cause cervical cancer.

Merck’s Gardasil, a vaccine against human papilloma virus (HPV), has been hailed as perhaps the biggest boon for women since the contraceptive pill. Across the world, including many American states, politicians and activists have proposed laws to make Gardasil mandatory for girls in their early teens or younger. Australia has already started a national programme of free vaccines for young girls.

All that sounds a bit premature — and rightly so. As we find out more about this vaccine, including new studies in last week’s New England Journal of Medicine¹^,², it’s clear we simply don’t know enough about it to be giving it to young girls en masse.

Continue reading →

No periods. Fullstop.

writing

(This post appeared on Nature Medicine’s Spoonful of Medicine blog on May 9, 2007.)

If you could take a pill that completely eliminates your periods, would you?

Women taking Seasonale have four periods a year.

Turns out the answer is rather emotional for many people. I say people because some men seem to have strong feelings about it too (as they do about many things that affect only women).

Most contraceptive pills entail 21 days of hormones, followed by 7 days of placebo. What follows is a period only in name, since women don’t actually ovulate while taking the pill. This fake period was designed into the pill when it was first introduced in 1960 so as not to freak women out too much.

This month, the FDA is evaluating Wyeth’s Lybrel, with which women would take hormones for a full year or longer (Women taking Seasonale, available now, still have 4 periods a year), remaining period-free throughout. And this is getting many experts riled up: those who think it might be unsafe, yes, but also those who argue that it is culturally dangerous–as in, it redefines femininity! Ahem.

Last year, I summarized the pros and cons of pills like Lybrel for the mainstream magazine Women’s Health, but briefly: the new pill could be healthier, because it cuts down on the hundreds of periods women now have on average as compared with about 50 or so not too long ago. On the other hand, we don’t really know what the long-term consequences might be.

So, what would you choose?

Science on trial

writing

(This post appeared on Nature Medicine’s Spoonful of Medicine blog on May 1, 2007.)

It’s always frightening when matters of science are settled in a court of law. And a relief

Robert Gallo

when reason prevails.

Last week, an Australian judge declared that yes, HIV does exist and that it causes AIDS.

The criminal case was filed against a HIV-positive man, Andre Chad Parenzee, for knowingly exposing his sexual partners to the virus. In his defense, he maintained that “the existence of HIV has not been proven” and that “there is no scientific evidence that AIDS is caused by a unique infectious agent.”

The case dragged on for months and although it wasn’t covered much outside the US, did create waves in Australia. Robert Gallo, who established the link between HIV and AIDS in 1984, appeared (by videolink) for the prosecution and was grilled by the defense about his research and his notorious squabble with French virologist Luc Montagnier. AIDS denialism has its supporters even among scientists and the dissident Perth Group, led by two Australian doctors, appeared as “expert witnesses” for the defense.

Parenzee had been convicted on three counts of endangering lives and had appealed. Justice John Sulan said last week that the Perth Group witnesses lacked credibility and threw out the appeal.

The two doctors continue to be employed by the Royal Perth Hospital, although AIDS Truth, a loosely banded group of scientists and activists, and other are calling for their dismissal. As I’ve written here before, AIDS denialism has serious consequences in some parts of the world and is not simply an academic debate. It’s time Australian scientists joined these activists in making sure science prevails.

The sunshine cure

writing

I wrote this feature for Nature Medicine after receiving a poorly-written email extolling vitamin D’s benefits. The writer was so impassioned, though, that I was intrigued. This ran in the April 2007 issue. You can view a pdf version of the article here.

Could ten minutes of sunlight a day be all that’s needed to fight multiple sclerosis, cancer and tuberculosis? Apoorva Mandavilli discovers the growing interest in vitamin D’s many virtues.

Long before antibiotics turned tuberculosis (TB) into a curable disease, a Danish scientist found an unusual way to treat it. In 1895 Niels Ryberg Finsen, then just 35, discovered that light from an electric arc lamp cured most people with TB of the skin. Over the following six years, he successfully treated 804 patients.

Nobody understood how the treatment worked, and the condition, lupus vulgaris, was relatively rare. But TB was such a fearsome scourge at the time that Finsen’s discovery won him the 1903 Nobel Prize in Physiology or Medicine. It also began the trend of sending those sick with TB to recover in sanatoriums housed in sunny locales.

It’s only now, more than a century later, that scientists are beginning to understand why Finsen’s method worked.

“It had to be through vitamin D,” says Barry Bloom, dean of the Harvard School of Public Health.

Last year, Bloom and his colleagues published evidence suggesting that vitamin D, made in response to sunlight, stimulates the production of a compound in the body called cathelicidin, which can kill various viruses and bacteria, including the TB microbe (Science 311, 1770– 1773; 2006).

It’s not often that you hear scientists of Bloom’s caliber extolling the virtues of a vitamin; that’s more commonly associated with over-anxious parents or ardent fans of alternative medicine.

Vitamin D may be best known for its role in harnessing calcium from the diet to build strong bones. But Bloom’s report is one of several in the past few years published in top journals— including the New England Journal of Medicine, Journal of the American Medical Association and Nature Immunology—that suggest a far meatier role for the vitamin in the body’s defense against diseases such as tuberculosis, multiple sclerosis (MS) and cancer.

“I think there’s an emerging mainstream acceptance of vitamin D as an immune- regulating factor,” says Eugene Butcher, professor of pathology at Stanford University. “The only people who are going to be skeptical of it are people who haven’t bothered to read the literature in the last five years.”

Continue reading →

Of men and monkeys

writing

(This post appeared on Nature Medicine’s Spoonful of Medicine blog on March 30, 2007. You can see the original post here.)

Sooty mangabey

I realize that my previous blog entry makes it sound as if HIV researchers are a complaining and bitter bunch. Far from it. They do complain, but they are also one of the friendliest and most unpretentious group of researchers anywhere. They can go from discussing how quickly HIV can wipe out the immune system to the latest in footwear and eyewear in a flash.

Last night was the finale of the HIV meeting — and may I just say, these scientists also know how to party.

Earlier in the week, bigwig HIV researcher Bruce Walker hosted his annual keystone bash. Here are a few things that should tell you it was a great party: there was much spilled drink; people sang Happy Birthday to Philip Goulder at midnight (it really was his birthday); everyone with a camera or cellphone snapped incriminating pictures of everyone else; one noted scientist was so falling down drunk that he really did fall down and had to be escorted home; and the police came — twice.

Last night’s was almost a repeat performance, but the police didn’t make an appearance — not that I know of anyway. In between their drunken revelry, these scientists also managed to put on one of the most interesting conferences I’ve ever been to. As per keystone rules, I can’t really write about the specifics, but among the topics I found most interesting were those that delved into why sooty mangabey monkeys infected with SIV, the monkey version of HIV, never progress to a disease like AIDS and on elite controllers, a group of people who, despite being infected with HIV for more than a decade, have undetectable levels of the virus in their blood.

Figuring out what protects the monkeys or the elite controllers could be the key to a good vaccine. And this week’s talks made me feel optimistic that at some point in my lifetime, even if not in the next 15 or 20 years, we’ll know the answer.

Held to ransom

writing

(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.

Continue reading →

Nanocosmetics: Buyer beware

writing

(The following article appeared in the March/April 2007 issue of Technology Review.)

There’s a lovely jar of night cream that’s been sitting on my dresser for a month. According to the salesperson who spent a half-hour on the phone with me extolling its virtues, the cream will dig up the gunk that’s clogging my pores, soak up excess oil, and “teach” my cells to make less of it.

Sounds fantastic, doesn’t it? Too bad I’m too scared to use it.

The cream, which cost me $163 for half an ounce, is made by New York City-based Bionova. The company’s website makes much of its “nano tech platform,” and explanations of its products feature incomprehensible phrases such as “restoration of the malfunctioning biological information transfer.” But details in plain English of how any of this would actually work are sketchy. And the saleswoman’s explanation was similarly cryptic. The cream, she informed me, has various “nano complexes” in an exact ratio that is customized for my age, my gender, and my face’s precise degree of oiliness–information gleaned from a number of probing questions she asked me.

How, I asked, did I know these tiny particles weren’t going to creep under my skin and wreak havoc with my body?

Continue reading →

India’s watchdog: A breath of fresh air

writing

(I met Sunita Narain, the charismatic leader of the Center for Science and Environment, while on a reporting trip to Delhi about Indian science. She’s extremely press-savvy, so I was certainly being shown what she wanted me to see, but after several disheartening interviews with government officials about AIDS and other pressing issues, I couldn’t help but be impressed with her efficient and single-minded approach. Nothing is simple in India, as even this article, which began as a straightforward profile of this organization, shows. The feature appeared in Nature in February 2007. You can download a pdf of this article.)

How often does independent research change laws as well as minds? A lobby group in Delhi is forcing the Indian government into new regulations. Apoorva Mandavilli meets its leader.

Sunita Narain

A decade ago the city of Delhi was choking. Fumes from the growing traffic rendered the air thick and foul with toxic chemicals, earning India’s capital city the dubious distinction of being the fourth most polluted city in the world. Levels of fine particles in the air were nearly 17 times higher than the permissible maximum. You could almost feel them as you breathed.

Visit Delhi today, and the difference is palpable. Green-striped buses and auto rickshaws rush past powered by compressed natural gas. Levels of sulphur in diesel have been brought down from 2,500 parts per million to 500 parts per million. Concentrations of particles in the air are still three times the national standard, but more bearable — the air feels unmistakably cleaner.

The improvement is largely due to the efforts of one small non-governmental organization, the Centre for Science and Environment (CSE). Founded by the science journalist Anil Agarwal in 1980, the Delhi-based group launched a relentless campaign in 1996 to replace diesel in Delhi’s public transport with a cleaner fuel: compressed natural gas. Its headline-grabbing tactics were what you might expect from a group founded by a science journalist: at one point it hired a booth at a Delhi car show and offered attendees lung tests. In April 2002, after years of legal battles, India’s Supreme Court forced Delhi’s public vehicles to switch to compressed natural gas. “It’s undoubtedly one of the most influential organizations in the country,” says Mahesh Rangarajan, a former Rhodes scholar and commentator on Indian politics based in Delhi.

So how did a small band of campaigning journalists evolve into a respected environmental pressure-group powerful enough to change laws and send multinational companies running for cover?

Continue reading →

DDT is back

writing

(This article was #29 in Discover Magazine’s top 100 stories of 2006.)

More than 30 years after the use of DDT was abandoned in many countries, the much-maligned pesticide is making a comeback. In September the World Health Organization openly endorsed indoor spraying of DDT, saying it is not only the best weapon against malaria, it is also cheaper and more effective than other insecticides. The announcement followed a similar move in May by the United States Agency for International Development (USAID).

One of the reasons for the more aggressive stance is President Bush’s Malaria Initiative, launched in 2005 after Congress reproved USAID for spending the lion’s share of its budget on operational costs—and less than 8 percent on the insecticides, bed nets, and medicines that would actually save lives. In 2007, USAID plans to spend more than $20 million on indoor spraying—up from less than $1 million spent in 2005.

Many environmental groups support the use of DDT for malaria—but only in the short term. Meanwhile, USAID representatives say that, when used properly, the chemical poses little risk to the environment or to human health. “Until we find that it is hazardous,” says Admiral Tim Ziemer, coordinator of the President’s Malaria Initiative, “it’s unconscionable not to use something that can save lives.”

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.”